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“Seven Years And Counting”: House Republican On Health Care Plan: ‘Give Us A Little Time’

One of the best running jokes in American politics is the one about Republicans releasing their own alternative to the Affordable Care Act. Any day now, GOP leaders have been saying for many years, they’re going to have a plan that rivals “Obamacare,” and it’s going to be awesome.

Yesterday, The Hill reported on the latest installment in this ongoing fiasco.

A group of senior House Republicans is promising to deliver proof that the party is making headway in its six-year struggle to replace ObamaCare.

“Give us a little time, another month or so,” House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) told reporters this week. “I think we’ll be pretty close to a Republican alternative.”

Upton is not just some random figure in the broader effort: The Michigan Republican is a key committee chairman and a member of House Speaker Paul Ryan’s “task force,” responsible for coming up with the GOP’s reform alternative.

Upton said the Republican group is currently in “listening mode” – which it’s apparently been in since its creation 14 months ago.

And yet, we’re apparently supposed to believe that in “another month or so,” House Republican lawmakers will be “pretty close” to having their own reform plan.

Who knows, maybe the GOP is making enormous strides towards its goal. Maybe “listening mode” is going so well that the Republican alternative to the Affordable Care Act is nearly complete. Maybe, with “a little time,” they’re ready to deliver.

It’s certainly possible, but the odds are heavily against it.

As we discussed when the Republican “task force” was created early last year, the political world may not fully appreciate just how overdue this GOP health care plan really is. It was on June 17, 2009 that then-Rep. Roy Blunt (R-Mo.) made a bold promise. The Missouri Republican, a member of the House Republican leadership at the time, had taken the lead in crafting a GOP alternative to the Affordable Care Act, and he was proud to publicly declare, ”I guarantee you we will provide you with a bill.”

The same week, then-Minority Whip Eric Cantor (R-Va.) told reporters that the official Republican version of “Obamacare” was just “weeks away.” We’d all see the striking proof that far-right lawmakers could deliver real solutions better than those rascally Democrats.

This was nearly seven years ago. The Huffington Post’s Jeffrey Young has gotten quite a bit of mileage out of a joke, documenting all of the many, many times in recent years GOP officials have said they’re finally ready to unveil their big health care solution, only to quietly fail every time.

In early April 2014, then-House Majority Whip Kevin McCarthy (R-Calif.) said his party’s health plan was nearly done, but it was being delayed “at least a month.” That was 24 months ago. In 2015, assurances that the Republican plan was on the way were also wrong.

In 2016, however, a GOP leader has been reduced to arguing, “Give us a little time,” seemingly unaware of how hilarious this is.

As we talked about last week, the problem probably isn’t dishonesty. In all likelihood, Republicans would love to have a health care plan of their own – no one likes to appear ridiculous while breaking promises – but haven’t because they don’t know how to craft one.

As New York’s Jon Chait explained, “The reason the dog keeps eating the Republicans’ health-care homework is very simple: It is impossible to design a health-care plan that is both consistent with conservative ideology and acceptable to the broader public. People who can’t afford health insurance are either unusually sick (meaning their health-care costs are high), unusually poor (their incomes are low), or both. Covering them means finding the money to pay for the cost of their medical treatment. You can cover poor people by giving them money. And you can cover sick people by requiring insurers to sell plans to people regardless of age or preexisting conditions. Obamacare uses both of these methods. But Republicans oppose spending more money on the poor, and they oppose regulation, which means they don’t want to do either of them.”

Or as a Republican Hill staffer famously put it in 2014, “As far as repeal and replace goes, the problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act…. To make something like that work, you have to move in the direction of the ACA.”

Which, of course, Republicans can’t bring themselves to do.

But hope springs eternal, and I can’t wait to hear more about the GOP’s progress in “another month or so.”

 

By: Steve Benen, The Maddow Blog, April 19, 2016

April 19, 2016 Posted by | Affordable Care Act, Fred Upton, Health Care, House Republicans | , , , , , , , | 1 Comment

“The Exact Opposite Of Reality”: Rubio’s Principal Talking Point Starts To Crumble

One of the more dramatic flaws in Marco Rubio’s presidential candidacy is a brutal contradiction: he’s a career politician, winning six elections before his 41st birthday, with no real accomplishments to his name.

In the enormous Republican field, voters can choose between established, experienced candidates who’ve done things in public office (Kasich, Bush) or insurgent outsiders with non-governmental records (Trump, Carson), but Rubio is burdened with the worst of both worlds, winning several elections without having done much in the way of meaningful work.

It’s a point about which the Florida senator appears increasingly sensitive. In fact, in October, Rubio tried to take credit for others’ work during his tenure in the state legislature. This week, Rubio’s begun telling voters that he actually has a major federal accomplishment – he helped undermine the American health care system – and his allied super PAC is pushing the line in a commercial:

“On Obamacare, some Republicans gave up. Some talked tough but got nowhere. For all the Republican talk about dismantling the Affordable Care Act, one Republican hopeful has actually done something.”

For some GOP voters and much of the media, this seems compelling – Rubio hasn’t just spun his wheels for five years on Capitol Hill; when he’s bothered to show up for work, he invested real time and energy into interfering with families’ access to medical care.

There are, however, two important flaws in the pitch. The first, of course, is the fact that deliberately trying to undermine the American health care system is not an accomplishment upon which to build a presidential campaign.

The second, as the Washington Post explained today, is that Rubio didn’t do what he claims to have done.

Success always has many fathers, but Rubio goes way too far in claiming credit here. He raised initial concerns about the risk-corridor provision, but the winning legislative strategy was executed by other lawmakers.

The irony is, Rubio has recently tried to take credit for others’ work as a way of differentiating himself from President Obama. “I’m not like that other one-term senator who ran for president,” the Florida Republican has effectively argued, “because I’ve gotten things done in Congress.”

It’s not just a lazy lie; it’s actually the exact opposite of reality.

As we discussed a few months ago, Obama put far more effort into his congressional career than Rubio, and as a result, he had more success. As a senator, Obama developed a reputation as a work horse, being well prepared for briefings and hearings, introducing a lot of bills, and developing an expertise on serious issues like counter-proliferation.

There’s a great story from 2005 in which the Senate Foreign Relations Committee held a day-long hearing on U.S. policy in Iraq, and then-Chairman Dick Lugar (R-Ill.) praised Obama for being the only other senator who was on hand for the entire thing, start to finish. As Salon’s Simon Maloy noted, “It was minor stuff, but it gave Obama a reputation as someone who was willing to do the basic work needed to get things done.”

Rubio has never developed that kind of reputation among his colleagues. On the contrary, he’s seen as a senator who misses a lot of votes, skips a lot of hearings, and fails to show up for a lot of briefings.

Eight years ago, there was a talking point that made the rounds in GOP circles when going after then-candidate Obama: he’d never run a city; he’d never run a state; and he’d never run a business. The trouble is, the exact same talking point can be applied to Rubio, and can even be made a little worse: he’s never built up a legislative record, either.

It’s not fair to say Rubio never passed a bill, but it’s awfully close. According to congress.gov, the far-right Floridian, over the course of five years, took the lead in sponsoring a measure that was signed into law. It’s called the “Girls Count Act,” and it encourages developing countries to register girls’ births. There’s certainly nothing wrong with the policy, but it was a largely symbolic measure that passed both chambers without so much as a vote.

He also helped name September as National Spinal Cord Injury Awareness Month.

That’s about it.

If Rubio and his allied super PAC find that embarrassing, they should probably try to change the subject – because deceptive claims and taking credit for others’ work isn’t generally a recipe for an improved presidential campaign.

 

By: Steve Benen, The Maddow Blog, December 23, 2015

December 26, 2015 Posted by | Florida Legislature, Health Care, Marco Rubio | , , , , , , | 2 Comments

Interim Meeting of The American Medical Association-Atlanta, Georgia

I’m sure some of you may have noticed my lack of postings over the last several days. I want to assure you that I am still alive and well. As a physician, one of the most important functions for me is advocating on behalf of “Patients” and our Profession of Medicine. We generally meet on a national level at least twice per year at various sites across the country. There are over 530 delegates representing every state and virtually every speciality and sub-speciality that you can imagine. Additionally, each delegate has an alternate. Today, we have multiple ongoing Reference Committees, during which anyone can make his/her case for a particular issue. We are the official body of The House of Delegates to the American Medical Association. I am presently in one reference committee discussing such topics as merging of Health Insurance Companies, Veterans Health, Pain Manangemet, Opioid Abuse, Access To Care,Women’s Health and their decision to determine their health care desires for themselves. This is in no way all encompassing, only a snapshot of this one committee. The General Meeting started with a “Big Bang”….A movement by a few obstructionists (we have them here too) for the AMA to  support the defunding of Planned Parenthood was resoundingly smacked down, not once but twice. It’s not over till it’s over,  so I am waiting to see what parliamentary methods will be conjured up to somehow come back to this issue.

So, this is my focus right now and through mid-week. I’ll be back to my regular routine as soon as possible, but for now, I’m in this fight to the end. I’ll rejoin you as soon as I can!

 

RAEMD95, November 15, 2015

 

November 15, 2015 Posted by | Access To Care, Health Care, Health Insurance Companies | , , , , | 2 Comments

“A Vague Hand-Waving Promise Is Not A Plan”: The Republican Plans To Replace Obamacare Have Been Tried, And They Failed

Before Obamacare, the individual insurance market for people who could not get health care through their job was a nightmare. The only way for insurers to make money was to avoid getting stuck with customers who would rack up high medical bills, forcing them to expend enormous time and expense to screen potential customers for preexisting conditions. Even people who could find plans with affordable premiums had to sign contracts loaded with fine-print exclusions leaving them responsible for unexpected costs. Obamacare overhauled that market, eliminating insurers’ ability to screen out healthy customers. In the new, regulated individual markets, people buy plans regardless of their prior health status. This has been a godsend to those unable to obtain coverage before.

Republicans would repeal all these new protections. But never fear, conservatives insist. In their place will be new protections. Ramesh Ponnuru, writing in National Review, points to two protections put in place by Scott Walker’s proposal, which is the prototypical Republican “see, we do too have a plan to replace Obamacare” plan.

Ponnuru mentions two protections. The first is a provision that would “bar insurers from charging higher prices to sicker customers provided they had maintained continuous coverage.” Republicans have taken to using this line a lot, because it sounds to the average person tuning in a lot like a promise to protect people with preexisting conditions, but the last six words are crucial. Maintaining continuous coverage is really hard. We know this because Congress passed a law in 1996 letting people who have employer-provided insurance keep their plan if they maintain continuous coverage. It has proven nearly useless. Maintaining continuous coverage is really hard for people who have financial distress, and it’s harder if the insurance company has every incentive for you to miss a payment or fail to dot one of your i’s or cross one of your t’s, so they can kick you out. And, of course, in a market where insurers can charge higher prices to sicker customers, “maintaining continuous coverage” means buying insurance that’s really expensive and can deny you coverage for lots of treatments you need.

The second provision is high-risk pools. This is a special market for the customers with the most expensive medical needs. Many states have tried high-risk pools. They also work really, really badly. There are all sorts of practical barriers that make it hard to operate a special insurance system for people with the most expensive conditions. For instance, how do you determine eligibility? Tens of millions of Americans have something in their medical history that makes them a less than perfect risk, from the insurance company’s standpoint. Where do you draw the cutoff for eligibility? And how do you keep insurance companies from skimming the high-risk pools, too — after all, they’ll want to cover the least costly people in the high-risk pool, not the most costly ones.

Even if it is possible to devise solutions to these problems, the biggest single impediment is that high-risk pools cost money. There’s no magic secret in a high-risk pool that makes insurers able to sell affordable insurance to people who need lots of medical care. And where would Republicans get the money to finance the high-risk pools? They don’t say. And they all have signed the Grover Norquist pledge that they will never raise taxes under any circumstances — even if aliens come to Earth and threaten to destroy humanity unless the president agrees to raise taxes by a single penny.

The funding problem is not ancillary. There’s an old joke in which a chemist, a physicist, and an economist are trapped on a desert island, and some cans of food wash up onshore. The physicist devises a plan to smash open the cans. The chemist comes up with a plan to heat them open. And the economist says “assume a can opener.” This is the problem not just with the high-risk pools, but the Republican health-care plans as a whole. They assume the availability of funding, but the party is theologically opposed to raising revenue of any kind. Like having a can opener, if the Republicans were able to overcome their fanatical opposition to revenue, the problem wouldn’t exist in the first place. Any reform that assumes Republicans will find a way to fund it is assuming a can opener. It’s premised on a fantastical assumption. That is why, in the absence of some concrete way around the no-taxes-ever problem, a vague hand-waving promise can’t be called a real plan.

Before Obamacare took effect, different measures were tried to reform America’s cruel and dysfunctional individual health-care marketplace. The continuous-coverage protection and high-risk pools both failed. One thing that succeeded was tried in Massachusetts, by Mitt Romney. The Obama administration decided to build that model out nationally, and it has worked very well — premiums have actually come in well under projections. But since it was Obama’s plan, Republicans oppose it. But since Obamacare is working, they need to have something they can say they’ll replace it with, and they’ve turned to the things that have already failed.

 

By: Jonathan Chait, Daily Intelligencer, New York Magazine, August 21, 2015

August 22, 2015 Posted by | Affordable Care Act, Health Care, Republicans | , , , , , , , | 1 Comment

“They Show That They Still Have No Answer”: Scott Walker, Marco Rubio Propose ‘Plans’ To Replace Obamacare

Today, Scott Walker and Marco Rubio have published plans — really, not so much plans as skeletal descriptions of planlike concepts — to replace Obamacare. Their fundamental dilemma is that Obamacare provides a popular benefit to millions of voters. Appealing to the conservative base demands they eliminate the program that provides this benefit. Appealing to the general election requires them to promise something to compensate the victims of repeal. How will they fund that something? This is the basic problem that for decades has prevented Republicans from offering a health-care plan. Rubio and Walker show that they still have no answer.

The usual pattern in politics is for politicians to turn complex problems into simple ones. But covering the uninsured is a simple problem they want to make complex. The main reason people lacked insurance before Obamacare is that they did not have enough money to afford it. Some of those uninsured people had unusually high health costs. Some of them had unusually low incomes. Boiled down, Obamacare transferred resources from people who are rich and healthy to people who are poor and sick, so the poor and sick people can afford insurance.

It cuts funds, but not benefits, from Medicare. And it transfers resources to sick people through regulations. The individual insurance market is reorganized so that insurers can’t deny essential health services or jack up prices to people with preexisting conditions. This means people with expensive medical needs pay less, and people with cheap medical needs have to pay more. Repealing Obamacare means eliminating all these forms of redistribution from the rich and healthy to the poor and sick. And replacing them with … what?

Walker and Rubio are fairly clear about their plans for regulating the insurance market. They want to go back to the pre-Obamacare, deregulated system. They’d eliminate the requirements that insurance plans cover essential benefits, and let them charge higher prices to sicker customers. That’s good for people who have very limited medical needs (as long as they never obtain a serious medical condition, or have a family with somebody with a serious medical condition). It’s bad for people who have, or ever will have, higher medical needs.

Both Walker and Rubio promise to take care of people with preexisting conditions by creating separate “high-risk pools.” That is a special kind of insurance market for people with expensive medical conditions. As you may have guessed, insurance for people with expensive medical needs is, well, expensive. Making that insurance affordable therefore requires lots of subsidies from the government. Where would Walker and Rubio get the money for that? They don’t say.

Both the Rubio and Walker planlike concepts share a basic structure and an extreme lack of detail. Walker’s document is a few pages padded out with ample white space. Rubio’s op-ed, which repeats the talking points of another op-ed from a few months ago, contains even less information. And the lack of detail is not a matter of filling in the fine print. Both Walker and Rubio have signed the Grover Norquist pledge to never raise a single penny of tax revenue ever, under any circumstances.

Both Walker and Rubio propose to cut funding for Medicaid, but this doesn’t create much room to subsidize coverage, since Medicaid is already much cheaper than Medicare or private insurance. Indeed, the main conservative complaint about Medicaid is that it is so cheap that many doctors refuse to see its patients. Republicans are willing to cut Medicaid because they’re generally willing to cut programs that focus on the very poor, but there’s not much blood to be drawn from this stone.

It is tempting to treat the lack of specifics in the Republican health-care plans as a problem of details to be filled in. But it is not a side problem. It is the entire problem. They will not finance real insurance for the people who have gotten it under Obamacare, nor will they face up to the actual costs they’re willing to impose on people. The party is doctrinally opposed to every available method to make insurance available to people who can’t afford it. They have spent six years promising to come up with an alternative plan, and they haven’t done it, because they can’t.

 

By: Jonathan Chait, Daily Intelligencer, New York Magazine, August 18, 2015

August 21, 2015 Posted by | Affordable Care Act, Health Care, Marco Rubio, Scott Walker | , , , , , , , | 1 Comment

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