“Mooching Off Medicaid”: Conservatives Like Big Government Just Fine When It Lines Their Pockets
Conservatives like to say that their position is all about economic freedom, and hence making government’s role in general, and government spending in particular, as small as possible. And no doubt there are individual conservatives who really have such idealistic motives.
When it comes to conservatives with actual power, however, there’s an alternative, more cynical view of their motivations — namely, that it’s all about comforting the comfortable and afflicting the afflicted, about giving more to those who already have a lot. And if you want a strong piece of evidence in favor of that cynical view, look at the current state of play over Medicaid.
Some background: Medicaid, which provides health insurance to lower-income Americans, is a highly successful program that’s about to get bigger, because an expansion of Medicaid is one key piece of the Affordable Care Act, a k a Obamacare.
There is, however, a catch. Last year’s Supreme Court decision upholding Obamacare also opened a loophole that lets states turn down the Medicaid expansion if they choose. And there has been a lot of tough talk from Republican governors about standing firm against the terrible, tyrannical notion of helping the uninsured.
Now, in the end most states will probably go along with the expansion because of the huge financial incentives: the federal government will pay the full cost of the expansion for the first three years, and the additional spending will benefit hospitals and doctors as well as patients. Still, some of the states grudgingly allowing the federal government to help their neediest citizens are placing a condition on this aid, insisting that it must be run through private insurance companies. And that tells you a lot about what conservative politicians really want.
Consider the case of Florida, whose governor, Rick Scott, made his personal fortune in the health industry. At one point, by the way, the company he built pleaded guilty to criminal charges, and paid $1.7 billion in fines related to Medicare fraud. Anyway, Mr. Scott got elected as a fierce opponent of Obamacare, and Florida participated in the suit asking the Supreme Court to declare the whole plan unconstitutional. Nonetheless, Mr. Scott recently shocked Tea Party activists by announcing his support for the Medicaid expansion.
But his support came with a condition: he was willing to cover more of the uninsured only after receiving a waiver that would let him run Medicaid through private insurance companies. Now, why would he want to do that?
Don’t tell me about free markets. This is all about spending taxpayer money, and the question is whether that money should be spent directly to help people or run through a set of private middlemen.
And despite some feeble claims to the contrary, privatizing Medicaid will end up requiring more, not less, government spending, because there’s overwhelming evidence that Medicaid is much cheaper than private insurance. Partly this reflects lower administrative costs, because Medicaid neither advertises nor spends money trying to avoid covering people. But a lot of it reflects the government’s bargaining power, its ability to prevent price gouging by hospitals, drug companies and other parts of the medical-industrial complex.
For there is a lot of price-gouging in health care — a fact long known to health care economists but documented especially graphically in a recent article in Time magazine. As Steven Brill, the article’s author, points out, individuals seeking health care can face incredible costs, and even large private insurance companies have limited ability to control profiteering by providers. Medicare does much better, and although Mr. Brill doesn’t point this out, Medicaid — which has greater ability to say no — seems to do better still.
You might ask why, in that case, much of Obamacare will run through private insurers. The answer is, raw political power. Letting the medical-industrial complex continue to get away with a lot of overcharging was, in effect, a price President Obama had to pay to get health reform passed. And since the reward was that tens of millions more Americans would gain insurance, it was a price worth paying.
But why would you insist on privatizing a health program that is already public, and that does a much better job than the private sector of controlling costs? The answer is pretty obvious: the flip side of higher taxpayer costs is higher medical-industry profits.
So ignore all the talk about too much government spending and too much aid to moochers who don’t deserve it. As long as the spending ends up lining the right pockets, and the undeserving beneficiaries of public largess are politically connected corporations, conservatives with actual power seem to like Big Government just fine.
By: Paul Krugman, Op-Ed Columnist, The New York Times, March 3, 2013
“Peacemaking On Contraception”: An Olive Branch To The Catholic Church On Contraception Coverage
America’s Big Religious War ended on Friday. Or at least it ought to.
A little more than a year ago, the Obama administration set off a bitter and unnecessary clash with the Roman Catholic Church over rules mandating broad contraception coverage under the Affordable Care Act. The Department of Health and Human Services’ announcement of new regulations is a clear statement that President Obama never wanted this fight.
The decision, the administration’s second attempt at compromise, ought to be taken by the nation’s Catholic bishops as the victory it is. Many of the country’s most prominent prelates are inclined to do just that — even if the most conservative bishops seem to want to keep the battle raging.
But more importantly, the final HHS rules are the product of a genuine and heartfelt struggle over the meaning of religious liberty in a pluralistic society. The contraception dispute was difficult because legitimate claims and interests were in conflict.
The vast majority of Americans believe that health insurance should cover contraception. At the same time, the Catholic Church has a theological objection to contraception, even if most Catholics (including regular churchgoers) disagree with its position. The church insisted that its vast array of charitable, educational and medical institutions should be exempt from the contraception requirement.
The church made a mistake in arguing its case on the grounds of “religious liberty.” By inflating their legitimate desire for accommodation into a liberty claim, the bishops implied that the freedom not to pay for birth control rose to the same level as, say, the freedom to worship or to preach the faith. This led to wild rhetorical excesses, including a comparison of Obama to Hitler and Stalin by one bishop and an analogy between the president’s approach and the Soviet constitution by another.
But the church had good reason to object to the narrowness of the original HHS definition of what constituted a religious organization entitled to exemptions from the contraception requirement. If an organization did not have “the inculcation of religious values” as its purpose and did not employ or serve primarily those who shared the faith, it got no exclusion at all.
The problem is that the vast charitable work done by religious organizations to help millions, regardless of their faith, is manifestly inspired by religion. The church could not abide the implicit reduction of its role merely to private expressions of faith. Don’t most Americans devoutly wish that religious people will be moved by their beliefs to works of charity and justice?
The HHS rules announced Friday scrapped this troubling definition in favor of long-established language in the Internal Revenue Code. In an interview, HHS Secretary Kathleen Sebelius showed a becoming humility, and it would be nice if this rubbed off on her critics. However defensible the original rules might have been, she said, “they really caused more anxiety and conflict than was appropriate.”
“What we’ve learned,” she said, “is that there are issues to balance in this area. There were issues of religious freedom on two sides of the ledger” — the freedom of the religious institutions and the freedom of their employees who might not share their objections to contraception.
This is where the other accommodation kicked in: Many Catholic institutions self-insure. While the administration rightly wants broad contraception coverage to include hospital workers, teachers and others at religious institutions, it also seeks to keep religious organizations from having “to contract, arrange, pay or refer” for coverage “to which they object on religious grounds.”
Under the new rules, employees who want it will be able to get stand-alone coverage from a third party. Some of the costs will be covered by small offsets in the fees insurers will have to pay to participate in the new exchanges where their policies will be on sale. It’s an elegant fix.
There are two reasons for hope here, particularly for Catholic progressives. First, the administration recognized the problem it had created and resolved it. Vice President Biden played a key role here, keeping lines of communication with the church open.
Second, many bishops have come to realize that the appearance of a state of war with Obama not only troubled many of the faithful — Obama, after all, narrowly carried the Catholic vote — but also threatened to cast a church with strong commitments to immigrants, social justice and nonviolence as a partisan, even right-wing organization.
This war has been bad for everyone involved. Obama has moved to end it. Here’s a prayer that the bishops will also be instruments of peace.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, February 3, 2013
“The Big Freaking Deal”: Progressives Might Want To Take A Brief Break From Anxiety And Savor Their Real Victories
On the day President Obama signed the Affordable Care Act into law, an exuberant Vice President Biden famously pronounced the reform a “big something deal” — except that he didn’t use the word “something.” And he was right.
In fact, I’d suggest using this phrase to describe the Obama administration as a whole. F.D.R. had his New Deal; well, Mr. Obama has his Big Deal. He hasn’t delivered everything his supporters wanted, and at times the survival of his achievements seemed very much in doubt. But if progressives look at where we are as the second term begins, they’ll find grounds for a lot of (qualified) satisfaction.
Consider, in particular, three areas: health care, inequality and financial reform.
Health reform is, as Mr. Biden suggested, the centerpiece of the Big Deal. Progressives have been trying to get some form of universal health insurance since the days of Harry Truman; they’ve finally succeeded.
True, this wasn’t the health reform many were looking for. Rather than simply providing health insurance to everyone by extending Medicare to cover the whole population, we’ve constructed a Rube Goldberg device of regulations and subsidies that will cost more than single-payer and have many more cracks for people to fall through.
But this was what was possible given the political reality — the power of the insurance industry, the general reluctance of voters with good insurance to accept change. And experience with Romneycare in Massachusetts — hey, this is a great age for irony — shows that such a system is indeed workable, and it can provide Americans with a huge improvement in medical and financial security.
What about inequality? On that front, sad to say, the Big Deal falls very far short of the New Deal. Like F.D.R., Mr. Obama took office in a nation marked by huge disparities in income and wealth. But where the New Deal had a revolutionary impact, empowering workers and creating a middle-class society that lasted for 40 years, the Big Deal has been limited to equalizing policies at the margin.
That said, health reform will provide substantial aid to the bottom half of the income distribution, paid for largely through new taxes targeted on the top 1 percent, and the “fiscal cliff” deal further raises taxes on the affluent. Over all, 1-percenters will see their after-tax income fall around 6 percent; for the top tenth of a percent, the hit rises to around 9 percent. This will reverse only a fraction of the huge upward redistribution that has taken place since 1980, but it’s not trivial.
Finally, there’s financial reform. The Dodd-Frank reform bill is often disparaged as toothless, and it’s certainly not the kind of dramatic regime change one might have hoped for after runaway bankers brought the world economy to its knees.
Still, if plutocratic rage is any indication, the reform isn’t as toothless as all that. And Wall Street put its money where its mouth is. For example, hedge funds strongly favored Mr. Obama in 2008 — but in 2012 they gave three-quarters of their money to Republicans (and lost).
All in all, then, the Big Deal has been, well, a pretty big deal. But will its achievements last?
Mr. Obama overcame the biggest threat to his legacy simply by winning re-election. But George W. Bush also won re-election, a victory widely heralded as signaling the coming of a permanent conservative majority. So will Mr. Obama’s moment of glory prove equally fleeting? I don’t think so.
For one thing, the Big Deal’s main policy initiatives are already law. This is a contrast with Mr. Bush, who didn’t try to privatize Social Security until his second term — and it turned out that a “khaki” election won by posing as the nation’s defender against terrorists didn’t give him a mandate to dismantle a highly popular program.
And there’s another contrast: the Big Deal agenda is, in fact, fairly popular — and will become more popular once Obamacare goes into effect and people see both its real benefits and the fact that it won’t send Grandma to the death panels.
Finally, progressives have the demographic and cultural wind at their backs. Right-wingers flourished for decades by exploiting racial and social divisions — but that strategy has now turned against them as we become an increasingly diverse, socially liberal nation.
Now, none of what I’ve just said should be taken as grounds for progressive complacency. The plutocrats may have lost a round, but their wealth and the influence it gives them in a money-driven political system remain. Meanwhile, the deficit scolds (largely financed by those same plutocrats) are still trying to bully Mr. Obama into slashing social programs.
So the story is far from over. Still, maybe progressives — an ever-worried group — might want to take a brief break from anxiety and savor their real, if limited, victories.
By: Paul Krugman, Op-Ed Columist, The New York Times, January 20, 2013
“Scottie’s Star Trek Tricks”: Rick Scott’s Parallel Universe Of Ideological “Facts”
Via Think Progress, another item from the ever-increasing database of “facts” Republicans use to buttress ideologically dictated positions comes from everybody’s favorite health care expert, Florida Gov. Rick Scott.
Scott has been bruiting it about that his refusal to implement the Medicaid expansion provided for in the Affordable Care Act, which would have supplied health insurance to a cool million residents of that steamy state, was based on its vast cost: $26 billion over ten years in new state costs!
Them’s a lot of dollars, to be sure. But turns out Scott just kinda made the number up, or more accurately, didn’t bother to share the preposterous assumptions needed to generate it. Health News Florida explains:
The state’s chief economist has warned the staff of Gov. Rick Scott that his Medicaid cost estimates are wrong, but Scott keeps using them anyway, according to a series of e-mails obtained by Health News Florida.
Scott says he opposes expanding Florida Medicaid because it would cost too much: $63 billion over 10 years, he says, with the state paying $26 billion of that.
But those numbers are based on a flawed report, according to a legislative budget analyst and State Economist Amy Baker. A series of e-mails obtained by Health News Florida shows the analysts warned Scott’s office the numbers were wrong weeks ago, but he is still using them. He cited them in a Tampa Bay Times op-ed on Sunday and at at a Washington press conference on Monday.
The trumped-up number, it seems, comes from assuming the federal super-match for the expanded Medicaid coverage provided for in the ACA will never actually materialize. Why? Here’s the response from Scott’s “health policy coordinator,” Michael Anway:
Anway said he doesn’t believe the federal funds will come through. “The federal government has a $16 trillion national debt, must borrow 46 cents of every dollar it spends, and in 2011 had its credit rating downgraded for the first time in history,” he wrote in explanation.
So Scott is assuming the feds will renege on their statutory obligation to provide the Medicaid match. That’s a new one, and is particularly ironic since the only threat to the federal government defaulting on its spending obligations comes from Scott’s conservative buddies in Congress.
Truth is, the most authoritative estimate of state costs associated with the Medicaid expansion, from the Kaiser Family Foundation, put Florida’s costs at $1 billion over ten years, and that doesn’t even include potential savings from costs currently incurred by the state in uncompensated care for the uninsured.
So Scott’s costs estimates are off a mere 96%, at least. But what are facts when it comes to the ontological necessity of thwarting Obamacare and saving a million Floridians from the slavery of dependence on government?
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, January 8, 2013
“The GOP Crusade Against The UnInsured”: Republicans Are Doing Everything They Can To Sabotage Obamacare
When House Speaker John Boehner declared Obamacare the “law of the land” two days after his party took a drubbing in the election, the real reveal came in what happened next: he walked it back in record speed and re-affirmed his commitment to getting rid of it.
Having failed to repeal the Affordable Care Act at the national level, Republicans are now dedicating their efforts to botching its implementation at the state level. And having failed to invalidate the law at the Supreme Court, they’re now seeking alternate legal avenues to weaken its regulations.
Republican governors are turning down the law’s Medicaid expansion, a move made easier by the Supreme Court decision that made the expansion optional. Among them are Bobby Jindal of Louisiana, Phil Bryant of Mississippi and Nikki Haley of South Carolina. Given that the federal government pays the vast majority of the cost in the medium term, these states are, in effect, rejecting an extraordinarily generous financial incentive to insure their residents.
Implementing the expansion in full would insure about 17 million people. “If [many states] don’t accept the Medicaid expansion you’re going to have millions of low income Americans who will remain uninsured and without access to health care,” said Tim Jost, a health care expert at Washington and Lee University who supports the Affordable Care Act.
Some dozen Republican governors are refusing — and about a dozen more are considering refusing — to build state-based insurance exchanges, the law’s primary vehicle for expanding and improving coverage. These governors, which include John Kasich of Ohio, Rick Perry of Texas, Nathan Deal of Georgia and Mary Fallin of Oklahoma, are consequently empowering the federal government to build one for them.
The law does not set aside funds for the federal government to construct or operate exchanges, creating implementation headaches for the Obama administration. But it can be self-sustained through user fees, and Jost argues that state residents with governors who are uncommitted would be better served by a federal exchange that wants to cover them.
Conservative thinkers are also resurrecting their argument, championed by top Republicans, that federally-administered exchanges lack the legal authority to provide tax subsidies, which are critical to making them work. Although the language of the law is vague on this question, the IRS has said federal exchanges are permitted to provide the premium subsidies.
“I don’t believe they’re going to win on that one,” Jost said. “If they did win that would do serious damage to what Congress intended, which is to have a federal fallback exchange.”
Utah Gov. Gary Herbert (R) is flirting with continuing his state’s existing insurance exchange even though it does not comply with rules in the Affordable Care Act.
Meanwhile, conservative advocates are advancing a separate legal challenge to the law’s requirement that insurance plans cover contraception for women as part of a copay-free preventive services package. Cheered on by congressional Republicans, Catholic institutions such as the Archdiocese of Washington and University of Notre Dame are moving forward with lawsuits that could end up in the Supreme Court.
All in all, Republicans and conservatives are telegraphing that they’re not chastened by years of failed efforts to wipe away Obamacare. The crusade shows no signs of ending, and could still do serious damage to the law.
By: Sahil Kapur, Talking Points Memo, November 21, 2012
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