“Mythical Republican Reform”: Will Romney Pretend to Have a Health Plan?
The health-care ruling has exposed a delicate dance within the Republican Party. Romney does not want to run on the health-care issue. To the extent that he wants to invoke the issue, it’s to flay Obama for having focused on it as a distraction from the economy, not as an ideological crusade against Big Government. But conservative activists want to be sure that, if Romney wins, he will commit his political capital to repealing the Affordable Care Act. Thus their current focus on demanding that Romney pledge to repeal the law (see Avik Roy, Keith Hennessey, Rich Lowry, and David Brooks, among many others).
The interesting thing about these conservatives’ arguments is that they are all committed, to varying degrees, to upholding the pretense that the Republican Party really wants to impose a more technocratically sound version of health-care reform. To be sure, they insist they are advocating a vastly different philosophical vision centered around self-empowerment and free markets and other wonderful things. But all of them say, or imply, that they share the basic goals of the Affordable Care Act, which is to make coverage available to all Americans and to control cost inflation. So, for instance, Lowry argues, “The two central selling points of the law — insuring millions more people and keeping people with pre-existing conditions from getting locked out of insurance — can be addressed with policies that are cheaper and less disruptive (a tax credit for purchase of insurance and high-risk pools, respectively).”
I see two problems with this hopeful scenario, both fatal.
The first is that the mythical Republican reform plan is really hard to pass. Conservatives may think they have a cheaper way to fix the system, but it still costs money. And Republicans have never appropriated any money to cover the uninsured. Indeed, all their plans divert money that already exists to cover people who need health care for other purposes. Conservatives hopefully propose turning the health-care tax deduction into a more progressive tax credit. Great idea! Except the plans put forward by Romney and Paul Ryan plow the savings from eliminating that tax deduction back into lower tax rates. And it leaves no budgetary provision for high-risk pools or any other mechanism to subsidize coverage for the poor and sick.
Now, you could suppose that maybe this is all one giant oversight. Republicans failed to craft an alternative plan during the health-care debate, then voted to just straight repeal Obamacare with no replacement, then voted for a budget that just straight repeals Obamacare with no replacement, but when they have power, then they’ll really come up with a plan.
But where is the evidence that they have any desire to do so? Sunday, the two most powerful Republicans in Congress appeared on interview shows and were asked what they plan to do for the uninsured. Mitch McConnell hilariously danced and weaved, admitting that covering the uninsured is “not the issue”: http://youtu.be/QvZvNSKrOZ4
Paul Ryan, as he is apt to do, offered a much smoother take, couching his position in philosophical abstractions:
What — what Mrs. Kennedy and others were saying is this is new government-granted right. We disagree with the notion that our rights come from government, that the government can now grant us and define our rights.
Those are ours. Those come from nature and God, according to the Declaration of Independence, a huge difference in philosophy.
What this blather actually means is that he does not accept that the government has an obligation to ensure that all Americans have access to health care.
If Republicans really wanted to replace Obamacare with some more “market-friendly” alternative, then there’s a simple way they could go about it. They could promise to repeal the law only if they packaged the repeal with a replacement that did not increase the number of uninsured. But they’ll never do that, because the magic, cheaper free-market alternative does not exist, and the GOP has no interest in diverting resources to cover the poor and sick.
Hennessey, who lays out the most specific vision for repealing Obamacare, asserts, “Repeal and replacement should be separate legislative efforts.” This means, of course, that the actual plan is first to get rid of Obamacare, then pretend to work on a replacement before eventually discovering that it’s expensive and unpopular. Oh well. The only interesting question here on any level is why so many conservatives feel bound to pretend that the Republicans really are going to formulate some other plan to care for the poor and sick.
By: Jonathan Chait, Daily Intel, July 4, 2012
“Failures Of Spin”: Republicans Really Don’t Give A Crap About The Uninsured
Republican Senate leader Mitch McConnell is ordinarily a spinner of unusual skill. He’s relentlessly focused on his message and doesn’t let any interviewer frame a question in a way he (McConnell) doesn’t like. Which is why it was a little odd to see Fox News’ Chris Wallace catch him without a handy talking point when it came to covering the uninsured. This excerpt is a little long, but you have to see the whole thing:
WALLACE: All right, let’s move on. If voters elect a Republican president and a Republican Senate, your top priority will be, you say, to repeal and replace “Obama-care.” And I want to drill down into that with you. One of the keys to “Obama-care” is that it will extend insurance access to 30 million people who are now uninsured. In your replacement, how would you provide universal coverage?
MCCONNELL: Well, first, let me say the single the best thing we could do for the American health care system is to get rid of “Obama- care,” get rid of that half a trillion dollars in Medicare cuts, get rid of the half a trillion dollars in taxes. In other words, the single biggest step we could take in the direction of improving American health care is to get rid of this monstrosity.
WALLACE: But if I may, sir, you’ve talked about repeal and replace. How would you provide universal coverage?
MCCONNELL: I will get to it in a minute. The first step we need to take is to get rid of what is there, this job-killing proposal that has all of these cuts to existing health care providers. Secondly, we need to go step by step to replace it with more modest reforms. There will not be a 2,700-page Republican alternative. We will not take a meat axe to the American health care system. We will pull out a scalpel and go step by step and make the kinds of more modest changes that would deal with the principal issue which is cost. Things like interstate sales of health insurance. Right now you don’t have competition around the country in the selling of health insurance. That is a mistake. Things like lawsuit reform. Billions and billions of dollars are lost every year by hospitals and doctors in defensive medicine. Those kinds of steps…
WALLACE: But respectfully sir, because we are going to run out of time and I just want to ask, what specifically are you going to do to provide universal coverage to the 30 million people who are uninsured?
MCCONNELL: That is not the issue. The question is, how can you go step by step to improve the American health care system? It is already the finest health care system in the world.
(CROSSTALK)
WALLACE: But you don’t think the 30 million…
MCCONNELL: What our friends on the other…
(CROSSTALK)
WALLACE: You don’t think the 30 million people that were uninsured is an issue?
MCCONNELL: Let me tell you what we are not going to do. We are not going to turn the American health care system into a Western European system. That is exactly what is at the heart of “Obama- care.” They want to have the federal government take over all of American health care.
And there you have it. Obviously, McConnell can’t come out and speak the truth, which is that while there are a few changes Republicans would like to see on health care, not only isn’t it an issue they care very much about, they really don’t give a crap about people who don’t have insurance. Never have, and probably never will. First of all, those just aren’t their people, and second of all, actually helping the uninsured requires things they don’t like, such as expanding Medicaid.
But that doesn’t mean there’s nothing they can say. McConnell ought to know that when asked questions like this, Republicans are supposed to say, “The way you expand coverage to everyone is to increase competition and unleash the free market, not through big government blah blah blah.” That way it looks like you’ve actually responded to the question, even though you haven’t actually said anything. The great thing about conservative talking points is that they can be used almost anywhere, no matter how empty they are. McConnell is seriously off his game.
I stand by my prediction that Republicans are going to stop talking about health care within a few days. They just don’t feel comfortable with the topic.
By: Paul Waldman, Contributing Editor, The American Prospect, July 2, 2012
“Tolerating Poor People”: Republicans Explore New Moral Depths On Medicaid
As the lawsuits challenging the Affordable Care Act worked their way up to the Supreme Court, I always found the challenge to the expansion of Medicaid to be the strangest part. Quick context: the program provides insurance for poor people, splitting the cost between the federal government and the states. But the current rules say that each state gets to set its own eligibility standards, which meant that if you live in a state run by Democrats and you’re poor, you can get Medicaid, but if you live in a state run by Republicans, you have to be desperately poor to get Medicaid. For instance, in Mississippi, a family of four has to have a yearly gross income below a princely $9,828 to qualify. Because if a family is living high on the hog with their $10,000 a year, they aren’t really poor, right?
Fortunately, the Affordable Care Act fixed this, by changing Medicaid so that everyone with up to 133 percent of the federal poverty level ($30,657 for a family of four) would qualify. And to make things easier on the states, the bill provided that the federal government would pick up almost all of the tab. The federal government pays 100 percent of the cost of paying for the new enrollees through 2016, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent from then on. In other words, the federal government is saying to states, “Here’s a bunch of free money to insure a whole lot of your citizens, which will make them healthier and more productive.” And almost every state run by Republicans replied, “How dare you do such a thing to us! It’s unconstitutional! We’re suing!”
And unfortunately, the Supreme Court gave them the right to turn down the money, so each state gets to decide whether it wants to accept the expansion. The irony is that this change in Medicaid is much, much more valuable to the states that have been the stingiest with Medicaid up until now. Massachusetts, for instance, already sets Medicaid eligibility at 133 percent of the poverty level, so they get no new money. It’s the Republican states with Scroogian eligibility who will get the most benefit, insuring millions of their citizens at little cost. But they’re the ones who don’t want it.
It’s pretty obvious that many Republicans wish there was no such thing as Medicaid at all. But if they have to tolerate poor people getting health care, they want to make sure as few of those poor people get it as possible. Because after all, if you can take your kids to the doctor whenever they get sick, how are you going to learn that being poor proves how sinful you are?
When this all comes down in 2014, the Republican governors and legislators who choose to opt out of the Medicaid expansion shouldn’t be allowed to claim that it’s a budgetary issue, because it isn’t—it’s free money, as far as their state budgets are concerned. They’re already trying. Here’s Phil Bryant, the governor of Mississippi, saying that the state doesn’t have the money to cover the estimated 330,000 people in the state who would get insurance paid for by the federal government. Here are Republican officials in Florida, where around a million people could get coverage under the Medicaid expansion, pleased as punch that the Court gave them the opportunity to say “No coverage for you!” to those poor Floridians.
So these Republican officials will be saying to their own citizens, “The federal government is offering to give you free health insurance, but we won’t let you have it. Your health is less important than us making a statement about how much we hate the welfare state and how much we hate Barack Obama and everything he touches.” They believe that it’s better for a person to have no insurance at all than to get insurance from the government. That position is morally vile enough in the abstract, but when they’re actually confronted with a choice to make about whether to allow their citizens to have health insurance, some of them are going to say no. I struggle to find words to describe how despicable and cruel that is.
Now, it’s possible that once that money is actually being offered, the states will all say yes. That’s what Nancy Pelosi argued yesterday. But that depends on the Republican leadership of those states actually giving a crap about their poor citizens. Let’s just say we should believe it when we see it.
By; Paul Waldman, Contributing Editor, The American Prospect, June 29, 2012
“About As Screwed As You Can Get”: The Uninsured Continue To Annoy Us With Their Pain
There are a lot of reasons why the United States is the only advanced democracy that does not guarantee basic medical services to all its citizens. One reason is that the convoluted construction of the U.S. health-care system has made it hard to fix the dysfunctional elements without threatening to change existing arrangements for people who profit from the status quo, or at least fear change. (That’s why both Presidents Obama and Clinton have tried so hard to convince Americans with health insurance they could keep what they have.)
Another reason is that people without health insurance are politically weak. They lack political organization, and many, reports Alec MacGillis, lack even the awareness that there was this big health-care law that gives them help:
As Robin Layman, a mother of two who has major health troubles but no insurance, arrived at a free clinic here, she had a big personal stake in the Supreme Court’s imminent decision on the new national health care law.
Not that she realized that. “What new law?” she said. “I’ve not heard anything about that.”
The circumstances of MacGillis’s story itself tell you something else about the weakness of the uninsured: Their cause is slightly disreputable. MacGillis straightforwardly and without advocacy examines up-close the conditions of the uninsured and their level of awareness, or lack thereof, of the Affordable Care Act. MacGillis reported the story for Kaiser Health News, and offered it to the Washington Post, which planned to run it on its front page but decided against it.
It is certainly true that a story examining the plight of the uninsured, and one that notes that they would stand to gain from a law subsidizing their health insurance, would tend to make readers think more favorably of such a law. But that is not the sort of objection a newspaper normally considers fatal. It all depends on whose plight we’re talking about. The complaints of business leaders who want more favorable regulatory and fiscal policies have received blanket coverage. Even when such complaints have a strong partisan tilt, beliefs like “we need less regulation” or “we must focus on reducing the deficit” carry a presumption of public-spiritedness.
The uninsured are in such bad political shape that even describing their physical suffering in a political context is considered dangerously partisan. That’s about as screwed as you can get.
By: Jonathan Chait, Daily Intel, June 18, 2012
“A Pathetic Scam”: Boehner On Health Care, “Everything Must Go”
For about three years now, congressional Republicans have sworn up and down that they’re hard at work on a health care reform package of their own. It’s going to be awesome, they said, and will meet Obamacare’s goals without all that unpopular stuff.
Sensible people gave up on actually seeing this vaporware quite a while ago, realizing that “repeal and replace” was a rather pathetic scam. But with the Supreme Court ruling on the Affordable Care Act due fairly soon, and with the possibility of a Republican White House and a Republican Congress on the horizon, there’s renewed interest in what, exactly, GOP policymakers intend to do on the issue.
There was some talk this week that Republicans, fearing a public backlash, would “draw up bills to keep the popular, consumer-friendly portions in place — like allowing adult children to remain on parents’ health care plans until age 26, and forcing insurance companies to provide coverage for people with pre-existing conditions.” (The interconnectivity of the popular and unpopular parts are generally as lost on Republicans as they are on the general public.)
The GOP’s base immediately said this would be outrageous. Yesterday, House Speaker John Boehner (R-Ohio) joined them, making it clear that Republicans intend to kill the whole law, including the parts Americans like, want, and have come to expect.
House Speaker John Boehner (R-Ohio) reiterated Thursday that he wants to repeal all of President Obama’s healthcare law if the Supreme Court doesn’t toss out the entire statute.
“We voted to fully repeal the president’s healthcare law as one of our first acts as a new House majority, and our plan remains to repeal the law in its entirety,” Boehner said to reporters. “Anything short of that is unacceptable.”
Let’s not brush past too quickly exactly what this means. The only “acceptable” outcome for Romney is one in which tens of millions of Americans lose their health care coverage, seniors pay higher prescription drug costs, small businesses lose their tax breaks, and the deficit goes up by hundreds of billions of dollars over the next decade.
But there’s another point that’s gone largely forgotten: we’ve gone from a policy landscape in which Republicans agreed with 80% of Obamacare to one in which Republicans agree with 0% of Obamacare.
No one seems to remember this, but in September 2009, Louisiana Rep. Charles Boustany (R), the Republican who delivered the official GOP response to President Obama’s speech on health care reform, made an interesting declaration, telling MSNBC “about 80%” of the Democratic proposal is acceptable to Republicans.
Soon after, none other than Eric Cantor, now the House Majority Leader, said Republicans and Democrats agree on 80% of the health care reform measures.
Keep in mind, these comments came when the public option was still a key component of the Democratic plan — which suggests by the time the proposal was being voted on, Republicans liked more than 80% of Obamamcare.
This, of course, leads us to a few questions for Boehner and his cohorts. One, how is it congressional Republicans went from 80% to 0%, when the reform package itself did not move to the left? And two, if Republicans intend to get rid of “the entirety” of the law, including parts that enjoy overwhelming public support, why should voters back GOP candidates?
By: Steve Benen, The Maddow Blog, May 18, 2012
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