“Just Die Already!”: GOP Would Bar Poor From Health Care Altogether
During a Republican primary debate in the last presidential election cycle, there was a dispiriting moment in which Tea Party audience members cheered at the idea that a comatose uninsured American — unable to afford health insurance — would be left to die. That infamous outburst, among others, has prompted GOP bigwigs to try to cut back on primary season debates, hoping to limit appearances that might expose the party’s baser impulses.
But that mean-spirited and contemptuous attitude toward the sick is alive and well in the Grand Old Party, as its maniacal (and futile) resistance to Obamacare has made clear. Now, one Republican politician is pushing that callousness to new lows: He wants to bar the uninsured from hospital emergency rooms.
Last week, Georgia Gov. Nathan Deal criticized a decades-old federal law that requires all hospitals that receive Medicare funds and have emergency facilities — and that’s most — to treat any patient who walks in needing care, regardless of his ability to pay. “It came as a result of bad facts,” Deal said, according to The Atlanta Journal-Constitution. “And we have a saying that bad facts make bad law.”
Deal says that many people use emergency rooms unnecessarily, and those patients inflate health care costs. He is factually correct. But there are other facts that undercut his arguments and reveal his hypocrisy.
First off, Deal is among those red-state Republicans who have vociferously opposed the Affordable Care Act, which makes health insurance available to hundreds of thousands of people who couldn’t otherwise afford it. If more people had health insurance policies that paid for doctors’ visits, fewer would use emergency rooms for routine complaints.
Second, Deal, like many Republican governors, has refused the Medicaid expansion made possible by Obamacare, even though the federal government would pick up 100 percent of the cost for the first three years and 90 percent until the year 2022. That expansion is the best chance many Georgians without means have for getting health insurance.
So, to sum up, Deal hates Obamacare and refuses its Medicaid expansion, which would keep the working poor out of emergency rooms. In addition, he wants to deny them access to emergency rooms unless they can pay. Really, governor? Don’t you insist that your values are “pro-life”?
It’s no wonder that GOP strategists shuddered when audience members responded so cruelly during the CNN/Tea Party Express debate in September 2011. It portrays the party as pitiless — a reputation unlikely to attract a majority of voters.
Quiet as it’s kept, most Americans support keeping Obamacare, despite the relentless pounding it has taken from Republicans. (And despite a website rollout that was infuriatingly incompetent.) A new poll by the Kaiser Family Foundation found that 56 percent of Americans favor keeping it in place, while just 31 percent want to repeal it. (Twelve percent want to replace it with a GOP plan.)
That’s likely because most voters, no matter their reservations about Obamacare, know that the Republican Party has no good solution for the millions of Americans who work every day but still don’t earn enough money to buy a health care plan. Americans have struggled with the nation’s dysfunctional health care “system,” and they know it’s overdue for an overhaul.
Meanwhile, as the midterm elections draw closer, the GOP struggles to come up with a plan that pretends to overhaul the health care system. Looking to avoid being painted as mere obstructions, House Republican honchos are working to draw their caucus together behind a bill that would replace Obamacare with a workable alternative.
But the most sincere plan so far — one offered by Sens. Richard Burr (R-NC), Tom Coburn (R-OK) and Orrin Hatch (R-UT) — would probably offer policies too skimpy to do any good once a policyholder gets sick.
Besides, even that replacement idea seems unlikely to draw broad support among the far-right Tea Partiers, who believe that allowing the uninsured poor to die is the appropriate government response to the health care crisis.
That’s a hulking bit of hypocrisy for a party that advertises itself as “pro-life.” Deal’s latest proposal is one more reminder of how little that label means.
By: Cynthia Tucker, The National Memo, March 1, 2014
“No Vote Head-Faking”: How John Boehner Is Playing Washington
There were no fireworks when John Boehner stood before Republican members at their retreat in rural Maryland and unveiled the House GOP’s “principles” for immigration reform. Even as the speaker outlined policies intolerable to hawkish conservatives, such as providing citizenship to undocumented children, there was, amazingly, no ugly dissent inside the Hyatt conference center.
There’s a simple reason why: Most members realized that Boehner was presenting broad ideas to be discussed, not specific proposals to be voted on.
“I thought the principles were vague enough that most people could agree with them,” Rep. Raul Labrador said after the retreat.
That was the idea.
At the beginning of the year, interviews with dozens of lawmakers and aides revealed a strategic dichotomy forming within the House GOP. Many conservatives craved a “bold” voting schedule in 2014 that would draw sharp policy contrasts on a host of issues. Republican leaders, on the other hand, saw such aggression as counterproductive in an election year and preferred to play it safe by pounding the issues of Obamacare, government oversight, the economy, and opportunity for middle-class Americans.
What has emerged is something of a safe middle ground. Boehner said Thursday that Republicans “will not shy away from” advancing major legislation this year. But the pace of that advance will be slow. Indeed, as GOP leadership carefully navigates an election year that appears promising for the party, Boehner is allowing conservative policy solutions to emerge from the conference—but they are meant to elicit positive headlines and score political points, not to expedite votes.
Take immigration. In the abstract, plenty of Republicans support legal status for undocumented immigrants (albeit only after several triggers, such as border security and employment verification, are in place.) Still, they say 2014 isn’t ripe for such an overhaul, citing election-year politics and a belief that President Obama is unwilling to enforce immigration laws. Boehner, knowing the reticence of his members yet understanding the necessity of appearing proactive on immigration, felt he had to act.
So the speaker released a nebulous outline of principles. Republicans rolled their eyes, sensing that significant legislative action was unlikely, but the media went crazy, splashing front-page headlines heralding the House GOP’s embrace of legalization for the undocumented. And one week later, after lawmakers lodged obligatory concerns and reporters wrote glowing reviews, Boehner dutifully acknowledged that immigration reform probably won’t happen this year.
“This is an important issue in our country,” Boehner said on Feb. 6. “It’s been kicked around forever, and it needs to be dealt with.”
The speaker was discussing immigration, but he could have been referencing any number of policies his GOP members want to bring to a vote—tax reform, health care, privacy, and welfare reform among them. Republicans want action, but it’s becoming clear that most of these will share immigration’s fate: Principles will be shared and a discussion will be had, but a vote will not.
Tax reform is the latest example. Rep. Dave Camp, chairman of the Ways and Means Committee, made a splash last week by introducing a long-awaited overhaul of the tax code. Many conservatives have eagerly anticipated Camp’s proposal for three years, and are now agitating for a vote. “If this is a really powerful document that can rally a bunch of support in the party, then what’s to stop us from having a vote in the House?” Rep. Mick Mulvaney of South Carolina said of Camp’s tax plan.
Boehner’s response when asked about Camp’s plan on Wednesday: “Blah, blah, blah, blah.”
Leadership sees the details of this proposal, such as eliminating popular deductions, as politically perilous. But they also know how enthusiastic some members are about tax reform. So rather than rankle conservatives by suffocating the plan altogether, or irritate the business community by bringing a risky proposal to the House floor, Boehner’s team is content to have Camp to unveil his plan—allowing for a broad messaging campaign but not a specific vote.
This head-faking has provided GOP leadership with a blueprint for 2014. Now, with immigration and tax reform essentially taken off the table, and fewer than 75 legislative days left before midterm elections, Boehner’s team will have to grapple with but a few more potentially troublesome policy pushes.
Privacy legislation, if it’s a libertarian-backed bill with teeth, is unlikely to reach the floor.
Same goes for welfare reform. A group of conservatives, led by Rep. Jim Jordan of Ohio, have worked with the Heritage Foundation on a proposal to roll back welfare spending to pre-recession levels and add work requirements to the food-stamp program. But a vote on this plan is unlikely. Tinkering with the social safety net is always hazardous, and, as with other bold proposals, leadership won’t risk an election-year backlash by voting on something that stands no chance of clearing the Senate.
The one major issue that Boehner’s strategy won’t apply to is Obamacare. Conservatives have demanded action—and were promised votes—on an alternative to the Affordable Care Act. Majority Leader Eric Cantor earned applause in Cambridge when he guaranteed an Obamacare replacement plan, and is beginning to meet with colleagues to piece something together. Cantor is widely expected to deliver.
Still, as National Journal reported in January, the House Republican health care plan is likely to be a medley of poll-tested proposals slapped together— not one of the comprehensive alternative plans that conservatives have been boosting.
For conservatives who demanded an aggressive, wide-ranging legislative agenda in 2014, winding up with one vote on a watered-down health care bill might not suffice. “Instead of talking, we could actually act—and we could have a real impact,” said Rep. Tim Huelskamp of Kansas, a frequent critic of leadership. “It’s easy to blame Harry Reid and the president for everything, but we’re missing a lot of opportunities. Standing back and waiting is not going to win elections.”
Still, after initially decrying a play-it-safe strategy, other conservatives now sound comfortable with the approach. “When you put a bill out there,” said Rep. John Fleming of Louisiana, “it has a lot of details that can detract from the overall concept.”
By: Tim Alberta, The National Journal, March 2, 2014
“Promises, Promises”: The Elusive Policy That’s Always On The Horizon
In 2009, as Democrats advanced the Affordable Care Act, congressional Republicans promised to produce an alternative plan to prove to the public that the GOP approach was superior. It sounded very nice.
But Republicans, working in secret, missed their own deadline. Then they missed another. Eventually, GOP lawmakers threw together a half-hearted package, which was a bit of a joke. As Matt Yglesias noted at the time, the Republican approach to reform sought to create a system that “works better for people who don’t need health care services, and much worse for people who actually are sick or who become sick in the future. It’s basically a health un-insurance policy.” The CBO found that the plan would leave “about 52 million” Americans without access to basic medical care.
Four-and-a-half years later, we find ourselves in a surprisingly similar situation. For reasons they sometimes struggle to explain, congressional Republicans still hate “Obamacare,” and just as importantly, are still working in secret on an alternative reform plan that will prove their superior policymaking skills. One of these days, they keep saying. Just you watch. It’ll be **awesome.
Except, of course, the elusive policy is always just out of reach. It sits at the horizon, but it never draws closer.
Suddenly, a House vote on a Republican alternative to Obamacare seems less likely.
Speaker John Boehner (R-Ohio) declined to commit to an alternative measure coming up for a vote this year but said GOP leadership is going to “continue to having conversations with our members” about items like tax reform and replacing President Barack Obama’s signature domestic legislation.
And what about the recent promises from House Republican leaders that they will present an ACA alternative – and vote on it – sometime in 2014? “We’re going to continue to go through a lot of ideas,” Boehner said yesterday, using the most non-committal language possible.
By any fair standard, this is quickly becoming a rather ignominious fiasco.
Jon Chait published a gem this week, highlighting the recent Republican rhetoric.
* On Jan. 30, House Majority Leader Eric Cantor (R-VA.) vowed, “This year, we will rally around an alternative to ObamaCare and pass it on the floor of the House.”
* On Feb. 21, Cantor said Republicans are working “to finalize our Obamacare replacement plan.”
* On Feb. 24, Cantor’s office said it’s prepared to “begin” working on the party’s alternative.
* On Feb. 27, Boehner said he’s prepared to “have conversations” with Republicans about what might be in an alternative policy.
Notice the pattern? Over the course of four weeks, we’ve gone from a guaranteed vote on an alternative to descending assurances about whether an alternative will ever even exist. Chait explained:
Lots of people treat the Republican Party’s inability to unify around an alternative health-care plan, four years after the passage of the Affordable Care Act, as some kind of homework assignment they keep procrastinating on. But the problem isn’t that Cantor and Boehner and Ryan would rather lay around on the sofa drinking beer and playing video games than write their health-care plan already.
It’s that there’s no plan out there that is both ideologically acceptable to conservatives and politically defensible.
Quite right. Republicans could present an alternative policy that they love, but it’ll quickly be torn to shreds, make the party look foolish, and make clear that the GOP is not to be trusted with health care policy. Indeed, it would very likely scare the American mainstream to be reminded what Republicans would do if the power over the system were in their hands.
On other hand, Republicans could present a half-way credible policy, but it would have to require some regulations and public investments, which necessarily means the party’s base would find it abhorrent.
And so we get … nothing. Years of promises later, the GOP can’t meet its own commitment to the public, not because Republicans are lazy, but because it’s a post-policy party.
They sure are great at complaining, though, aren’t they?
By: Steve Benen, The Maddow Blog, February 28, 2014
“Show Me The Medicaid Money”: Buckle Up Republicans, Obamacare Is Here To Stay
Somewhat quietly, Obamacare enrollment hit 4 million this week. Now, it’s certainly true—as critics have noted—that enrollees aren’t the same thing as people who will continue to stay with their plan for a full year. If an enrollee encounters an unexpected expense of replacing a head gasket or something like that, he might skip a payment. But even so, 4 million’s a more-than-respectable number.
Also rather quietly this week, a new tracking poll from the Kaiser Family Foundation showed support for repeal of Obamacare down to 31 percent. As Jay Bookman noted in the Atlanta Journal-Constitution, overall the poll wasn’t something the president would exactly brag about, but it did represent noticeable change, especially among independents, 57 percent of whom now support the law.
That 31 percent number made me sit up straight for one reason. The percent of Americans who identify themselves as conservative is, lately, about 38 percent, says Gallup. So 31 percent is getting down there. And consider this: As of mid-December 2013, the percentage of Americans who favored repeal was 52.3 percent in a Real Clear Politics average of numerous polls. The Affordable Care Act may not be as popular as Twelve Years a Slave, but it’s not The Lone Ranger anymore either.
I would think there’s a direct correlation between these two sets of facts, no? The more people go to the web site and see that they can get insurance at a decent price (in most cases), the more they tell their co-workers and neighbors that doing so wasn’t the horror show they expected. The more people learn about some of the law’s benefits, the more opposition to it softens.
There are still a few more things the American people need to learn about the law, though, and it’s up to the Democrats to tell them, and I’m going to bang on about this until I see some action. As I wrote Wednesday, Governor Rick Perry has said no to $9 billion in free money. Texas is the largest state in the union that hasn’t accepted the Medicaid expansion money, so that’s the biggest figure, but the figures are significant in relation to the population and budget in every single state.
These figures are from a Commonwealth Foundation report from three months ago. Florida is saying no to $9.6 billion, Georgia to $4.9 billion, North Carolina to $5.7 billion. Wisconsin is passing on $1.75 billion, Virginia on $2.15 billion, and Pennsylvania on $5.5 billion (although Pennsylvania is considering the opt-in). And this report’s figure for Texas is actually $9.6 billion.
You know how states clamor for federal highway money? Well, as Commonwealth points out, in every one of these cases, the Medicaid money is more—at least double, typically, and sometimes far more—than what these states get in highway money. And yet they say they don’t want it. They say that over time, they’re going to be on the hook for vast expenditures they can’t afford, or they fret publicly that Washington might change the formula. They’re both bogus arguments.
The federal government is paying 100 percent of states’ expansion costs through 2016 and no less than 90 percent thereafter on a permanent basis. It’s a sweet deal. But okay, what about that (up to) 10 percent that states are going to have to start paying? Ten percent doesn’t sound like a lot, but in dollar terms, isn’t that real money?
The answer is, not really, in most cases. This gets complicated and involves a category of spending by the states for something called “uncompensated care,” which is just what it sounds like—health care provided for free to poor people. State and local governments typically pitch in now on uncompensated care. But as the Center on Budget and Policy Priorities explains in a 2012 report: “The Medicaid expansion will reduce state and local government costs for uncompensated care and other services they provide to the uninsured, which will offset at least some—and in a number of states, possibly all or more than all—of the modest increase in state Medicaid costs.” Overall, the health-care consulting firm The Lewin Group estimates a minimal increase in states’ spending obligations, around 1 or 2 percent, depending on the state.
As for the argument that some GOP governors make that they fear Washington might change the formula…well, that’s straight from Orwell or Kafka. That is: Barack Obama isn’t going to change any formula. President Hillary Clinton wouldn’t be changing any formula. A Democratically controlled Congress won’t be changing any formulas. Only Republican presidents and congresses would do that. In other words, these Republican governors are saying—yeah, the deal looks fine now, but my party might take over, and then I’d be really screwed!
The ACA is here to stay. It’s not going to be struck down. It’s not going to be repealed. That would require a Republican president and 60 GOP senators and a solid GOP House majority, and the odds are strongly against the emergence of such a confluence. It’s going to exist. And inevitably, it’s going to grow. And more and more people are going to get used to it and learn to live with it. And over time, the people in states like Texas and Georgia and Wisconsin are going to see that people in nearby states that took the money are in fact pretty happy with their situations.
It’s only a matter of time before these resistant governors and state legislatures start caving. Democrats have it in their power to help hasten that timetable by making this an issue. They have to have the courage not to wilt or get the vapors whenever a right-winger invokes the evil gummint or the hated Kenyan. Democrats say they’ve waited decades for this moment. Well, it’s here. Now’s not the time to run away from the fight.
By: Michael Tomasky, The Daily Beast, February 28, 2014
“Senate GOP Blocks Veterans’ Bill”: Shame On Republicans For Bringing Base Politics Into A Bill To Help Veterans
As a rule, legislation related to veterans’ benefits tends to garner bipartisan support, but as we were reminded this afternoon, there are exceptions.
Senate Republicans stopped Democrats from advancing a bill that would have expanded healthcare and education programs for veterans.
In a 56-41 vote Thursday, the motion to waive a budget point of order against the bill failed. Democrats didn’t have the 60 votes needed to overcome the Republican roadblock.
Only two of the Senate’s 45 Republicans – Sens. Dean Heller (Nev.) and Jerry Moran (Kan.) – voted with the Democratic majority. That was obviously not enough to end the GOP’s obstruction.
The bill, the Comprehensive Veterans Health and Benefits and Military Pay Restoration Act, was quite expansive. Sen. Chris Coons (D-Del.), a co-sponsor, posted an overview of the legislation, highlighting its expanded VA health care access, tuition assistance, and job training. These certainly sound like the sort of things GOP lawmakers could go for.
So why did Senate Republicans block it?
Some GOP senators said they were unsure of the pay-for provisions – helping veterans matters, but making sure the deficit isn’t slightly larger really matters – but perhaps the biggest complaint had to do with Iran.
Senate Republicans demanded a vote on their own alternative legislation, which included a provision to impose new sanctions on Iran, and which would imperil the delicate international nuclear talks that are still ongoing.
GOP senators want a vote on the sanctions, regardless of the consequences; Senate Majority Leader Harry Reid (D-Nev.) won’t go along; so the Republican minority blocked the bill on veterans’ benefits.
“I hope all the veterans groups have witnessed all the contortions the Republicans have done to defeat this bill,” Reid said this afternoon. “Shame on Republicans for bringing base politics into a bill to help veterans.”
By: Steve Benen, The Maddow Blog, February 27, 2014
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