“Is The GOP Giving Up Tea?”: It’s An Illusion For The GOP To Think Bashing Obamacare Is An Elixir
The botched rollout of the health-care law has called forth some good news: Republicans are so confident they can ride anti-Obamacare sentiment to electoral victory that they’re growing ever-more impatient with the tea party’s fanaticism. Immigration reform may be the result.
The GOP is looking like a person emerging from a long binge and asking, “Why did I do that?” The moment of realization came when last fall’s government shutdown cratered the party’s polling numbers. Staring into the abyss can be instructive. For the first time since 2010, the middle of the House Republican caucus — roughly 100 of its 233 members — began worrying less about primaries from right-wing foes and more about losing their majority status altogether.
Obamacare’s troubles reinforced the flight from the brink. House Speaker John Boehner (R-Ohio) is telling his rank-and-file that they can win the 2014 elections simply by avoiding the stupid mistakes their more-ferocious colleagues keep urging them to make. In this view, the health insurance issue will take care of everything, provided Republicans end their tea party fling.
In fact, it’s an illusion for the GOP to think that bashing Obamacare is an elixir, especially if Democrats embrace and defend the law. Now that its benefits are fully kicking in, Republicans should be asked persistently, “Who do you want to throw off health insurance?”
Also: Do you want to go back to denying people coverage for preexisting conditions? And: What about those 3 million young adults now on their parents’ health plans? “Repeal Obamacare” is not as popular as it seems in GOP bastions. Some Republicans know this, which is why they are trying to cobble together much narrower alternatives to the law.
Nonetheless, some illusions are useful. Boehner is using them aggressively. The immigration principles he announced at his caucus’s retreat last week in Cambridge, Md., are a breakthrough because they are potentially more elastic than they sound. This is why many immigration reform advocates were elated, and why President Obama, sensing what was coming, offered not a hint of partisanship on the issue in his State of the Union address.
The principles have been loosely described as favoring the legalization of undocumented immigrants without a path to citizenship. But what the statement actually opposes is a “special path to citizenship” for the roughly 11 million who are here illegally. Everything hangs on the implications of that word “special.”
A bill barring a path to citizenship would be a nonstarter for Democrats — and it ought to be a nonstarter for Republicans and conservatives. Creating a vast population of legal residents who lack citizenship rights undercuts the rights of those who are already citizens. It would undermine the commitment of a democratic republic to equal treatment and self-rule.
But reform advocates inside and outside the Obama administration note that even without a “special” path, many immigrants, once legalized, could find ways of gaining citizenship eventually.
Changes in visa allocations, including more generous rules for the spouses and parents of citizens, could help as many as 4 million undocumented residents, as The Post’s Pamela Constable has reported. Republicans have already signaled openness to a path for “dreamers” — their numbers are estimated at between 800,000 and 1.5 million — who were brought to the United States illegally as children. The bill already passed by the Senate would put as many as 8 million people on a path to citizenship. A compromise that found “non-special” ways of reaching a number reasonably close to the Senate’s is now at least possible.
It’s also possible, of course, that Boehner could make a play to improve his party’s image with Latinos by appearing to be flexible at the outset but in the end appease hard-liners by balking on a final bill — and try to blame Democrats for not compromising enough. Rep. Paul Ryan (R-Wis.) warned on ABC’s “This Week” Sunday that passage of a bill was “clearly in doubt.”
But the GOP consists of more than the tea party. Both business interests and conservative evangelical leaders really want a reform law. Most of the intra-party tiffs have been over tactics: whether to use shutdowns or debt-ceiling fights to achieve shared objectives. The immigration battle, by contrast, will expose more fundamental rifts among party constituencies along philosophical lines.
None of this heralds the dawn of a new Moderate Republican Age. Shifts in the Republican primary electorate and the tea party insurgency dragged the party so far to the right that it will take a long time to bring it within hailing distance of the middle of the road. But change has to start somewhere, and the GOP’s slow retreat from the fever swamps may turn out to be one of Obamacare’s utterly unintended effects.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, February 2, 2014
“Bette In Spokane”: Consumers Hear More About The Horror Stories Than The Follow-Up Reports Proving The Horror Stories Wrong
For the last several months, conservative opponents of the Affordable Care Act, including congressional Republicans, have encouraged Americans to contact the GOP with “Obamacare horror stories.” The more the right can highlight those adversely affected by the law, the argument goes, the more ACA critics can undermine public support for reform.
To that end, Rep. Cathy McMorris Rodgers (R-Wash.), the House Republican Conference chair, used her party’s official response to the State of the Union to highlight a woman in her home state who, she claimed, was better off before the law.
“Not long ago, I got a letter from Bette in Spokane, who had hoped the president’s health care law would save her money, but found out instead her premiums were going up nearly $700 a month…. No, we shouldn’t go back to the way things were, but this law is not working.”
Almost immediately, red flags went up among those who follow the health care debate closely. And for good reason: over the last several months, Republicans and their allies have put a spotlight on quite a few “Obamacare victims,” but the stories invariably fell apart after modest scrutiny.
With this in mind, it was only natural to wonder about the circumstances surrounding “Bette in Spokane,” who presumably represented the single best piece of anecdotal evidence McMorris Rodgers could find as part of her ACA indictment. Fortunately, we now have a better sense of the relevant details, which, like so many “Obamacare horror stories,” don’t help the Republicans’ case at all.
The local newspaper, the Spokesman-Review, tracked down Bette Grenier, who wrote the letter used in McMorris Rodgers’ remarks.
[T]he “nearly $700 per month” increase in her premium that McMorris Rodgers cited in Tuesday night’s GOP response to the State of the Union address was based on one of the pricier options, a $1,200-a-month replacement plan that was pitched by Asuris Northwest to Grenier and her husband, Don.
The carrier also offered a less expensive, $1,052-per-month option in lieu of their soon-to-be-discontinued catastrophic coverage plan. And, Grenier acknowledged the couple probably could have shaved another $100 a month off the replacement policy costs by purchasing them from the state’s online portal, the Health Plan Finder website, but they chose to avoid the government health exchanges.
In a familiar situation, the horror story isn’t as horrible as we’d been led to believe. In this case, “Bette in Spokane” didn’t have a health care plan so much as she had insurance that covered catastrophic coverage – and nothing else – with a $10,000 deductible.
Because the law transitions consumers from these bare-bones plans to actual coverage – plans that offer meaningful health care security – she had to choose real insurance. For reasons that are unclear, “Bette in Spokane” refused to check the exchange marketplace to see if she could find a good deal and instead chose an expensive plan from her existing insurer.
Also note, it’s not too late for “Bette in Spokane” – the state insurance commissioner said his office can help her and her family review the available options.
In the official Republican Party’s SOTU response, all of these relevant details were ignored. Viewers were led to believe the law forced higher premiums on this consumer as part of some kind of inherent flaw in the system, but that’s not at all what happened in reality.
And circling back to the last time we talked about a story like this, it’s worth emphasizing that there are Americans who’ve been adversely affected by health care reform. In a nation of 314 million people, it will be possible to find some who didn’t benefit as much as everyone else. In fact, it’s inevitable.
But in the rush to condemn the law, the public has been confronted repeatedly with anecdotal evidence that’s completely fallen apart. Worse, consumers invariably hear more about the horror stories than the follow-up reports proving the horror stories wrong.
If the Affordable Care Act were really as awful as the right claims, shouldn’t it be easier to find genuine examples of Obamacare’s “losers”?
By: Steve Benen, The Maddow Blog, January 31, 2014
“Republican Alternative To Obamacare”: Pay More, Get Less, Put The Insurance Companies Back In Charge
Boy, can Democrats have fun with the new Republican alternative to Obamacare. It puts the health insurance companies back in charge and raises costs for almost all Americans. In particular, it substantially raises costs and threatens to cut coverage for the half of all Americans who get health insurance at work. Seniors, the group that Republicans have scared witless about Obamacare, would lose the real benefits they receive under Obamacare. The proposal from three Republican senators is a golden opportunity for Democrats to contrast the specific benefits of the Affordable Care Act (ACA) with what a repeal-and-replace agenda would really mean for Americans’ lives and health.
When it comes to the politics of health care reform, my first adage is “the solution is the problem.” That is because once you get past vague generalities, like lowering costs and making coverage available, to proposing specifics, people will look to see how the proposals impact them personally. This is why health reform is such a political nightmare. Unlike most public policy issues, the impact is very understandable and real.
With the ACA as the law of the land, in analyzing the Republican proposal we must compare its impact to the law it would repeal. The pre-ACA model of health insurance is irrelevant. Here is how the Republican plan would impact people, compared with the ACA:
People who get health insurance at work – bottom line: pay more for worse coverage.
Almost half of all Americans (48 percent), or 148 million people, obtain health insurance at work. The Republican plan would tax 35 percent of the average cost of health insurance benefits at work. This is a big tax increase on working people and is extraordinarily unpopular, as the Obama campaign used to devastating impact on John McCain. And while people would pay more, they would get less coverage, as the GOP plan would allow insurance companies to once again limit the amount of benefits they will pay out in one year and return to the day when employers could offer bare-bones plans.
While taxing health benefits would apply to all employer-provided coverage, the Republicans would give the 30 percent of people who work for businesses who employ fewer than 100 workers a tax credit. That might balance out the increased taxes for some people. However, doing so would create a huge set of economic distortions, as employers might seek to keep firm size under the 100-employee threshold.
Individuals who buy coverage on their own or who are uninsured – bottom line: insurance companies could again deny coverage for pre-existing conditions and offer bare-bones coverage, while the cost of decent coverage would go up for most people.
This is the group that the ACA is most aimed at helping, including the 5 percent of Americans who buy private health insurance and the 15 percent who are uninsured, totaling 64 million people. The ACA offers income-based subsidies to these people when they earn between 100 percent and 400 percent of the federal poverty level (FPL) and enrolls people under 133 percent of FPL in Medicaid, when states agree.
The Republican plan is toughest, in comparison with the ACA, on the lowest-income people and on the higher-income middle class, compared with Obamacare. But many families in between will do worse too.
The Republican plan would wipe out the expansion of Medicaid to people earning less than 133 percent of FPL, a provision the Supreme Court has made optional. It would cut back on Medicaid, ending the federal government’s offer to pay 90 percent of the cost of expanded coverage and replacing that with the federal government paying what it has paid historically, which is between half and three-quarters of the cost of Medicaid, with poorer states getting a bigger share. Crucially, the funding would only be for pregnant women, children and parents with dependent children who earn under the poverty level, as opposed to the ACA’s funding of all adults up to 133 percent of FPL. That means many fewer people covered and states getting less Medicaid money. Republican governors may not complain, but you can bet hospitals will. Adults without dependent children would not be covered by federal Medicaid, which means millions will stay uninsured or lose coverage they now have, unless states pay for coverage without federal support.
For individuals not covered by Medicaid or employees of firms with fewer than 100 workers, the Republican plan would replace the ACA’s sliding-scale subsidies, which now go to 400 percent of FPL, with a subsidy that is the same for everyone of the same age who is under 200 percent of FPL and lowersubsidies for people from 200 percent to 300 percent. In addition, the subsidies would be higher for older people than younger. The Republican plan also would take away the requirements that insurance plans offer decent benefits and free preventive care and charge women the same prices as men for coverage, along with every other consumer protection, with the exception of keeping in place no lifetime caps for covered benefits.
Comparing the value of the Republican plan subsidies vs. the ACA subsidies for the people who would still qualify depends on income, age, and family size. Generally, it appears that the Republican subsidies are much less than the ACA for people under 150 percent of the FPL ($35,000 for a family of four) and much less than the ACA for younger people, but more for older people. However, insurance rates for younger people would go down some at the expense of older people, who insurance companies could charge a lot more than under ACA. And families with incomes above $70,000 for a family of four would lose subsidies entirely.
Seniors and the disabled on Medicare – bottom line: seniors would pay more for prescription drugs and preventive care.
By repealing the ACA, the Republican plan would take away its two concrete benefits for seniors. One is that preventive care services are now free under Medicare (as they are under all insurance). The other is that the ACA is lowering drug prices for seniors by slowly closing the “donut hole,” under which seniors must pay the full cost of prescription drugs even though they are paying premiums for drug coverage. In other words, the Republican plan is simply bad news for seniors, the constituency that they have scared the most about Obamacare… groundlessly.
It is not surprising that Republicans have been reluctant to come up with a replacement for Obamacare. It’s much easier to throw darts – or bombs – at the ACA than to come up with a replacement that meets Republican ideological tenets of less regulation and less government. Any plan that meets the ideological test will be much worse for people in ways they can understand. It is our job to explain it to the public clearly: pay more, get less, put the insurance companies back in charge. This debate is not simply the political game Republicans want to make it. It is about our health and our lives.
By: Richard Kirsch, The National Memo, January 29, 2014
“Life Changing And Life Saving”: Remembering What Matters About The Affordable Care Act
On the Affordable Care Act front today, there’s very good practical news, and not-so-good political news. That gives us an excellent opportunity to remind ourselves to keep in mind what’s really important when we talk about health care.
Let’s start with the good news. First, as Marketplace reported this morning, a new report from PriceWaterhouseCoopers shows that the average health insurance premium on the exchanges is actually lower than the average premium in employer-sponsored plans. And it isn’t because the coverage is inadequate; according to a spokesperson, “even when you factor in all the out-of-pocket costs, the average top tier gold and platinum plans are similar to employer ones.” It’s hard to overstate what a success this is. If you’ve ever bought health insurance on the individual market before now, you know that if you could get covered at all, you were likely to get a plan that was expensive but had lots of gaps and lots of cost-sharing. The whole point of the exchanges was to give people buying insurance on their own the same advantage of pooling large numbers of customers that you get when you’re covered through your employer. If it’s working, then that’s something to celebrate.
Second, as Jonathan Cohn tells us, Wellpoint, one of the nation’s largest insurers, is reporting that exchange sign-ups are meeting their expectations; they have 400,000 new customers, and expect the number to rise to a million by the end of open enrollment. Even more critically, although their new customers are slightly older than the population as a whole, they expected this because people with a more pressing need for insurance would be the first to sign up, and they already incorporated that into their rates for this year. That means they’re unlikely to lose money, there is unlikely to be a huge rate spike next year, and the dreaded “death spiral” looks less and less likely.
This supports the contention I’ve had for some time, that in its first few years the Affordable Care Act is going to basically be fine—it may not create a health care paradise, but nor will it be the disaster conservatives are so fervently hoping for.
Before we get to sorting through what matters from what doesn’t, let’s look at the not-so-good political news. The Kaiser Family Foundation is out with their latest health care tracking poll, and there isn’t a lot to be glad about. More people have an unfavorable than a favorable view of the ACA. Most Americans are unaware that almost all the provisions of the law are now in force. And maybe most troubling, nearly half of Americans are still unaware of the law’s most popular provision, that insurance companies are no longer allowed to discriminate against people with pre-existing conditions:
Before you say, “Obama should have told people about it!” I must remind you that during the last four years you spent away from Earth, the administration and its allies did in fact repeat over and over and over again that the ACA prohibits insurance companies from denying you coverage if you have a pre-existing condition. There are many reasons why so many people haven’t yet understood, but you can’t say they didn’t try (you can read more about the myth of the bad sales job here).
In any case, here’s what we have to remember: On the scales of history, a person with a pre-existing condition who gets health coverage weighs much more than a person who doesn’t know that because of the ACA, people with pre-existing conditions can get health coverage. We spend so much time talking about politics that it’s easy to forget that politics are not an end in themselves, they’re a means to an end. Liberals advocated for comprehensive health insurance reform for so many decades not because it was politically advantageous (at some times it was, and at other times the voters didn’t seem to care), but because it was right. The fact that so many millions of Americans had no health security up until now was a moral obscenity. The ACA is beginning to fix things—slower and less completely than we might like, but it is a beginning. And if it never becomes the political boon you were hoping for, it was still the right thing to do.
That isn’t to say that political effects don’t matter, because they do. If the Republicans take over the Senate this fall, bad things would result, particularly if they also win the White House two years later, and if the ACA’s political troubles contributed to that turn of events, it would be unfortunate. But in the long run, what matters most is the effect on Americans’ lives. When you get distressed by a story about a Democratic member of Congress who’s in a tough race where her opponent is hitting her for supporting Obamacare, you can think of the families who never had health coverage before, but do now. For millions of people it will life-changing, and for many, literally life-saving. Try not to forget.
By: Paul Waldman, Contributing Editor, The American Prospect, January 30, 2014
“A Moral Issue”: Blacks, Latinos To Pay Disproportionate Price Over Blocked Medicaid Expansion
Minorities are disproportionately affected by 25 states’ decision to opt out of Medicaid expansion, a report finds.
Blacks make up 13 percent of the nation’s population but will represent 27 percent of those who will lose out on Medicaid coverage because of these states’ refusal to expand the program’s eligibility to the national standard under Obamacare, according to the 11th Annual Martin Luther King Jr. State of the Dream Report.
Latinos make up 15 percent of the population and 21 percent of the coverage gap. Whites, meanwhile, will be underrepresented—they are 65 percent of the population but have only 47 percent in the gap.
Had the Affordable Care Act been fully implemented, half of the 50 million people who were uninsured before the 2010 law was passed would gain access to coverage through the state and federal health insurance exchanges or the Medicaid expansion. Because of the 2012 Supreme Court decision that ruled states’ expansion of the program optional, 25 states have chosen not to expand Medicaid to include wage earners up to 138 percent of the federal poverty line.
The Medicaid coverage gap will leave out 5 million of the 10 million who would have gained coverage, exacerbating existing racial health disparities in the United States, a focus of Thursday’s report from the equal-rights group United for a Fair Economy.
Poor blacks are 7.3 times—and poor Latinos 5.7 times—as likely as poor whites to live in high-poverty neighborhoods that aggravate health problems. That gap is because of minorities’ limited access to health services and good food, as well as the great stresses from crime and racism, according to the report.
The data also find that 29 percent of Latinos, 19 percent of blacks, 15 percent of Asians, and 11 percent of whites were uninsured in 2012.
Republican governors are leading many of the states that have declined to expand the entitlement program. The federal government has committed to paying 100 percent of the expansion for the first few years, but the governors say they fear the feds will go back on their word, leaving states with unsustainable budget costs.
Other GOP governors have declined to expand the program out of ideological objections to an expansion of the nation’s social safety net.
The report’s authors are frustrated by the blocked expansion.
“With no expanded Medicaid, and little or no assistance to purchase insurance in the health exchanges, the actions of these elected leaders in these states are creating a vast hole in the new health care law—a 25-state coverage gap—through which nearly 5 million low income Americans will now fall,” UFE writes.
“Access to health care is, first and foremost, a moral issue,” the report continues. “It’s a question of right and wrong. Tolerating vast inequalities in health and health care along the lines of race or class sends the disturbing message that we as a society value the lives of people in various groups differently.”
Despite the blocked Medicaid expansion, the Affordable Care Act diminishes the racial health gap by expanding programs to promote diversity in health professions; supports cultural competency training to help doctors communicate with patients of color; and establishes research initiatives to explore the cause of health inequality. It also allows people with preexisting conditions—more common in impoverished neighborhoods due to the quality of life—to gain access to coverage.
But some people who do not have health insurance will continue to live without it. Others will be ineligible because of their immigration status. Still others won’t qualify because of their employment situation. Blacks and Latinos are more likely to work in lower-wage or part-time jobs where they are less likely to receive employer-sponsored coverage.
In addition to the lack of insurance and access to affordable health services, residential segregation and the stress of living in poverty are primary factors contributing to poor health in the black and Latino communities. Those types of communities are commonly found in “food deserts,” or areas of the country where people have little access to a grocery store with fresh produce and instead are surrounded by fast food joints. The report says that half of black neighborhoods lack a full-service grocery.
Among UFE’s recommendations to permanently close the racial health gap are the continued pursuit of a single-payer, universal health insurance system, where employment and work situations would no longer play a role in access, quality, and cost of care. They also, of course, hope to see all 50 states expand Medicaid and take the lead on fully implementing and supporting the Affordable Care Act.
They also propose increasing funding to permanently fund Medicaid at the federal level, heighten funding for outreach and education efforts, and allow undocumented immigrants to take part in the system. More systemic policies—more diverse housing, improved access to services in areas of extreme poverty, raising the minimum wage—would also help address the disparity between the races in overall population health.
By: Clara Ritger, The National Journal, January 16, 2014
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