“An Important Milestone”: In Michigan, A Defeat For The Tea Party And Victory For Common Sense
Obamacare took a big step forward on Tuesday night, when the Michigan Senate approved an expansion of the state’s Medicaid program. The state House is likely to back the same measure, as early as next week. And while the program requires a special federal waiver, the Obama Administration is likely to grant it. Assuming all of that happens, Michigan will become the twenty-fifth state to expand Medicaid as part of the Affordable Care Act. As a result, a few hundred thousand residents are likely to get insurance—and the state will get a much-appreciated infusion of federal funds, while putting up a much smaller share of state money.
For the advocates of making health insurance available to all Americans, it’s a huge victory. But the victory did not come easy—or without some last-minute drama.
Tuesday’s vote was the product of a long, sustained campaign by Democrats, moderate Republicans, progressive organizers and business leaders. For months, they have made the case for expansion—citing the likely financial and health benefits for Michigan’s uninsured citizens, and the expected boost to Michigan’s economy. The federal government is picking up most of the expansion’s costs, they have argued, and hospitals need the revenue to make up for money they lost on charity care and declining reimbursement from other sources.
Among those assessing the statistical impact were Marianne Udow-Phillips, director at the Center for Healthcare Research and Transformation and a lecturer at the University of Michigan School of Public Health. As she told me on Wednesday,
if you look at all the facts—the fact that the majority of physicians in the state are ready to serve this population; the positive impact on the state budget, on the state’s economy at large, on hospitals, on businesses, on all those who are currently insured (by reducing cost shifting) – not to mention the half a million people who will directly benefit by getting health insurance coverage in a program that has the highest satisfaction of any insurance coverage type in the state – you have to draw the conclusion that the Medicaid expansion is the right thing to do for the state.
Governor Rick Snyder and the state Chamber of Commerce have been among the strongest proponents of expansion. The state’s health care industry, naturally, has lobbied furiously. But Tea Party Republicans and their allies have been dead set againt it, arguing that Medicaid is a wasteful, expensive program that subsidizes the indolent—and that the size of the federal subsidies masked the true impact on the state, which would actually be negative.
Writing this week in the Detroit Free Press, Joseph G. Lehman and Clifford W. Taylor from the Mackinac Center for Public Policy warned that
The state’s main incentive to expand Medicaid is a federal promise to transfer to Michigan $2 billion (increasing to $3 billion) annually for three years if we add 320,000 Michiganders earning up to 138 percent of the poverty level to Medicaid rolls.
After three years our federal subsidy would shrink by $300 million per year, meaning either Michigan taxes increase by that much or lawmakers kick 320,000 people off Medicaid, which seems unlikely.
Expansion supporters have responded that, even after the reduction, the federal government would still be picking up 90 percent of the new cost. They have also tried to accommodate concerns about Medicaid efficiency, by, among other things, proposing that some Medicaid recipients pay a portion of their own costs. The compromises changed a few votes, and in June the state House approved its version of the expansion. But the Senate in June surprised everybody, including the governor, by rejecting the measure. One likely reason: Tea Party groups, and their financial backers, were threatening to support primary challenges to Republicans who voted yes.
The expansion’s supporters spent the remainder of the summer making their case, rallying the public, and lobbying individual members. As of Tuesday morning, they were confident they had 19 senators willing to vote yes. That would produce a tie in the 38-member chamber, with the lieutenant governor prepared to vote yes and break the tie. But when the Senate first voted in early afternoon, only 18 said yes. The chamber quickly voted to reconsider and, after a feverish few hours of lobbying and meeting, tried one more time. This time, the bill passed 20 to 18.
Progressives aren’t thrilled about some of the compromises, particularly those asking Medicaid recipients to pay a larger share of their costs. (Sarah Kliff has more of the details if you want them.) And it’s not out of the question that the federal government will raise objections, because the federal Medicaid law limits the ability of states to change the program. But given political resistance to any expansion, supporters are mostly elated at Tuesday’s outcome. “It’s not perfect, but it’s going to help nearly half a million Michiganders,” Amy Lynn Smith wrote at Electablog, a progressive website based in Michigan.
Michigan’s decision is an important milestone in the effort to make Medicaid available to all low-income Americans—an endeavor that has proven far more difficult than most experts anticipated. Last summer, when the Supreme Court made it easier for states to reject Obamacare’s planned expansion of Medicaid, many of us assumed the vast majority of states would participate anyway. The need for coverage was too great, and the allure of federal money too tempting, for even most Republicans to reject. Quite obviously we were wrong. Conservatives serving either as governor or state legislators have successfully blocked expansion across a wide swath of the country, including the huge states of Florida and Texas, where a few million people would be eligible.
But the Medicaid expansion has gotten support from several other Republican governors, including Jan Brewer in Arizona (where the expansion is already going forward) as well as Rick Scott in Florida and John Kasich in Ohio. Florida looks hopeless, at least for the time being, given the grip extreme conservatives have over the legislature. Ohio is another story: The politics there look a lot like the politics in Michigan. The same goes for Pennsylvania, although that state’s Republican governor, Tom Corbett, doesn’t yet support expansion.
Obamacare’s Medicaid component, in other words, is moving ahead. But progress is taking place in fits and starts, with frequent setbacks, thanks mostly to political opposition that’s strongest in the most conservative parts of the country.
Yeah, you should get used to that pattern.
By: Jonathan Cohn, Sebior Editor, The New Republic,
“Just Don’t Say It Out Loud”: Every Member Of Congress Who Gets Coverage Through An Exchange Will Be Participating In Obamacare
In the very near future, congressional Republicans have some important decisions to make when it comes to health care policy. Will they threaten a government shutdown over funding for the Affordable Care Act? Will they use the issue as the basis for a debt-ceiling crisis?
And perhaps more directly, will they personally sign up for subsidized insurance through an exchange created by the health care law?
As we discussed a couple of weeks ago, the right is heavily invested in the idea that members of Congress are “exempt” from “Obamacare.” The claim is plainly untrue — thanks to a scheme Sen. Chuck Grassley (R-Iowa) stumbled into, lawmakers will give up their current health care coverage and get coverage through a marketplace where insurers compete for their business.
There are, however, some complications — these exchanges were designed for the uninsured and small-business owners looking to cover their employees, not wealthy federal lawmakers who already have perfectly good coverage. It’s why the Obama administration had to work out a fix for members of Congress and their aides a few weeks ago.
But for Republicans this creates yet another problem: if they sign up for coverage, doesn’t that mean they’re necessarily participating in the health care system they claim to hate? As far-right groups urge the uninsured to stay that way on purpose by staying out of the exchange, won’t those same lobbying efforts apply to lawmakers themselves?
If conservatives genuinely believe that Obamacare is a threat to the country they will extend their campaigns to convince people to skip Obamacare from nameless powerless young people to elected officials and their aides. And if those members and aides have the courage of their convictions they’ll follow suit.
To the extent that none of this happens — that conservative groups keep quiet, and conservative members and aides enroll in the exchanges — it’ll expose the right’s anti-Obamacare activism as a shallow enterprise undertaken by people who are happy to see millions go without insurance, so long as it’s not themselves or their families.
So, what are far-right lawmakers going to do? I’m glad you asked.
As Igor Volsky reported, so far, two current members are prepared to bypass the system on purpose.
[North Carolina Republican Robert Pittenger has] voluntarily withdrawn from health coverage altogether. [North Carolina Republican Mark Meadows] added that his staff has also voluntarily declined the subsidies. And while most members of Congress may be able to afford to forfeit the government contribution — Meadows has a net worth between $1,674,034 to $12,017,998 [and] Pittenger is worth between $18,615,005 to $48,551,997.
Two GOP members out of 233 in the House obviously isn’t a large number, but don’t be surprised if this number grows as right-wing lobbying becomes more intense.
Also note, a lot of these folks have convenient outs — if they have spouses with employer-based coverage of their own, members and staffers can get insurance anyway. For that matter, if you’re a multi-millionaire lawmaker, you can afford to get coverage without a subsidy anyway.
But the underlying point remains the same: every member of Congress, in both parties, who gets coverage in the coming months through an insurance exchange will be participating in “Obamacare,” even conservatives who will be reluctant to say so out loud.
By: Steve Benen, The Maddow Blog, August 26, 2013
“A Dog’s Life Can Be Dizzying”: The Obamacare Opposition Has Finally Caught Its Own Tail
It’s time to pop the champagne and blow the kazoos: the war on Obamacare has officially reached its point of reductio ad absurdum. Two of the opposition’s favored fevered conspiracy theories about the law have clashed, like two asteroids headed for the planet that smash into each other before they can do any damage below.
First, there was the opposition’s demand that members of Congress and their staff be subjected to Obamacare—that they be forced to give up their coverage in the health plans for federal employees and join the new insurance exchanges on the theory that “if Congress was going to impose Obamacare upon the country, it should have to experience what it is imposing firsthand.” This never really made sense from the outset since the exchanges, at least for the foreseeable future, are meant only for people without employer coverage and for small businesses buying coverage for their workers. That is, most of “the country” is not going to have anything to do with the exchanges—they are just going to keep being covered by their employers.
Forcing the incongruous requirement that Hill employees enter the exchanges resulted, inevitably, in a snafu: the exchanges are not designed for employers and employees to share the cost of plans that are selected by workers, since the exchanges are meant for people buying coverage on their own. Congress, like most large employers, covers the lion’s share of their workers’ premiums, but wasn’t going to be able to do so as the law was written, leaving Hill workers with thousands more dollars a year in premium costs than they now pay. To fix this problem—which was never intended even by the members of Congress who wanted Hill staff to share in the burdens of Obamacare—the administration and Congress agreed on a tweak that would maintain the requirement for congressional staff to enter the exchanges, while allowing for the federal government to pick up its share of the costs. Conservatives decried this as an “exemption” from Obamacare, which was flatly untrue: in fact, the Hill is being included in Obamacare to an extent beyond what the law was built to allow for. For a pithy dismissal of the “exemption” trope, see the recent letter to the editor in the Wall Street Journal by the gentleman from Verona.
Meanwhile, opponents of the law have since the early days of its drafting been busy fanning flames on another front as well: charging that the law would allow for federal funding of abortions, which has been barred for years. This line almost managed to stop the legislation in its tracks before supporters settled on a highly unwieldy compromise—plans on the exchanges can cover abortions (as many insurance plans now do) but the abortion coverage must be offered in a supplemental plan, purchased separately from the main coverage, and without the help of the federal subsidies many people will receive to help them buy the plans. This is such a messy arrangement that abortion rights supporters fear that precious few plans on the exchanges will even bother to include abortion coverage. And the law also allows states to pass laws banning abortion coverage, period, from plans in their exchanges, as many states have already done.
Do you see where this is headed? The law forces Congress and its staffers into the exchanges…the law, in theory, allows for plans with abortion coverage to be sold on the exchanges…and, voila, the crash in the skies above. Take it away, Associated Press:
The politics of the abortion debate are always tricky for lawmakers. They may soon get personal. An attempt to fix a problem with the national health care law has created a situation in which members of Congress and their staffers could gain access to abortion coverage. That’s a benefit currently denied to them and to all federal employees who get health insurance through the government’s plan…
Abortion opponents say the regulation would circumvent a longstanding law that bars the use of taxpayer funds for “administrative expenses in connection with any health plan under the federal employees health benefits program which provides any benefits or coverage for abortions.” Unlike many private corporate plans, federal employee plans only cover abortions in cases of rape, incest or to save the life of the mother.
“Under this scheme, (the government) will be paying the administrative costs,” said Rep. Chris Smith, R-N.J., author of the abortion funding ban for federal employee plans. “It’s a radical deviation and departure from current federal law, and it’s not for all federal employees, but for a subset: Congress. Us.” Smith is calling on the Obama administration to specify that lawmakers and staffers must choose a plan that does not cover abortions. The funding ban, in place since the 1980s, is known as the Smith amendment.
This framing is actually off the mark. It’s not “an attempt to fix a problem” with the law that has created this situation. It was the original demand by Republicans (Iowa Sen. Chuck Grassley led the way) that members of Congress and their staff be forced into the exchanges. The administration is downplaying the whole matter, noting that, technically, Hill members and staffers who buy a plan on the exchanges that comes with the abortion coverage will be paying for that part of the coverage out of their own pocket. But yes, in theory, a member of Congress and his or her staff may now be able to have abortion coverage, which was not the case previously. The horror! After all, we know that some members of Congress have a messy track record with abortions—like, say, demanding that their mistresses get one.
So, tiger, how does that tail of yours taste?
By: Alec MacGillis, Senior Editor, The New Republic, August 20, 2013
“First Do No Harm”: It’s Time To Rethink The Oath Of Office For People We Vote To Represent Us
First do no harm. That’s a tenet of medical ethics that future doctors worldwide are taught in medical school.
If only the people we elect to represent us were required to take such an oath when they’re sworn into office.
Because they aren’t, folks in Florida are facing having to pay far more for health insurance over the next two years than necessary. And health insurance executives will be laughing all the way to the bank.
Florida state lawmakers, in their ongoing efforts to block the implementation of Obamacare in the Sunshine State, recently passed a law that will allow health insurance companies to gouge Floridians more than any corporate boss dreamed was possible.
And if that weren’t bad enough, insurers will actually be required by law to mislead their Florida customers about why they’re hiking their premiums.
Republicans, who control the governor’s office as well as both houses of the Florida legislature, were confident the U.S. Supreme Court would declare the Affordable Care Act unconstitutional. Not only did they vote to prohibit the state from spending money to implement a law they just knew would be overturned by the high court, they refused to accept money from the federal government that would have enabled the state’s department of insurance to do a better job of regulating health insurers and enforcing new consumer protections in the law.
When the Supreme Court shocked Obamacare opponents last year by upholding the law, Florida lawmakers were in a pickle.
Their response? They passed a bill that prohibits the state’s Office of Insurance Regulation from protecting consumers from unreasonable rate increases for two years.
I learned about what is essentially a “first do as much harm as possible” bill in a letter the nine Democrats in the Florida congressional delegation sent to U.S. Secretary of Health and Human Services Kathleen Sebelius earlier this month pleading with her to step in to protect Floridians by taking an active role in regulating rate increases in the state.
The lawmakers said intervention by HHS was urgently needed because of a law signed in May by Gov. Rick Scott that specifically prohibits Insurance Commissioner Kevin McCarty from doing his job of reviewing rate increases and rejecting those he and his staff determine are unjustifiably high.
Until the passage of SB 1842, McCarty had the power to do that. Florida state lawmakers who voted for the bill, including a few Democrats who seemed to think HHS has more authority than it does, took the position that since the federal government was requiring insurance companies to be more consumer friendly, the federal government should assume the responsibility of enforcing the new consumer protections in Obamacare. The problem is that Congress gave the federal government no such additional powers. As a consequence, HHS really can’t take over what is still a state responsibility. And since Florida turned down the federal money that McCarty would have used to do his job, Floridians appear to be out of luck.
Last month, McCarty’s office said insurance premiums for individuals in Florida would be significantly higher than they are now. In their letter to Sebelius, the state’s congressional Democrats wrote that those increases are “not a coincidence, but rather the product of a cynical and intentional effort by Gov. Scott and the Florida legislature to undermine the Affordable Care Act and make health insurance premiums on the Florida Health Insurance Marketplace more expensive by refusing to allow the insurance commissioner to negotiate lower rates with companies or refuse rates that are too high.”
As PolitiFact noted in a recent analysis of the charges made by the Democrats in their letter (which PolitiFact ruled are true), the states that have authority to approve or disapprove rates were “able to extract significant reductions.” PolitiFact cited a Palm Beach Post story which noted that Maryland’s insurance department had used its regulatory powers “to push rates for next year’s premiums down by as much as a third.”
As Florida CHAIN, a state advocacy group, pointed out when Scott signed SB 1842, the law not only blocks McCarty’s office from protecting consumers, a provision in the law actually requires insurers to send deceptive and misleading notices about rate increases to consumers — and to blame Obamacare for them.
“The only ’public education’ of any sort authorized by the Legislature related to the ACA (Affordable Care Act) is a requirement … that insurers send extremely biased and incomplete notices this fall about the ACA and its effect on policyholders’ rates,” Florida CHAIN said in a statement.
“The sole purpose of the requirement is to create ‘sticker shock’ that can be blamed on the ACA. There will be no mention of the many uncertainties or any other relevant factors, such as past rate increases or how actual rates will be reduced for many by the availability of premium tax credits (to low and middle income earners.)”
So not only will many Floridians be harmed by SB 1842, they will, by law, be misled about who caused the harm.
Maybe it’s time to rethink the oath of office for people we vote to represent us.
By: Wendell Potter, The Center for Public Integrity, August 19, 2013
“The GOP In Fantasyland”: Unhinged, Uncontrollable And Fully Capable Of Knocking Themselves Out
The make-believe crusade by publicity-hound Republicans to somehow stop Obamacare is one of the most cynical political exercises we’ve seen in many years. And that, my friends, is saying something.
Charlatans are peddling the fantasy that somehow they can prevent the Patient Protection and Affordable Care Act from becoming what it already is: the law of the land. Congress passed it, President Obama signed it, the Supreme Court upheld it, many of its provisions are already in force, and others will soon take effect.
No matter how contemptuous they may be about Obamacare, opponents have only two viable options: Repeal it or get over it.
Sen. Ted Cruz (R-Tex.) the Canadian American who appears to be running for president, has grabbed headlines and air time by being the loudest advocate of an alleged third option: Congress could refuse to fund Obamacare, thereby starving it and effectively killing it. This is a ridiculous fantasy, as Cruz, who has brains beneath all that bombast, surely knows.
Congress needs to pass a continuing resolution to fund the government beyond Sept. 30, the end of the fiscal year. The idea, if you can call it one, is that Republicans can refuse to pass any funding bill that contains money for implementing Obamacare.
Theoretically, Republicans could pull this off in the House, where they hold the majority. But the chance that a bill stripped of money for the Affordable Care Act could make it through the Senate, where Democrats hold power, is precisely zero. The chance that a House-Senate conference would starve Obamacare to death while Sen. Harry Reid (D-Nev.) remains the majority leader is also zero.
And if by some miracle such a bill were to make it to Obama’s desk, the chance he would sign it is way less than zero. To swallow the snake oil that Cruz and some other hard-right conservatives are peddling, you have to believe Obama is willing to nullify the biggest legislative accomplishment of his presidency.
So with the bill vetoed and no authorization to spend money, much of the government would have to shut down.
This gambit damaged the Republican Party back when Newt Gingrich tried it. In today’s toxic political climate, with approval ratings for Congress sinking toward single digits, it could be catastrophic. As things stand, Democrats have an uphill struggle next year to win the 17 House seats they need to regain the majority in that chamber. If the GOP forces a shutdown, however, Democrats’ chances might get better.
The basic elements of Obamacare — including the mandate that compels individuals to buy health insurance or pay a fine — originated in conservative think tanks, including the Heritage Foundation. So it is beyond ironic that Heritage — under its new leader, former senator Jim DeMint — is pushing hard for the defund-Obamacare suicide leap.
DeMint has gone so far as to make a campaign swing through the South and the Midwest, whipping up support among the GOP base. Asked by an audience member in Arkansas why Congress should pass a bill starving Obamacare when everyone knows Obama would never sign it, DeMint replied, “Well, we don’t know that, do we?”
Come on. We know.
And we also know that painting Obamacare as the end of America as we know it is an effective way for DeMint to rebrand Heritage , moving it away from mainstream Republican orthodoxy into tea party la-la land. Noisemaking and fundraising go hand in hand; this crazy exercise promises to be very bad for the GOP, but it might end up being very good for the Heritage Foundation’s coffers.
Similarly, Cruz gets to preen before a national audience and demonstrate the fervor of his opposition to Obama and all that he stands for. “If you have an impasse, you know, one side or the other has to blink,” he said recently. “How do we win this fight? Don’t blink.”
The GOP establishment is blinking like crazy. Trying to defund Obamacare has little support among Republicans in the Senate. “I’m for stopping Obamacare, but shutting down the government will not stop Obamacare,” Minority Leader Mitch McConnell (Ky.) said recently, demonstrating a grasp of reality.
The Republican majority in the House, though, is . . . what’s the word? Unpredictable? Uncontrollable? Unhinged? They pay little attention to wise political advice and less attention to their leader, Speaker John Boehner of Ohio. And while they can’t lay a glove on Obamacare, they’re fully capable of knocking themselves out.
By: Eugene Robinson, Opinion Writer, The Washington Post, August 22, 2013
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