“Still Playing Games”: House Votes To Undermine ACA, Again
The House of Representatives held its first meaningful floor vote of 2014 this morning, sending a clear signal about the Republican majority’s priorities. Did they vote on unemployment benefits? The farm bill? One of the many other unfinished bills from 2013?
No, the GOP majority is still playing games with health care.
A significant number of Democrats broke party lines to vote on the House’s first anti-Obamacare vote of 2014 on Friday, a blow to party unity and leadership’s advice that rank-and-file members stand strong against GOP “gotcha” bills.
The legislation, which would require victims of security breaches through HealthCare.gov insurance exchanges to be notified within two days, passed 291-122. Sixty-seven Democrats sided with all voting Republicans to hoist the bill over the finish line.
The fact that so many Democratic lawmakers broke ranks wasn’t a huge surprise – it’s now an election year and they seem reluctant to create attack-ad fodder by opposing pointless “messaging” bills.
As we discussed last week, the proposal comes by way of Majority Leader Eric Cantor (R-Va.), who has a lengthy record of preferring partisan games to actual governing. It also dovetails with a coordinated messaging campaign championed by House Oversight Committee Chairman Darrell Issa (R-Calif.).
Indeed, today’s vote was unusually vapid. As has been reported many times, there have been no security breaches; literally zero Americans’ personal information has been compromised; administrative security testing for healthcare.gov is constant; and when rare vulnerabilities have popped up, the problems have been identified and resolved quickly and safely.
What’s more, while the bill approved by the House today would require HHS to notify consumers if their personal information is accessed improperly, it’s worth noting (a) HHS is already required to make these notifications, making the legislation unnecessary; and (b) since consumers’ personal information is not actually stored on healthcare.gov, the underlying concern really doesn’t make a lot of sense.
So what’s the point of pushing a pointless bill and making it the first proposal voted on in 2014? I found remarks from Rep. Elijah E. Cummings (D-Md.), ranking member of the House Oversight Committee, quite compelling.
“Despite all these positive results, Republicans are still obsessed with killing this law. Since they cannot do so legislatively, they have shifted to a different tactic: scaring people away from the website.
“So my second point is this: there have been no successful security breaches of Healthcare.gov. Nobody’s personal information has been maliciously hacked. […]
“These are important facts for the American people to know. But the Republicans disregard them and omit them because they undermine their claims. Many of us would support efforts to strengthen requirements for the entire federal government and private sector to notify consumers of breaches. But today’s bill does not do that. Today’s bill is the latest attempt to attack the Affordable Care Act and deprive millions of Americans of the healthcare they deserve.”
As for actual security threats, Jennifer Bendery makes a point that can’t be emphasized enough: “[T]he most credible threat to the website’s security may be the loudest critic of the website’s security: Rep. Darrell Issa (R-Calif.), chairman of the House Oversight and Government Reform Committee.”
By: Steve Benen, The Maddow Blog, January 10, 2014
“There Won’t Be Any Highs Ahead”: Congress Deserves Public’s Contempt For Its Obsession With Destroying Obamacare
Congress is back—and the House has an ambitious plan for the year ahead. OK, an ambitious plan to cement its place in history as the Do-Nothingest Congress of all time.
The House has scheduled all of 97 days in session before the November elections, with many of them being half days or pro forma ones. And Majority Leader Eric Cantor’s memo to his troops outlining the plan for the year ahead made it clear that there is at most a bare-bones agenda, focused like a laser, yet again, on repealing or further sullying and delegitimizing Obamacare. The only possible good news coming out of that is that the obsessive focus on killing Obamacare may provide the excuse for House leaders to extend the debt ceiling without blackmail this time, by convincing their rank-and-file that it is the best way to avoid distractions and keep the focus on the health insurance law.
The obsession with Obamacare, and the near-universal belief among Republican lawmakers and conservative spinmeisters that the law will collapse spectacularly of its own weight, is fascinating.
Remember that when Sen. Ted Cruz incited the shutdown last year over the demand to defund Obamacare, his argument was that this was the last chance before the law was implemented in January—after which it would be impossible to stop it, because so many Americans would be delighted with its benefits. Cruz told Sean Hannity last July, “If we don’t do it [defund Obamacare] now, in all likelihood, Obamacare will never, ever be repealed. Why is that? Because on January 1, the exchanges kick in, the subsidies kick in; … their plan is to get the American people addicted to the sugar, addicted to the subsidies, and once that happens, in all likelihood, it never gets …”
At which point Hannity agreed, saying, “It’s over—it never gets repealed.”
The awful and bumpy rollout of the plan changed all that; now, for Cruz, Hannity, and everyone else in the right-wing echo chamber, there won’t be any highs ahead, or at least the highs and sugar addictions will be overwhelmed by bad drugs and overdoses.
Which view is right? We don’t know for sure, but there is some interesting evidence in the rollout of the Medicare Part D plan in 2005, via an excellent analysis by Georgetown University’s Center on Health Insurance Reform. The report makes clear that there are many parallels between Part D and Obamacare.
First, both plans passed with substantial partisan tension, which tarnished the initial public views of them. Second, both plans created much confusion in the public, with small proportions of Americans having even a basic understanding of what was in the plans and how they would work. Third, both plans had a lot of time after passage and before they actually took effect to prepare for a massive rollout. Fourth, neither had its website ready to roll when the deadline hit, and both had crashes and long delays to gain access. Fifth, even after the websites became more reliable, other problems persisted, including inadequate call centers and inexperienced navigators at the local level who were unprepared with full or sophisticated answers to questions posed by those trying to sign up. Sixth, supporters of the laws issued cautions when they were first unveiled, warning of glitches ahead and asking the public for understanding and help at ameliorating the problems.
Now for the differences. While Medicare Part D was the subject of serious partisan chicanery—the infamous three-hour vote in the House; the conference committee that barred key Senate Democrats from participating, including Senate Democratic Leader Tom Daschle; the “bait and switch” that in the end took out all the parts of the bill that had made Ted Kennedy an initial partner of the Bush administration—once it was law, most Democrats worked hard to make the plan accessible and workable for seniors, as did Democratic governors and state legislatures.
Of course, the opposite is true of Obamacare. Despite yeoman efforts to make the bill bipartisan—months and months of negotiation by Senate Finance Chairman Max Baucus with Chuck Grassley and other Senate Republicans, starting from a framework devised and endorsed by Grassley—it got not a single GOP vote. But after passage, it has received nothing but yeoman efforts to sabotage it, including from a slew of Republican governors denying insurance to the most needy of their constituents simply to stymie the law’s implementation. And whenever a Republican talks about how to make the law work better, instead of blowing it up (Jack Kingston of Georgia comes to mind), he or she is vilified by partisans and their media acolytes.
Second, the mainstream media reported on the glitches in the Medicare Part D plan but did not jump all over them with front-page or highlighted stories, or repeated and lengthy inquests on Sunday talk shows. The opposite has been true of Obamacare, with an added twist that reflects the new economic and political realities for media, as reported in a piece by Maggie Mahar at healthinsurance.org. Mahar investigated a ballyhooed article in the Fort Worth Star-Telegram titled “Obamacare Stirs Anxiety for Thousands.” The cases of those who were purportedly shafted by Obamacare proved to be false or exaggerated, and three of the four cases cited were tea-party adherents who strongly opposed the law, two of whom had never even checked for prices on the exchanges. After a lengthy stonewall by the paper’s editors, it became clear that no one had fact-checked the piece, which was written by a reporter with no expertise in health policy, under a tight time frame, assigned by an editor who only wanted bad news, not any stories of those who had been helped by the new law. This is more a case of underresourced news outlets eager to report bad news than bias, but it reflects the tougher climate for a law that affects far more people in far more ways than Part D did.
Eight years after its rocky rollout and deep public skepticism, the Medicare Part D plan is widely popular. I have no idea if that will be the case with Obamacare—and if achieving popularity takes any length of time, the political damage, in this November election and maybe even in 2016, will already have been done. What I do know is that there are going to be a whole lot of winners under the Affordable Care Act, and a smaller number, but still a significant one, of losers or those caught up in the inevitable upheaval to the health care system.
And I know if your only legislative or policy plan for 2014, in the face of a sluggish economy, a crisis of long-term unemployment, and a host of other short and long-term problems facing the country, is to bet on the spectacular failure of the health care plan, you deserve the public contempt your Congress is receiving.
By: Norm Ornstein, The National Journal, January 8, 2014
“Becoming Increasingly Clear”: Despite What The Critics Say, Obamacare Is Working
Despite the treasured right-wing talking points, it’s increasingly clear that Obamacare is a success. Moreover, in places where Obamacare is not succeeding, it’s also clear that the right wing is to blame. Well, it’s clear to any who look at the state-by-state numbers of the newly insured. A whole lot of Americans will have to look, however, for the program’s success to redound to Democrats’ advantage.
Charles Gaba, an enterprising Web site designer, has taken it upon himself to track the number of Americans who have gained health insurance under the Affordable Care Act (ACA). Tallying those who have signed up on the state and federal exchanges (2.1 million), those who have obtained Medicaid coverage (4.4 million) and those who gained coverage through the law’s requirement that private plans allow parents to cover their children up to age 26 (3.1 million), he cites more than 9 million newly insured through Obamacare.
The meaning of that number is, to be sure, a little fuzzy. To begin, it’s a gross, not a net, increase. Some of the 2.1 million who purchased insurance on exchanges did so after their previous plans were altered or canceled. In some states, the increase in those insured through Medicaid does not distinguish between those not eligible previously and those who are simply renewing coverage.
All that said, whether the total is 9 million or 7 million, it’s a big number and it’s rising rapidly: December sign-ups far exceeded those in November, and the number is expected to continue growing through 2014.
Whether you can access the benefits of the ACA, however, depends on where you live. In states that set up their own exchanges and accepted federal funding for Medicaid expansion, the increase in the number of insured vastly exceeds that in states that declined to do either.
Theda Skocpol, a Harvard professor of government and sociology, has compared state totals of those who gained insurance through the exchanges and Medicaid with Congressional Budget Office projections of the number of enrollees in each state for the first year the ACA is in effect, as well as with the Kaiser Medicaid Commission’s projections of new Medicaid recipients in that first year.
In the three months since the exchanges opened, she wrote this week, the 14 states that established their own exchanges and accepted Medicaid funding reported increases amounting to 37.2 percent of the projected yearly exchange purchases and 42.9 percent of the projected Medicaid enrollments. In the 23 states that refused to establish insurance exchanges, refused to cooperate in making the federal Web site easily accessible and declined to expand Medicaid, exchange purchases were just 5.6 percent of the projected increase and Medicaid enrollments just 1.5 percent. (The 13 states that partially embraced the programs generally had increases lower than the 14 full implementers but higher than the 23 refusniks.)
Which is to say, the ACA is working as planned, perhaps a little better, in the states where governors and legislatures chose to implement it, such as California and New York. It is barely working in those states where governors and legislators have refused to implement it, such as Texas. Although the number of states declining any participation probably will diminish over time, as the tea party’s grip on the Republican Party wanes or as older white conservative voters die off, the resulting red-blue division between the states probably will be a feature of the nation’s political economy for some time.
Consider the implications: A larger share of Californians will be able to afford regular medical check-ups than Texans. A smaller share of Californians is likely to be bankrupted by the expense of major medical treatment than Texans. When the law’s tax penalties take effect, a smaller share of Californians will be subject to the penalties that come with the individual mandates than will Texans. In the coming years, a smaller share of California hospitals will face financial risk for indigent care than hospitals in Texas, where fewer of the sick and poor will be covered by Medicaid.
The conservative argument that the ACA is a disaster is true only when it’s a self-fulfilling prophecy: Most of the negative consequences that right-wingers have warned against have occurred only in those places where right-wingers have subverted implementation of the law. What supporters of the ACA must keep in mind, however, is that Americans who live in states where implementation has been stymied may continue to see the act as a failure and continue to blame President Obama and his party.
Only by publicizing the act’s manifest success in states where it has been implemented can supporters begin to change the public’s verdict.
By: Harold Meyerson, Opinion Writer, The Washington Post, January 8, 2014
“The GOP’s Obamacare Obsession Will Sink Them In 2014”: As A Democrat, I Like The Republican Strategy, For It’s Political Suicide
2014 has arrived – an election year. President Obama is surely happy to have 2013 behind him, excited to have a new year ahead to work on issues that the American people care about: immigration reform, the budget, extending unemployment benefits, job creation and raising the minimum wage to name a few.
Republicans are also excited about the year ahead. And their agenda?
Replace, repeal, demonize and continue to oppose Obamacare.
Yes folks, the 47 attempts to repeal this law at your time and expense (literally); weren’t enough.The fact is that the Republicans promised, ‘hey, vote for us, we’ll take over the House and create jobs!’ was a broken, empty promise.
The fact is that Americans still care about the economy (a category into which job creation, extending unemployment benefits and raising the minimum wage fall), still ranks numero uno on their list of must haves for 2014.
The fact is that poll after poll shows that the majority of Americans feel there is a disparity of wages in America, want unemployment benefits extended and support raising the minimum wage to a more livable wage.
The fact is that in the last election, Democrats won landslide victories by hitting home the point of income inequality in America and how it must be changed.
And the fact is that, polls show, the majority of Americans don’t like Obamacare, but do like “The Affordable Care Act” and don’t want it repealed or replaced, just repaired – and they do not want Republicans fighting over it or voting on it anymore. Despite all that, Republicans are still betting that their opposition to Obamacare will help them win and win big in November 2014.
And the machine’s already in motion. It started with the Republican National Committee’s announcement that it would emphasize the Democrats’ support of Obamacare, hoping to gain seats in both the House & the Senate in the next election. RNC Chairman Reince Priebus, said Obamacare is going to be the issue of 2014. As the new year starts, so starts the launch of a multistate radio ad campaign targeting Democrats.
Although Republicans see the continued attack of “if you like your health care plan, you can keep it” comment by the president as their golden egg, I believe it will eventually fall on deaf ears. Those that aren’t Democrats or don’t like the Democrats won’t vote for them, whether they like their insurance, their plan, their doctor or not.
And by November, the website will be fixed, even more people will be insured as millions more will sign up for Obamacare by the end of March and by November rather than death panels we’ll be hearing about how many people were able to have early detection of cancer and get it treated and be cured, rather than die; due to having health insurance and receive preventative care.
We will hear how no jobs were lost due to Obamacare and the economy will continue to improve; despite Republican claims otherwise. In other words, there will be – and Democrats better drive these points home – more success stories and satisfaction with Obamacare than not.
So as a Democrat I like the Republican strategy, for it’s political suicide; oh but it will gain seats in the House and the Senate … for the Democrats.
By: Leslie Marshall, U. S. News and World Report, January 8, 2014
“Obamacare And Emergency Rooms, A Bit Of Perspective Needed”: Oregon Study Doesn’t Undermine Affordable Care Act Claims
Headlines based on a study of emergency room visits by a few thousand Oregon Medicaid beneficiaries undoubtedly gave the Obama administration heartburn last week. Although the study predated the Medicaid expansion authorized by the Affordable Care Act — which began in some states on January 1 — many who wrote about the Oregon study jumped to the conclusion that the millions of newly enrolled Medicaid beneficiaries would make greater — not less — use of the ER for routine care.
I may be going out on a limb, but I for one don’t buy the idea that the Oregon study means emergency rooms are going to get even more crowded. And that’s because more Americans will finally have insurance.
Reform advocates have long suggested that getting folks out of the ranks of the uninsured should cut down on visits to the ER for noncritical medical care. Many people who lack coverage don’t have a primary care physician and all too often make trips to the ER when their illness or injury could have been treated more appropriately and inexpensively in a clinic or doctor’s office.
The Oregon study, which was published in the journal Science, would seem to disprove that theory.
In 2008, two years before the ACA was enacted, Oregon increased the number of Medicare beneficiaries in a novel way: by lottery. Many Oregonians who had been on a waiting list for the state’s Medicaid program got lucky when their names were drawn and they were added to the rolls.
The researchers who wrote the Science article studied the emergency room use of about 25,000 of the successful and unsuccessful lottery participants and found that those who won coverage actually made more trips to the ER over 18 months than those whose names were not drawn.
Headline writers were quick to draw their conclusions: Obamacare would not reduce unnecessary ER visits.
“Emergency Visits Seen Increasing with Health Law,” read the headline above the New York Times story last Thursday.
“Obamacare Medicaid Expansion to Worsen Hospital ER Burden,” said Bloomberg.
And Forbes gave us this: “New Oregon Data: Expanding Medicaid Increases Usage of Emergency Rooms, Undermining Central Rational for Obamacare.”
“For years,” wrote Forbes columnist Avik Roy, “it has been the number one talking point of Obamacare supporters. People who are uninsured end up getting costly care from hospitals’ emergency rooms. ‘Those of us with health insurance are also paying a hidden and growing tax for those without it — about $1,000 per year that pays for [the uninsureds’] emergency room and charitable care,’ said President Obama in 2009. Obamacare, the President told us, would solve that problem by covering the uninsured, thereby driving premiums down. A new study, published in the journal Science, definitively reaches the opposite conclusion.”
There is more than a bit of twisted logic in that paragraph. It is true that those of us with insurance pay considerably more for it because those who don’t have it often can’t pay for their ER care. That’s because the hospital shifts the cost of that “uncompensated care” to its insured customers. Researchers have estimated that people with insurance pay $1,000 more a year for it than they would if this cost shifting didn’t have to occur.
Bringing uninsured people into coverage eliminates much of that cost shifting. And that’s a good thing, considering that the vast majority of Americans with health coverage — even after the Medicaid expansion — get it through private insurance companies, either at work or on their own.
The actual increase in the number of visits per person among the newly insured in Oregon via the Medicaid lottery was 0.41. In other words, each new enrollee made 0.41 visits more on average during the 18 months than the 1.02 ER visits made by those who remained uninsured.
When you look at it from the perspective of those numbers, and the actual amount Oregon spent per person, as University of Chicago health policy expert Harold Pollack did in a healthinsurance.org post, this is far from a “sky is falling” disaster in the making. And it is actually reducing the cost shifting.
Also, as Pollack pointed out, “the emergency departments will be reliably paid for care they provide … (With coverage expansion) providers don’t have to fear the burdens or uncompensated care, and…they don’t need to cruelly pursue low-income patients over bad debts.
It’s also important to keep in mind that private insurers now manage most of the states’ Medicaid populations, and they will be vigilant in their efforts to steer their new Medicaid enrollees away from the ERs and to more appropriate and cost-effective settings. WellPoint subsidiary Amerigroup described in a recent policy brief, for example, how its efforts to reduce primary care-treatable ER visits among Medicaid beneficiaries resulted in a savings of more than 50 percent.
Rather than rushing to conclusions, let’s see how the Medicaid expansion under Obamacare actually plays out in the years ahead.
By: Wendell Potter, The Center for Public Integrity, January 6, 2014
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