“We’ll Never Stop Arguing About It”: Obamacare Is Helping A Lot Of People. Not Everyone Thinks That’s Good News
In politics there are some issues where liberals and conservatives share the same goal, but disagree about how to achieve it — we all want to have as little crime as possible, for instance, but there are different ideas about how to accomplish that. Then there are issues where the two groups have different goals — liberals want to preserve women’s reproductive rights, and conservatives don’t. And sometimes, there are issues we think fall in the first category, but actually belong in the second.
Health care may just be that kind of issue, where we talk as though we all have the same fundamental goals, but we actually don’t. There’s an interesting article in the New York Times today on a major success of the Affordable Care Act that demonstrates why we’ll never stop arguing about it. Here’s how it begins:
The first full year of the Affordable Care Act brought historic increases in coverage for low-wage workers and others who have long been left out of the health care system, a New York Times analysis has found. Immigrants of all backgrounds — including more than a million legal residents who are not citizens — had the sharpest rise in coverage rates.
Hispanics, a coveted group of voters this election year, accounted for nearly a third of the increase in adults with insurance. That was the single largest share of any racial or ethnic group, far greater than their 17 percent share of the population. Low-wage workers, who did not have enough clout in the labor market to demand insurance, saw sharp increases. Coverage rates jumped for cooks, dishwashers, waiters, as well as for hairdressers and cashiers. Minorities, who disproportionately worked in low-wage jobs, had large gains.
Before we go farther, we should remember that the ACA is a complex piece of legislation that affects every area of American health care, but for now we’re going to talk just about insurance coverage. When liberals see a report like this one, they say, that’s terrific — some of the most vulnerable people in America, and those who had the hardest time getting covered before, now have health insurance. They offer this as practical evidence of the law’s success.
But conservatives (not all conservatives, but many of them) don’t see that as a success at all. If the government is helping an immigrant who washes dishes for a living get health coverage, then to them that means that government is redistributing tax money from deserving people to undeserving people. The two groups look at the same practical effect, and interpret it in opposite ways.
That isn’t to say that the ACA didn’t give benefits to everyone, because it did. Millions of middle-class and even upper-class people were hurt by the fact that insurance companies used to be able to deny you coverage if you had a pre-existing condition, but the ACA outlawed that. And if the payment reforms in the law bring down overall health spending, we all benefit. But the most visible and dramatic parts of the law relate to the tens of millions of Americans who used to be without health coverage but now have it.
This is why Republicans continue to call the ACA a “disaster” and a “catastrophe” despite the good it has done. Liberals hoped that once the law was implemented and its practical effects became clear, the law would become hugely popular. Instead, views of the law divide closely on ideology and partisanship, and that hasn’t changed and won’t change.
That’s because there’s a fundamental clash of values at work, which means that liberals and conservatives will always judge it according to different standards. Because the law did a large amount to bring coverage to those who couldn’t afford it (through both the expansion of Medicaid and subsidies), and because it included a raft of new regulations meant to solve a variety of problems within the health care system, conservatives will always oppose it, whether it succeeds on its own terms or not. To doctrinaire conservatives, a government regulation that accomplishes what it sets out to isn’t a success at all; it’s a moral failure by definition. That’s why liberals will never convince them to support the ACA by pointing to its practical successes.
That isn’t to say that conservatives don’t make practical arguments against the ACA, because they do. But they’re mostly window dressing placed atop their moral objections to government involvement in health care. So yes, they predicted that Obamacare would destroy the economy, and cost millions of jobs, and lead to fewer people with health coverage, and balloon health care spending, and make premiums skyrocket. When they turned out to be wrong about all these things, conservatives didn’t say, “Well gee, I guess this law was a pretty good idea after all.” Because the fundamental moral objection remains, whatever the practical impact.
You can see it in the decision to accept or reject the law’s expansion of Medicaid. The federal government offered states a huge pot of free money to provide coverage to their poor citizens, and though some conservative governors tried to argue that it would be too expensive, those arguments were laughably weak. As one independent analysis after another has shown — from groups like the Rand Corporation, not exactly a bunch of lefties — taking the expansion leads to healthier state finances and better economic growth, on top of helping your state’s constituents. But for many governors, insuring poor people isn’t a moral good at all; just the opposite, in fact. So they were even willing to incur economic damage in order to avoid it (and to give Barack Obama the finger, of course).
Where this all leaves us is that the ACA will never become something we agree on, no matter what it does or doesn’t do in the real world. But even that’s not the whole story, because there are political factors at work. Smart Republicans understand that with each passing year, the law becomes more and more entrenched and harder to unwind, no matter how much they hate it. It’s one thing to keep people from getting insurance, but it’s something quite different, and far more politically dangerous, to take away insurance people already have — and if they really repealed the law, that’s what they would be doing, not just to a few people but to 20 million or so.
That’s why Republicans have so much trouble coming up with their “repeal and replace” plan. It’s not because there aren’t conservative health care wonks who could give them an outline. It’s because any real repeal would be so spectacularly disruptive to the system that it would a political nightmare. Just today there’s an article in The Hill on the efforts of the Republican task force charged with producing the new repeal-and-replace legislation, under the title, “GOP group promises ObamaCare replacement plan — soon.” If you’ve been following this issue, you know that title is a joke. As the piece says:
Coming up with a plan to replace ObamaCare has been an aim for the Republican Party for so long that it’s become a laugh line even in conservative circles. Despite voting more than 50 times in the House to repeal the law, the GOP has not once voted on legislation to take its place.
But every couple of months, they say that they’ll be releasing their plan any day now.
If Republicans actually took the White House and held Congress, my guess is that they’d pass something they called “repeal and replace” but which would leave the ACA largely intact. Just as they propose to privatize Medicare but rush to tell seniors who love it that their own coverage wouldn’t be affected, it would be some kind of time-delayed change that would avoid kicking people who now have insurance off their coverage. And if Hillary Clinton gets elected in the fall, it’ll be another four or eight years before they could even try this. No matter what happens between now and then, conservatives won’t ever decide that the ACA has worked out well, whether it actually did what it was designed to do or not. As far as they’re concerned, the design itself was the problem. But they may decide, as they did with Medicare, that doing away with it isn’t worth the bother — at least not worth bothering to to try all that hard.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Plum Line Blog, The Washington Post, April 18, 2016
“Who Hates Obamacare?”: Progressives Should Not Be Trash-Talking Progress And Impugning Motives Of People On Their Side
Ted Cruz had a teachable moment in Iowa, although he himself will learn nothing from it. A voter told Mr. Cruz the story of his brother-in-law, a barber who had never been able to afford health insurance. He finally got insurance thanks to Obamacare — and discovered that it was too late. He had terminal cancer, and nothing could be done.
The voter asked how the candidate would replace the law that might have saved his brother-in-law if it had been in effect earlier. Needless to say, all he got was boilerplate about government regulations and the usual false claims that Obamacare has destroyed “millions of jobs” and caused premiums to “skyrocket.”
For the record, job growth since the Affordable Care Act went fully into effect has been the best since the 1990s, and health costs have risen much more slowly than before.
So Mr. Cruz has a truth problem. But what else can we learn from this encounter? That the Affordable Care Act is already doing enormous good. It came too late to save one man’s life, but it will surely save many others. Why, then, do we hear not just conservatives but also many progressives trashing President Obama’s biggest policy achievement?
Part of the answer is that Bernie Sanders has chosen to make re-litigating reform, and trying for single-payer, a centerpiece of his presidential campaign. So some Sanders supporters have taken to attacking Obamacare as a failed system.
We saw something similar back in 2008, when some Obama supporters temporarily became bitter opponents of the individual mandate — the requirement that everyone buy insurance — which Hillary Clinton supported but Mr. Obama opposed. (Once in office, he in effect conceded that she had been right, and included the mandate in his initiative.)
But the truth is, Mr. Sanders is just amplifying left-wing critiques of health reform that were already out there. And some of these critiques have merit. Others don’t.
Let’s start with the good critiques, which involve coverage and cost.
The number of uninsured Americans has dropped sharply, especially in states that have tried to make the law work. But millions are still uncovered, and in some cases high deductibles make coverage less useful than it should be.
This isn’t inherent in a non-single-payer system: Other countries with Obamacare-type systems, like the Netherlands and Switzerland, do have near-universal coverage even though they rely on private insurers. But Obamacare as currently constituted doesn’t seem likely to get there, perhaps because it’s somewhat underfunded.
Meanwhile, although cost control is looking better than even reform advocates expected, America’s health care remains much more expensive than anyone else’s.
So yes, there are real issues with Obamacare. The question is how to address those issues in a politically feasible way.
But a lot of what I hear from the left is not so much a complaint about how the reform falls short as outrage that private insurers get to play any role. The idea seems to be that any role for the profit motive taints the whole effort.
That is, however, a really bad critique. Yes, Obamacare did preserve private insurance — mainly to avoid big, politically risky changes for Americans who already had good insurance, but also to buy support or at least quiescence from the insurance industry. But the fact that some insurers are making money from reform (and their profits are not, by the way, all that large) isn’t a reason to oppose that reform. The point is to help the uninsured, not to punish or demonize insurance companies.
And speaking of demonization: One unpleasant, ugly side of this debate has been the tendency of some Sanders supporters, and sometimes the campaign itself, to suggest that anyone raising questions about the senator’s proposals must be a corrupt tool of vested interests.
Recently Kenneth Thorpe, a respected health policy expert and a longtime supporter of reform, tried to put numbers on the Sanders plan, and concluded that it would cost substantially more than the campaign says. He may or may not be right, although most of the health wonks I know have reached similar conclusions.
But the campaign’s policy director immediately attacked Mr. Thorpe’s integrity: “It’s coming from a gentleman that worked for Blue Cross Blue Shield. It’s exactly what you would expect somebody who worked for B.C.B.S. to come up with.” Oh, boy.
And let’s be clear: This kind of thing can do real harm. The truth is that whomever the Democrats nominate, the general election is mainly going to be a referendum on whether we preserve the real if incomplete progress we’ve made on health, financial reform and the environment. The last thing progressives should be doing is trash-talking that progress and impugning the motives of people who are fundamentally on their side.
By: Paul Krugman, Op-Ed Columnist, The New York Times, February 5, 2016
“Living Exact Same Day Over And Over Again”: On Groundhog Day, Republicans Vote To Repeal Obamacare
President Obama hasn’t spent a lot of time with House Speaker Paul Ryan (R-Wis.), but the two leaders, joined by Senate Majority Leader Mitch McConnell (R-Ky.), met at the White House this morning. The point, according to everyone involved, was to look for ways the policymakers can find some common ground and try to get things done in 2016.
To help set the tone, the Wisconsin congressman told reporters yesterday he was excited about the Iowa caucuses because “what it tells me is the days of Barack Obama’s presidency are numbered.”
He’s a real charmer, this one. You can just feel his enthusiasm for bipartisan policymaking in an era of divided government.
After the meeting in which the president tries to find areas of possible agreement with GOP leaders, Ryan will hold another vote on repealing the Affordable Care Act. The Washington Post reported:
The House is scheduled to vote Tuesday on overturning President Obama’s veto of legislation to repeal Obamacare and defund Planned Parenthood. The vote, appropriately scheduled for Groundhog Day, is expected to fail, leaving conservatives to gear up for a final year of budget fights with the president.
Asked about today’s events, White House Press Secretary Josh Earnest told reporters, “Republicans are poised to host another vote in the United States Congress today for the 60th time to repeal Obamacare. It’s almost like it’s Groundhog Day, except today it is actually Groundhog Day and they’re doing it again.”
Earnest added, “So I’m not really sure that qualifies as the contours of a proactive legislative agenda but it does put some pressure on Speaker Ryan and Leader McConnell, and other Republicans in Congress, to lay out what it is exactly they support and try to find some common ground with the administration.”
For the record, estimates vary on exactly how many times Republicans have tried to repeal all or part of the ACA, but the last time I checked, they were up to 62. In other words, Earnest might have been understating the case a bit.
Incidentally, shortly before the last repeal vote, Ryan was asked why he was moving forward with a bill to eliminate the Affordable Care Act before the Republican alternative is ready. The Republican leader told reporters with a smile, “Just wait.”
We later learned that this wait will continue past this year – because GOP lawmakers have already effectively given up on their plans to unveil a reform alternative in 2016.
As for today’s veto-override vote, there’s no chance of the bill succeeding. Paul Ryan and his team know that, of course, but they’re holding the vote anyway, just to go through the motions.
Postscript: In case anyone doesn’t get the reference, I should probably mention “Groundhog Day” was a classic movie from 1993 in which Bill Murray is stuck in a time loop, forced to live the exact same day over and over again. For those who haven’t seen the movie, I can assure you it’s far more entertaining than watching Republicans vote 63 times to take health care benefits away from millions of families for no particular reason.
Update: Reader F.B. emails, “In the movie, the character played by Bill Murray learns from each repetition how to live that day better. Unfortunately the Republicans show no similar improvement.”
By: Steve Benen, The Maddow Blog, February 2, 2016
“A Political Disaster Of Unimaginable Proportions”: Why Republicans Wouldn’t Actually Repeal Obamacare
Last week, in a bold example of their governing prowess, congressional Republicans took their 62nd vote to repeal the Affordable Care Act, and this time they actually passed it through both houses and sent it to President Obama to be vetoed. Naturally, they were exultant at their triumph. Speaker Paul Ryan admitted that there is as yet no replacement for the ACA, but they’ll be getting around to putting one together before you know it. The fact that they’ve been promising that replacement for more than five years now might make you a bit skeptical.
What we know for sure is this: If a Republican wins the White House this November, he’ll make repeal of the ACA one of his first priorities, whether there’s a replacement ready or not. To listen to them talk, the only division between the candidates is whether they’ll do it on their first day in the Oval Office, in their first hour, or in the limo on the way back from the inauguration.
But I’ve got news for you: They aren’t going to do it, at least not in the way they’re promising. Because it would be an absolute catastrophe.
Let’s take a brief tour around the consequences of repealing the ACA. First, everyone who benefited from the expansion of Medicaid would immediately lose their health coverage. According to Charles Gaba of acasignups.net, who has been tracking these data as assiduously as anyone, that amounts to about nine million people. Granted, the working poor are not a group whose fate keeps too many Republicans up at night, but tossing nine million of them off their health coverage is at least bound to generate some uncomfortable headlines.
Then there’s all the people who now get their health coverage through the exchanges that the ACA set up. Remember how fake-outraged Republicans were back in the fall of 2013 because some people with crappy health plans got letters from their insurers telling them that they’d have to sign up for a plan that was compatible with the ACA’s new standards? The truth was that some of them would wind up paying more for coverage while others would pay less, but it was the subject of a thousand credulous news stories portraying them all as victims, to Republicans’ unending joy.
Now imagine that ten million people, the number signed up for private coverage through the exchanges, all had their coverage simultaneously thrown into doubt. Think that might cause some bad press for the party and the president who did it?
There’s more. The ACA also allowed young people to stay on their parents’ insurance until age 26; three million took advantage of the provision. They’d likely lose their insurance too. Oh, and if you’re a senior on Medicare? Get ready for the return of the “doughnut hole” in prescription drug coverage, which the ACA closed.
Let’s add in one more element (though there are lots of the ACA’s provisions we don’t have time to discuss). One of the central and most popular provisions of the ACA banned insurance companies from even asking about pre-existing conditions when they offer you a plan. About half of Americans have some kind of condition that in the old days would mean they either could get insurance but it wouldn’t cover that condition, or they couldn’t get covered at all. If you bought insurance in the old days, you remember what a hassle it was to document for the insurer every time you saw a doctor for years prior. You don’t have to do that now, but if Republicans succeed, we’ll be back to those bad old days. So they can look forward to lots of news stories about cancer survivors who now can’t get insurance anymore, thanks to the GOP.
But wait, they’ll say, our phantom replacement plan has a solution: high-risk pools! This is a common element of the various inchoate health-care plans Republicans have come up with. Anyone who knows anything about insurance knows why these are no solution at all. They take all the sickest people and put them together in one pool, which of course means that the premiums to insure them become incredibly high. As I’ve written elsewhere, high-risk pools are the health insurance equivalent of going to a loan shark: You might do it if you’re desperate and have no other option, but you’re going to pay through the nose. So good luck with that.
Even if Republicans could come together around a single replacement plan, that plan would still be a political disaster. The theory behind their health-care ideas is that once we inject some more market magic into health care, everything will be great. But there are a couple of important things to understand about this idea. First of all, their plans don’t even try to achieve anything like universal coverage. It just isn’t one of their goals, and as a consequence, implementing their plans is going to mean a lot more uninsured than we have now, a reversal of the progress the ACA is made, with millions or even tens of millions of people likely to lose coverage. Second, even if the market mechanisms they use were to work out how they predict—and it’s almost certain they won’t, but let’s give them the benefit of the doubt for a moment—it would take a substantial amount of time.
In this, the ACA is direct. You can’t afford coverage? Here’s a subsidy, now you can afford coverage. But under Republican plans, more people shopping around for their health care is, over time, supposed to bring costs down, which will eventually translate to lower premiums. But in the meantime, while we wait for the invisible hand to perform its alchemy, millions upon millions of Americans will get screwed. Think there’s going to be a political backlash?
I suspect that many conservatives understand that, but still think that in the long term, their small-government ideas will leave us with a superior system. But that still leaves them with a political dilemma. On one hand, repealing the ACA would be spectacularly disruptive—in fact, unwinding the law will probably be more disruptive than putting it in place was, now that the entire health-care and health-insurance industries have adapted to it—and there will be millions of people victimized by repeal. It will be a political disaster of unimaginable proportions.
On the other hand, they’ve invested so much emotional, political, and rhetorical energy over the last six years into their opposition to this law that they would seemingly have no choice but to repeal it, no matter the consequences. Liberals may argue that the ACA would have been a lot better if it hadn’t worked so hard to accommodate the market-based character of the American health-care system, but Republicans have been telling their constituents that it’s the most horrific case of government oppression since the Cultural Revolution (or as Ben Carson says, “the worst thing that’s happened to this nation since slavery”). They can’t exactly turn around to the people who elected them and say, “Look, I know we said we’d repeal this thing, but that’s going to be a real mess. How about if we just make some changes to it so it works more like we’d like?”
Or maybe they could. Just look what happened to Matt Bevin, the new governor of Kentucky. He ran on a platform of purging the state of every molecule of that despicable Obamacare, but now that he’s in office, things are looking a little more complicated. That’s because Kentucky is one of the great ACA success stories, where the expansion of Medicaid brought health insurance to a half a million low-income people who didn’t have it, and the state’s health-care exchange, Kynect, was a model of success. So Bevin is now backtracking on his promise, saying that instead of just eliminating the Medicaid expansion he’s going to reform it. And Kynect may get the axe (which would mean just turning it over to the federal government), but that won’t happen for quite some time, if at all.
And that’s what I think we’d see if we actually got a Republican president and a Republican Congress forced to deal with the consequences of what they’ve been promising for so long. Once they have the ability to bring down such a health-care calamity on the public, it’s not going to seem like such a great idea. They’ll say they’re as committed to it as ever, while behind the scenes they’ll be frantically trying to figure out how to do something they can call “repeal” but that won’t actually get rid of all the things people like about the law. I wouldn’t be surprised if we saw a “repeal” bill that, in the name of an effective transition, left much of the law in place, then slowly instituted their market-driven ideas over time. Because there are limits to even what kind of damage an all-Republican government would inflict—if not on the country, then at least on their political fortunes.
By: Paul Waldman, Senior Writer, The American Prospect, January 10, 2016
“Elections Have Consequences”: Don’t Let Anyone Tell You Otherwise
You have to be seriously geeky to get excited when the Internal Revenue Service releases a new batch of statistics. Well, I’m a big geek; like quite a few other people who work on policy issues, I was eagerly awaiting the I.R.S.’s tax tables for 2013, which were released last week.
And what these tables show is that elections really do have consequences.
You might think that this is obvious. But on the left, in particular, there are some people who, disappointed by the limits of what President Obama has accomplished, minimize the differences between the parties. Whoever the next president is, they assert — or at least, whoever it is if it’s not Bernie Sanders — things will remain pretty much the same, with the wealthy continuing to dominate the scene. And it’s true that if you were expecting Mr. Obama to preside over a complete transformation of America’s political and economic scene, what he’s actually achieved can seem like a big letdown.
But the truth is that Mr. Obama’s election in 2008 and re-election in 2012 had some real, quantifiable consequences. Which brings me to those I.R.S. tables.
For one of the important consequences of the 2012 election was that Mr. Obama was able to go through with a significant rise in taxes on high incomes. Partly this was achieved by allowing the upper end of the Bush tax cuts to expire; there were also new taxes on high incomes passed along with the Affordable Care Act, a.k.a. Obamacare.
If Mitt Romney had won, we can be sure that Republicans would have found a way to prevent these tax hikes. And we can now see what happened because he didn’t. According to the new tables, the average income tax rate for 99 percent of Americans barely changed from 2012 to 2013, but the tax rate for the top 1 percent rose by more than four percentage points. The tax rise was even bigger for very high incomes: 6.5 percentage points for the top 0.01 percent.
These numbers aren’t enough to give us a full picture of taxes at the top, which requires taking account of other taxes, especially taxes on corporate profits that indirectly affect the income of stockholders. But the available numbers are consistent with Congressional Budget Office projections of the effects of the 2013 tax increases — projections which said that the effective federal tax rate on the 1 percent would rise roughly back to its pre-Reagan level. No, really: for top incomes, Mr. Obama has effectively rolled back not just the Bush tax cuts but Ronald Reagan’s as well.
The point, of course, was not to punish the rich but to raise money for progressive priorities, and while the 2013 tax hike wasn’t gigantic, it was significant. Those higher rates on the 1 percent correspond to about $70 billion a year in revenue. This happens to be in the same ballpark as both food stamps and budget office estimates of this year’s net outlays on Obamacare. So we’re not talking about something trivial.
Speaking of Obamacare, that’s another thing Republicans would surely have killed if 2012 had gone the other way. Instead, the program went into effect at the beginning of 2014. And the effect on health care has been huge: according to estimates from the Centers for Disease Control and Prevention, the number of uninsured Americans fell 17 million between 2012 and the first half of 2015, with further declines most likely ahead.
So the 2012 election had major consequences. America would look very different today if it had gone the other way.
Now, to be fair, some widely predicted consequences of Mr. Obama’s re-election — predicted by his opponents — didn’t happen. Gasoline prices didn’t soar. Stocks didn’t plunge. The economy didn’t collapse — in fact, the U.S. economy has now added more than twice as many private-sector jobs under Mr. Obama as it did over the same period of the George W. Bush administration, and the unemployment rate is a full point lower than the rate Mr. Romney promised to achieve by the end of 2016.
In other words, the 2012 election didn’t just allow progressives to achieve some important goals. It also gave them an opportunity to show that achieving these goals is feasible. No, asking the rich to pay somewhat more in taxes while helping the less fortunate won’t destroy the economy.
So now we’re heading for another presidential election. And once again the stakes are high. Whoever the Republicans nominate will be committed to destroying Obamacare and slashing taxes on the wealthy — in fact, the current G.O.P. tax-cut plans make the Bush cuts look puny. Whoever the Democrats nominate will, first and foremost, be committed to defending the achievements of the past seven years.
The bottom line is that presidential elections matter, a lot, even if the people on the ballot aren’t as fiery as you might like. Don’t let anyone tell you otherwise.
By: Paul Krugman, Op-Ed Columnist; Opinion Pages, The Conscience of a Liberal, The New York Times, January 4, 2015
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