“The GOP Grand Swindle”: “We’re Not Going To Do Anything To Address Health Care”
It’s been nearly three months since House Majority Leader Eric Cantor (R-Va.) declared, “This year, we will rally around an alternative to ObamaCare and pass it on the floor of the House.” Last week House Majority Whip Kevin McCarthy (R-Calif.) said the plan is being delayed “at least a month.” A month from when? He didn’t say.
ThinkProgress reports that Rep. Dennis Ross (R-Fla.) is telling his constituents that his party doesn’t intend “to do anything” on this issue for the rest of the year.
CONSTITUENT: You’ve voted to repeal it approximately 50 times. Had zero votes on a replacement. So my question is, why do you think it is so good to deny seniors on Part D to make them pay more, about $4,000 more for medicine, and people with pre-existing conditions get denied insurance, have 26-year-olds have a harder time getting insurance because they can’t get on their parents’? Why do you think those are good ideas?
ROSS: I don’t. And let me tell you, I think one of the most unfortunate things my party did the last three years was not offer an alternative to health care. I’ve always felt that way. I think it’s absurd when I tell people that this isn’t what you should do, but I don’t have an alternative for you…. I wish we had an alternative. For the next six months, we’re going to go into an election knowing that we’re not going to do anything to address health care. Because we’ve gone so far in the last few years saying “no” that we don’t have an alternative to say “yes” to.
It’s not too common to hear House Republicans referring to their own party’s posture on health care as “absurd,” which make Ross’ comments fairly striking on their own.
There’s also the news that Ross is apparently under the impression that his party won’t bother with an ACA alternative at all in 2014, despite literally years of Republican promises to the contrary.
But perhaps most interesting of all was the two-word answer in response to the question from Ross’ constituent: “I don’t.”
The question made a lot of sense: here’s a Republican congressman who voted several dozen times to repeal – either in whole or in part – the Affordable Care Act, including all kinds of popular provisions, benefits, and consumer protections. Why is Ross against them?
He’s not, he says.
It’s part of an increasingly common pitch from congressional Republicans: they share the goals of “Obamacare,” they say, but disagree with how the reform law achieves those goals.
Rhetorically, that’s not a bad idea. Substantively, as Brian Beutler explained, it’s nonsense.
Republicans have replaced an unabashed “full repeal!” mantra with a deluge of weasel words meant to conceal the fact that “repeal” is still the beginning and end of their health-care reform agenda. It’s still the goal – they’re just a little ashamed of it now. And that places an onus on Dems (and reporters and anyone else who believes politicians should own the consequences of their policies) to be extremely explicit about the benefits Obamacare is conferring, and what an unvarnished rendering of GOP health policy would really look like.
This is clearly true of Ross, who went on to tell his constituents how much he likes all kinds of ACA provisions, making it sound as if he were somehow sympathetic to the law he voted to repeal several dozen times.
But real health care policy doesn’t work this way. A policymaker can’t (1) vote to gut the federal health care system; (2) endorse the goals of the federal health care system; (3) talk up the need for a credible alternative; (4) and offer no credible alternative, all at the same time.
It is, as Beutler added, “a grand swindle.”
By: Steve Benen, The Maddow Blog, April 17, 2014
“Rube Goldberg Survives”: Face It Republicans, Health Reform Has Won
Holy seven million, Batman! The Affordable Care Act, a k a Obamacare, has made a stunning comeback from its shambolic start. As the March 31 deadline for 2014 coverage approached, there was a surge in applications at the “exchanges” — the special insurance marketplaces the law set up. And the original target of seven million signups, widely dismissed as unattainable, has been surpassed.
But what does it mean? That depends on whether you ask the law’s opponents or its supporters. You see, the opponents think that it means a lot, while the law’s supporters are being very cautious. And, in this one case, the enemies of health reform are right. This is a very big deal indeed.
Of course, you don’t find many Obamacare opponents admitting outright that 7.1 million and counting signups is a huge victory for reform. But their reaction to the results — It’s a fraud! They’re cooking the books! — tells the tale. Conservative thinking and Republican political strategy were based entirely on the assumption that it would always be October, that Obamacare’s rollout would be an unremitting tale of disaster. They have no idea what to do now that it’s turning into a success story.
So why are many reform supporters being diffident, telling us not to read too much into the figures? Well, at a technical level they’re right: The precise number of signups doesn’t matter much for the functioning of the law, and there may still be many problems despite the March surge. But I’d argue that they’re missing the forest for the trees.
The crucial thing to understand about the Affordable Care Act is that it’s a Rube Goldberg device, a complicated way to do something inherently simple. The biggest risk to reform has always been that the scheme would founder on its complexity. And now we know that this won’t happen.
Remember, giving everyone health insurance doesn’t have to be hard; you can just do it with a government-run program. Not only do many other advanced countries have “single-payer,” government-provided health insurance, but we ourselves have such a program — Medicare — for older Americans. If it had been politically possible, extending Medicare to everyone would have been technically easy.
But it wasn’t politically possible, for a couple of reasons. One was the power of the insurance industry, which couldn’t be cut out of the loop if you wanted health reform this decade. Another was the fact that the 170 million Americans receiving health insurance through employers are generally satisfied with their coverage, and any plan replacing that coverage with something new and unknown was a nonstarter.
So health reform had to be run largely through private insurers, and be an add-on to the existing system rather than a complete replacement. And, as a result, it had to be somewhat complex.
Now, the complexity shouldn’t be exaggerated: The basics of reform only take a few minutes to explain. And it has to be as complicated as it is. There’s a reason Republicans keep defaulting on their promise to propose an alternative to the Affordable Care Act: All the main elements of Obamacare, including the subsidies and the much-attacked individual mandate, are essential if you want to cover the uninsured.
Nonetheless, the Obama administration created a system in which people don’t simply receive a letter from the federal government saying “Congratulations, you are now covered.” Instead, people must go online or make a phone call and choose from a number of options, in which the cost of insurance depends on a calculation that includes varying subsidies, and so on. It’s a system in which many things can go wrong; the nightmare scenario has always been that conservatives would seize on technical problems to discredit health reform as a whole. And last fall that nightmare seemed to be coming true.
But the nightmare is over. It has long been clear, to anyone willing to study the issue, that the overall structure of Obamacare made sense given the political constraints. Now we know that the technical details can be managed, too. This thing is going to work.
And, yes, it’s also a big political victory for Democrats. They can point to a system that is already providing vital aid to millions of Americans, and Republicans — who were planning to run against a debacle — have nothing to offer in response. And I mean nothing. So far, not one of the supposed Obamacare horror stories featured in attack ads has stood up to scrutiny.
So my advice to reform supporters is, go ahead and celebrate. Oh, and feel free to ridicule right-wingers who confidently predicted doom.
Clearly, there’s a lot of work ahead, and we can count on the news media to play up every hitch and glitch as if it were an existential disaster. But Rube Goldberg has survived; health reform has won.
By: Paul Krugman, Op-Ed Columnist, The New York Times, April 3, 2014
“A Vile And Wicked Plot”: How Barack Obama Trapped The GOP On Health Care
Barack Obama has done many dastardly things to Republicans. He regularly ridicules their arguments. He insists on being treated as though he were legitimately the president of the United States. And most cruelly of all, he beat their standard-bearers in two national elections. Is it any wonder they loathe him so? But one thing Obama has done to the GOP has gone unnoticed: he made it impossible for them to be serious about health care policy.
By now you’re well familiar with how the core of the Affordable Care Act—a ban on insurance companies denying coverage for pre-existing conditions (also known as “guaranteed issue”), accompanied by an individual mandate and subsidies for people of moderate incomes to purchase private insurance—was originally a conservative proposal. The idea was that unlike in most other western countries where a large government program like Medicare covers all citizens, you could achieve something close to universal coverage and health security through the use of markets. When Mitt Romney installed it in Massachusetts, it worked quite well and everybody was pleased. But then Barack Obama came along and embraced it, so all good and true conservatives had to conclude that it was not only a terrible idea in practical terms but a vile and wicked plot to rob Americans of their freedom.
And that has left Republicans in a difficult spot. They would very much like to have market-based health care ideas they could rally around, if nothing else than to demonstrate to the public that they sincerely want to fix what’s wrong in America’s health care system. But the theft of the guaranteed issue-plus-mandate-plus-subsidies framework has left them with nothing but unappetizing scraps off the health care table, none of which will do much of anything to address problems like the large number of uninsured Americans.
There’s a ritual people like me have taken to of late. Republicans announce that they’re about to release a health care plan. Then we say sarcastically, “Gee, let me guess. It involves 1) tort reform; 2) letting people buy insurance across state lines; 3) incentives for more use of health savings accounts, and 4) high-risk pools for people with pre-existing conditions” (here’s a recent example). And we’re always right, because those are the Big Four conservative health care ideas, and nobody can come up with anything different.
Here’s the thing about these ideas: neither any of them individually, nor all of them collectively, would even begin to tackle the things that ail the American health care system, the things the Affordable Care Act was meant to address. Tort reform—which means making it difficult or impossible for patients to sue for malpractice—won’t bring down costs like conservatives think it will. We know this because a number of states have enacted the kind of tort reform Republicans advocate for the whole nation, and it had no impact on spending. Realistic assessments of the effect of tort reform on medical spending conclude that if there’s any impact at all, it would be tiny (I discussed this issue at length here).
Letting people buy insurance across state lines would be fine if it was accompanied by national standards for policies; you’ve surely forgotten it by now, but the more liberal House version of the ACA created a national insurance exchange instead of 50 state exchanges, in which you could have bought insurance from anywhere. But a well-regulated system isn’t what conservatives want; they propose to remove the ACA’s regulations and then initiate a race to the bottom, where the least-regulated state would offer cheap insurance to lure customers who wouldn’t realize the limits of what they had bought until they got sick (here’s an explanation of just how bad an idea this is).
As for health savings accounts, we already have them. They’re a great deal for people who are healthy, but not so much when you actually need care. And high-risk pools are a terrible solution as anything other than a temporary stopgap—they put all the sick people in the same pool, meaning covering them is extremely expensive. That’s no help to the tens of millions of Americans with pre-existing conditions.
Which brings us to Louisiana governor Bobby Jindal, who is almost certainly running for president in 2016. There aren’t a lot of Republicans who have a good understanding of health care policy, but Bobby Jindal is one of the ones who do. Back in 1996, at the tender age of 24, he was appointed the head of the Louisiana Department of Health; George W. Bush later made him an assistant secretary of health and human services. So he’s well familiar with this issue, and surely has a reasonably good understanding of which policies are likely to have a large impact and which are likely to make no difference at all.
But Jindal is hamstrung, like all Republicans, by the fact that they can’t advocate anything Barack Obama has ever supported. So when he released a health care plan yesterday, it was a predictable mixture of small-bore proposals (Wellness incentives! Eliminate fraud!), and the Big Four conservative ideas. For good measure, he threw in a version of Paul Ryan’s plan to turn Medicare from an insurance program into a voucher program, where the government would give seniors a certain amount of money and then they’d seek private insurance, with the invisible hand of the market bringing prices down, all previous evidence to the contrary notwithstanding.
In fairness to Jindal, he has tweaked a few things from the standard conservative playbook. He would require insurance companies, once they’ve sold you insurance, to continue your plan even if you get sick—but doesn’t say how he’d protect the tens of millions of Americans with pre-existing conditions who would have trouble getting covered in the first place, other than state high-risk pools. And there are a few smaller features of his proposal that make sense. For instance, he’d change the tax treatment of health insurance so everyone could get the same favorable treatment that people with employer-provided insurance get. That would increase the fairness of the system, even if Jindal’s assertions that it would magically cut the ranks of the uninsured by 9 million and dramatically slow health care spending are absurd on their face.
But if we repealed the ACA and instituted all of Jindal’s proposed reforms, we’d still have all the problems we had before the ACA was passed. And I suspect that if you gave him a truth serum, he’d admit that none of what he proposes would have much of a salutary effect. But that’s where conservatives are. Barack Obama stole the one market-based idea they had that might actually bring us to something close to universal coverage. They have no idea where to go from there, and that’s how it’s going to be for the foreseeable future. They’ll feel the need to keep saying, “We have a plan too!” And when everyone says, “OK, tell us what it is,” it will be the same old thing, and no one will take them seriously.
By: Paul Waldman, Contributing Editor, The American Prospect, April 3, 2014
“BobbyCare”: Jindal’s Generic Obamacare Alternative
If congressional Republicans need a fresh excuse to delay settling on an Obamacare “replacement” plan, Bobby Jindal’s given them one by throwing another plan into the mix. But on further examination, the Genius’ proposal is sort of the ultimate Generic Conservative Plan, complete with a Generic Conservative label, the Freedom and Empowerment Plan. It was released by Jindal’s pocket “think tank,” America Next.
Is there any hoary conservative health policy pet rock this plan omits? I don’t see any on a quick examination. You got your interstate insurance sales. You got “tort reform.” You got new incentives for setting up Health Savings Accounts. You got state-run high-risk pools for those with pre-existing conditions. You got a shift in the tax code from deductions for employer-sponsored health insurance to individually purchased health insurance. There’s a Medicaid block grant, and for extra measure, borrowed from the Ryan Budget, there’s Medicare converted to a premium support system for private insurance instead of single-payer government-supplied insurance.
There are a couple of wrinkles that stand out. Unlike, say, John McCain’s 2008 health care proposal, which BobbyCare resembles, Jindal would deploy not tax credits for insurance purposes but a new standard deduction. Wouldn’t that be regressive in its impact? No problem, says Jindal: po’ folks with little use for a tax deduction could share the state-run high-risk pools designed for those with preexisting conditions, providing an appropriately fenced-off health insurance ghetto for the poor and the sick (I’m sure that would fare really well in the federal and state appropriations processes).
Jindal’s plan is also a little vague about the transition to voucherized Medicare, though he suggests traditional Medicare should include a cap on “catastrophic” health expenses, presumably to reduce reliance on Medigap policies.
One provision isn’t vague at all:
[R]epeal of Obamacare will remove the law’s anti-conscience mandates, and the funding of plans that cover abortions. But true health reform should go further, instituting conscience protections for businesses and medical providers, as well as a permanent ban on federal funding of abortions, consistent with the Hyde Amendment protections passed by Congress every year since 1976.
BobbyCare is the work of a genius only if hunting and collecting past proposals is a brilliant endeavor (indeed, he seems concerned to take credit for Medicare as Premium Support away from Ryan by noting the 1999 commission he chaired proposed something similar). It will probably undercut support for more novel and politically feasible Republican proposals like the Coburn-Burr-Hatch plan. But no matter: the Legend of Bobby Jindal, Boy Genius, will get another layer of thin varnish.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, April 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
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