“A Steady Drumbeat”: Republican Governors Buck Party Tenets To Seek Expanded Medicaid
Republican governors are pressing forward to expand Medicaid even after being stymied by lawmakers in their own party.
As the Obama administration vows to help develop plans that will pass muster with conservatives, the governors of Utah and Wyoming said they still want the health care program for the poor broadened. Georgia Gov. Nathan Deal, who declined to act in 2013, may seek a federal waiver to make insurance available to more residents. Louisiana’s Republican legislature also opened a legal door.
Their views challenge party orthodoxy, even if some governors are crafting their own proposals and denying that what they’re doing is expanding Medicaid. Twenty states have refused the expansion under President Barack Obama’s 2009 health care overhaul because of cost and ideological opposition. The resistance is easing as states see a chance to recoup tax dollars and help hospitals get paid for charity care.
“This is about your citizens’ financial and health security, and it’s also about the economic health of your states,” Sylvia Mathews Burwell, U.S. secretary of health and human services, said Saturday at a National Governors Association meeting in West Virginia. “We want to help you design a system.”
This month, Alaska became the 30th state to expand, including 10 with Republican governors, according to the nonprofit Kaiser Family Foundation, a health-research group in Menlo Park, California. Gov. Bill Walker, a first-term independent, used his authority under state law to accept the expansion unless the legislature returns by September 1 and votes it down.
“I did it unilaterally because it was the right thing to do,” Walker said in an interview.
Governors in Tennessee, Utah, and Wyoming lack the ability to act alone, and their Republican-led legislatures declined to adopt expansion this year.
Even so, Utah’s Gary Herbert plans to meet with legislative leaders this week and said he hopes to call a special session in September to pass what he’s calling an alternative to Medicaid expansion.
Herbert’s program also would require a waiver from Medicaid officials for elements designed to appeal to Republicans, such as having applicants get job training.
“I’m optimistic,” Herbert said in an interview. “I think our approach is better than traditional government-assistance Medicaid.”
In Georgia, lawmakers last year blocked the governor from expanding Medicaid without their approval. A provision tucked into this year’s budget, though, allows the state to pursue a waiver.
Wyoming Gov. Matthew Mead called his expansion effort “a colossal failure.” Still, he hopes to bring it back in February’s budget session or in 2017.
“It’s going to take probably some time and continued work by all of us to eventually get to that point,” Mead said.
Tennessee Gov. Bill Haslam, a Republican, said he doesn’t know whether he’ll try next year after failing in February.
While Louisiana Gov. Bobby Jindal, a Republican presidential candidate, has been an adamant opponent, his state still could move, said Joan Alker, executive director of the Center for Children and Families at Georgetown University.
Jindal leaves office at year’s end, and Republicans running to replace him have all expressed support for expansion in some form, she said. The legislature has passed a provision requiring hospitals to pay the state’s share of expansion.
“I don’t think we are going to see a super-large number of states moving forward,” Alker said. “But it is a steady drumbeat.”
By: Mark Niquette and Margaret Newkirk, The National Memo, July 29, 2015
“The Free Market Failed”: Here’s Some More Good News About Obamacare. Too Bad It Won’t Dent The Debate
Whenever a health insurer announces that it will be requesting significant premium increases in the coming year, it’s guaranteed to generate news stories that are waved triumphantly by conservatives as proof that the Affordable Care Act is a failure and, just as they predicted, premiums are skyrocketing because the government is messing around in health care.
When a story like this one comes along, on the other hand, it seems to generate much less attention:
California’s Obamacare exchange negotiated a 4% average rate increase for the second year in a row, defying dire predictions about health insurance sticker shock across the country.
The modest price increases for 2016 may be welcome news for many of the 1.3 million Californians who buy individual policies through the state marketplace, known as Covered California.
California’s rates are a key barometer of how the Affordable Care Act is working nationwide, and the results indicate that industry giants Anthem and Kaiser Permanente are eager to compete for customers in the nation’s biggest Obamacare market.
Leading up to Monday’s announcement there had been a steady drumbeat of news about major insurers outside California seeking hefty rate hikes of 20% to 40% for Obamacare open enrollment this fall.
Keep in mind that before the ACA went into effect, annual premium increases of 10 percent or so had become the norm. California is only one state, and when you go across the country the picture is complicated — in some states premiums are rising more slowly than they did before the law; in other states they’ve jumped; and in some places they’ve declined. There are many reasons why. But what’s important to understand is that the predictions of the law’s critics — that both overall health spending and premiums would explode — were completely wrong.
The key word in this story comes in the first paragraph: “negotiated.” California is one of the states where officials running the health care exchange negotiate with insurers over rates, and when you have a negotiation, you can get better terms for the people you represent. Yet incredibly, we’re still arguing over whether what the health insurance market needs is less government involvement and more of that free market magic.
So for the millionth time: the reason we have the world’s most expensive health care system is precisely because the free market failed.
If conservatives were right and government is the problem, then in all the world’s other advanced nations, where there is much more government regulation of health care than we have, they’d be paying more for their health care than we do. But they spend far less, often with better health outcomes and usually with virtually no uninsured. And after watching this debate for the better part of a decade, I’ve yet to hear a single conservative explain why that’s the case, and how it squares with their beliefs about government and markets. How can it possibly be that government-heavy systems — whether you’re talking about a completely socialized one like Great Britain’s or a system like France’s that combines a basic government plan with heavily regulated private supplemental insurance — work so much better and cost so much less than ours? If you have a religious belief that markets are always right and government is always wrong, it’s just impossible to reconcile.
The point isn’t that the ACA is a perfect piece of legislation that has solved all our problems, because it isn’t and it hasn’t. The ACA is a gigantic kludge layered on top of what was already a terribly dysfunctional system. Health insurance in America remains incredibly complicated — for instance, if you’re on an exchange, in order to get the best rate you may have to shop around every year. Unfortunately, Republicans have made it impossible to fix the law’s weaknesses as we used to do with complex legislation, because they’ve fed their constituents a lie that any day now they’re going to repeal the whole thing, so there’s no point in trying to make it work better (and that doing so would be a compromise with evil, of course).
Fifty years ago this Thursday, Lyndon Johnson signed Medicare into law. At the time, Republicans predicted not only that the program would be a failure, but that it would send America hurtling toward a socialist nightmare of oppression. Ronald Reagan famously said that if the law passed, “we are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.” Yet this big-government, single-payer health insurance program for seniors turned out to be one of the most successful and popular pieces of legislation in American history. Not only that, due in part to the Affordable Care Act, the projected future cost of Medicare keeps going down — another conservative prediction about the ACA that has proven wrong by 180 degrees.
And today, Republicans pretend they love Medicare and only want to preserve it, while they present plans that would eliminate its guarantee of coverage and turn it into a voucher program, on the failed theory that whatever the private sector does in health care must be superior. These efforts always fail, because the program is just too popular.
The ACA isn’t politically bulletproof in the same way, in large part because it’s so many different things. No one “has” Obamacare in the way you have Medicare, with a card in your wallet; in fact, tens of millions of people are affected by the ACA, usually in positive ways, without ever realizing it. But here’s a crazy idea: What if we looked at where the law is succeeding and tried to build on that success, and looked at where it isn’t and tried to correct those shortcomings, doing it all with the best understanding of the actual facts we can gain?
Oh, who am I kidding.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Plum Line Blog, The Washington Post, July 28, 2015
“Another Ridiculous Endeavor”: Republicans Schedule New ‘Obamacare’ Repeal Vote
There’s some disagreement about how many times House Republicans have voted to repeal all or parts of the Affordable Care Act. I’ve seen some estimates of 56 separate votes, though some put the total a little higher.
But let’s not forget their friends on the other side of the Capitol. As National Journal reports, Senate Republicans are at least going through the motions to keep their repeal crusade alive, too.
Senate Majority Leader Mitch McConnell has proposed repealing Obamacare as part of the long-term highway bill currently being considered in the upper chamber.
McConnell’s office said Friday that the Senate would vote Sunday on an amendment to the highway legislation that would repeal the Affordable Care Act. The initial vote, which would cap debate on the repeal amendment, would need 60 votes.
Obviously, this is a ridiculous endeavor. The very idea of repealing an effective health care law is increasingly bizarre, and as Senate GOP leaders realize, there’s zero chance of the repeal measure passing. The fact that Mitch McConnell sees this as a necessary part of the debate over highway spending is itself quite sad.
So why in the world is the Republican leader doing this, announcing an ACA repeal vote out of the blue? Apparently because McConnell is looking for an adequate pacifier for his far-right flank and this is the best he could come up with.
This gets a little complicated, but McConnell appears to see Obamacare repeal as a spoonful of sugar to help the medicine go down. The medicine, in this case, is the restoration of the Export-Import Bank. The Washington Post reported this morning on how the Senate Majority Leader hopes to get the highway bill through the chamber:
McConnell … set up votes on two controversial measures – a repeal of the Affordable Care Act, and a reauthorization of the Export-Import Bank of the United States – and did it in such a way that will make it difficult for other amendments to be considered.
That move incensed [Sen. Ted Cruz] – who had announced his intention to offer other amendments, and who, like many conservatives, strongly opposes the bank’s reauthorization, though it enjoys support from a supermajority of his Senate colleagues. While McConnell has personally spoken against Ex-Im reauthorization, Democrats said in June he had agreed to schedule an Ex-Im vote in order to get highly divisive trade legislation passed.
Though McConnell said there was no deal, Cruz is now convinced that McConnell lied, which has apparently enraged the Texas Republican. Politico added:
Ted Cruz took to the Senate floor Friday and charged that Mitch McConnell told a “lie,” escalating his campaign against GOP leaders and challenging the traditions of the usually decorous chamber.
In a scathing floor speech, the Texas firebrand accused the Senate majority leader of breaking his word to him and the rest of the GOP conference over McConnell’s plans for the controversial Export-Import Bank, the country’s chief export credit agency.
C-SPAN posted Cruz’s entire harangue to YouTube. For a senator who claims to abhor “Republican-on-Republican violence” when the topic is Donald Trump, Cruz has no similar qualms when publicly expressing his scorn for Mitch McConnell.
By: Steve Benen, The Maddow Blog, July 24, 2015
“The Obamacare Resistance Regroups”: Delving Even Deeper Into Denial
The 16th Amendment to the Constitution, authorizing the federal income tax, was ratified in 1913. Still, every once in a while, the news will report the arrest of some right-wing kook who has failed to pay his income tax on the grounds that it’s illegal. Also in 1913, the 17th Amendment, requiring the popular election of senators (who before then were often appointed by state legislatures) took effect. And yet many conservatives still want to repeal it — and not just kooks, or at least influential kooks and not just completely marginal and obscure kooks. And those things happened more than a century ago.
So how long will the Obamacare resistance live on? A long, long time.
Obamacare has survived when it appeared to be dead in Congress in 2009, then even more dead the next year, and then survived a Supreme Court case, a presidential election, a rollout crisis, and another Supreme Court case. National Journal’s Josh Kraushaar has lovingly tended the flickering flame of health-care repeal for years. In 2013, he predicted that barring “an unlikely fourth quarter comeback,” Congressional Democrats would soon join with Republicans to repeal the law over a presidential veto. In the wake of the King v. Burwell verdict, Kraushaar regroups with a new column laying out a path. Kraushaar refers repeatedly to the law’s “unpopularity,” which is … barely correct:
Proceeding from this shaky premise, he argues that, if they win the presidency, enough Senate Democrats might join Republicans to create a filibuster-proof supermajority:
The third group, which Sasse labels the “Replacement Caucus,” would make significant changes to the law after campaigning on a reform-oriented health care agenda in the presidential election. That’s the most tenable approach — and the fact that Sasse, a hard-line Senate conservative, is calling for something other than outright repeal is telling. (Sasse still supports repealing the law but only with a replacement plan in hand.)
If Republicans win the presidency, the political momentum — and votes for rolling back core elements of Obamacare — would be in place. In that scenario, Republicans would have won three out of four elections, and a depleted Democratic Party would be in disarray. Republicans could credibly claim a health care mandate, given how prominently the issue played in recent elections.
Kraushaar allows that these “significant changes” to Obamacare would fall short of repeal, though he does not indicate what those changes would entail. He links to a National Review column by Republican Senator Ben Sasse, which also fails to describe what changes should be implemented. The closest Sasse comes to specifying a proposal is calling for an “understandable, common-sense, patient-centric alternative.” Of course, Republicans have been urging other Republicans to come up with a common-sense, patient-centric health-care plan since the health-care debate began six years ago. They have remained stuck in the same unsolvable problem: Their actual health-care policy ideas are either all less popular than the specific policies in Obamacare, unworkable, or both. When Republicans start naming actual policy changes they would implement, they would do things like let insurance companies deny coverage to people with preexisting conditions, or stop covering popular services like maternity care. That’s why the only specific partial changes Republicans actually want to vote on simply attack the law’s financing provisions. They’re not willing to eliminate Obamacare’s benefits, but they’re happy to stop paying for them. That plan (keep the benefits, oppose the taxes) is pretty much the party’s approach to other established social insurance programs like Medicare and Social Security. If Republicans win the presidency, they may bite the bullet and repeal Obamacare because their base demands it, but they won’t have Democrats on their side and it won’t be popular.
Even farther into denial is Michael Cannon, a Cato Institute scholar who played a leading role in promoting the King v. Burwell lawsuit. The basis for that lawsuit was seizing on an errant line of text implying that tax credits would be available only for customers using state-established exchanges, ignoring many other parts of the law, as well as massive amounts of evidence before, during, and after the debate implying the opposite. For a while, Cannon, the founder of the anti-Universal Coverage club, nurtured hopes of un-insuring 6 million Americans. He finds himself in the position of a despondent young Montgomery Burns mourning the destruction of his biological weapon (“My germs, my precious germs! They never harmed a soul. They never even had a chance!”)
Cannon, unlike Burns, does not seem to be accepting defeat. His Twitter bio continues to describe him as “the man who could bring down Obamacare,” a now-moot prediction. His new column argues, “Even in defeat, King threatens Obamacare’s survival, because it exposes Obamacare as an illegitimate law.” Cannon bases this claim on the fact that he believes, or purports to believe, that Obamacare is not what the Supreme Court says it is but a chimerical, never-implemented, doomed-to-fail alternative that will live on forever in his dreams. A century from now, right-wingers will emerge from their fortified mountain compounds, clutching Cannon’s writings and claiming to be following the True Obamacare.
By: Jonathan Chait, Daily Intelligencer, New York Magazine, July 10, 2015
“No Longer Any Political Margin To Be Gained”: Why Republicans Won’t Object To The Return Of ‘Death Panels’
There was a lot about the period leading up to the passage of the Affordable Care Act that was ridiculous and maddening, but perhaps no episode was worse than the controversy over “death panels.” Here you had a small provision of the bill that doctors, patient advocates, and health care experts all agreed would lead to better care, not to mention cost savings. Then Republicans concocted a lie about it, spread that lie as far as they could, and finally saw the provision removed from the final legislation.
Well, now Medicare is finally doing what that provision of the ACA would have done.
Under a newly proposed rule, it will reimburse doctors for the time they spend with patients planning how they want to be cared for near the end of their lives. And just you watch: this provision that Republicans said six years ago was so horrifying? They’re not even going to bother opposing it anymore, now that doing so serves no political purpose. It’s barely going to be a controversy at all.
That’s not what everyone else seems to be predicting. All over the web there are articles about this issue, many illustrated with photos of Sarah Palin, predicting that this is going to blow up into another angry debate. But I say it won’t. Here’s why: Republicans’ opposition to end-of-life counseling was always utterly cynical, a performance enacted for no purpose other than undermining the legislation. At this point, with the law implemented long ago and the major legal challenges over, there’s no longer any political margin to be gained in shaking their fists at patients and doctors talking about the options for end-of-life care.
Let’s review a little history. This whole thing got started when conservative activist Betsy McCaughey appeared on the radio in 2009, when versions of the legislation were working their way through Congress, and said this about the one in the House:
“And one of the most shocking things I found in this bill, and there were many, is on Page 425, where the Congress would make it mandatory — absolutely require — that every five years, people in Medicare have a required counseling session that will tell them how to end their life sooner, how to decline nutrition, how to decline being hydrated, how to go in to hospice care. And by the way, the bill expressly says that if you get sick somewhere in that five-year period — if you get a cancer diagnosis, for example — you have to go through that session again.”
To paraphrase what Mary McCarthy said about Lillian Hellman, every word of that statement is a lie, including “and” and “the.” The actual provision stated that if a patient wanted to have a consultation about their options, including how to create an advanced directive that would lay out what sorts of treatment they wanted and didn’t want if they got to a point where they couldn’t communicate it themselves, Medicare would pay the doctor for the time counseling the patient. Nothing was mandatory, nothing would require doctors to “tell them how to end their life sooner,” and nothing required anyone to have the session again. It was all lies.
But that didn’t prevent the claim from taking off like a rocket. Sarah Palin floated the “death panel” talking point. Chuck Grassley told a crowd back home, “We should not have a government program that determines if you’re going to pull the plug on grandma.” Although media outlets tried to explain that the allegation was false, millions of people believed it anyway. Chastened Democrats removed the provision from the bill.
So now that Medicare is finally moving ahead with this provision, are Republicans really going to fight it? No, they won’t. I’ve been looking around for condemnations from conservative media outlets or prominent Republican politicians, and so far I’ve come up empty. There was one small item on the National Review’s blog, with no substantive objection, just a little harumphing about bureaucracy. No outraged statements from Mitch McConnell and John Boehner, no thunderous denunciations from the presidential candidates, nothing.
Maybe they just haven’t gotten around to it yet, and the indignation is on its way. But I wouldn’t bet on it. In this somewhat cooler environment, it isn’t going to be easy for them to argue that patients shouldn’t sit down with their doctors and plan for their future care. And with congressional Republicans all but giving up on repealing the ACA, this isn’t a battle that offers much to be gained.
So five years after the ACA was passed, doctors will know that they can get paid for this absolutely vital service, explaining the options to their patients and making sure that when the time comes, those patients’ wishes are honored. The people like McCaughey, Palin, and Grassley who back then lied to the country in order to score a few points against Barack Obama ought to hang their heads in shame. But at least it’s finally happening. Better late than never.
By: Paul Waldman, Senior Writer, The American Prospect; The Plum Line Blog, The Washington Post, July 9, 2015
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