“GOP Like The Dog That Chases A Car”: Republican’s Can’t Do Better Than ObamaCare No Matter What They Would Like You To Believe
We are all familiar with the spectacle of a dog frantically chasing a car, which strikes us as stupid because, after all, what on Earth would the dog do with the car if it actually caught it?
That’s basically what we’re witnessing with the Republicans’ monomaniacal war on the Affordable Care Act:
The GOP’s message may well evolve between now and November, but the most tangible early indicator — advertising spending by conservative groups against Democratic candidates — shows how intensely it is focusing on the health-care law.
“It has been the predominant focus of both our grass roots and our advertising efforts,” said Tim Phillips, president of Americans for Prosperity, the primary political operation of a donor network backed by billionaire industrialist brothers Charles and David Koch.
Of the roughly $30 million the group has spent on ads since August, Phillips said, at least 95 percent has gone toward spots about the health-care law.
Democrats have been tracking that spending to help gauge what their candidates will be facing.
In Senate races, where control of the chamber is on the line, all but $240,000 of the $21.2 million that super PACs are spending on television advertising has gone into attacks centered on the health-care law, said Matt Canter, deputy executive director of the Democratic Senatorial Campaign Committee. The exceptions were ad buys in three states that criticized Democratic senators for supporting President Obama’s judicial nominees.
There is a lot of polling data about ObamaCare, and you can pick and choose which numbers you want to focus on. I like the fact that 57% of self-proclaimed independents think we should either keep the law as it is or make improvements to it, versus 33% who think it should be scrapped. I don’t like that 29% of voters say that they have been negatively impacted by the law versus 17% who say that they have benefitted.
Overall, you could fairly say that the law is slowly becoming less unpopular. This is a victory in itself, considering how much money the Republicans have spent on trashing the law, and how little money the Democrats have spent defending it. If the law were to become popular, the Republicans’ entire midterm strategy would collapse.
As I’ve noted in recent days, the Republicans are so focused on using ObamaCare as a weapon in the midterms that they don’t want to take on tax or immigration reform because either issue would divide their caucus and take the country’s focus off their war on health coverage.
But, I think the public is going to notice that they are like the dog that chases the car. If you elect them to dismantle ObamaCare, they will have no solutions. They can’t do better than ObamaCare no matter what they would like you to believe. Their proposed reforms would cost more money, insure less people, and take away plans from people who like their plans. Everything they claim not to like about the law, they would make worse.
So, while I am nervous about the differential in firepower and resources being dedicated to arguing about ObamaCare, I think the Republicans are putting all their eggs in one basket full of lies and distortion and that we ought to be able to outflank such a clumsy, plodding, charge.
By: Martin Longman, Ten Miles Square, Washington Monthly, February 27, 2014
“They’ll Never Rally Behind A Single Plan”: The GOP’s Push To Replace ObamaCare Is Cynical And Doomed
On Friday, House Majority Leader Eric Cantor (R-Va.) is gathering key members of his caucus to work toward coming up with a single, official Republican alternative to the Democrats’ Affordable Care Act (ACA), or ObamaCare. Republican lawmakers have several competing bills to work with, and putting the party’s weight behind one plan or piece of legislation would be great for the country: Finally, America could have a real discussion about the best way to reform America’s health care insurance system.
But an official Republican health care plan would also be great for Democrats — which is reason No. 1 Republicans aren’t going to actually rally behind a single plan.
They will, of course, make a public effort. “GOP leaders have been clear that ahead of the 2014 elections, the conference wants to show what it is for, not simply what it is against,” says Daniel Newhauser at Roll Call. “Similarly, they want to show that they are not in favor of simply returning to the old health care system, which is viewed unfavorably by the electorate.” But any viable plan needs 218 votes from the fractured GOP caucus.
Cantor and his fellow House Republicans have at least three separate House bills to consider — from Reps. Tom Price (R-Ga.), Paul Broun (R-Ga.), and Phil Roe (R-Tenn.) — and a plan from Sens. Tom Coburn (R-Okla.), Richard Burr (R-N.C.), and Orrin Hatch (R-Utah) that was unveiled to much fanfare in January. There’s also a bill, from Rep. Todd Young (R-Ind.), that would raise ObamaCare’s definition of full-time employment to 40 hours a week, from 30. And a George W. Bush administration economist named Edward Lazear is pushing what he calls BushCare.
As they sort through these plans, what criteria will they use? If they can agree on one proposal, says Roll Call‘s Newhauser, it’s “likely to include poll-tested measures that have broad agreement in the GOP conference, including allowing the purchase of health insurance across state lines, allowing insurance portability between jobs, expanding access to health savings accounts, and limiting medical malpractice lawsuits.”
Another way of putting that: Republicans are looking for popular talking points that sound different enough from ObamaCare to win support from the more conservative factions of the GOP caucus. The problem, as The Washington Post notes, is that “there are only so many ways to preserve the patient protections that the ACA offers, which Republicans say they want to keep, while maintaining a private insurance market and assisting those who can’t afford coverage.”
Once Republicans hold up a specific plan, the Congressional Budget Office gets to issue its verdict and the public gets to weigh the proposals not just against ObamaCare but also the GOP’s attacks against ObamaCare.
The CBO analysis for Rep. Young’s bill to raise full-time employment to 40 hours, for example, found that the bill would raise the federal deficit by $74 billion while reducing the number of people getting employer-sponsored health insurance by about a million; about half of those people would go on Medicaid or other public programs, the other half would be uninsured.
It’s not clear the other Republican proposals would be popular in practice, either. Some of them, as the Washington Post editors note, would be better than ObamaCare at holding down health care costs and incentivizing people to buy private health insurance. But they are more disruptive to the status quo — especially post-ObamaCare — and almost all of them would be ripe for articles about sick people losing coverage or watching their health insurance costs skyrocket.
All of the GOP alternative plans, in other words, have their own drawbacks. Some people will lose, and some people will win. They would reduce the role of the federal government in most cases, but increase the power of insurance companies. Many of the policies are really interesting. Here are some examples of the big ideas from the GOP plans:
Cap or end employer tax breaks for providing health insurance: The idea here is that the insurance market is distorted by the tax incentives for employers to offering their workers insurance. It’s a fair point. But capping the tax breaks, as Coburn-Burr-Hatch does, or eliminating them would almost certainly cause employers to drop their plans. Almost 60 percent of Americans get their health insurance through work.
Provide tax breaks for individuals to buy their own insurance: With no employer-offered health plans, individuals and families would buy their own insurance on the open market. The Coburn-Burr-Hatch plan, for example, offers age-adjusted tax credits to people at up to 300 percent of the federal poverty line: Individuals 18 to 34 would get $1,560 a year, while those 50 to 64 would get $3,720 a year (families would get more than double those figures). Lazear’s BushCare would give all Americans with any type of health insurance $7,500 a year in tax breaks, or $15,000 for families; if people opted to buy low-cost, low-coverage insurance, they’d pocket the difference.
Allow insurance to be sold across state lines: This is a perennial GOP proposal to lower health insurance costs. The idea is that if insurers could sell the same policies to any state, regardless of that state’s own insurance regulations, it would increase market competition and drive down prices. A 2005 CBO report estimated those savings to consumers at about 5 percent overall, with the savings skewed toward the young and healthy; the old and sick would pay more. Enacting this option would require scrapping the minimum standards required for all plans under ObamaCare — a selling point for conservatives who argue we use too much health care, anyway.
“The fact that Republicans are coalescing around healthcare reform plans of their own could be very bad news for ObamaCare,” says Sally C. Pipes at Forbes. “Once voters see that the Republican alternative adds up to sensible and affordable health care, ObamaCare’s days will be numbered.”
But the opposite is almost certainly true. And House Republicans know that.
The GOP has gotten a lot of mileage out of its push to repeal ObamaCare — with a big assist, since October, from the Obama administration — but now the law is signing up real people (four million and counting) for real insurance policies. Republicans have to do better than provide plausible-sounding alternatives. They have to come up with a plan that Americans will think is much better than ObamaCare, and worth the disruption of overhauling the health care system again.
Here’s the bottom line: If reforming America’s health care system to provide near-universal affordable coverage were easy, it would have been done 60 years ago — or at any point since. Several Democratic presidents had tried and failed before President Obama. If Republicans had wanted to take their own bite at the apple, they had plenty of chances, too.
This isn’t spitballing. If Republicans want to be relevant voices in the health care debate, they have to come up with something. They should come up with a plan they can try to sell to America.
“One of the unseemly aspects of the last four-plus months is watching some on the right root for ObamaCare to fail,” says Forbes‘ Avik Roy, one of ObamaCare’s wonkiest critics. Among some conservatives, “there has been a kind of intellectual laziness, a belief that there’s no need for critics to come up with better reforms, because Obamacare will ‘collapse under its own weight,’ relieving them of that responsibility.” But it’s clear now that’s not going to happen, he adds. “And that makes the development of a credible, market-oriented health-reform agenda more urgent than ever.”
Well, don’t hold your breath.
The Affordable Care Act was written and enacted by Democrats — with a few exceptions — and that’s one of its main weaknesses: If Republicans had helped shape and pass the law, they probably wouldn’t have spent the last four years attacking and undermining it. They now have at least 10 months left to criticize the law without having to take any serious action to replace it. Don’t expect them to squander the opportunity.
By: Peter Weber, The Week, February 26, 2014
“When Conservatives Cry Wolf”: It’s More Like A Howl For Attention And A Public Relations Campaign
There were two important developments in the Republican Party last week. Let’s take stock.
First, after years of saying that yes, they would develop and introduce an alternative to Obamacare, three GOP senators finally presented one: Orrin Hatch, Tom Coburn, and Richard Burr unveiled what they call their PCARE plan (yes, it’s another one of those syrupy, dopey Washington acronyms that have become such a pestilential constant in our city). Conservatives exulted; “See? We can be serious about policy!” But as Jonathan Chait wrote, the thing was awfully general and sketchy, and as soon as people started asking serious questions about how this or that would work, “things began to fall apart.” As of now, the plan has evanesced into something that no one really takes seriously and everyone recognizes for what it is—a mere talking point, a general outline that exists solely so Republicans can go on teevee and say they have a plan.
The second development occurred several days ago when John Boehner promised big movement on the immigration front. We’ll do a bill this year, he said. No citizenship, no “amnesty,” but a process toward legal status. The Republicans were ready to cut a deal. Boehner posted his guidelines for reform on his web site Monday. By Friday, 4,500 comments had been posted, roughly 95 percent (or more!) of them negative (“Please tell the Jews that we don’t want their One World Order. If they like immigrants send them to Israel[sic],” wrote user “Barbara Cornett”). At the end of the week, Boehner suggested that immigration reform might not, after all, be on the docket this year. (Update: I softened this language from the original, at the suggestion of Greg Sargent, and he’s right about Boehner’s words, although I remain a hard-shell skeptic.)
Remember when we had a “budget deal” in December, and the government didn’t shut down again, and negotiations didn’t go until the eleventh-and-a-half hour? At that point, we actually had some people talking about the dawn of a new day in Washington. Maybe the Republicans really were changing their stripes.
When an alcoholic is destroying a family, it’s his drinking, self-denial and lies that are creating the problem. But a lot of the time, the family contributes, too. It’s in, perhaps, its own state of denial. “Oh it’s not so bad, really. Oh he’s under lots of pressure. I think he can stop, I really do. Maybe not just yet. As soon as he gets through this (intense time at work/family illness/etc.).”
This is what the larger Washington establishment has become: The enabling spouse of the drunk. “They’ll change. I just know it. This time, I really don’t see how they can’t. I mean, supporting immigration reform is so clearly in their own self-interest!” And certainly, it is. But laying off the sauce is certainly in the alcoholic’s self-interest, too. In that case, we all understand why the alkie doesn’t stop. It has nothing to do with self-interest. He knows his own self-interest. But he can’t change until his shame and disgust with himself is such that he’s ready to try.
With the GOP, it’s more complicated, because this isn’t just one person’s conscience. It’s an entire machinery of ideology-fueled delusion and rage. In fact, now that I think about it, our two examples above are perfect, because each describes the two huge problems with the GOP extremely well. They also explain why they’re not going to be putting down the bottle anytime soon.
The healthcare vignette provides us a textbook example of how the GOP has retreated into policy fantasyland. The specific policy point on which the plan began to unravel was as follows: Our GOP trio proposed, of course, a way to cover more Americans, because that’s pretty much the point, right? Right. Okay. Well, to cover more people, you have to spend money, which means you have to come up with a way to finance it.
Obviously, that’s a pretty thorny dilemma for Republicans. But the trio decided to finance their healthcare expansion by placing a cap on untaxed health benefits. That is, healthcare benefits are untaxed right now. So Hatch, Burr, and Coburn would have taxed benefits starting at about 65 percent of the average cost of a plan.
In other words—yes, a tax increase! An expert from the Kaiser Family Foundation told Talking Points Memo: “This would be a meaningful hit on people. It’s a big radical change. This is not an incremental thing, and it affects most people under 65.” So, they quietly changed it, raising the cap, which obviously means less revenue and less coverage.
You can imagine what those three would have said if Obama had put forward something like this. (He proposed a tax on “Cadillac plans,” but they affect only a small percentage of health consumers.) So why would they do the same? Because they live in policy fantasyland. This plan wasn’t intended as anything serious. It was created for public relation purposes only.
Immigration showcases the other malignant GOP tumor: The rage of the base. The base won’t permit immigration reform. It’s pretty much that simple. Boehner, of course, could stand up to that base, and he’d pass a bill, with mostly Democrats. But he just told us he’s not going there.
And so it goes. People often ask me, Tomasky, when do you think they’re going to change? The answer, of course, is it depends. If they somehow capture the White House in 2016, then there’s no incentive to change, and the future is pretty bleak. But if they lose to Hillary Clinton, and she wins reelection, then I do think that by 2024 it will finally be a different party. Is that supposed to be reassuring? That’s a decade away!
In the meantime, they will keep doing what they do. I really wish Washington would stop enabling them, but people are nervous about their nonprofit status, their funders and board members, and are simply devoted to the idea that both parties are responsible. They’re helping the drunk stay drunk. As my friend Bill B. says, from their comments and actions on healthcare and immigration, to contraception and most everything else, the Republicans keep telling us who they are. When are people going to believe them?
By: Michael Tomasky, The Daily Beast, February 10, 2014
“Republican Alternative To Obamacare”: Pay More, Get Less, Put The Insurance Companies Back In Charge
Boy, can Democrats have fun with the new Republican alternative to Obamacare. It puts the health insurance companies back in charge and raises costs for almost all Americans. In particular, it substantially raises costs and threatens to cut coverage for the half of all Americans who get health insurance at work. Seniors, the group that Republicans have scared witless about Obamacare, would lose the real benefits they receive under Obamacare. The proposal from three Republican senators is a golden opportunity for Democrats to contrast the specific benefits of the Affordable Care Act (ACA) with what a repeal-and-replace agenda would really mean for Americans’ lives and health.
When it comes to the politics of health care reform, my first adage is “the solution is the problem.” That is because once you get past vague generalities, like lowering costs and making coverage available, to proposing specifics, people will look to see how the proposals impact them personally. This is why health reform is such a political nightmare. Unlike most public policy issues, the impact is very understandable and real.
With the ACA as the law of the land, in analyzing the Republican proposal we must compare its impact to the law it would repeal. The pre-ACA model of health insurance is irrelevant. Here is how the Republican plan would impact people, compared with the ACA:
People who get health insurance at work – bottom line: pay more for worse coverage.
Almost half of all Americans (48 percent), or 148 million people, obtain health insurance at work. The Republican plan would tax 35 percent of the average cost of health insurance benefits at work. This is a big tax increase on working people and is extraordinarily unpopular, as the Obama campaign used to devastating impact on John McCain. And while people would pay more, they would get less coverage, as the GOP plan would allow insurance companies to once again limit the amount of benefits they will pay out in one year and return to the day when employers could offer bare-bones plans.
While taxing health benefits would apply to all employer-provided coverage, the Republicans would give the 30 percent of people who work for businesses who employ fewer than 100 workers a tax credit. That might balance out the increased taxes for some people. However, doing so would create a huge set of economic distortions, as employers might seek to keep firm size under the 100-employee threshold.
Individuals who buy coverage on their own or who are uninsured – bottom line: insurance companies could again deny coverage for pre-existing conditions and offer bare-bones coverage, while the cost of decent coverage would go up for most people.
This is the group that the ACA is most aimed at helping, including the 5 percent of Americans who buy private health insurance and the 15 percent who are uninsured, totaling 64 million people. The ACA offers income-based subsidies to these people when they earn between 100 percent and 400 percent of the federal poverty level (FPL) and enrolls people under 133 percent of FPL in Medicaid, when states agree.
The Republican plan is toughest, in comparison with the ACA, on the lowest-income people and on the higher-income middle class, compared with Obamacare. But many families in between will do worse too.
The Republican plan would wipe out the expansion of Medicaid to people earning less than 133 percent of FPL, a provision the Supreme Court has made optional. It would cut back on Medicaid, ending the federal government’s offer to pay 90 percent of the cost of expanded coverage and replacing that with the federal government paying what it has paid historically, which is between half and three-quarters of the cost of Medicaid, with poorer states getting a bigger share. Crucially, the funding would only be for pregnant women, children and parents with dependent children who earn under the poverty level, as opposed to the ACA’s funding of all adults up to 133 percent of FPL. That means many fewer people covered and states getting less Medicaid money. Republican governors may not complain, but you can bet hospitals will. Adults without dependent children would not be covered by federal Medicaid, which means millions will stay uninsured or lose coverage they now have, unless states pay for coverage without federal support.
For individuals not covered by Medicaid or employees of firms with fewer than 100 workers, the Republican plan would replace the ACA’s sliding-scale subsidies, which now go to 400 percent of FPL, with a subsidy that is the same for everyone of the same age who is under 200 percent of FPL and lowersubsidies for people from 200 percent to 300 percent. In addition, the subsidies would be higher for older people than younger. The Republican plan also would take away the requirements that insurance plans offer decent benefits and free preventive care and charge women the same prices as men for coverage, along with every other consumer protection, with the exception of keeping in place no lifetime caps for covered benefits.
Comparing the value of the Republican plan subsidies vs. the ACA subsidies for the people who would still qualify depends on income, age, and family size. Generally, it appears that the Republican subsidies are much less than the ACA for people under 150 percent of the FPL ($35,000 for a family of four) and much less than the ACA for younger people, but more for older people. However, insurance rates for younger people would go down some at the expense of older people, who insurance companies could charge a lot more than under ACA. And families with incomes above $70,000 for a family of four would lose subsidies entirely.
Seniors and the disabled on Medicare – bottom line: seniors would pay more for prescription drugs and preventive care.
By repealing the ACA, the Republican plan would take away its two concrete benefits for seniors. One is that preventive care services are now free under Medicare (as they are under all insurance). The other is that the ACA is lowering drug prices for seniors by slowly closing the “donut hole,” under which seniors must pay the full cost of prescription drugs even though they are paying premiums for drug coverage. In other words, the Republican plan is simply bad news for seniors, the constituency that they have scared the most about Obamacare… groundlessly.
It is not surprising that Republicans have been reluctant to come up with a replacement for Obamacare. It’s much easier to throw darts – or bombs – at the ACA than to come up with a replacement that meets Republican ideological tenets of less regulation and less government. Any plan that meets the ideological test will be much worse for people in ways they can understand. It is our job to explain it to the public clearly: pay more, get less, put the insurance companies back in charge. This debate is not simply the political game Republicans want to make it. It is about our health and our lives.
By: Richard Kirsch, The National Memo, January 29, 2014
“We Invent, Experiment, And Fix What Has To Be Fixed”: Why You Shouldn’t Succumb To Defeatism About The Affordable Care Act
Whatever happened to American can-do optimism? Even before the Affordable Care Act covers its first beneficiary, the nattering nabobs of negativism are out in full force.
“Tens of millions more Americans will lose their coverage and find that new ObamaCare plans have higher premiums, larger deductibles, and fewer doctors,” predicts Republican operative Karl Rove. “Enrollment numbers will be smaller than projected and budget outlays will be higher.”
Rove is joined by a chorus of conservative Cassandra’s, from Fox News to the editorial pages of the Wall Street Journal, all warning that the new law will be a disaster.
Robert Laszewski, president of Health Policy and Strategy Associates, anticipates a shortage of doctors. “There just aren’t going to be enough of them.”
Professor John Cochrane of the University of Chicago predicts the individual mandate will “unravel” when “we see how sick the people are who signed up on exchanges, and if our government really is going to penalize voters for not buying health insurance.”
The round-the-clock nay-saying is having an effect. Support for the law has plummeted to 35 percent of those questioned in a recent CNN poll, a 5-point drop in less than a month. Sixty-two percent now say they oppose the law, up four points from November.
Even liberal-leaning commentators are openly worrying. On ABC’s “This Week,” Cokie Roberts responded to my view that the law eventually would prove popular by warning of “a whole other wave of reaction against it” if employers start dropping their insurance.
Some congressional Democrats are getting cold feet. West Virginia Senator Joe Manchin recently fretted that “if it’s so much more expensive than what we anticipated and if the coverage is not as good as what we had, you’ve got a complete meltdown.”
Get a grip.
If the past is any guide, some fixes will probably be necessary – but so what? Our current healthcare system is the real disaster — the most expensive and least effective among all developed countries, according Bloomberg’s recent ranking. We’d be collectively insane if we didn’t try to overhaul it.
But we won’t get it perfect immediately. What needs fixing can be fixed. And over time we can learn how to do it better.
If enrollments are lower than anticipated, the proper response is to keep at it until larger numbers are enrolled. CHIP, the Children’s Health Insurance Program, got off to a slow start in 1998. The Congressional Research Service reported “general disappointment … with low enrollment rates early in the program.” CHIP didn’t reach its target level of enrollment for five years. Now it enrolls nearly ninety percent of all eligible children.
Richard Nixon’s Supplemental Security Income program of 1974 – designed to standardize welfare benefits to the poor — was widely scorned at the time, and many states were reluctant to sign up. Even two years after its launch, only about half of eligible recipients had enrolled. Today, more than 8 million Americans are covered.
If mistakes are made implementing the Affordable Care Act, the appropriate response is to fix them. When George W. Bush’s Medicare Part D drug benefit was launched, large numbers of low-income seniors had to be switched from Medicaid. Many needed their prescriptions filled before the switch had been completed, causing loud complaints. The website for the plan initially malfunctioned. Pharmacies got the wrong information. Other complications led even Republican Representative John Boehner to call it “horrendous.” But the transition was managed, and Medicare Part D is now a firm fixture in the Medicare firmament.
If young people don’t sign up for the Affordable Care Act in sufficient numbers and costs rise too fast, other ways can be found to encourage their enrollment and control costs. If there aren’t enough doctors initially, medical staffs can be utilized more efficiently. If employers begin to drop their own insurance, incentives can be altered so they don’t.
Why be defeatist before we begin? Even Social Security — the most popular of all government programs — had problems when it was launched in 1935. A full year later, Alf Landon, the Republican presidential candidate, called it “a fraud on the workingman.” Former President Herbert Hoover said it would imprison the elderly in the equivalent of “a national zoo.” Americans were slow to sign up. Not until the 1970s did Social Security cover most working-age Americans.
As Alexis de Tocqueville recognized as early as the 1830s, what distinguishes America is our pragmatism, resilience, and optimism. We invent, experiment, and fix what has to be fixed.
Of course there will be problems implementing the Affordable Care Act. But if we’re determined to create a system that’s cheaper and more effective at keeping Americans healthy than the one we have now – and, in truth, we have no choice – we have every chance of succeeding.
By: Robert Reich, The Robert Reich Blog, December 27, 2013
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