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“Way Off Base”: Busting Zombie Obamacare Myths

The Republican effort to defund or delay health care reform at any cost has kept alive many misconceptions and false claims about the Affordable Care Act. This roundup of Center on Budget and Policy Priorities’ work on issues related to health reform and the federal government shutdown provides a large dose of reality.

A delay in the individual mandate is neither harmless nor fair: Let’s start with the big one: that a one-year delay in the individual mandate requiring everyone to acquire health insurance as long as it is affordable is harmless and fair because the Obama administration delayed for a year the requirement that large employers provide health insurance or pay a penalty. I discussed some flaws in that argument in an earlier post on this blog.

In CBPP’s shutdown roundup, Edwin Park reiterates why a delay in the individual mandate is neither harmless nor fair. It’s not harmless because it would cause 11 million more Americans to remain uninsured in 2014 and result in higher premiums in the individual market for many others, according to the Congressional Budget Office. It also would disrupt the new health insurance exchanges and likely delay the availability of coverage through the exchanges.

It’s also not fair to equate delay of the individual mandate to a delay in the employer requirement. Park highlights an Urban Institute analysis which showed that the employer delay would have only a small effect on the coverage gains expected under the ACA and which concluded that it would “be dangerously wrong” to assume a similarly small effect from a delay of the individual mandate. Similarly, CBO estimates that delaying the employer requirement would increase the number of uninsured by less than 500,000 – a far cry from the estimated 11 million increase from delaying the individual mandate.

The ACA will not likely cause a significant shift to part-time work: The employer responsibility provision whose implementation was delayed until 2015 requires larger employers (those with at least 50 full-time-equivalent workers) to offer health coverage to their full-time employees (those working 30 or more hours a week) or pay a penalty. Critics claim that we could already see a shift to part-time work in the data before the announced delay. Some have argued that the cutoff for defining full-time work should go from 30 hours a week to 40.

In CBPP’s shutdown roundup, Paul Van de Water shows that data this year provides scant evidence of a significant shift toward part-time work and that there’s every reason to believe that the ultimate effect will be small as a share of total employment. Van de Water shows, however, that raising the threshold from 30 to 40 hours a week would expose a significant number of workers to a reduction in hours.

Medical device manufacturers are unlikely to lose from the ACA despite a tax: A strong lobbying effort is underway to repeal the ACA’s 2.3 percent tax on certain medical devices such as coronary stents, artificial knees and hips, cardiac pacemakers, irradiation equipment and imaging technology. In the CBPP roundup, Paul Van de Water explains why that tax, which helps pay for extending health coverage to millions of uninsured Americans, is sound and the arguments against it are not.

First, the tax does not apply to wheelchairs, eyeglasses and other devices that the public generally buys at retail and for individual use. Second, the tax is levied on equipment that manufacturers will likely see a boost in revenue from due to the increase in health coverage afforded by the ACA. As Van de Water points out, a study by Wells Fargo Securities finds that health reform will increase device sales by 1.5 percent in 2014 and by 3.6 percent cumulatively through 2022 – enough to offset the tax.

Finally, this is a highly profitable industry, and the stock prices of the top device manufacturers have generally outperformed market averages since the tax was introduced this year.

The ACA is a major piece of legislation with many interrelated moving parts, and there will be some glitches along the way as it’s implemented. But the criticisms we’re hearing in the current budget fight are way off base.


By: Chad Stone, U. S. News and World Report, October 4, 2013

October 5, 2013 Posted by | Affordable Care Act, Individual Mandate | , , , , , | 1 Comment

Mitt Romney Must Clarify Defense Of Individual Mandate

I sympathize a little with former Gov. Mitt Romney on the issue of the individual mandate. In effect, the conservative movement pulled the rug out from under him.

He copped the idea from the Heritage Foundation, a conservative think  tank. Conservative legal scholars didn’t cry foul when Romneycare  passed in 2006. Tea Party enforcer Sen. Jim DeMint didn’t seem to have a problem with it. Former Speaker Newt Gingrich explicitly supported it as late as 2008.

But when it became a central element of Obamacare, it suddenly became the thin end of the socialist wedge.

Still, Romney stretches things with his recent defense of the mandate:

What we did was right for the people of Massachusetts,  the plan is still favored by 3 to 1 and it is fundamentally a  conservative principle to insist that people take personal  responsibility as opposed to turning to government for giving out free  care.

Is the mandate really a reflection of the principle of personal responsibility?

Doesn’t the purist case for personal responsibility look more like the one made by Rep. Ron Paul in the Tea Party debate, in which Paul said freedom is about letting people suffer the consequences of risky behavior?

Put it this way: If Romney and Paul both say they’re for insisting on personal responsibility, they can’t both be right.

What we have here are two subtly different conceptions of “personal responsibility.”

When Romney uses the phrase, he means that, in the decision to  purchase a major medical insurance policy, there’s a self-evidently  “responsible” choice: You get coverage, even if you’re young and  healthy.

When Paul uses it, he means you should be free not to buy it—and the  rest of us shouldn’t have to foot the bill if your luck turns rotten.

Romney the technocrat probably thought of the individual mandate in  terms of Cass Sunstein (currently serving in the White House’s Office of  Information and Regulatory Affairs) and Richard Thaler’s “nudge theory” of human behavior: Government can encourage people to make better choices through wiser “choice architecture” instead of blunt instruments.

The problem for Romney, of course, is that lots of conservatives now  believe the mandate is a blunt instrument—and lustily cheer at Paul’s  more exacting definition of personal responsibility.

If Romney wants to continue to use the phrase to win over  conservative skeptics, he’s going to have to clarify what he means by  it.


By: Scott Galupo, U. S. News and World Report, December 28, 2011

December 29, 2011 Posted by | Election 2012, Individual Mandate | , , , , , , | 2 Comments

Romney Describes Healthcare Mandate As Conservative Principle

GOP presidential candidate Mitt Romney said the insurance mandate included in the Massachusetts healthcare law he signed is fundamentally a conservative principle.

Speaking Wednesday on “Fox and Friends,” Romney defended the Bay State’s healthcare law, which includes a version of the individual mandate, as inline with the Republican world view. The individual mandate was the centerpiece and most controversial aspect of the Obama administration’s Affordable Care Act, which has widely been blasted by Republicans as governmental overreach.

“I’m happy to stand by the things that I believe. I’m not going to change my positions by virtue of being in a presidential campaign,” Romney said. “What we did was right for the people of Massachusetts, the plan is still favored there by 3 to 1 and it is fundamentally a conservative principle to insist that people take personal responsibility as opposed to turning to government for giving out free care.”

On Tuesday, Romney and rival Newt Gingrich jabbed at each other over the matter after The Wall Street Journal uncovered a 2006 memo in which Gingrich said he “agreed entirely” with Romney’s healthcare bill.

Buzzfeed also uncovered a 2008 video in which Gingrich passionately defended the idea of an individual mandate and called it “immoral” for those who can afford to have insurance not to buy it.

“I knew that [Gingrich] supported the plan in the past, and I believe he supported it until he got into the race this year, but maybe before that he changed his view,” Romney said. “Look, our plan was right for our state, and in my view it was based on conservative principles that frankly came from Newt Gingrich and the Heritage Foundation, which was that instead of people relying on government to provide their care, they should take personal responsibility.”
But Gingrich said he now realizes that there are aspects of the law that are “unacceptable,” and that unlike Romney, he has the courage to say so.

“There are a lot of details of ‘Romneycare’ that are unacceptable,” Gingrich said Tuesday on CNN. “And the difference between me and Romney is I’ve concluded — and I’m prepared to say publicly — I’ve concluded, just as the Heritage Foundation did, that the idea didn’t work. Romney’s still defending the mandate that he passed.”

Both Romney and Gingrich have vowed to repeal Obama’s healthcare law if elected president.

Romney is battling Ron Paul for the lead in polls of Iowa voters less than a week before that state’s GOP caucus. Gingrich had been in the lead, but has faded under attack from Romney and other GOP candidates.


By: Jonathan Easley, The Hill, December 28, 2011

December 29, 2011 Posted by | Election 2012, Health Reform, Individual Mandate | , , , , , | Leave a comment

Newt Praised Romneycare Before He Was Against It

From the WSJ’s use of the Internet comes a 2006 letter on the website of a former Newt Gingrich consulting company praising a then-new development in healthcare, the Massachusetts health care law – or, as it’s known today, Romneycare:

The health bill that Governor Romney signed into law this month has tremendous potential to effect major change in the American health system,” said an April 2006 newsletter published by Mr. Gingrich’s former consulting company, the Center for Health Transformation.

The two-page “Newt Notes” analysis, found online by The Wall Street Journal even though it no longer appears on the center’s website, continued: “We agree entirely with Governor Romney and Massachusetts legislators that our goal should be 100% insurance coverage for all Americans.”

Mr. Gingrich’s rise to the top of the field has come in part from his bashing Mr. Romney for engineering a state health-care expansion that became a model for President Barack Obama’s 2010 health law. “Your plan essentially is one more big-government, bureaucratic, high-cost system,” Mr. Gingrich told Mr. Romney during an October debate in Las Vegas. He said Mr. Romney was trying to solve Massachusetts’ health-care problems “from the top down.”

R.C. Hammond, a spokesman for Mr. Gingrich, said the April 2006 essay shouldn’t be read as an endorsement of Mr. Romney’s health plan. He noted that it raised several questions about the Massachusetts effort, including whether the plan would work in the state. “Being critical…isn’t endorsing it,” he said.

Mr. Hammond said the Newt Notes essay wasn’t written by Mr. Gingrich himself.

It is true that the “Newt notes” wasn’t totally sanguine about the Romney health care plan, and Gingrich – or whoever the author was – warned its success depended on how it played out. However, there were other interesting bits in the “Newt notes,” such as this, per the original letter, flagged by Andrew Kaczynski:

The Romney plan attempts to bring everyone into the system. The individual mandate requires those who earn enough to afford insurance to purchase coverage, and subsidies will be made available to those individuals who cannot afford insurance on their own. We agree strongly with this principle, but the details are crucial when it comes to the structure of this plan…While the Commonwealth’s plan will naturally endure tremendous scrutiny from those who assert that the law will not work as intended, Massachusetts leaders are to be commended for this bipartisan proposal to tackle the enormous challenge of finding real solutions for creating a sustainable health system.

By: Maggie Haberman, Politico, December 26, 2011

December 27, 2011 Posted by | Health Reform, Individual Mandate | , , , , | Leave a comment

The GOP Policy Problem

Ezra Klein has an excellent point to make about Republicans and policy this morning. He’s writing about how many policies Mitt Romney and Newt Gingrich once supported that turned out to be Kenyan socialism once Barack Obama adopted them. Jonathan Cohn has yet another excellent example: Newt was an enthusiastic backer (with John Kerry!) of comparative effectiveness research — that is, having the government collect data about which medical treatments actually work. That was way back in 2008, but as Cohn points out, after it became part of ACA a few months later it immediately became evil socialist rationing, something that Gingrich can now get in trouble for with conservatives on the campaign trail.

Klein concludes that the reason that Romney and Gingrich are stuck with having supported so many now-forbidden policy is because they are “wonks.” I think that’s too strong, however, or perhaps not strong enough, depending on your perspective. Klein provides a long list of Republicans who once supported an individual mandate on health insurance, but surely they weren’t all wonks? Nope. Most of them were just Republicans following the standard Republican line of the time, a line that was good enough until Barack Obama and the Democrats adopted a kitchen sink to health care reform and tossed in any decent idea that they could find (remember all that rhetoric back then about all the Republican-sponsored ideas included in ACA? It was true!).

No wonder that House Republicans are spending much of their energy repealing non-existent regulations about farm dust or affirming the US motto. Or why Romney’s entire foreign policy program appears to be a pledge not to go on an “apology tour” that never happened. It’s a lot easier to be certain that you always completely oppose the president’s program when you write your own fictional version of the president.

But Klein’s conclusion is right on the mark:

At the end of the day, the GOP will nominate somebody for president…The bigger problem will be if that individual wins. At that point, they’ll need actual solutions for the problems facing the nation. But the Republican Party has ruled out an individual mandate to help with health-care reform, a cap-and-trade program to mitigate global warming and speed the development of renewable energy options, tax increases to help reduce the deficit, and stimulus to help boost the economy. That leaves a potential GOP president with a lot of problems to solve, but few workable policies with which to solve them.

Well, they still have tax cuts for rich people.


By: Jonathan Bernstein, Washington Monthly, December 14, 2011

December 15, 2011 Posted by | Affordable Care Act, Individual Mandate | , , , , , | Leave a comment

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