“The Three Stages Of Obamacare Acceptance”: It’s Increasingly Difficult To See How Repeal Would Work, Even With Full GOP Control
Now that Obamacare is clearly moving forward, Republicans are adjusting to a new reality: it may no longer be a realistic option to simply wait until the law collapses under its own weight and vanishes entirely. GOP lawmakers are increasingly discussing a range of responses, from proposing profound changes to finally embracing a comprehensive alternative.
Which raises a question: Is it possible to envision a future in which Republicans and Democrats do enter into real negotiations over the future of the law and the health system, in which each side gets some changes it wants, in exchange for accepting some of the other’s proposed changes?
Yes, it is. But to get there, Republicans will first have to pass through what might be called the Three Stages of Obamacare Acceptance.
Right now, Republicans entertaining changes or alternatives are still proceeding from the premise that no outcome is acceptable unless it fatally cripples the law or eliminates it entirely. Republicans don’t believe the law can be fixed, since they think that even if it does work according to its own lights, it will still amount to a colossal policy failure. If Republicans want to hold that position indefinitely, there’s not much Dems can do about it.
But if Republicans do get to a point where crippling or eliminating the law is not the only acceptable outcome, there are scenarios under which they might negotiate for certain types of changes to the law, in exchange for changes Dems or liberals want.
Larry Levitt of the Kaiser Family Foundation laid out the types of incremental changes Republicans might pursue. He suggested Republicans might propose various ways of relaxing Obamacare’s regulations, in keeping with conservative policy ideas, that wouldn’t destroy the law. For instance, they could propose allowing insurance sales across state lines so competition drives down prices, something liberals might be willing to accept under certain circumstances if the law’s uniform federal minimum coverage standards are kept (which could theoretically prevent the “race to the bottom” liberals fear).
Or Republicans could propose to make tax deductions available to those over 400 percent of the poverty line who do not qualify for Obamacare subsidies, helping those who see premiums go up (which Republicans have turned into a major issue) and mitigating Obamacare’s redistributive elements a bit. Or Republicans could propose relaxing the limitations on age ratings, allowing insurance companies to charge more than the current three-to-one ratio the law mandates between older and younger people.
In exchange, liberals might ask for subsidies to be expanded to those who fall into the Medicaid gap — making too little to qualify for subsidies but too much to qualify for Medicaid in states that haven’t opted in to the expansion. Or they might ask for more in subsidies for those who currently qualify.
The point is, there are scenarios under which real negotiations over the future of the law could take place. But Republicans would have to be willing to accept something less than its complete destruction. (As Jonathan Bernstein has detailed, a general unwillingness by Republicans to try to get some of what they want on multiple issues has made the GOP into a kind of dysfunctional “post policy” opposition.)
Let’s be clear: It is certainly still possible that over the long term, Obamacare could fail, if, say, the demographic mix is bad, insurers pull out, and the exchanges collapse. If so, Republicans would theoretically be able to simply wait for the law to fall apart in a few years. But some experts are cautiously optimistic that the latest enrollment numbers suggest the law could be on track to work.
And that’s where the Three Stages of Obamacare Acceptance come in — presuming, again, that the law works at least moderately well over the long term:
* Stage One: A dim awareness that there might be some good elements in the law, and that the public might not support returning to the old system. GOP Rep. Jack Kingston, for instance, recently suggested that it might not be “responsible” to simply let the law fall apart, and that lawmakers should be open to anything in it that would help people get coverage. Kingston was immediately slapped down by his primary opponent and quickly reiterated his zeal to get rid of it entirely. Something similar happened to a GOP Senate candidate in Michigan.
* Stage Two: A genuine recognition that large numbers of people are already benefitting from the law, and that this reality needs to be reckoned with — such as by proposing alternatives or changes that purport to accomplish similar goals, even as the elimination or crippling of it remains a paramount aim. GOP Rep. Tom Price has proposed an alternative designed, in part, to cover people with preexisting conditions, but it would probably cover far fewer people, and Price continues to insist on Obamacare’s repeal, maintaining its demise is a certainty.
Meanwhile, Senator Ron Johnson has admitted that “we have to deal with the people who are currently covered under Obamacare,” and to do this, he has proposed keeping the exchanges while getting rid of the individual mandate. The latter, experts say, would fatally undermine the law, and as such this isn’t a serious proposal.
* Stage Three: Republicans accept Obamacare is likely here to stay, abandon the premise that the only acceptable outcome is crippling or eliminating the law, and negotiate to achieve incremental changes they want. This is the scenario outlined by Levitt above. It’s hard to know when this might happen in earnest – certainly not in 2014, and GOP presidential primary politics could also make this difficult next year. But you’re already seeing this a bit with GOP governors who are negotiating with the feds to create their own versions of the Medicaid expansion.
It’s always possible Republicans could win the presidency and both houses of Congress in 2016 and pass legislation repealing the law. And again, if the law fails over time, the above stages could be moot. But it’s increasingly difficult to see how repeal would work in practical terms, even with full GOP control. What’s more, as Jonathan Cohn has detailed, experts think early returns suggest the law is likely to work out. Which means you can begin to imagine Stage Three kicking in. At some point.
“If Republicans were to accept that the law is in place for the foreseeable future, then one could envision tweaks that could move it in a more conservative direction without undermining its goals, while also providing improvements to the law that liberals are looking for,” Levitt says.
By: Greg Sargent, The Plum Line, The Washington Post, January 2, 2014
“No Defense For Nonsense”: How Not To Argue Against Medicaid Expansion
Medicaid expansion is a sensible move for literally every state, but Mississippi, with more than its share of residents who lack insurance, live near the poverty line, and suffer from poor health, needs the policy more than most. Even Mississippi’s insurance commissioner, a conservative Republican, has urged Gov. Phil Bryant (R) to put aside ideology and embrace the provisions of “Obamacare” for the good of the state.
But Bryant has refused. Last March, the governor said he wouldn’t accept Medicaid expansion in part because the Affordable Care Act is not “the law of the land.” By any standard, the argument was gibberish.
This week, the Republican governor came up with a new argument.
“For us to enter into an expansion program would be a fool’s errand. I mean, here we would be saying to 300,000 Mississippians, ‘We’re going to provide Medicaid coverage to you,’ and then the federal government through Congress or through the Senate, would do away with or alter the Affordable Care Act, and then we have no way to pay that. We have no way to continue the coverage.”
Let’s think about this for a minute. There are, by everyone’s estimation, several hundred thousand folks in Mississippi who would benefit from Medicaid expansion. According to Bryant, the state could help them, but he doesn’t want to – because in his mind, Congress might repeal the health care law at some point in the future, and the state wouldn’t be able to afford to pick up the slack.
But even by GOP standards, it’s impossible to take this seriously. For one thing, it’s pretty obvious Congress isn’t going to repeal the law, as even the most right-wing lawmakers on Capitol Hill are grudgingly conceding.
For another, even in the extraordinarily unlikely event that the law is repealed sometime after 2017, Mississippi could simply revert back to its current policy once the federal well runs dry. In other words, Bryant is effectively telling struggling families, “We’ll refuse to help you now because of the remote possibility we may no longer be able to help you later. It’s better to leave you with nothing now and for the foreseeable future than risk helping you and your family for the next several years.”
There is simply no defense for such nonsense.
Postscript: In the same interview, the governor was asked about drug testing, and why it’s limited to welfare recipients, as opposed to corporate leaders whose companies get state tax money and/or public employees like himself.
“If I was receiving any federal or state benefits to help raise my family, I’d be glad to take a drug test,” he replied.
Bryant receives $122,160 a year in taxpayer money as his salary. He also has the people of the state of Mississippi to thank for his health care benefits.
By: Steve Benen, The Maddow Blog, January 2, 2014
“Republicans Could Care Less”: Millions More Denied Coverage By GOP Refusal To Expand Medicaid Than Obamacare Cancelations
For weeks as HealthCare.gov foundered, Republicans focused on President Barack Obama’s claim that “if you like your plan, you can keep it,” which was dubbed PolitiFact‘s Lie of the Year. Republicans purposely neglected to differentiate between the number of Americans whose plans were being canceled and those whose entire coverage was lost.
Now it turns out that the millions of notices that were sent out will result in just thousands of Americans losing access to affordable insurance.
A new report, however, from the minority staff of the House Committee on Energy and Commerce shows that only 0.2 percent of the approximately five million cancelations – the number often referenced by the Republican Party – will lose coverage because of Obamacare, and be unable to regain it.
In other words, only 10,000 people will lose complete coverage.
The report assumes that 4.7 million people will receive cancelation letters about their current plans. It then finds that half of that number will have the option to renew their 2013 plans, due to an administrative fix to the health law. Of the remaining 2.35 million Americans, 1.4 million would be eligible for tax credits through the ACA exchanges or Medicaid coverage, and out of the 950,000 individuals left, according to the report, “fewer than 10,000” people would lack access to an “affordable catastrophic plan.”
As the Washington Post notes, “there’s no doubt that for those 10,000 people, the health care law left them worse off than before.” Still, that number is significantly less than the amount of people who did not have access to any coverage prior to Obamacare.
“This new report shows that people will get the health insurance coverage they need, contrary to the dire predictions of Republicans,” says Democratic representative Henry Waxman (CA). “Millions of American families are already benefitting from the law.”
Ironically, as Republicans fret over the approximate 10,000 people who will lose coverage in 2014, they are to blame for the nearly five million Americans who will not have any health insurance this year because of the GOP’s refusal to expand Medicaid in various states across the country.
Though the Affordable Care Act provides complete funding through 2016 for Medicaid expansion in all states – and 90 percent funding in the following years – 25 Republican-controlled states have still refused to expand the program that offers coverage to the poor.
As a result, approximately 4.8 million people will find themselves inside the so-called “coverage gap,” which one report suggests could cost 27,000 Americans their lives in 2014.
By: Elissa Gomez, The National Memo, January 1, 2014
“Happy New Year, Losers”: The “Supreme Court Gap” In Unversal Health-Care Coverage
Chief Justice Roberts wishes a Happy New Year to all those losers who will not get health care insurance, thanks to his clever reading of the Constitution. There are 4.8 million of these losers and 2.6 million of them are people of color, black and Hispanic mainly. Not that the Chief Justice and his right-wing colleagues on the Supreme Court would make racist distinctions. No, no, no. They assure us their decision is solely driven by a matter of high comstittional principle—States Rights.
The problem with these people is that they are low-income adults without dependent children—not quite poor enough to qualify for Medicaid nor old enough to qualify for Medicare. President Obama’s original legislation took care of them by expanding Medicaid coverage and putting up the federal money to pay for it. The Roberts decision insisted that state governmednts have a constitutional right to reject this financial aid from Washington. And twenty-five states took him up on the offer.
This odd failure will probably be blamed on Obama but should rightly be called the “Supreme Court gap” in unversal health-care coverage. Because these folks do not not quite earn enough to qualify for Obamacare’s tax credits to help people purchase health insurance. A report from the Kaiser Family Foundation outlined the consequences. “Most of these individuals have very limited coverage options and are likely to remain uninsured,” the foundation explained.
Of course, they could get a job that pays more. Or maybe get married and have children that would qualify them for Medicaid. State governments set many of the rules for Medicaid coverage and some conservatives think fedeal aid saps individual initiative and rewards indolence. It is not entirely a coincidence that many of these rejectionist states are the same states that defied the Supreme Court half a century ago and resisted racial integration and equal rights for minorities. Some of them are the very states that went to war to defend slavery. Republicans are sometimes called a “neo-confederate party.” After the Supreme Court gutted the voting-rights act, the neo-confederates were free to pass restrictive laws designed to shrink minority voting, and so they did.
The Kaiser Foundation doesn’t get into any of that but simply observed, “These continued coverage gaps will likely lead to widening racial and ethnic as well as geographic disparities in coverage and access.”
Don McCanne of Physicians for A National Health Program circulated the Kaiser report with this comment: “What a terrible way to start the first of the year of what is essentially the full implementation of the Affordable Care Act. It seems pretty obvious what our New Year’s resolution should be. Let’s bring health care to everyone through an improved and expanded Medicare for all.”
Democrats ought to call out Republicans on these questions. And citizens generally ought to call out the Roberts court. The Supremes have done quite a lot in the last fifteen years to mess up our already weakened democratic system. They stole the presidential election in 2000. They cut loose big money to swamp elections by destroying lawful restraints. They are trying step-by-step to restore hoary old legalisms that favor capital over labor, corporations over individuals. Shouldn’t we be talking about how to stop them?
By: Wiliam Greider, The Nation, December 31, 2013
“Stunning New Report Undermines Central GOP Obamacare Claim”: The Arguments Made By Republicans Simply Lack A Firm Factual Basis
A crucial GOP line of attack against the Affordable Care Act (ACA) is that millions of people will supposedly lose coverage thanks to shifting requirements on the health insurance exchanges — a flagrant violation of President Obama’s infamous “if you like your plan, you can keep it” proclamation. The truth has always been more complicated, of course. Republicans are constantly blurring the line between people who lose a plan and people who lose coverage. That is, many people might lose a particular insurance plan but immediately be presented with other options.
Now, a new report from the minority staff of the House Committee on Energy and Commerce has destroyed the foundation of that particular GOP claim. It projects that only 10,000 people will lose coverage because of the ACA and be unable to regain it — or in other words, 0.2 percent of the oft-cited 5 million cancellations statistic.
The report starts with an assumption that 4.7 million will receive cancellation notices about their 2013 plan. (Notably it doesn’t endorse that figure, just takes it on for the sake of argument.) But of those, who will get a new plan?
- According to the report, half of the 4.7 million will have the option to renew their 2013 plans, thanks to an administrative fix this year.
- Of the remaining 2.35 million individuals, 1.4 million should be eligible for tax credits through the marketplaces or Medicaid, according to the report.
- Of the remaining 950,000 individuals, fewer than 10,000 people in 18 counties will lack access to an affordable catastrophic plan.
“This new report shows that people will get the health insurance coverage they need, contrary to the dire predictions of Republicans,” said Rep. Henry Waxman (D-Calif.), the ranking committee member. “Millions of American families are already benefiting from the law.”
The report is somewhat speculative, of course, since there is no central repository of data on the individual health insurance market. But the methods are clear, and the onus is now on Republicans to explain why it isn’t true.
As we’ve noted, Republicans have had an awful hard time finding people who completely lost coverage because of the ACA. (Think of the man who starred in Americans for Prosperity ads last week and whose story still hasn’t been fully explained.) Perhaps it’s because there just aren’t that many of them.
Of course, there’s no doubt that for those 10,000 people, the health-care law left them worse off than before. And by no means is the rocky political ride over for Democrats — back-end problems still present a serious threat to implementation. But as is sadly too often the case, the arguments made by Republicans simply lack a firm factual basis — and deserve much more scrutiny that they’ve received in many sectors of the mainstream press.
By: George Zornick, The Plum Line, The Washington Post, December 31, 2013
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