“Obamacare Is For Republicans, Too”: If GOP Governors Think Stonewalling Health Exchanges Hurts Only Democrats, They’re Wrong
Three months from now, Americans will get their first look at whether Obamacare works. The answer will depend a lot on Republican governors and legislatures — and they should want the law’s exchanges to be successful as much as the president does.
The new state insurance exchanges are supposed to start selling health coverage Oct. 1. The idea behind these marketplaces is that allowing apple-to-apple comparisons between health plans will foster competition and lower prices. Most Republican governors and legislatures, however, have resisted running their own exchanges; 19 states have refused to play any role whatsoever.
Continued resistance could hamper an already fraught process. In a report this week, the U.S. Government Accountability Office warned that the federal government is behind schedule in building exchanges in states that have refused to do so. This makes it even more crucial that all states pitch in to help.
Why should Republican opponents of the exchanges change tack now? First, there are the crass politics: Many residents who stand to benefit are their constituents. Federal exchange subsidies are available for people earning between 138 percent and 400 percent of the poverty level, or $32,500 to $94,200 for a family of four. According to 2012 exit polls, 42 percent of people with family incomes between $30,000 and $50,000 voted for Mitt Romney; for those earning between $50,000 and $100,000, the share was 52 percent. If Republican governors think stonewalling exchanges hurts only Democrats, they’re wrong.
Then there are the economic reasons: States with weak exchanges could become less attractive to businesses. John Hickenlooper, the Democratic governor of Colorado, said this week that his state supports its insurance exchange in part to help small businesses, which want healthy and productive workers.
Finally, and most compellingly, there is the human reason – – rather, 25 million human reasons. Well-run exchanges will make getting health insurance easier and more affordable. Even philosophical opponents of the Patient Protection and Affordable Care Act must concede this practical point. Obamacare also happens to be the law of the land.
Some Republican governors have already accepted a role in their exchanges. Iowa and Michigan are partnering with the federal government, while Idaho, Nevada and New Mexico agreed to build their own. It’s too late for other states to follow those courses, but there are still meaningful steps they could take.
One thing they can do is smooth the path for “navigators” – – people or organizations that will help others shop for insurance on the exchanges. Florida requires navigators to register with the state, and Pennsylvania is considering a similar move. This should be fine as long as registration is quick and straightforward.
States should also build solid lines of communication between the exchanges and state-run programs, especially Medicaid. Exchanges can use the information that states keep about people’s income and insurance status to determine whether they’re eligible for subsidies. Easy access to Medicaid databases will mean fewer errors and faster service for people in both programs.
State insurance regulators, who have the authority to approve insurance plans sold on federally run exchanges, can do their part by monitoring the participating insurance plans aggressively enough to keep rates down.
Perhaps the single biggest thing Republican officials could do is simply be ready and willing to address the inevitable hiccups. If states look for ways to stall progress, they’ll find them. Conversely, if governors who oppose the law nonetheless direct their officials to cooperate, the exchanges are more likely to survive those hiccups.
Governors could set a positive tone by reminding their residents that the exchanges are coming. Instead of saying the exchanges “are not going to work,” as Texas Governor Rick Perry did in December, they should encourage their constituents to see whether they’re eligible for subsidies. It doesn’t need to cost the states anything.
By: The Editors, Bloomberg, June 20, 2013
“They Won’t Be Moving On”: What Will Republicans Do if Obamacare Turns Out OK?
Ramesh Ponnuru has a long piece at National Review imploring conservatives to come up with a health-care plan they can swiftly put in place when Obamacare inevitably collapses under the weight of its disastrous big-government delusions. Though I disagree with almost every point Ponnuru makes along the way, from his analysis of what will happen with Obamacare to his recommendations of what a conservative health-insurance system should look like (the fact that anyone, even a free-market dogmatist, thinks catastrophic coverage plus high-risk pools would work out great is just incredible), I’ll give him credit for trying to get his ideological brethren to come up with a proposal to solve what they themselves keep saying is a terrible problem. But alas, his effort is doomed to fail. Why? Because when it comes to health care, conservatives just don’t care. I’ll elaborate in a moment, but here’s the crux of Ponnuru’s argument:
Opponents of Obamacare should plan instead for the likelihood that in its first years of full operation the law will fail in undramatic and unspectacular ways. Premium increases, cost overruns, and the like may keep the law from becoming popular, but they will not prompt the third of the public that supports it to switch sides, or even get its many soft opponents fired up about it. Meanwhile, the administration will spend millions of taxpayer dollars to advertise the law’s benefits. The law’s dogged defenders will explain away all the disappointing developments, and the polls, as the result of continuing opposition in red states. A few conservative lawmakers have speculated that the law will crash so badly that the Democrats will themselves demand repeal in the next couple of years. That is not the way to bet.
Republicans’ confidence that Obamacare will collapse has contributed to their lassitude in coming up with an alternative. It is a perverse complacency. If the program were going to collapse in the next three years, it would be all the more important for Republicans to build the case for a replacement for it. We can be sure that the Left would respond to any such collapse by making the case for a “single payer” program in which the federal government directly provides everyone insurance.
The biggest problem with this kind of appeal is that he will never, ever get anything beyond a tiny number of Republicans to invest any effort in coming up with a health-care plan. That would involve understanding a complex topic, weighing competing values and considerations against one another, and eventually getting behind something that will be something of a compromise. And let me say it again: They. Just. Don’t. Care.
That isn’t to say there are no conservatives who care about health care, because there are a few (like the folks at the Heritage Foundation who came up with the individual mandate!). But they are few and far between on the right. Your typical Republican, on the other hand, cares deeply about issues like taxes and defense policy, and works hard to understand them and come up with ideas for where they should go in the future. But had President Obama not passed health-care reform, they would have been perfectly happy to let the status quo continue indefinitely. They donned their fervent opposition to Obamacare like a new jacket, for reasons of politics, not policy. Sure, it was in many ways a conservative plan, much of whose complexity comes from the fact that it works to expand coverage within the private market. But it was big and important, and it was Obama, and it was a way to articulate their anti-government philosophy, and so they got fired up about it. But it isn’t because health-care policy is something they’re passionate about. Republicans care about taxes whether or not at the moment we happen to be having a big public debate about taxes. But if we weren’t debating health care, they wouldn’t be staying up nights coming up with interesting solutions to health-care problems, because it just isn’t their thing.
Ponnuru doesn’t allow for the possibility that Obamacare will turn out to be something less than a total failure, and he says that conservatives all believe the same thing (though he does differ from some of his allies on whether it will collapse dramatically or simply limp miserably along). But let me suggest another possible scenario: It ends up working pretty well. It doesn’t turn America into a health-care paradise, and there are some implementation problems here and there, and we still have to pay more for our system than other countries do. But people like the fact that their coverage is guaranteed, and the doomsaying turns out not to be borne out. Critically, the middle class and wealthy people who collectively hold political influence discover that their lives haven’t really been changed all that much, except in some ways that are positive. And it becomes hard to get voters too angry about Obamacare.
What will Republicans do then, if the issue doesn’t seem to have much political potency? Will they keep working to come up with new health-care proposals more in line with their values? Or will they move on to some other issues that seem to offer better opportunities to gain political advantage? If you think it’s the former, you’re dreaming.
By: Paul Waldman, Contributing Editor, The American Prospect, June 13, 2013
“HOAP Hypocrisy”: Republicans Who Want To Repeal The Health Law Are Still Taking Money From It
House Republicans are launching a coordinated campaign against Obamacare, hoping to emphasize the negative effects of the health law to their constituents at upcoming town hall meetings. At the same time, however, they’re fully prepared to tell those same constituents to enjoy all the benefits available to them under health reform — ultimately taking advantage of Obamacare funding in their home districts.
As Politico reports, several of the GOP members of the new coalition — called the “House Obamacare Accountability Project,” or HOAP — went on the record to confirm they will help their constituents figure out how to get the benefits funded through the health reform law. The Republicans said that if they’re asked, they will help people get access to the insurance premium subsidies or the Medicaid coverage that’s available to them under Obamacare. “That’s an important part of constituent services,” Rep. Kevin Brady (R-TX) explained.
They’re not the only lawmakers who have advocated for getting rid of the health law even while simultaneously enjoying its benefits. As Lee Fang reports in the Nation, several anti-Obamacare Republicans like Sens. John Cornyn (R-TX) and Rob Portman (R-OH) have requested grants funded through the health reform law for their districts. GOP lawmakers who decry Obamacare in public have requested Obamacare money to bolster their states’ health clinics, extend health services to uninsured residents, and launch public health campaigns.
In their letters requesting Obamacare funds, Republican lawmakers have praised the positive long term effects of the health reform law’s initiatives. Cornyn wrote that a grant from the Affordable Care Act would “improve the health and quality of life of area residents.” In reference to the same grant, Rep. Michael McCaul (R-TX) called the effort a “crucial initiative to achieve a healthier Houston/Harris County.” Rep. Aaron Schock (R-IL) praised a local nonprofit for winning Obamacare funds that will help give “people the tools to live healthier and longer lives.”
That reflects a larger trend when it comes to Obamacare: Although Americans may say they oppose the health law as a whole, they support its individual provisions. That seeming contradiction may partly be thanks to GOP-led initiatives like HOAP. Since political controversy has swirled around the health reform law for the past three years, Americans remain confused about what Obamacare actually does — and over 40 percent of the public isn’t even sure whether it’s still law.
By: Tara Culp-Resseler, Think Progress, June 7, 2013
“The Spite Club”: Driving Home The Fact Of Just How Little The GOP Cares About Your Well-Being
House Republicans have voted 37 times to repeal ObamaRomneyCare — the Affordable Care Act, which creates a national health insurance system similar to the one Massachusetts has had since 2006. Nonetheless, almost all of the act will go fully into effect at the beginning of next year.
There is, however, one form of obstruction still available to the G.O.P. Last year’s Supreme Court decision upholding the law’s constitutionality also gave states the right to opt out of one piece of the plan, a federally financed expansion of Medicaid. Sure enough, a number of Republican-dominated states seem set to reject Medicaid expansion, at least at first.
And why would they do this? They won’t save money. On the contrary, they will hurt their own budgets and damage their own economies. Nor will Medicaid rejectionism serve any clear political purpose. As I’ll explain later, it will probably hurt Republicans for years to come.
No, the only way to understand the refusal to expand Medicaid is as an act of sheer spite. And the cost of that spite won’t just come in the form of lost dollars; it will also come in the form of gratuitous hardship for some of our most vulnerable citizens.
Some background: Obamacare rests on three pillars. First, insurers must offer the same coverage to everyone regardless of medical history. Second, everyone must purchase coverage — the famous “mandate” — so that the young and healthy don’t opt out until they get older and/or sicker. Third, premiums will be subsidized, so as to make insurance affordable for everyone. And this system is going into effect next year, whether Republicans like it or not.
Under this system, by the way, a few people — basically young, healthy individuals who don’t already get insurance from their employers, and whose incomes are high enough that they won’t benefit from subsidies — will end up paying more for insurance than they do now. Right-wingers are hyping this observation as if it were some kind of shocking surprise, when it was, in fact, well-known to everyone from the beginning of the debate. And, as far as anyone can tell, we’re talking about a small number of people who are, by definition, relatively well off.
Back to the Medicaid expansion. Obamacare, as I’ve just explained, relies on subsidies to make insurance affordable for lower-income Americans. But we already have a program, Medicaid, providing health coverage to very-low-income Americans, at a cost private insurers can’t match. So the Affordable Care Act, sensibly, relies on an expansion of Medicaid rather than the mandate-plus-subsidy arrangement to guarantee care to the poor and near-poor.
But Medicaid is a joint federal-state program, and the Supreme Court made it possible for states to opt out of the expansion. And it appears that a number of states will take advantage of that “opportunity.” What will that mean?
A new study from the RAND Corporation, a nonpartisan research institution, examines the consequences if 14 states whose governors have declared their opposition to Medicaid expansion do, in fact, reject the expansion. The result, the study concluded, would be a huge financial hit: the rejectionist states would lose more than $8 billion a year in federal aid, and would also find themselves on the hook for roughly $1 billion more to cover the losses hospitals incur when treating the uninsured.
Meanwhile, Medicaid rejectionism will deny health coverage to roughly 3.6 million Americans, with essentially all of the victims living near or below the poverty line. And since past experience shows that Medicaid expansion is associated with significant declines in mortality, this would mean a lot of avoidable deaths: about 19,000 a year, the study estimated.
Just think about this for a minute. It’s one thing when politicians refuse to spend money helping the poor and vulnerable; that’s just business as usual. But here we have a case in which politicians are, in effect, spending large sums, in the form of rejected aid, not to help the poor but to hurt them.
And as I said, it doesn’t even make sense as cynical politics. If Obamacare works (which it will), millions of middle-income voters — the kind of people who might support either party in future elections — will see major benefits, even in rejectionist states. So rejectionism won’t discredit health reform. What it might do, however, is drive home to lower-income voters — many of them nonwhite — just how little the G.O.P. cares about their well-being, and reinforce the already strong Democratic advantage among Latinos, in particular.
Rationally, in other words, Republicans should accept defeat on health care, at least for now, and move on. Instead, however, their spitefulness appears to override all other considerations. And millions of Americans will pay the price.
By: Paul Krugman, Op-Ed Columnist, The New York Times, June 6, 2013
“Your Tax Dollars At Work, Or Not”: Marco Rubio Wants To Amend The Constitution To Repeal Obamacare
Sen. Marco Rubio (R-FL) proposed a constitutional amendment Tuesday that, if approved, would nullify Obamacare’s individual mandate. The amendment is the latest in a string of failed GOP attempts to repeal Obamacare, which many Republicans still view as unconstitutional.
The “Right to Refuse” amendment would make any laws that tax Americans who fail to purchase goods or services unconstitutional, targeting the Affordable Care Act’s stipulation that nearly all Americans must purchase health insurance. The amendment was introduced by Rep. Steven Palazzo (R-MS) in the House in February.
In a press release, Rubio cited the recent Internal Revenue Service scandal as one of his reasons for introducing the bill:
“ObamaCare is a disastrous policy that is not only destructive to job creation, it will also unleash the corrupt and scandal-ridden IRS on taxpayers simply for not buying health insurance,” said Rubio. “We should put our faith in the American people to decide what goods and services they want to buy, not have Congress dictate it and have the IRS empowered to harass Americans to make sure they do it.”
The Supreme Court ruled in 2012 that Obamacare’s individual mandate could be considered a tax, and therefore was upheld under the constitution. But that hasn’t stopped many Republicans from claiming Obamacare is unconstitutional — the act has survived at least 37 repeal attempts since Republicans took control of the House in 2011, the most recent repeal vote occurring in mid-May. Since news broke in May that the IRS flagged certain conservative groups applying for tax-exempt status for additional scrutiny, several Republican leaders have used the scandal to question whether the IRS can be trusted to implement Obamacare.
Constitutional amendments are far more difficult to pass than bills — amendments proposed by Congress require a two-thirds majority vote in the House and Senate. With a Democrat-controlled Senate, Rubio and Palazzo’s amendment would have difficulty achieving even a simple majority. Rubio has been billed as a rising star in the Republican party and likely 2016 presidential candidate, but his fervent opposition to Obamacare — along with several other positions — show that his views don’t stray far from the status quo of the Republican party.
By: Katie Valentine, Think Progress, June 4, 2013
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