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“The GOP’s Obamacare Alternative; Crickets”: Now Railing Against Obamacare Without Having To Come Up With A Replacement

Now that the Supreme Court has saved the Affordable Care Act for a second time, what do Republicans do? We already know they won’t tone down their rhetoric and will continue to call for repeal because that’s what Republican primary voters want to hear. The candidates will package together vague alternative proposals that they will pledge to pass and enact as the first act of their presidency.

But they don’t have even a remote chance of repealing the ACA, even if a Republican is elected president in 2016.

“The ruling is the last gasp,” says Chris Jennings, a health policy expert who worked in both the Clinton and Carter administrations. While the presidential contenders will keep alive the hope for their base that if elected they can sweep away Obamacare, Jennings says the issue will be dead and gone by fall 2016. The voters will have moved on.

Conservatives feel betrayed yet again by Chief Justice John Roberts joining with the liberals on the Court to uphold the constitutionality of the ACA, but they should thank Roberts. He saved the GOP from having to bail out 6½ million people, the majority of them in red states, who would have lost their health insurance if the Court had ruled the other way.

Now Republicans can continue to rail against Obamacare without the responsibility of actually coming up with a law to replace it. “This decision gives them a vast canvas on which to write,” says Jack Pitney, a government professor at Claremont McKenna College in California. “There’s no need for immediate replacement, so rhetoric will fill the vacuum of legislation.”

There will be proposals, enough to satisfy the GOP faithful that the presidential candidates are doing something to end the abomination of Obamacare. But these will not be serious efforts because it is not possible to write health-care legislation that leaves in all the goodies everybody supports, like no discrimination for preexisting conditions, and leaves out what people oppose, like the mandate.

A reading of the majority opinion written by Roberts reveals that he paid close attention to the argument put forth by the health insurance industry in an amicus brief. Without the subsidies, millions could not afford coverage and only those with significant medical expenses would apply, sending the ACA into a “death spiral.”

The Roberts Court handed another lifeline to President Obama, but the decision is also a huge victory for the health industry. Asked how difficult it is for the GOP to step in with their own plan to counter Obamacare, Ceci Connolly, a Health Research Institute Leader and a former Washington Post reporter covering politics and health care, countered with some hard numbers. “The 2.9 trillion dollar health sector is exceedingly complex and changing; it takes an enormous amount of time and work,” she said. “Not only has the ACA expanded coverage, it has pumped billions of dollars in revenue to the health industry, and going back would upset a very large and important market.”

If the subsidies were removed or denied, it would have cost the health industry $36 billion in premium revenue next year alone, Connolly told The Daily Beast. Hospitals would have seen their revenue fall about $9 billion. While still a fraction in a huge market, “that’s real money to the industry,” she says. “The legislative process is cumbersome to say the least, and it would be a steep climb to replace the ACA.”

If a Republican president is elected, and the GOP retains the Senate along with the House, “that’s a new ballgame,” Connolly said. “But by 2017 the law would have been implemented for seven years. It’s very hard to take away benefits and significantly restructure a market as big as the health care market.”

Connolly noted that the executives her research group talks to around the country anticipated the decision to come down the way it did. “They could not imagine the subsidies being taken away.”

The phrase that political scientists use is “past dependency.” Once a major policy is entrenched, it’s very difficult to change in a major way. We’ve seen that with social security and Medicare, programs that President Obama invoked in his remarks in the Rose Garden about the ACA’s rite of passage into “the fabric of America.”

 

By: Eleanor Clift, The Daily Beast, June 25, 2015

June 29, 2015 Posted by | Affordable Care Act, GOP, SCOTUS | , , , , , , , | 1 Comment

“GOP Failure Theater”: How Conservatives Convinced Themselves That Another ObamaCare Loss Is Just Prelude To Greater Victory

There’s a ritual carried out by losing candidates on election night, in which they come before their supporters gathered in a hotel ballroom, look out at all the long faces and tired eyes, and say, “This has been a noble crusade. And though we may have lost today, the battle for the things we believe in goes on. I’ll be there fighting for that vision, and I hope you’ll be there with me.” Everyone applauds, and then they all go home.

Now that the Supreme Court has ruled against what was simultaneously the most absurd and the most threatening challenge to the Affordable Care Act, conservatives are enacting something similar to that election night ritual. In private, many are expressing relief, since there was widespread worry that if the King v. Burwell lawsuit had succeeded, they would have been responsible for at least six million Americans losing insurance subsidies, and quite appropriately gotten the blame for it. But what are they saying publicly?

The politicians are finding virtue in consistency; their line is that this changes nothing.

“Today’s ruling won’t change ObamaCare’s multitude of broken promises,” said Mitch McConnell.

“ObamaCare is fundamentally broken,” said John Boehner. “Today’s ruling doesn’t change that fact.”

“Today’s ruling makes it clear that if we want to fix our broken healthcare system, then we will need to elect a Republican president,” said RNC chair Reince Priebus, who also made the fascinating observation that a Hillary Clinton presidency would be terrible for America.

Naturally, conservatives are disgusted with Chief Justice Roberts, whom they regard as an unreliable ally, unlike Justices Scalia, Thomas, and Alito. Quin Hillyer of the National Review summed up their feelings: “He is a disgrace. That is all.” But as far as conservative commentators are concerned, the perfidy extends beyond the Supreme Court to the cowards and quislings in Congress. And so, in a particularly optimistic strain of thought, they’re arguing that the decision is really an excellent outcome.

That’s because it has saved the right from another round of what blogger Allahpundit calls “GOP failure theater,” in which Republicans in Congress “make a pretense of putting up a fight in hopes that conservative voters will be impressed and to obtain some sort of mostly meaningless concession to wave at them when the inevitable, and predestined, cave finally happens.”

Similarly, Ben Domenech argues that the decision is a good thing for conservatives, because now Republican candidates will have to come up with really good health care plans to enact when they take back the White House: “Thus, I think the ruling today probably increases the likelihood of repealing ObamaCare in 2017 by a not insignificant margin.” On a similar note, Bill Kristol tweeted, “Repeal of ObamaCare and replacement with limited-government alternative in 2017 will be one of modern conservatism’s finest hours.”

That presumes that the Republican nominee will win, of course. But it also presumes that he would have the ability and willingness to repeal the ACA upon taking office.

There’s no question that the Republican presidential candidates will continue to express their eagerness to do so, at least until we get to the general election. Though none of them has anything resembling a fully-formed plan for the “replace” part of “repeal and replace” that Republicans have been advocating for years, they still have to pay lip service to the idea that the consensus conservative health care plan is coming any day now. When you’ve spent the last five years arguing that this law is a poison-tipped dagger plunging into liberty’s heart, you can’t just say, “Eh, looks like we’ll live with it,” no matter what the practical reality might be.

The practical reality is that whatever public opinion may be about this large abstraction called “ObamaCare,” the law is delivering particular benefits of which Americans are quite fond and that they don’t want to lose. Taking away those subsidies through a lawsuit would have been a political disaster for Republicans, and that would have affected only a portion of the public. What if Republicans were to take away subsidies from people in all 50 states, and toss millions more off Medicaid, and make it so that now insurance companies can deny you coverage because of a pre-existing condition again? That’s what repealing the ACA would mean. Republicans may not be able to admit it, as they promise that their phantom alternative plan would take care of all that, but they know that just undoing the ACA would be a disaster.

They can’t acknowledge that fact, because they have a constituency that has been fed heaping plates of apocalyptic rhetoric on this issue ever since the ACA became law. Those Republican base voters need to be told that, though they’ve suffered a loss, the fight is not over. As Ted Kennedy said 35 years ago in what may be the prototypical example of that losing candidate’s speech to his dismayed supporters, “the work goes on, the cause endures, the hope still lives, and the dream shall never die.”

 

By: Paul Waldman, Senior Writer, The American Prospect; Contributing Writer, The Week, June 25, 2015

June 26, 2015 Posted by | Affordable Care Act, Conservatives, GOP | , , , , , , , , | 1 Comment

“The G.O.P. Opts Out Of Equality”: Conscience Is Never Just Personal When The Occasion Is A Fraught Debate Over Public Morality

On May 28th, North Carolina Governor Pat McCrory vetoed Senate Bill Two, which proposed allowing public officials to temporarily stop performing weddings based on “any sincerely held religious objection.” In other words, if a public official were confronted by a gay couple who wished to marry, he could refuse to perform the ceremony. McCrory’s veto put the Republican governor at odds with a Tea Party legislature, which immediately promised to override it. On June 1st, the state senate voted to override, and, this morning, the house of delegates did, too, making it legal for North Carolina magistrates to turn away gay couples.

The Bartleby-like public official who “would prefer not to” marry same-sex couples would not have been asked to just one year ago. In 2012, North Carolina adopted a constitutional amendment banning same-sex marriage, in line with thirty other states where a majority at one point opposed it. Then, in June, 2013, the Supreme Court struck down the Defense of Marriage Act, and federal courts turned decisively in favor of gay marriage. In October, 2014, a federal judge ruled North Carolina’s marriage amendment unconstitutional, and same-sex ceremonies began. That month alone, court decisions also lifted same-sex-marriage bans in thirteen other states—Alaska, Arizona, Colorado, Idaho, Indiana, Nevada, New Jersey, Oklahoma, Utah, Virginia, West Virginia, Wisconsin, and Wyoming—more than twice the number of states where same-sex marriage was legal in 2010.

Following this rout, conservatives have moved rapidly from enforcing a unified public morality based on traditional marriage to speaking the language of pluralism as they seek exemptions from the rising legal norm of marriage equality. Their model has been the Religious Freedom Restoration Act (R.F.R.A.), of 1993, which exempts believers from federal laws that “substantially burden” their religious exercise, except where the regulation is the least burdensome way to fulfill a “compelling governmental interest.”

The R.F.R.A.—which was intended to protect neglected religious minorities, such as Native American worshippers who had recently lost public-sector jobs in Oregon because of their ritual use of peyote—was the basis of last year’s Supreme Court decision in Burwell v. Hobby Lobby, which held that certain business owners can refuse to offer insurance coverage for contraception based on their religious objections. The Indiana Religious Freedom Restoration Act, which was signed into law this March, is a model for the state-level expansion of religious exemptions, applying its protections to all corporations and making religious belief a defense in private legal actions, such as anti-discrimination suits. A similar bill passed in Arkansas later that month.

Supporters describe the state R.F.R.A.s and other religious accommodation laws as acknowledging the “increasing religious pluralism in American culture,” and protecting “religious liberties and the freedom to live out religious convictions,” as Russell Moore, the president of the Ethics and Religious Liberty Commission of the Southern Baptist Convention, put it in March. These exemptions, for the individuals, public officials, and business owners who wish to say, “I would prefer not to,” have become the new front in the culture war, the redoubt of attitudes that were recently in the majority. Invoking tolerance to defend intolerance is ironic at best, but at a moment when disapproval of gay marriage looks ever more like plain bigotry, it is better to say not, “I disapprove of you,” but rather, “This is who I am.”

The Bartleby strategy has taken center stage in conservative resistance to a wide range of liberal policies. In 2012, the Supreme Court nearly overruled the Affordable Care Act’s requirement that individuals buy insurance. Five justices voted to protect the consumer’s freedom to opt out of a market, such as the health-insurance market, warning that, if Congress could require this purchase, it could also command people to buy health-club memberships, American cars, or broccoli. (The insurance requirement survived through a sleight of hand, as Chief Justice John Roberts, who agreed with the rest of the Bartleby argument, found a hook for the law in Congress’s constitutional power to impose taxes.) In 2014, the Court held that certain members of public-sector unions could opt out of paying their union dues, which fund organizing and advocacy. Writing for the majority, Justice Samuel Alito argued that mandatory dues impinge on the First Amendment’s rights of free expression and voluntary association, and hinted that dues requirements in general might be found unconstitutional in the future.

As conservatives press these claims for personal exemptions, they have also been highly solicitous of states that would prefer not to accept new federal standards. The Supreme Court did real damage to the Affordable Care Act when, as part of its 2012 ruling, it found that states could not be penalized for refusing to expand Medicaid, which was an essential part of the A.C.A.’s path to near-universal coverage. As a result, twenty-one states have not signed on to the Medicaid expansion, and nearly four million low-income Americans have not obtained health insurance that the federal government intended them to have.

Similarly, Senate Majority Leader Mitch McConnell is urging state governments to disobey the Obama Administration’s order to develop climate-change regulations. McConnell has some support for his argument that the Clean Air Act does not stretch far enough to require these regulations, and there is sure to be litigation on the issue. But his call for a coordinated strategy of passive resistance in the meantime is extraordinary. The more opt-outs any climate policy includes, the more likely it is to fall apart in a wave of free-riding, as everyone decides to let someone else make the sacrifice, leaving no one to make the sacrifice at all.

Of course, a state refusing to make law is different from an individual refusing to bake a wedding cake for a gay couple. Medicaid policy and pollution regulation directly affect millions of people and billions of dollars of economic activity. The argument for conscience-based individual exemptions is that they concern the exempted individual most of all. The problem with this argument is that an individual’s conscience is never just a personal matter when, as in the case of the Hobby Lobby decision, it bears on the terms of employment. Then the person denied contraceptive benefits, or who is looking for a new job where she can get those benefits, is also part of the picture. Economic life is deeply interdependent, and involves conflicting interests and unequal power. This is why, from the New Deal until very recently, the Supreme Court did not permit many opt-outs from economic regulation. The new raft of conscience claims is creating unprotected spaces within an already precarious economy.

A second problem with individual opt-outs is just as basic. Conscience is never just personal when the occasion is a fraught debate over public morality. Once public laws banning same-sex marriage are gone, authorizing supposedly private discrimination against same-sex couples continues the cultural fight by other means. In hindsight, no one doubts that allowing business owners to discriminate against black people during the Civil Rights era would have denied them full equality and hampered desegregation. (Arguably, the continued tolerance of discrimination by private clubs also undermines desegregation, though club membership is less essential to daily life than shopping.) Similarly, allowing private discrimination against gay couples is not an exemption from a new rule of full equality; it is a compromise that allows inequality to persist. Proposals to let magistrates withhold marriage licenses have the same problems, with the added insult that the discrimination is effectively coming from the state. If officials can decide not to implement laws they dislike, then equality under the law—for gay couples, at least —is just a slogan.

The Bartleby position appeals to touchstone liberal values: personal conscience, diversity, tolerance, and autonomy. On their face, these values seem to promise there are no hard conflicts: there is room for everyone’s conscience, everyone’s outlook, and tolerance enough for each person’s freedom. The new generation of opt-outs show that this is a misconception: there is conflict over what these values mean, and there is never enough room for all their meanings. The politics of tolerance, diversity, and autonomy are distributive politics, with winners and losers.

From Thoreau’s night in jail protesting slavery and the Mexican-American War to the Greensboro lunch-counter sit-ins, sitting still and not doing as you are told has been among the most potent of political tactics, though its effects are often complex and long delayed. As in much else, initiative in this tradition of creative refusal belongs to the political right today. There is no paradox in conservatives using liberal values and tactics to their ends. By the same token, there should be no liberal embarrassment in resisting. There is no incoherence here, but there is disagreement too sharp for tolerance alone to resolve it.

 

By: Jedediah Purdy, The New Yorker, June 11, 2015

June 13, 2015 Posted by | GOP, Marriage Equality, North Carolina | , , , , , , , , | Leave a comment

“Some GOPers Want To Play Chicken”: Getting An Obamacare Repeal Bill On Obama’s Desk; For What?

There’s an interesting Rachel Bade/Jennifer Haberkorn piece up at Politico about all the trouble congressional Republicans have encountered in trying to use the budget reconciliation process to pass a simple veto-proof “root and branch” repeal of the Affordable Care Act. Seems the Senate parliamentarian is telling them they’d have to limit themselves to items with an immediate budgetary impact in any reconciliation bill. But any “partial” repeal–much less a replacement–legislation would raise policy questions on which Republicans disagree, and might also involve deficit-boosting consequences for which offsets would have to be found. So some GOPers want to play chicken:

Some conservatives and staff in both chambers, like House Freedom Caucus Chairman Jim Jordan (R-Ohio), are urging the chambers to do a straight one- or two-sentence repeal of everything. They argue that the parliamentarian has to look only at the words in front of her during reconciliation and should not be able to force lawmakers to break out the provisions on their own.

One aide working on the matter suggested they may try this and see if it works — but others are doubtful.

I guess I’m unclear as to why this is worth the trouble. Getting legislation repealing Obamacare onto Obama’s desk, long the obsessive goal of congressional Republicans, will not accomplish a thing other than confirming that Obama doesn’t want to kill his signature domestic policy achievement and Republicans do. I think most voters out there for whom opposition to Obamacare is a “bullet vote” have probably already figured out they should vote Republican in 2016. So the whole exercise appears to be one of those “energize the base” things whose value I am always questioning.

I do think that if SCOTUS kills Obamacare subsidies in states using federal exchanges there will be some value in Republicans getting a bogus “fix” onto the president’s desk in order to blame him for the subsequent chaos. In that contingency they could almost certainly structure a bill that would meet the conditions for reconciliation, and could probably tamp down any internal opposition by ensuring dissenters there’s zero chance any of it will become law. But on “root and branch repeal,” they might as well just promise they’ll git er done when President Bush or Walker or Rubio takes office.

 

By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, June 1, 2015

June 5, 2015 Posted by | Affordable Care Act, Budget Reconcilation, GOP | , , , , , , , | 1 Comment

“Creating Straw Politicians”: Scott Walker And The GOP Are Wrong About The Safety Net

It’s back and Democrats are going to have to deal with it. I’m talking about the political argument that they want to lure as many people as possible into government dependency.

This is a staple of Wisconsin Gov. Scott Walker’s incipient presidential campaign, and he frames it as simple common sense. “Oftentimes when I think about the president and people like Hillary Clinton, I hear people who I think measure success in government by how many people are dependent on the government. By how many people are on food stamps and Medicaid and unemployment,” he said this week at the Florida Economic Growth Summit in Orlando. “I don’t know about all of you, but my belief in America is that we should measure success by just the opposite.”

Walker added: “I don’t remember any of my classmates saying to me ‘Hey, Scott, someday when I grow up, I want to become dependent on the government.’ Nobody signed my yearbook ‘Dear Scott, Good luck becoming dependent on the government.’”

Very funny, and a lot more appealing than Mitt Romney’s assertion that 47 percent of the electorate is dependent on government and will never take responsibility for themselves. The problem with Walker’s formulation, however, is that he’s creating straw politicians. President Obama and Clinton and practically everyone in their party — in fact both parties — talk incessantly about education, job creation, income inequality, and how to increase wages. That doesn’t sound like a yearning for Handout Nation. It sounds like people obsessing over how to make America a country of tubs standing on their own bottoms.

I’m not saying that Democrats haven’t given Republicans ammunition. The 2012 Obama campaign’s “Life of Julia” cartoon slideshow was a parody waiting to happen. From Julia’s enrollment in Head Start as a preschooler to her retirement aided by Medicare and Social Security, the sequence gave off a distinctly Soviet, cradle-to-grave vibe.

As pediatric neurosurgeon-turned GOP candidate Ben Carson put it in his announcement, “We’re not doing people a favor when we pat them on the head and say ‘there there, you poor little thing, we’re going to take care of all your needs. You don’t have to worry about anything.’ You know who else said stuff like that? Socialists.” That was less than a week after a real socialist — Vermont Sen. Bernie Sanders — announced he was running for the Democratic nomination.

Obama came into office amid the worst recession since the Great Depression. The rolls of the three programs Walker named swelled as people lost jobs, income and health insurance. Job losses climbed to a terrifying 818,000 in January 2009, the month Obama was inaugurated. Another 2.2 million jobs were gone by the end of April. The unemployment rate was at or near 10 percent for eight months. So yes, there were a lot of people relying on government programs, for good reason. The private sector had completely failed them.

Obama’s chief economic message for years has been about sustained job creation and an unemployment rate nearly down to half its recession peak, not high enrollment in safety-net programs. Democrats do try to educate people about benefits for which they may qualify. But the goal is to get them on their feet, not lock them into dependency.

There is one area of government “dependency” that Obama and his party are proud of, and that is health insurance. The Department of Health and Human Services said this week that 10.2 million people bought private health coverage this year under the Affordable Care Act, and 85 percent of them receive federal subsidies to help pay for it. Millions more have been able to enroll in Medicaid as a result of the ACA expansion of the program to people with incomes slightly above the official poverty line. For those who believe health coverage should be universal, the numbers justify a victory lap.

People who receive insurance help, or food stamps or unemployment benefits, do indeed depend on the government — just like farmers, homeowners, corporations, and anyone else who receives subsidies or tax breaks, as well as companies that don’t provide health insurance or living wages. And just to be clear, if they are not children, disabled, or elderly, people who use the safety net often have jobs. Nearly 43 percent of all food-stamp recipients live in a household with earnings, according to the Department of Agriculture. The Kaiser Family Foundation, in a study of states that haven’t adopted the Medicaid expansion, found there are workers with full- or part-time jobs in 66 percent of the families eligible for it.

Jeb Bush has called the safety net “a spider web that traps people in perpetual dependence.” We are going to hear a lot of statements like that in the next 18 months. But that doesn’t make them true.

 

By: Jill Lawrence, The National Memo, June 4, 2015

June 5, 2015 Posted by | GOP, Scott Walker, Social Safety Net | , , , , , , | Leave a comment

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