“37 Pages Of Talking Points”: The Republican Healthcare Plan Isn’t Actually A Healthcare Plan
Rep. Billy Long (R-Mo.) boasted on Twitter yesterday, “You’ve asked for it and tomorrow, House Republicans will release our plan to replace Obamacare.” Whether or not this actually constitutes a “plan,” however, is open to some debate.
After six years of vague talk about a conservative alternative to the Affordable Care Act, House Republicans on Tuesday finally laid out the replacement for a repealed health law – a package of proposals that they said would slow the growth of health spending and relax federal rules for health insurance. […]
In finally presenting one, Speaker Paul D. Ryan of Wisconsin and his Republican team did not provide a cost estimate or legislative language. But they did issue a 20,000-word plan that provides the most extensive description of their health care alternative to date.
Perhaps, but let’s not grade on a curve. It was seven years ago this month that House Republican leaders began promising to unveil a GOP health-care-reform plan, and for seven years, the party has done nothing except offer vague soundbites and vote several dozen times to repeal the Affordable Care Act, replacing it with nothing.
Or put another way, we’ve seen seven years of posturing on health care policy, but no actual governing.
The New York Times is correct that we now have an “extensive description” of the House Republican vision on the issue, but an “extensive description” does not a plan make. There’s still no legislation; there are still no numbers; there’s still no substance to score and scrutinize.
The Huffington Post summarized the problem nicely: “Speaker Paul Ryan wants to replace 20 million people’s health insurance with 37 pages of talking points.”
The plan, which isn’t legislation and is more like a mission statement, lacks the level of detail that would enable a full analysis, but one thing is clear: If put in place, it would almost surely mean fewer people with health insurance, fewer people getting financial assistance for their premiums or out-of-pocket costs, and fewer consumer protections than the ACA provides.
It’s difficult to be certain, because the proposal, which House Speaker Paul Ryan (R-Wis.) will talk up at the American Enterprise Institute in Washington on Wednesday, lacks crucial information, like estimates of its costs and effects on how many people will have health coverage.
The document weighs in at 37 pages, which includes the cover, three full pages about how terrible Obamacare is, and two blank sheets.
As for the outline itself, the “plan” includes exactly what we’d expect it to include: tax credits, health savings accounts, high-risk pools that Republicans don’t want to finance, transitioning Medicare into a voucher/coupon system, and the ability to buy insurance across state lines without necessary consumer safeguards and protections.
After seven years of study, GOP lawmakers are stuck with the same collection of ineffective ideas they’ve been pushing to no avail all along.
When House Speaker Paul Ryan (R-Wis.) announced plans to unveil a six-part “Better Way” governing agenda, he vowed, “We’re not talking about principles here. This is substance.” That may have been the goal, but as of this morning, we’re still left with “a starting point” and “a broad outline” on health care that will ostensibly help Republicans to work out the details later.
There’s no great mystery here. Republicans haven’t been able to come up with a credible reform package for some pretty obvious reasons: (1) they’re a post-policy party with no real interest in governing; (2) health care reform has never really been a priority for the party, which would prefer to leave this in the hands of the private sector and free-market forces; and (3) trying to improve the system requires a lot of government spending and regulations, which contemporary GOP policymakers find ideologically abhorrent.
On this last point, New York’s Jon Chait explained a while back, “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.”
A Republican Hill staffer famously put it this way 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. The result is a shell of a plan, like the one Paul Ryan is rolling out today.
By: Steve Benen, The Maddow Blog, June 22, 2016
“Health Reform Realities”: A Simple, Straightforward Single-Payer System Just Isn’t Going To Happen
Health reform is the signature achievement of the Obama presidency. It was the biggest expansion of the social safety net since Medicare was established in the 1960s. It more or less achieves a goal — access to health insurance for all Americans — that progressives have been trying to reach for three generations. And it is already producing dramatic results, with the percentage of uninsured Americans falling to record lows.
Obamacare is, however, what engineers would call a kludge: a somewhat awkward, clumsy device with lots of moving parts. This makes it more expensive than it should be, and will probably always cause a significant number of people to fall through the cracks.
The question for progressives — a question that is now central to the Democratic primary — is whether these failings mean that they should re-litigate their own biggest political success in almost half a century, and try for something better.
My answer, as you might guess, is that they shouldn’t, that they should seek incremental change on health care (Bring back the public option!) and focus their main efforts on other issues — that is, that Bernie Sanders is wrong about this and Hillary Clinton is right. But the main point is that we should think clearly about why health reform looks the way it does.
If we could start from scratch, many, perhaps most, health economists would recommend single-payer, a Medicare-type program covering everyone. But single-payer wasn’t a politically feasible goal in America, for three big reasons that aren’t going away.
First, like it or not, incumbent players have a lot of power. Private insurers played a major part in killing health reform in the early 1990s, so this time around reformers went for a system that preserved their role and gave them plenty of new business.
Second, single-payer would require a lot of additional tax revenue — and we would be talking about taxes on the middle class, not just the wealthy. It’s true that higher taxes would be offset by a sharp reduction or even elimination of private insurance premiums, but it would be difficult to make that case to the broad public, especially given the chorus of misinformation you know would dominate the airwaves.
Finally, and I suspect most important, switching to single-payer would impose a lot of disruption on tens of millions of families who currently have good coverage through their employers. You might say that they would end up just as well off, and it might well be true for most people — although not those with especially good policies. But getting voters to believe that would be a very steep climb.
What this means, as the health policy expert Harold Pollack points out, is that a simple, straightforward single-payer system just isn’t going to happen. Even if you imagine a political earthquake that eliminated the power of the insurance industry and objections to higher taxes, you’d still have to protect the interests of workers with better-than-average coverage, so that in practice single-payer, American style, would be almost as kludgy as Obamacare.
Which brings me to the Affordable Care Act, which was designed to bypass these obstacles. It was careful to preserve and even enlarge the role of private insurers. Its measures to cover the uninsured rely on a combination of regulation and subsidies, rather than simply on an expansion of government programs, so that the on-budget cost is limited — and can, in fact, be covered without raising middle-class taxes. Perhaps most crucially, it leaves employer-based insurance intact, so that the great majority of Americans have experienced no disruption, in fact no change in their health-care experience.
Even so, achieving this reform was a close-run thing: Democrats barely got it through during the brief period when they controlled Congress. Is there any realistic prospect that a drastic overhaul could be enacted any time soon — say, in the next eight years? No.
You might say that it’s still worth trying. But politics, like life, involves trade-offs.
There are many items on the progressive agenda, ranging from an effective climate change policy, to making college affordable for all, to restoring some of the lost bargaining power of workers. Making progress on any of these items is going to be a hard slog, even if Democrats hold the White House and, less likely, retake the Senate. Indeed, room for maneuver will be limited even if a post-Trump Republican Party moves away from the scorched-earth opposition it offered President Obama.
So progressives must set some priorities. And it’s really hard to see, given this picture, why it makes any sense to spend political capital on a quixotic attempt at a do-over, not of a political failure, but of health reform — their biggest victory in many years.
By: Paul Krugman, Op-Ed Columnist, The New York Times, January 18, 2016
“The Problem Is The Politics”: Sanders’ Single-Payer Plan Is A Distraction
If you’ve successfully landed on the beaches, but your forces are still taking heavy fire, what do you do? Do you concentrate on trying to hold the line and make further advances or do you sit in a circle and design a better landing craft?
The problem with Bernie Sanders’ health care vision isn’t the vision. His raw outline for a greatly simplified and less expensive health-care system is excellent in theory. The problem is the politics — the reality of which battle-scarred Hillary Clinton clearly has the better grasp.
This was the message Clinton tried to convey in the Sunday Democratic debate. Her most potent point on health-care reform centered on recalling the “public option” fiasco during the fight for the Affordable Care Act.
The public option was to be a government-run health plan competing with the private offerings in the health-care exchanges. It was a no-brainer to keep the insurance companies on a shorter leash. But, as Clinton noted, “even when the Democrats were in charge of the Congress, we couldn’t get the votes for that.”
John E. McDonough, a health policy expert at Harvard, has also been through the health-care wars. As a Massachusetts state legislator, McDonough led an unsuccessful campaign to bring single-payer to his liberal state. In a recent New England Journal of Medicine article, he explained why a similar effort in Sanders’ own state of Vermont failed.
Vermont was the great hope for we fans of single-payer. (I was waving pompoms.) The state is progressive and one footstep from Canada. Gov. Peter Shumlin was totally onboard. He spent four years trying to make a single-payer plan happen. Three major-league studies showed that it was economically feasible.
But even in Vermont, a clear public mandate for single payer never materialized. A rebellion against it almost cost Shumlin the governor’s job.
Asked about this on Sunday, Sanders took a swipe at Shumlin (who has endorsed Clinton).
“Let me just say that you might want to ask the governor of the state of Vermont why he could not do it,” Sanders responded. “I’m not the governor. I’m the senator from the state of Vermont.”
Yes, and as senator from Vermont, Sanders introduced several single-payer bills that went nowhere. The most recent one, the 2013 American Health Security Act, attracted not a single co-sponsor.
The plan Sanders released two hours before the debate remains too sketchy for a reliable independent analysis, according to McDonough. But lack of detail isn’t his biggest concern. It’s opening a new front in the battle to defend Obamacare.
“Republicans sent a bill to the President’s desk last week that would eliminate health insurance for 22 million Americans by 2018,” McDonough wrote me. “This is not beanbag. It’s the real deal, and we have to focus where it matters the most.”
“Bernie wants to lead us on a distraction tour while Republicans want to kill the progress we have made.”
How far have we come? Thanks to Obamacare, almost 18 million formerly uninsured Americans now have health coverage. A report just out of Georgetown University has the rate of uninsured Hispanic children falling to a historic low.
Insurers can no longer turn down people with pre-existing conditions. And important politically, Obamacare has demonstrated that universal coverage is doable without creating mass unemployment or “exploding” deficits. On the contrary.
Making Obamacare more Medicare-like through incremental steps may not feed the romantic urge to reinvent health-care reform from scratch, but there’s no other road, not in the America of 2016. Finally, let’s not forget that vanguard of reform is still on the beaches and taking fire.
Correction: The health policy expert at Harvard is John E. McDonough, not Thomas. We regret the error. This article has been updated to reflect that change.
By: Froma Harrop, Featured Post, The National Memo, January 19, 2016
“The Urgency Of Six Years Later”: Ryan Sees ‘Urgent’ Need For GOP Alternative To Obamacare
House Speaker Paul Ryan (R-Wis.) delivered a fairly long speech at the Library of Congress yesterday, fleshing out his vision for making America “confident again” through a far-right approach to governing. There wasn’t anything particularly surprising about the remarks, and the Republican leader conceded his vision won’t be implemented so long as President Obama is in office.
But there was one part of the speech that jumped out at me as noteworthy. On health care policy, the new Speaker said “the other side” – presumably, Democrats – opposes giving consumers choices, while Republicans want to encourage “insurance companies to compete for your business.” It’s an odd line of attack, since the Affordable Care Act’s exchange marketplaces were specifically designed to invite insurers to compete for consumers’ business. I’m not sure how he could have missed this detail.
Ryan added:
“There are a lot of other ideas out there, but what all conservatives can agree on is this: We think government should encourage personal responsibility, not replace it. We think prices are going up because people have too few choices, not because they have too many. And we think this problem is so urgent that, next year, we are going to unveil a plan to replace every word of Obamacare.”
Let’s just skip the usual points about the efficacy of the ACA, the law’s many successes, and the millions of Americans benefiting from its implementation. Suffice it to say, there’s no credible reason to try – or even want to try, really – to replace “every word” of the Affordable Care Act.
What I found amusing, however, was Ryan’s use of the word “urgent.”
As the Republican leader sees it, there’s no time to waste. The problems in the health care system are so great that the Speaker believes it’s “urgent” for his party to present their conservative alternative – nearly six years after the ACA was signed into law, nearly two years after the ACA was fully implemented. Now Ryan’s serious about his party’s replacement plan.
It’s hard for even the most charitable observers not to laugh. On June 17, 2009, then-Rep. Roy Blunt (R-Mo.), a member of the House Republican leadership at the time, publicly declared that he was helping craft his party’s alternative to the Affordable Care Act. “I guarantee you we will provide you with a bill,” he said six and a half years ago.
The same week, then-Minority Whip Eric Cantor (R-Va.) told reporters that the official Republican version of “Obamacare” was just “weeks away.”
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.
We were told 2014 would be different. In April 2014, House Majority Whip Kevin McCarthy (R-Calif.) said his party’s plan was nearly done, but was being delayed “at least a month.” That was 20 months ago.
Then we were told 2015 would be different. Ryan was tasked with personally heading up a Republican “working group” that would finally put together the GOP’s health care plan. Then-House Speaker John Boehner promised Fox News, “There will be an alternative, and you’re going to get to see it.”
That was 11 months ago.
As of yesterday, however, Ryan believes the issue is “so urgent” that we’ll see the Republican “plan” in 2016. And who knows, maybe we will. I wouldn’t bet on it, but anything’s possible.
But revisiting a piece from February, I think we can safely assume that the House GOP alternative to “Obamacare” – if it ever exists – is going to be cover-your-eyes horrible. How can I know that? Because in order to actually reform the pre-2010 health care system – “replacing every word” of the ACA – policymakers have to commit to extensive public investments, expansive government regulation of the insurance industry, and a commitment to help struggling families receive guaranteed benefits.
In other words, to do reform right, Republicans would have to willingly take policy steps that are anathema to everything they believe about government. It’s a safer bet they’ll do reform wrong – if they follow through at all – and when the GOP alternative stands alongside “Obamacare” and consumers are allowed to compare, it won’t be much of a contest.
This point is routinely lost on much of the chattering class, but Republicans don’t actually like health care reform, which is why we’ve waited so many years to see a plan that still doesn’t exist. GOP lawmakers didn’t see the old system – the bankruptcies, the uninsured rates, the deaths, Americans paying more for less – as a problem requiring a solution, which is precisely why they haven’t invested time and energy in writing a detailed reform blueprint.
Ryan seems to think this time will be different.
By: Steve Benen, The Maddow Blog, December 4, 2015
“Health Reform Lives!”: The Reality Is That Obamacare Is An Imperfect System, But It’s Workable — And It’s Working
To the right’s dismay, scare tactics — remember death panels? — and spurious legal challenges failed to protect the nation from the scourge of guaranteed health coverage. Still, Obamacare’s opponents insisted that it would implode in a “death spiral” of low enrollment and rising costs.
I mention all of this to give you some perspective on recent developments that mark a break in the string of positive surprises. Yes, Obamacare has hit a few rough patches lately. But they’re much less significant than a lot of the reporting, let alone the right-wing reaction, would have you believe. Health reform is still a huge success story.
Obamacare seeks to cover the uninsured through two channels. Lower-income Americans are covered via a federally-funded expansion of Medicaid, which was supposed to be nationwide but has been rejected in many Republican-controlled states. Everyone else has access to policies sold by private insurers who cannot discriminate based on medical history; these policies are supposed to be made affordable by subsidies that depend on your income.
Nobody ever expected Obamacare to cover all the uninsured. In fact, Congressional Budget Office projections made in 2013 suggested that about 10 percent of nonelderly U.S. residents would remain uncovered: some because they are undocumented immigrants, some because of the gap created by red-state Medicaid rejection and some because they would fall through the cracks of a complicated system. But the law was nonetheless projected to produce a sharp reduction in the number of Americans without insurance, and it has, especially in states like California that have tried to make it work.
Meanwhile, both insurance premiums and the cost of subsidies designed to make them affordable came in far below expectations in both 2014 and 2015.
Sooner or later, of course, there were bound to be some negative surprises. And we’re now, finally, getting a bit of bad, or at least not-great, news about health reform.
First, premiums are going up for next year, because insurers are finding that their risk pool is somewhat sicker and hence more expensive than they expected. There’s a lot of variation across states, but the average increase will be around 11 percent. That’s a slight disappointment, but it’s not shocking, given both the good news of the previous two years and the long-term tendency of insurance premiums to rise 5-10 percent a year.
Second, some Americans who bought low-cost insurance plans have been unpleasantly surprised by high deductibles. This is a real issue, but it shouldn’t be exaggerated. All allowed plans cover preventive services without a deductible, and many plans cover other health services as well. Furthermore, additional financial aid is available to lower-income families to help cover such gaps. Some people may not know about these mitigating factors — that’s the problem with a fairly complex system — but awareness should improve over time.
Finally, UnitedHealth Group made a splash by announcing that it is losing money on the policies it sells on the Obamacare exchanges, and is considering withdrawing from the market after next year. There were some puzzling things about the announcement, leading to speculation about ulterior motives, but the main thing to realize is that UnitedHealth, while a huge provider of employment-based insurance, is actually a fairly small player in this market, and that other players are sounding much more positive.
Oh, and official projections now say that fewer people will enroll in those exchanges than previously predicted. But the main reason is that surprisingly few employers are dropping coverage; overall projections for the number of uninsured Americans still look pretty good.
So where does that leave us? Without question, the run of unexpectedly good news for Obamacare has come to an end, as all such runs must. And look, we’re talking about a brand-new system in which everyone is still learning how to function. There were bound to be some bobbles along the way.
But are we looking at the beginnings of a death spiral? Some people are indeed saying that, but as far as I can tell, they’re all people who have been predicting disaster every step of the way, and will still be predicting imminent collapse a decade from now.
The reality is that Obamacare is an imperfect system, but it’s workable — and it’s working.
By: Paul Krugman, Op-Ed Columnist, The New York Times, November 23, 2015
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