How The Budget Deal Affects The Affordable Care Act
So how does this mammoth budget-cutting deal, with its congressional “supercommittee” affect health reform?
Good question, because lots of people in Washington are asking it too.
More specific answers will become clearer in the next few weeks, but here’s a first version of the road map to both the policy and the politics.
First, understand there are two different processes – and each, separately, aims at cutting more than $1 trillion over the next decade.
The one that you’ve probably heard most about is the “supercommittee” of 12 members of Congress. They are supposed to identify savings by Thanksgiving. Entitlements – Medicare, Medicaid, Social Security and aspects of the Affordable Care Act – are part of their turf. So are taxes and revenue – at least in theory. It’s not so clear that the Republicans see it that way given the public statements of Congressional leaders.
If they agree on some kind of grand deal by Thanksgiving, Congress has to take it or leave it by the end of December, eliminating the usual congressional dilly-dallying. (It looks like dilly-dallying to the casual observer or much of the public, but remember that all that arcane, tedious process IS policy in Congress. If you slow something down, make it go through hoops, amend it, hold it up, etc., it doesn’t become law. That may be good or, depending on your point of view, bad politics.)
If Congress takes any recommendations that the supercommittee agrees on, that’s the law. If the committee fails, or Congress rejects it, then the “trigger” gets pulled. The official name is “sequestration.” That’s a fancy name for automatic cuts – 2 percent across-the-board cuts in Medicare, for instance, affecting all health care providers, doctors, hospitals, etc. It won’t affect beneficiaries – at least not directly.
Medicaid is not subject to the trigger. Neither, according to the preliminary interpretations I’ve received from analysts and congressional staff, are the big, key subsidies in the health care reform law – the Medicaid expansion and the subsidies that will help low-income and middle-income people afford health care in the new state exchanges.
Other parts of the health reform law are, however, subject to automatic cuts. Among them: Cost-sharing subsidies for low-income people. This isn’t the help paying the premium; this is the help with the co-pays when people do get care. But the payments are made to health plans, not directly to beneficiaries so it won’t have the direct impact of discouraging care. It may affect how health plans make decisions about what markets to participate in. Gary Claxton and Larry Levitt at Kaiser Family Foundation explain here.
Also, the supercommittee could have a partial deal – meaning there’s still a trigger, but a smaller one. Maybe they won’t reach agreement on $1.2 trillion to $1.5 trillion in savings, which would avoid the trigger. But maybe they could agree on, say, $500 billion. That means a trigger wouldn’t have to go as deep because some of the savings would already be identified.
To recap – before we go on to the second stage of this process: The “super-committee” can do whatever it wants to health care, Medicare, Medicaid, Social Security, etc. – if it can agree, if it can get the rest of Congress to agree and if the president doesn’t veto it.
Will the Democratic Senate and the Obama White House agree to cuts that eviscerate health reform? Not likely. In fact, the Democrats “won” on very few aspects of the budget/debt deal. Walling off Medicaid and key parts of the health coverage expansion were two of the “wins.” That’s a bright line worth paying attention to as this moves forward.
Does that mean other health-reform related spending will be untouched? Given how many moving parts there are to any spending deal, and the fact that defense and tax policy are also part of the mix, chances are it will be affected. But expect to see that bright line remain visible – maybe not quite as bright, but visible. (The CLASS Act, the voluntary long-term care program created under health reform, is a different story; it’s quite vulnerable.)
The second part is the annual appropriations process. The budget deal provides for cuts – real cuts in spending, not just slowing the rate of growth. Health programs (aspects of the health reform legislation touching on exchange creation, prevention, community clinics, etc., and just about everything else at the Department of Health and Human Services – the FDA, NIH, CDC, etc. – will be subject to these cuts. But this isn’t an across the board process, it’s a line-by-line, or at least category/agency-by-category/agency, process. And there is some horse trading.
It’s safe to say that the Republicans will try to cut discretionary portions of the new health law. That’s not a new political dynamic, it doesn’t arise out of the debt ceiling or the Wall Street woes. It’s what we’ve seen since last fall’s elections and the repeal/defund fights of the past few months. And House Budget Chairman Paul Ryan has publicly tried to insert health care into any potential deal. So expect to see more Republican push to cut, and continued Democratic push back. Will health spending emerge unscathed? It’s too soon to know but, given the amount of savings Congress needs to find –both in this budget deal and in the perennial quest to fund the “doc fix” payments – some cuts are clearly possible. Some of it may affect aspects of exchange establishment, regulation, prevention, public health, etc. But it’s hard to see the Democrats allowing cuts so deep that they basically constitute a side door to repeal.
One further twist – some Republicans are calling for a delay in health reform implementation to save money.”Delay” may sound better to an ambivalent public worried about spending than “repeal.” What’s delayed (if anything), how it’s delayed, how long it’s delayed, and what stopgaps are created in the meantime could have an impact on how many people get covered in 2014.
Assorted committees and government agencies are still examining the new budget law and how it will affect … everything. So the perspective I’ve outlined here – and I’m writing amid all the market turbulence – may change as the economic and political climates change. But the lines in the sand around the trigger – health reform, Medicaid and Social Security – tell us something about where the White House will come down.
By: Joanne Kenen, Association of Health Care Journalists, August 10, 2011
“Day Of Prayer And Fasting”: Rick Perry’s Houston Dog Whistle
The definition of a political “dog whistle” is a communication (or series of communications) that convey to key members of an interest or constituency group gratifying but potentially controversial affirmations of their views without the mainstream media or the broader electorate catching on. By that standard, Rick Perry’s big “day of prayer and fasting” in Houston over the weekend was a very successful dog whistle.
Mainstream and secular-conservative media coverage of the event (dubbed “The Response,” itself a dog whistle reference to an ongoing series of dominionist events operating under the brand of “The Call” aimed at mobilizing conservative evangelicals to assume leadership of secular society) generally concluded that it was a largely “non-political” gathering–just some Christians upset about the bad economy and their own moral failings who got together to pray over it.
A few reporters who watched and listened more carefully, and had a Christian Right decoder ring on hand, had a very different take. Religion Dispatches’ Sarah Posner, who knows the ins and outs of dominionist thinking exceptionally well, and who attended the Houston event, explained its intent as an act of political mobilization:
“[C]ommand” and “obedience” were the day’s chief buzzwords for many speakers, as repentance was required on behalf of yourself, your church, and your country for having failed to commit yourself to Jesus, for having permitted abortion and “sexual immorality,” for failing to cleanse yourself of “filthiness,” and to repent for having “touched what is unclean….”
The people who gathered at Reliant Stadium are not just Rick Perry’s spiritual army, raised up, as Perry and others imagine it, in the spirit of Joel 2, to sound an alarm and prepare the people for Judgment Day. They are the ground troops the religious right set out four decades ago to create, and duplicate over generations, for the ongoing culture wars. One part of that army is people like Perry himself, supported by religious right political elites who aimed to cultivate candidates, advocates, and political strategists committed to putting God before government.
That a sitting governor would laugh off charges that his “instigation” of an exclusively Christian–and, more specifically, a certain kind of Christian–event is proof of the success of the cultural and spiritual warriors, who believe they are commanded to “take dominion” over government and other spheres of influence. Perry is their man in a high place, in this case an especially courageous one, willing to rebuff charges from the “radical secularists” that he’s crossed the line between church and state. That makes him something much more than just a political or spiritual hero; he is an exemplar.
Slate’s Dave Weigel was also in Houston, and his report debunks the talk of the event being “nonpolitical” by understanding, like Posner, the political freight of the particular strain of evangelical Christianity mostly represented there:
[According to] Pete Ortega, one of dozens of people who’s come up from San Antonio on buses from John Hagee’s church…there is nothing political about the event, he says. He just wants to praise Perry.
“If this is successful here,” he says, “I think other governors, or other politicians, will come out of the closet. Christianity is under attack, and we don’t speak out about it.”
That’s the brilliance of what Perry has done here: These ideas don’t contradict each other at all. He doesn’t need to talk about politics, or do anything besides be here and understand this event. The religion is the politics. These worshippers understand that if they can bring “the kingdom of God” to Earth, economic problems, even macroeconomic problems, will sort themselves out….
The soon-to-be Republican presidential frontrunner, who is best known among liberal voters for raising the prospect of secession and for presiding over hundreds of executions, has just presented himself as a humble messenger of obvious biblical truth. “Our heart breaks for America,” he says. “We see discord at home.
We see fear in the marketplace. We see anger in the halls of government.” It’s one day since S&P downgraded America’s bond rating, in part because the agency worried that conservative Republicans had proved that they would never agree to a debt-reducing bargain that included tax increases. Perry was pulling off an impressive act of transference.
Observers who don’t get any of what Posner and Weigel are talking about are in effect assisting him in the effort to execute his dog whistle appeal to activists whose world-view is entirely alien to nearly all secular Americans and most mainstream Christians. But just because much of the country can’t hear it doesn’t mean it cannot serve as a powerful inducement to political activity in a presidential nominating process where small determined groups of people can have a big impact.
By: Ed Kilgore, The Democratic Strategist, August 8, 2011
The Tea Fragger Party: Remember Their Names
Fragging: “To intentionally kill or wound (one’s superior officer, etc.), esp. with a hand grenade.”
Take names. Remember them. The behavior of certain Republicans who call themselves Tea Party conservatives makes them the most destructive posse of misguided “patriots” we’ve seen in recent memory.
If the nation defaults on its financial obligations, the blame belongs to the Tea Party Republicans who fragged their own leader, John Boehner. They had victory in their hands and couldn’t bring themselves to support his debt-ceiling plan, which, if not perfect, was more than anyone could have imagined just a few months ago. No new taxes, significant spending cuts, a temporary debt-ceiling solution with the possibility of more spending cuts down the line as well as action on their beloved balanced-budget amendment to the Constitution.
These people wouldn’t recognize a hot fudge sundae if the cherry started talking to them.
The tick-tock of the debt-ceiling debate is too long for this space, but the bottom line is that the Tea Party got too full of itself with help from certain characters whose names you’ll want to remember when things go south. They include, among others, media personalities who need no further recognition; a handful of media-created “leaders,” including Tea Party Nation founder Judson Phillips and Tea Party Patriots co-founders Jenny Beth Martin and Mark Meckler (both Phillips and Martin declared bankruptcy, yet they’re advising Tea Party Republicans on debt?); a handful of outside groups that love to hurl ad hominems such as “elite” and “inside the Beltway” when talking about people like Boehner when they are, in fact, the elite (FreedomWorks, Heritage Action, Club for Growth, National Taxpayers Union, Americans for Prosperity); and elected leaders such as Minnesota Rep. Michele Bachmann, Ohio Rep. Jim Jordan, head of the Republican Study Committee, and South Carolina Sen. Jim DeMint, who grandstand and make political assertions and promises that are sheer fantasy.
Meanwhile, freshman House members were targeted and pressured by some of the aforementioned groups to vote against Boehner’s plan. South Carolina’s contingent was so troubled that members repaired to the chapel Thursday to pray and emerged promising to vote no. Why? Not because Jesus told them to but because they’re scared to death that DeMint will “primary” them — find someone in their own party to challenge them.
Where did they get an idea like that? Look no further than Sarah Palin’s Facebook page, where she warned freshmen about contested primaries and urged them to “remember us ‘little people’ who believed in them, donated to their campaigns, spent hours tirelessly volunteering for them, and trusted them with our votes.” Her close: “P.S. Everyone I talk to still believes in contested primaries.” While they’re at it, they also should remember that Palin came to the Tea Party long after the invitations went out. The woman knows where to hitch a wagon.
Unfortunately for the country, which is poised to lose its place as the world’s most-trusted treasury and suffer economic repercussions we can ill afford, the stakes in this political game are too high to be in the hands of Tea Partyers who mistakenly think they have a mandate. Their sweep in the 2010 election was the exclusive result of anti-Obama sentiment and the sense that the president, in creating a health-care plan instead of focusing on jobs, had overplayed his hand. Invariably, as political pendulums swing, the victors become the very thing they sought to defeat.
Who’s overplaying their hand now?
It must be said that the Tea Party has not been monolithic — and the true grass-roots shouldn’t be conflated with leaders who disastrously signed on to the so-called “Cut, Cap and Balance” pledge. What is it with Republicans and their silly pledges? Didn’t they get enough Scouting? This pledge now has them hog-tied to a promise they can’t keep — the balanced-budget amendment. As many as a third desperately want a pardon from that commitment, according to sources close to the action.
Hubris is no one’s friend, and irony is a nag. The Tea Partyers who wanted to oust Barack Obama have greatly enhanced his chances for reelection by undermining their own leader and damaging the country in the process. The debt ceiling may have been raised and the crisis averted by the time this column appears, but that event should not erase the memory of what transpired. The Tea Party was a movement that changed the conversation in Washington, but it has steeped too long and has become toxic.
It’s time to toss it out.
By: Kathleen Parker, Opinion Writer, The Washington Post, July 29, 2011
From Crazy To Insane: Conservatives Still Want More In Debt Ceiling Deal
Over on the progressive side of politics, they’re nursing their wounds and drowning their sorrows as details of the deal to increase the debt ceiling emerge. They feel like they lost to a Republican party that dug in and used the debt ceiling to achieve their goal of dramatically shrinking government spending and solving the deficit problem without raising a single penny in new revenue.
So they might be surprised to know that conservatives don’t think they won, either. The right, despite apparently negotiating Obama into a corner that pits him against large parts of his base, still isn’t satisfied.
“While this deal is moving in the right direction rhetorically thanks to pressure from conservatives, it still falls well short of the standards we have consistently laid out,” wrote the Heritage Action’s Michael Needham.
The group, a sister organization to the Heritage Foundation, says the upfront cuts included in the reported deal are “insufficient” and the super committee in charge of creating the next round of deficit reduction is a bad idea as reported.
“This deal highlights how dysfunctional Washington has become and we will continue to oppose it as insufficient to the task at hand,” Needham wrote.
On TV Sunday morning, Sen. Lindsey Graham (R-SC) said he expected a large number of conservatives to share Heritage’s view.
“It’s a $3 trillion package that will allow $7 trillion to be added to the debt in the next decade,” Graham said, dismissively. “So how much celebrating are you going to do?”
Graham said he expected around half of the House GOP caucus to vote against the deal. It doesn’t have his vote yet, either.
One of the patron saints of those hardcore conservative Republicans in the House, blogger Erick Erickson, is also underwhelmed by the deal (it’s not the first time.)
Despite the fact that progressives and Democrats are publicly lamenting the reported deal as indicative of the effect of rhetoric like Erickson’s has had on Washington, Erickson sounds as if he feels as betrayed as some on the left.
“What we know about the pending deal is that the Democrats and Republicans are agreeing to a Deficit Commission,” Erickson wrote Sunday. “Despite the media spin — and the spin of some Republican sycophants — the deficit commission, which will be a super committee of the Congress, will have the power to come up with new tax revenue.”
By: Evan McMorris-Santero, Talking Points Memo, July 31, 2011
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