“What’s Really Obstructing Obamacare?”: An Orchestrated GOP Resistance With Only One Very Ugly Precedent
So we’re a month into the Obamacare era. What does your average American know about it? That the website is a mess, and some number of Americans have suddenly lost their coverage after Barack Obama assured them that wouldn’t happen. These things are true, and a person would be quite wrong to deny this is deeply problematic.
But I wonder how many Americans know the other side of the coin. There are already numerous success stories out there. And then there’s the side of the story that has certainly received coverage but not nearly as much as it deserves to, which is the way—did I say way? Ways—the Republican Party is trying to make sure it fails. Todd Purdum wrote a piece for Politico yesterday on the GOP’s “sabotage” of the law. It was a terrific article, but he didn’t say the half of it.
All across the country, Republican governors and insurance commissioners have actively and directly blocked efforts to make the law work. In August, the Obama administration announced that it had awarded contracts to 105 “navigators” to help guide people through their new predicaments and options. There were local health-care providers, community groups, Planned Parenthood outposts, and even business groups. Again—people and groups given the job, under an existing federal law, to help people understand that law.
What has happened, predictably, is that in at least 17 states where Republicans are in charge, a variety of roadblocks have been thrown in front of these folks. In Indiana, they were required to pay fees of $175. In Florida, which under Governor Rick Scott (who knows a thing or two about how to game the health-care system, you may recall) has been probably the most aggressive state of all here, the health department ruled that local public-health offices can’t have navigators on their premises (interesting, because local public health offices tend to be where uninsured people hang out). In West Virginia, Utah, Pennsylvania, and other states, grantees have said no thanks and returned the dough after statewide GOP elected officials started getting in their faces and asking lots of questions about how they operate and what they planned to do. Tennessee issued “emergency rules” requiring their employees to be fingerprinted and undergo background checks.
America, 2013: No background checks to buy assault weapons. But you damn well better not try to enroll someone in health care.
If you Google “Obamacare navigators,” you will be hit smack in the face with the usual agitprop. “Reports” raise “questions” about their qualifications, you see. This is the old trick of finding one bad apple and extrapolating away to beat the band. But in this case the alleged bad apple wasn’t even bad. One enrollment assister in Lawrence, Kansas—one!—had an outstanding warrant. She hadn’t even been aware of the warrant. The group she worked for said, apparently credibly, that the warrant was “no longer active.” (Interestingly under the circumstances, it was about… an unpaid medical bill!) But my favorite story linked—inevitably—the navigator program to ACORN. You will recall that no one ever proved that anybody from ACORN ever did anything wrong, but of course in right-wing land this means nothing.
A second front: Now, with people trying to sign up, some Republican legislators are openly saying that they won’t permit their staffs to answer constituents’ questions about Obamacare. This is really the main job of a member of Congress, especially a House member: People call up all the time with questions about how to slice their way through the federal government’s briar patches, and you have caseworkers on duty—typically a couple in Washington and several more back home in the district regional offices—whose job is exactly that.
Purdum quoted Kansas Rep. Tim Huelskamp as saying he instructs his staff to refer callers to Kathleen Sebelius. But Huelskamp is not alone. Tennessee’s Diane Black says she doesn’t feel comfortable referring people to navigators. Utah’s Jason Chaffetz is referring people back to the administration, saying: “We know how to forward a phone call.”
Someone I know asked the other day: Has there ever been a law in the history of the country as aggressively resisted by the political opposition as this? Republicans didn’t do this with Social Security. Most of them voted for Social Security. They didn’t do it with Medicare. They, and the Southern racists who were then Democrats, didn’t do it with civil rights. There was a fair amount of on-the-ground opposition to that, but it wasn’t orchestrated at the national level like this was. And when the Voting Rights Act was passed the year after civil rights, Southern states in fact fell in line quickly. Check the black voter-registration figures from Southern states in 1964 versus 1966. It’s pretty amazing.
No, to find obstinacy like this, you have to go back, yes, to the pre-Civil War era. The tariff of 1828, the Kansas-Nebraska Act, which led to the civil war in “Bloody Kansas” and ultimately to the Civil War itself. Not a comforting thought. But it’s where we are.
The administration’s cockups are a legitimate story. I’ve never said otherwise. My first column about the website was quite tough on the administration and on Obama personally, when I wrote that I found it shocking that he apparently wasn’t riding herd on staff to make damn sure the thing worked. I said on television, to some host’s surprise, that yes, I did hold him accountable for the mistakes.
So I get why that’s a story. But the sabotage is a story, too. A huge one. It’s almost without precedent in American history, and the precedent it does have includes some of the ugliest chapters in this nation’s history. It gets coverage, yes. But not nearly the coverage it deserves. As is so often the case—as with Benghazi, as with Fast and Furious, as with the IRS—the bigger scandal is on the Republican side.
By: Michael Tomasky, The Daily Beast, November 1, 2013
“Plan Versus No Plan”: Virginia’s Gubernatorial Race Is A Referendum On ObamaCare, And The GOP Is Going To Lose
Republican Ken Cuccinelli became a national conservative star as Virginia’s attorney general by leading the legal fight to declare the Affordable Care Act unconstitutional all the way to the Supreme Court. Now he’s running for governor, and he’s making health care the defining issue of his campaign.
As the federal rollout continues to be plagued by website problems and renewed criticism over discontinued low-coverage individual plans, Cuccinelli told his supporters Monday, “We need people to know Nov 5th in Virginia is a referendum on ObamaCare.” His latest ad slams Democratic opponent Terry McAuliffe for wanting to “EXPAND OBAMACARE,” and closes by saying “to stop ObamaCare and higher taxes, there’s only one choice.” Outside conservative groups are also running ads excoriating McAuliffe as a supporter of ObamaCare.
Virginia voters appear to agree with Cuccinelli that health care is one of the most important issues of the campaign. The Washington Post poll conducted October 24-27 asked likely voters how important eight different issues were to determining their vote. Along with job creation and education, health care tied for first, with 72 percent saying those issues were “very important.”
And yet, in that same poll, Cuccinelli is losing by 12 points.
In fact, Cuccinelli is losing in every single poll that’s been taken in this race save for one in early July, suggesting that his defeat is a near-certainty.
Republicans are clinging to a bit of hope after a Quinnipiac poll released this week showed him only down by 4 points. But that poll only shows a minor tightening — within the margin-of-error — relative to the previous Quinnipiac poll from earlier in the month. Further, both Quinnipiac and the Washington Post polls peg Cuccinelli’s level of support around a meager 40 percent. And both polls show a third-party candidate in the race drawing support away from both major party candidates, which suggests if the also-ran fades in the stretch it won’t upend the stable trajectory of the race to date. (The Huffington Post synthesis of all the polls to date estimates McAuliffe’s lead to be a healthy eight points.)
Why isn’t health care helping Cuccinelli in the swing state of Virginia, despite all the very real problems ObamaCare has been facing this month? After all, the candidates’ positions on health care couldn’t make the choice any clearer. Cuccinelli wants the law repealed. McAuliffe says “it’s time to implement the law” by accepting federal money so the state can expand Medicaid coverage for the working poor, and having Virginia establish its own health insurance exchange.
The simplest answer is: McAuliffe’s position is shared by a whole lot of Virginians.
A plurality of 49 percent supported ObamaCare in a different Quinnipiac poll taken October 2-8. Voters said McAuliffe would do a “better job” on health care by a nine-point margin over Cuccinelli.
Of course, now that the shutdown is over and the program’s rollout is suffering significant flak, you might expect those numbers to worsen for McAuliffe. But this week’s Washington Post poll finds voters now trust McAuliffe to do a “better job” on health care by a whopping 21-point margin.
There is another plausible reason: Republicans still refuse to bolster their criticism of ObamaCare with serious policy alternatives.
Despite Cuccinelli’s insistence that the election is a referendum on ObamaCare, his website fails to include a page dedicated to what he would do about health care. Instead, he buries a few paragraphs on health care on his overall “Issues” page, which offers several conservative buzzwords but no actual policy specifics. Meanwhile, McAuliffe spells out his health care agenda in a seven-page white paper.
Plan beats no plan.
Despite all the troubles the Obama administration has had in getting ObamaCare off the ground, what’s been clear all month is this: Whatever misgivings and uncertainties persist, millions of people are going to Healthcare.gov and want the new system to work. But only Democrats, and a very small number of Republican governors, are showing a commitment to making the system work.
This should be a wake-up call to Republicans who thought the shaky Affordable Care Act rollout would shred belief in governmental competence, undermine liberalism, justify conservative obsession with repeal, and infuse Republicans with fresh momentum.
Because as this Virginia race shows, without plausible Republican policy alternatives, Democrats will able to ride out the inevitable hiccups that come with implementing new government programs and avoid any mass anti-government backlash. Simply hating on ObamaCare has not, is not, and will not be a potent political weapon.
By: Bill Scher, The Week, October 31, 2013
“Let’s Take A Step Back”: Despite Crappy Journalism, Things That Are Still True About Health Care
It’s been a pretty intense month on the health-care front, what with the beginning of open enrollment for the new exchanges giving rise to lots of disingenuous fulminating from Republicans, not to mention a whole lot of crappy journalism. Any time a story dominates the news for a couple of weeks, there’s a temptation to believe that what’s happening now will change everything. So I thought it might be a good idea to take a step back and remind ourselves about some things that are still true about the Affordable Care Act and still true about health care in America.
Over the long term, the problems with Healthcare.gov won’t have much of an effect on the success or failure of the law.
Yes, it has been a huge screw-up, with both the administration and the contractors sharing responsibility. Yes, it has caused a lot of people trying to sign up for new insurance a lot of hassle. But it’s the thing everybody’s focused on now in part because it’s the only thing happening with the law, until January 1st when a whole bunch of the law’s other provisions also go into effect. The problems with the web site are finite and fixable, and five years from now all this will seem like a minor footnote in the whole story.
Even if everything works perfectly with the ACA, we’re going to have a very expensive system for a long time.
The law did many things to try to “bend the cost curve,” including things like rewarding hospitals for reducing their readmission rates so there isn’t such an incentive to just pile on the procedures. But the fundamental fact is that America’s health-care system is far and away the most expensive in the world—nearly twice as expensive as the average for OECD countries—and it will still be very expensive for the foreseeable future.
There are many reasons why, but what they come down to is that there are lots of actors—insurance companies, hospitals, doctors, device makers—who make ungodly amounts of money off our health-care system, and unwinding all their influence and the points at which costs get driven up is unfathomably complicated. Other countries’ systems were designed by asking how good care can be delivered to everyone at a cost the country can afford; our system, outside of the government parts like Medicare, was basically designed by asking how to make sure everybody except patients can make as much money as possible. At its heart, the ACA doesn’t question that fundamental premise. So the curve may bend, but it won’t bend too sharply, and it’s starting from a very high place.
The expansion of Medicaid is the most significant thing the law did to help uninsured Americans.
It’s easy to forget, with all this talk about people on the individual insurance market, that they make up a small portion of the country. The most meaningful part of the ACA was always its expansion of Medicaid, promising to finally give insurance to millions of Americans who can’t afford it. So far, people signing up for Medicaid are significantly outnumbering those signing up for new private insurance, which isn’t surprising, especially given Healthcare.gov’s problems. And every time a poor family signs up for Medicaid, it’s cause for celebration—they’ll be healthier and more secure, they’ll be more productive at work, and the whole community benefits.
The Republican sabotage campaign against the ACA is unprecedented in American history. You can’t blame every problem the law has or will have on Republican sabotage, but this isn’t hyperbole. It truly is something we’ve never seen (here’s a recap). The only thing that comes close is efforts in the South to resist the school desegregation mandated by Brown v. Board of Education. That isn’t an excuse for any failures of the Obama administration, but it has made everything harder.
Republicans criticizing the ACA have no idea what they’d do to improve the health-care system. If you ask them, they’ll say, “Um … tort reform?” There are a very small number of conservative health-care wonks out there (like the people who came up with the plan that became Romneycare which became Obamacare!), but their ideas are laughably small-bore. Republicans are essentially satisfied with the pre-ACA status quo, with 50 million uninsured Americans and skyrocketing costs. That doesn’t necessarily mean that any particular critique they make of the ACA is wrong by definition, but it’s good to keep in mind.
There’s still no good reason your job should determine your health coverage. The linking of health insurance and employment is an historical accident. When wages were frozen in World War II, companies began offering insurance as a way to attract better workers, unions began demanding it as part of contracts, and today around 80 percent of American get their coverage through their job. One of the best things the ACA does is eliminate the “job lock” this produces, by making it illegal for insurance companies to deny coverage based on pre-existing conditions. Now you can quit your job to start that business you’ve dreamed of without worrying about whether you can get insurance. But the link between employment and insurance is just one more layer of complication that makes our health care system such an absurd kludge. Which leads to…
A single-payer-plus system would have made this whole thing simpler. Conservatives may roll their eyes and say, “Are you still going on about that?” but it’s something we should indeed keep talking about. The Affordable Care Act brings us to a system that is much better than what we have now, but still far worse than what it could be. I’ll continue to reiterate that we could have a system that satisfies the desires of both liberals and conservatives, insures everyone, and does it without all the layers of complication we suffer through now. If we wanted to, we could transition over time to a system like they have in France, with a basic, government-provided single-payer plan that covers every citizen, combined with a market for supplemental private insurance. That would give us the universal coverage and security liberals like, the ability to buy as much insurance as you want from a private company that conservatives like, and the efficiency and cost savings we all ought to like.
Would that be a big change? Sure. But it’s essentially what America’s seniors already have, and it has been very successful. They have their government plan so there are virtually no uninsured seniors, and they can buy Medigap coverage to give them extra benefits.
The ACA could make it easier to transition to a system where all Americans enjoy the same privilege. The exchange marketplace could be transitioned to become the place everyone buys supplemental insurance. We now have a system where a significant chunk of the population—the elderly and poor—are on government plans, and you could widen their availability in both directions (down in age and up in income) and unify the benefits.
That’s a long-term project, but it could be the next big health-care reform (in 20 years or so). Obviously, the most important priority in the next year or two is implementing the ACA and determining what’s working and what isn’t so it can be tweaked and improved. But we shouldn’t forget about what comes next.
By: Paul Waldman, Contributing Editor, The American Prospect, November 1, 2013
“Breathtakingly Cynical”: Guess Who Really Wants to Take Away Your Insurance? Republicans!
Republicans are outraged that some Americans must give up their current insurance plans because they don’t satisfy Obamacare’s new regulations for benefits and pricing. Partly they are mad at President Obama, because he repeatedly said people who like their coverage would get to keep it. And that’s fine. As I said yesterday, Obama should have said “most” people, not “all” people. Readers can decide for themselves whether, by the standards of politics, that’s a felony or misdemeanor.
But Republicans are also making a substantive argument here. It’s unconscionable, they say, that lawmakers would force people to give up their current coverage. Just a few minutes ago, during congressional testimony by Health and Human Services Secretary Kathleen Sebelius, an angry Representative Marsha Blackburn from Tennessee practically screamed at the witness: “You’re taking away their choice!”
It’s good politics, I’m sure. It’s also breathtakingly cynical. Republicans have repeatedly endorsed proposals that would take insurance away from many more Americans—and leave them much, much worse off.
Start with the federal budgets crafted by Paul Ryan. You remember those, right? Those proposals passed through the House with unanimous Republican support and were, in 2012, a basis of the Republican presidential platform. Those budgets called for dramatic funding cuts to Medicaid. If Republicans had swept into power and enacted such changes, according to projections prepared by Urban Institute scholars and published by the Kaiser Family Foundation, between 14 and 20 million Medicaid recipients would lose their insurance. And that doesn’t even include the people who are starting to get Medicaid coverage through Obamacare’s expansions of the program. That’s another 10 to 17 million people.
And it’s not just people on Medicaid who would lose coverage if Republicans got their way. While Republicans in Congress have not unified by a single alternative to Obamacare, a building block of virtually every proposal in circulation is to equalize the tax treatment of employer-sponsored insurance and individual insurance—which, in layman’s terms, means making it much more appealing for somebody who gets coverage on the job to buy coverage on his or her own. Typically these proposals would allow insurers selling individual coverage to continue some of their current practices, like charging higher premiums or refusing to cover certain services for people with pre-existing conditions, or offering coverage with serous gaps in benefits. Most experts believe such reforms would hike the cost of employer plans, as only sicker people remained on them, potentially creating a “death spiral” that would lead to fewer employers offering plans. (Even the more optimistic estimates assume erosion of employer-sponsored insurance.)
Note the difference in scale here. Nobody knows exactly how many people are giving up non-group policies because insurers are reacting to Obamacare regulations. But it’s probably in the millions—and still substantially less than the number of people who would lose insurance if Ryan’s proposal for Medicaid became law.
More important, though, look at the kind of change taking place. Almost everybody giving up a non-group policy today has the option to get new insurance either through Medicaid or one of the new Obamacare marketplaces. Some people will pay more for these policies, some will pay less, but everybody will be getting coverage that includes an array of “essential” benefits, limits out-of-pocket spending, and can never be taken away or limited because the policyholder gets sick. In other words, everybody ends up with comprehensive, stable insurance. It may not be the policy he or she has today. But the vast majority of people with non-group market don’t keep the same policy for more than two years anyway.
Under the Republican plan, by contrast, people losing employer insurance would end up in the dysfunctional, non-reformed individual market—the one full of confusing, junk policies that might not cover basic services like maternity or mental health or have huge gaps in coverage. And the people losing Medicaid? They would end up with … nothing at all.
The real issue here isn’t simply Republican opportunism and hypocrisy—although, please, let’s not ignore that either. The real issue is about the true trade-offs of policy. Both sides offer them. With Obamacare, a small number of people lose their current insurance but they end up with alternative, typically stronger coverage. Under the plans Republicans have endorsed, a larger number of people would lose their current insurance, as people migrated to a more volatile and less secure marketplace. Under Obamacare, the number of Americans without health insurance at all will come down, eventually by 30 or 40 million. Under most of the Republican plans, the number of Americans without insurance would rise.
Honest Republicans would justify their policies by arguing that Medicaid is a wasteful, inefficient program not worth keeping—and their changes, overall, would reduce health care spending while maximizing liberty. In other words, forcing people to give up their coverage is worth it. I don’t agree with those arguments, but they are honest. But they should stop pretending that it’s possible to address the problems of American health care without disrupting at least some people’s insurance arrangements—because, after all, they want to do the very same thing.
By: Jonathan Cohn, The New Republic, October 30, 2013
“The Right’s Sickest Obamacare Lie Yet”: Republicans Believe People Who Live In Flat Places Shouldn’t Have To Buy Cars With Brakes
During Congressional hearings with Health and Human Services Secretary Kathleen Sebelius, Congresswoman Marsha Blackburn (R-Tenn.) made an interesting argument that some Americans don’t want quality health insurance. “Some people like to drive a Ford and not a Ferrari,” Blackburn asserted. But that begs the question: What kind of Ford?
As early as 1972, there were reports that when a Ford Pinto was involved in a low-speed collision, the car would spontaneously burst into flames. According to a 1977 investigation by Mother Jones magazine, Ford was aware of the problem — resulting from a flaw in the gas tank design — but instead of paying to recall and redesign the car, Ford decided it would be cheaper to pay for the lawsuits. Ultimately, at least 27 people and as many as 180 people died as a result of Pinto fires. But it took the government forcing Ford to recall the Pinto for the problem to actually be solved.
In 2009, millions of Americans lacked any health insurance whatsoever and millions more had private health insurance metaphorically designed to explode at the hint of any serious illness or pre-existing conditions or exorbitant medical costs. So, in 2009, 14,000 Americans were losing their health insurance every single day. And medical bills were prompting more than 60% of all bankruptcies in our nation. In other words, many health insurance policies were patently dangerous and unsafe.
Now, Congresswoman Blackburn and her ilk might argue that people should have been free to buy the Pinto if they wanted, without government intrusion into personal choices or private business practice — just like they seem to want to argue that Americans should be free to hold onto their inadequate, costly and reckless insurance policies that throw them off at the slightest sign of illness while forcing costs up for the rest of us. But arguably most Americans want to buy cars that are safe. Auto companies didn’t want to install seat belts and airbags, just like Ford didn’t want to fix the Pinto. That was government regulation at work, making us all more safe — even if, in some cases, it made cars more expensive. We ultimately save, in every way imaginable, when the number of traffic deaths are dramatically cut.
This is, in effect, exactly what the Affordable Care Act does with respect to some currently existing, private insurance policies. If those policies don’t meet a new, higher bar of quality coverage, then the government will no longer allow insurance companies to sell them. Instead, the 5 percent of Americans who rely on the individual insurance market for their coverage will have other options, all that provide better quality coverage and many of which are far less expensive. Plus at least half of folks on the individual market will be eligible for subsidies that further bring costs down.
A great example comes from Deborah Cavallaro, who has been making the rounds on television complaining about her current insurance plan being cancelled. Cavallaro had not looked into her other, new options under Obamacare until a Los Angeles Times reporter called. Together, they looked at Cavallaro’s options — and found a “silver” plan for Cavallaro that would cost slightly more in her monthly premium but save her tons in terms of her annual deductible and out-of-pocket costs as well as doctor visit expenses. Plus, thanks to Obamacare, this plan would not be subject to the annual payment caps or pre-existing condition clauses that have been exploding in the faces of consumers for decades. After all, it’s important to remember that in 2009, most Americans were not very satisfied with their insurance plans. People wanted better options and now, thanks to Obamacare, they’ve got ‘em!
Congresswoman Blackburn and her cohort might fire back something about young healthy men being required to pay for good insurance plans that cover maternity — one of 10 basic coverage requirements mandated under the Affordable Care Act, this one designed to undo the history of insurance plans discriminating against women and families. Perhaps Republicans might also argue that Americans who live in really flat places should be able to buy cars without breaks. But that wouldn’t be safe for drivers or the rest of us. And in the case of health care reform in particular, the point here is to bring down costs and raise the quality of care for all of us. Those young, healthy men are going to grow up and have families one day — and then eventually become elderly — and will benefit from an insurance system that keeps costs manageable throughout and doesn’t kick off the elderly or infirm. Just like we all benefit from seatbelts and airbags, even if we never get in an accident.
Nobody is forcing anyone to buy a Ferrari plan in the individual health insurance exchange. At least 6.4 million Americans will pay less than $100 per month for coverage in the Obamacare exchanges — which means there are plenty of Ford’s available. What the Affordable Care Act simply ensures is that those policies will be safe and reliable — and not catch fire when we least expect it.
By: Sally Kohn, Salon, October 31, 2013
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