Of Course Newt Gingrich Supported A Health Care Mandate
Mitt Romney continues to face all kinds of heat over his support for a health care mandate, in large part because he continues to defend it. But Sam Stein notes this week that disgraced former House Speaker Newt Gingrich, a Romney rival for the Republican presidential nomination, was just as ardent an advocate of the idea.
In his post-congressional life, Gingrich has been a vocal champion for mandated insurance coverage — the very provision of President Obama’s health care legislation that the Republican Party now decries as fundamentally unconstitutional.
This mandate was hardly some little-discussed aspect of Gingrich’s plan for health care reform. In the mid-2000s, he partnered with then-Sen. Hillary Clinton (D-N.Y.) to promote a centrist solution to fixing the nation’s health care system. A July 22, 2005, Hotline article on one of the duo’s events described the former speaker as endorsing not just state-based mandates (the linchpin of Romney’s Massachusetts law) but “some federal mandates” as well. A New York Sun writeup of what appears to be the same event noted that “both politicians appeared to endorse proposals to require all individuals to have some form of health coverage.”
Neera Tanden, an aide to Clinton at the time who went on to help craft President Obama’s law, said she couldn’t recall exact speeches, but “strongly” believed that the both Clinton and Gingrich backed the individual mandate. Either way, she added, “Gingrich has been known as a supporter” of the idea for some time.
A simple newspaper archive search bears this out.
Gingrich endorsed the individual health care mandate over and over again, in public remarks, in media interviews, and in policy proposals. Ironically, he even explained the importance of the mandate in a book entitled, “Winning the Future.” Gingrich didn’t just grudgingly go along with the measure as part of some kind of compromise; he actively touted it as a good idea.
And he was right.
But that was before President Obama decided he also agreed with the idea, at which point the mandate became poisonous in Republican circles.
The point to keep in mind, though, is that Gingrich’s support for the idea isn’t at all surprising. Indeed, it would have been odd if Gingrich didn’t endorse the mandate.
For those who’ve forgotten, this was a Republican idea in the first place. Nixon embraced it in the 1970s, and George H.W. Bush supported the idea in the 1980s. When Dole endorsed the mandate in 1994, it was in keeping with the party’s prevailing attitudes at the time. Romney embraced the mandate as governor and it was largely ignored during the ‘08 campaign, since it was in keeping with the GOP mainstream.
In recent years, the mandate has also been embraced by the likes of John McCain, Chuck Grassley, Orrin Hatch, Bob Bennett, Tommy Thompson, Lamar Alexander, Lindsey Graham, John Thune, Scott Brown, and Judd Gregg, among many others. Indeed, several of them not only endorsed the policy, they literally co-sponsored legislation that included a mandate.
During the fight over Obama’s reform proposal, Grassley told Fox News, of all outlets, “I believe that there is a bipartisan consensus to have an individual mandate” — and there was no pushback from party leaders. This isn’t ancient history; it was a year and a half ago.
Newt Gingrich touted the same idea? Well, sure, of course he did.
By: Steve Benen, Contributing Writer, The Washington Monthly, May 13, 2011
Health Care Hypocrisy: How Paul Ryan And House Republicans Are Contradicting Themselves Over Medicare
In the debate over the House Republicans’ budget plan championed by Representative Paul Ryan, it’s been remarkable to watch the contortions and contradictions in the GOP on the issue of health care. The cornerstone of the Republican critique of the Affordable Care Act over the past year or so has been that it would lead to rationing. While Republicans initially manufactured lies about this issue—anyone remember death panels?—they eventually focused on one provision in the bill that was focused on cutting costs: the Independent Payment Advisory Board (IPAB). As specified in the legislation, the IPAB is a 15-member board of medical experts who are appointed by the president, confirmed by the Senate, and tasked with cutting costs in the Medicare system, unless Congress acts to alter the proposal or discontinue automatic implementation. The legislation also specifies that a goal of such cost-cutting should be to actually improve access for beneficiaries. At a time when rising health care costs are a concern for families’ pocketbooks and the federal budget, the IPAB was a means to maintain public oversight of Medicare but insulate it from the normal politics of congressional decision-making, thus helping ensure that best medicine was the driver of cost reductions.
Republicans, however, viciously attacked the IPAB as being a bunch of unelected bureaucrats making decisions to cut costs at the expense of the quality of care seniors would receive. The rhetoric became quite heated: Congressman Phil Roe went so far as to call the IPAB the “real death panel.” Other Republicans, like Representative John Fleming, likened the IPAB to communism, saying, “It will take you back to the old Soviet Union, that’s the way they did things—with a central planning committee that set prices, targeted costs.”
Now, more than a year after health care reform passed, Paul Ryan, facing stiff opposition to his plan to end Medicare as we know it, has taken to attacking the IPAB as a way to rebut his critics. He’s arguing that, while his plan would keep Medicare the same for current beneficiaries, the IPAB “puts a board in charge of cutting costs in Medicare” that will “automatically put price controls in Medicare” and “diminish the quality of care seniors receive.” It’s this sort of dishonest vitriol that has led to 73 House Republicans, as well as some Democrats, to cosponsor legislation to eliminate the IPAB.
What’s fascinating about the posture of these cosponsors is that it runs into direct conflict to the vote the House took mere days ago on the overall Ryan budget, which passed thanks to broad Republican support. Indeed, the budget, which the co-sponsors voted for, changes Medicare into a voucher program in which seniors can only choose from among private insurance options, eliminating the public insurance that is currently at the heart of Medicare. In other words, rather than public officials, elected or unelected, making decisions as to what is covered in Medicare, the Republicans just voted to more or less privatize the program. So, , after all of their complaining about how the IPAB moved too far away from public accountability, they’ve just proposed eliminating all such accountability, insisting instead that private insurance companies know best.
Would Americans really feel better with insurance companies deciding whether they or their parents get the care they need? Probably not. The truth is that Republicans are not actually worried about accountability or giving Americans more health care options. They are not even worried about cutting costs: Medicare has a much lower cost per beneficiary than private health care now, so it makes no sense to privatize it in order to lower costs. What they are worried about is public health care; they can’t stand it—and are even willing to contradict themselves and hand people’s health over to unelected, private insurers to defeat it.
By: Neera Tanden, Chief Operating Officer, Center for American Progress, April 30, 2011
Seniors, Are You Paying Attention To Paul Ryan’s Medicare Plan?
Tea Party members who railed against health care reform because of the spin they were sold about how “Obamacare” would affect Medicare played a big role in returning the House of Representatives to Republican control.
I’m betting that many of them, if they’re paying attention to what Rep. Paul Ryan (R-Wisconsin), wants to do to the Medicare program, are having some serious buyer’s remorse. If Democrats are wise, they’re already drafting a strategy to remind Medicare beneficiaries, including card-carrying Tea Party members, just how fooled they were into thinking that Republicans were the protectors of the government-run program they hold so dear.
As a speaker at an especially contentious town hall meeting during the summer of 2009, I saw firsthand just how many senior citizens were snookered about how reform legislation would alter Medicare. Shortly after I testified before Congress about how the insurance industry was conducting a behind-the-scenes campaign to influence public opinion about reform, Rep. Bill Pascrell (D-New Jersey) invited me to share my perspective as a former insurance industry insider at his September 3, 2009, town hall meeting at Montclair State University.
More than 1,000 people had crammed into the school’s auditorium, not so much to hear the speakers as to express their opinions. Reform opponents were on one side of the auditorium, and reform advocates were on the other side. I had to shout just to be heard above the insults the groups were hurling at each other. Many of the reform opponents were carrying signs that read, “Hands Off My Medicare!” They clearly had bought the lie that the Democrats planned to dismantle the program.
There was no doubt in my mind that the insurance industry was the original source of that lie. While insurers liked the part of reform that would require all Americans not eligible for Medicare or Medicaid to buy coverage from them, they did not like the provision that would eliminate the overpayments the federal government has been paying private insurers for years to participate in the Medicare Advantage program, which was created when Republicans controlled both chambers of Congress in the late 1990s.
A little history: A provision of the Balanced Budget Act of 1997, written primarily by the insurance industry and backed by House Speaker Newt Gingrich and Senate Majority Leader Trent Lott, gave Medicare beneficiaries the option of getting their benefits through private insurers. Republicans envisioned this as the first step toward the total privatization of Medicare.
The Insurance Industry’s Government Favor
The problem was that insurers were reluctant to jump in unless they could be assured of a substantial profit. To get them to market Medicare Advantage plans, the government agreed to give them a big bonus. As a result, we the taxpayers now pay private insurers 14 percent more than the per-patient cost of the traditional Medicare program. These overpayments have contributed significantly to the record profits insurance companies have been posting in recent years, even though only 22 percent of people eligible for Medicare have bought what they’re selling.
The insurers were not able to keep the Democrat-controlled Congress of 2010 from eliminating those bonuses when they passed the Affordable Care Act. The law will indeed reduce future Medicare spending — not benefits — by an estimated $500 million over the next 10 years in a variety of ways, one of which is to stop overpaying insurers. This means that they will not get an extra $136 billion that they — and their shareholders — had been counting on, and they’re really bummed about that.
Knowing they fare much better when the GOP is running things on Capitol Hill, they devoted millions of the premium dollars we paid them to help elect more Republicans to Congress.
An Insurer-Funded Misinformation Campaign
The insurers funneled millions of dollars to their business allies and front groups in an effort to convince the American public that the Democrats wanted to cut Medicare benefits. Not only is that not true, but the new law actually adds an important new benefit and greatly improves another. For the first time, Medicare now pays for preventive care. And the law closes the hated “doughnut hole” in the Medicare prescription drug program.
But thanks to the success of the insurer-funded misinformation campaign, many seniors went to the polls last November convinced that the Democrats not only had created death panels in the Medicare program, they had also slashed their benefits.
The insurance industry funneled $86 million to the U.S. Chamber of Commerce to pay for TV ads that charged that the new law would “cut Medicare.” Also joining in on the campaign of lies was the 60 Plus Association, a group that, according to the Washington Post, AARP and other sources, has received the lion’s share of its funding over the years from the pharmaceutical industry and other special interests.
The 60 Plus Association ran TV ads in numerous congressional districts last fall against Democrats who had voted for the reform law. The ads were amazingly effective. Most of the Democrats they targeted lost.
The irony, of course, is that the GOP had no intention of preserving Medicare as seniors have known it since it was created more than 45 years ago. Ryan’s plan to reduce the deficit — which was approved by the House last week — would complete the privatization of Medicare that insurers and their Republican allies have been plotting for years.
The Republican Effort to Kill Medicare: a Losing Proposition
Ryan wants to give Medicare beneficiaries a voucher they can use to get coverage from a private insurance company. Initially, the vouchers would enable beneficiaries to get coverage comparable to what they have today. But the value of the vouchers would diminish over time. The Congressional Budget Office predicts that 65-year-olds would be paying 68 percent of their Medicare coverage costs by 2030, compared with 25 percent today.
What this means is that almost all Medicare beneficiaries would eventually be woefully underinsured, just as an estimated 25 million younger Americans already are and just as most of the nation’s elderly — the ones who could afford coverage at all — were before Medicare was enacted in 1965. (Most senior citizens had no health coverage before Medicare because insurance companies refused to sell it to them. That’s why it was so urgently needed.)
Ryan’s plan is a losing proposition for just about every American who lives long enough to qualify for Medicare benefits, but it is the business model that insurance firms have been dreaming of for years. It would enable them to reap profits that would make their earnings today pale by comparison.
If Democrats have any hope of keeping control of the Senate and regaining the House, they better be able to explain what’s really going on in ways that even the Tea Party seniors will understand. If I were a Democratic strategist, I would be ordering enough “Hands Off My Medicare” signs to blanket the country.
By: Wendell Potter, Center for Media and Democracy, April 18, 2011
Health Care Reform in Massachusetts: State Model for the Affordable Care Act Is Working And Broadly Popular
The Affordable Care Act was signed into law one year ago. It is modeled in large part on the landmark Massachusetts health reform law enacted four years earlier in 2006. Opponents of the Affordable Care Act often attack it by distorting the facts about the Massachusetts experience. They selectively alternate between snapshots of and trends in Massachusetts and comparisons between Massachusetts and the United States.
The most appropriate way to assess the impact of the Massachusetts law is to compare changes over time in things like health coverage and premium costs in Massachusetts to changes over time in the United States as a whole. We use that approach below to debunk many of the myths opponents propagate regarding Massachusetts’s experience with health care reform.
Massachusetts increased health coverage while coverage declined in the rest of the country.
Myth
The Massachusetts law failed to significantly reduce the ranks of the uninsured in the state.
Fact
The Massachusetts health reform law dramatically increased the insurance rate in the state over a period when the national health coverage rate declined. As of the end of 2010, 98.1 percent of the state’s residents were insured compared to 87.5 percent in 2006 when the law was enacted. Almost all children in the state were insured in 2010 (99.8 percent). In comparison, at the national level the health insurance rate dropped from 85.2 percent in 2006 to 84.6 percent in 2010.
Employers continued the same level of health coverage in Massachusetts while dropping people in the rest of the country.
Myth
The Massachusetts health reform law is eroding employer-sponsored health insurance.
Fact
The number of people in Massachusetts with employer-sponsored health insurance has not dipped below 2006 levels since passage of the health reform law. Approximately 4.3 million people in Massachusetts obtained health insurance through their employer in 2006. This figure increased to 4.5 million in 2008 before returning to 2006 levels in 2010. In comparison, the number of nonelderly people in the United States with employer-sponsored health coverage declined from 161.7 million in 2006 to 156.1 million in 2009.
Since passage of Massachusetts’s health reform law, a larger share of the state’s employers have offered health insurance to their workers when compared to the United States as a whole. At the national level only 60 percent of employers offered health coverage to their employees in 2005. This is significantly lower than Massachusetts’s rate of 70 percent at that time. The Massachusetts rate increased to 76 percent in 2009, which is 7 percentage points higher than the national figure for 2010.
People buying insurance on their own in Massachusetts are paying lower premiums. Premiums in the nongroup market have increased in the rest of the country.
Myth
Massachusetts residents are paying higher premiums in the nongroup market as a result of the health reform law.
Fact
Nongroup health insurance premiums in Massachusetts have fallen by as much as 40 percent since 2006 because health reform brought healthy people into the insurance market. In contrast, at the national level nongroup premiums have risen 14 percent over that period of time.
More than 98 percent of Bay Staters met the law’s individual insurance requirement.
Myth
A significant portion of Massachusetts residents are ignoring the mandate and only purchasing health insurance when they need care.
Fact
The size of Massachusetts’s individual market more than doubled after passage of the health reform law. This boost and the accompanying drop in the average cost of individual premiums were due in part to more healthy—and previously uninsured—individuals entering the market. Only 1.3 percent of the state’s 4 million tax filers who were required to and did report their coverage status were assessed a penalty for lacking coverage in 2008, the last year for which complete data are available. About 26,000 of these 56,000 people were actually in compliance for part of the year.
The cost of health care in Massachusetts is in line with expectations.
Myth
The Massachusetts law is bankrupting the state.
Fact
The fiscally conservative Massachusetts Taxpayers Foundation, or MTF, finds that under reform, “State spending is in line with what [the organization] expected.” An MTF report released in 2009 found that state spending on health reform increased from $1.041 billion in fiscal year 2006 to a projected $1.748 billion in fiscal year 2010—an increase of $707 million over the four-year period, half of which is covered by the federal government.
Higher-than-expected enrollment in Commonwealth Care, the state-subsidized health insurance program, initially raised fears that policymakers had dramatically underestimated the number of low-income uninsured in Massachusetts. These concerns, however, were unfounded. Commonwealth Care enrollment peaked in mid-2008 with 176,000 members. The MTF attributes the initial rapid growth in Commonwealth Care enrollment to the state’s early success in getting residents signed up for the program.
The majority of people in Massachusetts like the health reform law, and it has gotten more popular over time.
Myth
The Massachusetts health reform law is highly unpopular among members of the public, the business community, and policymakers.
Fact
Support for the law is strong among members of the public. Sixty-one percent of the Massachusetts nonelderly population approved of the law when it passed in 2006. Two years later, 69 percent of nonelderly adults viewed the law favorably. In a survey of employers conducted in 2007—shortly after passage of the health reform law—a majority of Massachusetts firms surveyed agreed that “all employers bear some responsibility for providing health benefits to their workers.”20 A survey of employers conducted a year later—after the individual and employer mandates were implemented— found that a majority of firms believed the law was “good for Massachusetts.”
The Massachusetts health reform law was also a bipartisan achievement, drawing support from both sides of the aisle throughout the process. The law was passed by a Democratic legislature with support from its Republican members and then signed by GOP Gov. Mitt Romney.
Massachusetts is building on its 2006 reforms to promote better quality care at lower costs.
Myth
Current Gov. Deval Patrick is proposing to ration health care in Massachusetts.
Fact
Gov. Patrick’s proposal would make Massachusetts a leader in nationwide efforts to reform health care delivery and bring down costs. The governor has proposed new tools for achieving integrated care—by holding providers accountable for working with each other and their patients to coordinate and delivery higher-quality care at a lower cost.
These innovative tools encourage providers to deliver better care—replacing the current payment system’s set of incentives that provide more care regardless of value. Indeed, more care can sometimes be harmful to patients. Hospital-acquired infections and medical errors are among the most common causes of preventable deaths and injuries in U.S. hospitals. Medical errors accounted for 238,000 preventable deaths in Medicare and cost the program $8.8 billion from 2004 to 2006. A recent study found that sepsis and pneumonia caused by hospital-acquired infections resulted in 48,000 deaths in 2006 and cost the program $8.1 billion.
Conclusion
The Massachusetts health reform law is a success story from every perspective. The state has expanded health coverage to almost all of its residents, maintained a strong market for employer-sponsored health insurance, gained the support of the business community and the public, and is moving forward in containing costs. We can look forward to a similar positive experience across the nation as we implement the Affordable Care Act modeled in large part on the Massachusetts law.
By: Nichole Cafarella and Tony Clark, Center for American Progress, April 13, 2011
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