“Everyone Just Chill Out”: Memo To Democratic Chicken Littles, The Sky Is Not Falling
Ah, now this is what politics is supposed to be like: Ruthless Republicans, gleeful at the prospect that they might increase the net total of human suffering. Timorous Democrats, panicking at the first hint of political difficulty and rushing to assemble a circular firing squad. And the news media bringing out the “Dems In Disarray!” headlines they keep in storage for just this purpose.
The problems of the last couple weeks “could threaten Democratic priorities for years,” says Ron Brownstein. It’s just like Hurricane Katrina, says The New York Times (minus the 1,500 dead people, I guess they mean, though they don’t say so). “On the broader question of whether Obama can rebuild an effective presidency after this debacle,” says Dana Milbank, “it’s starting to look as if it may be game over.” Ruth Marcus also declares this presidency all but dead: “Can he recover? I’m sorry to say: I’m not at all confident.”
Oh please. Everyone just chill out.
It’s incredible how often reporters and pundits proclaim that what’s happening this week is the most important political development in years, and the balance of political advantage today will remain just as it is indefinitely into the future. Then a few weeks or months later things change, and they forget about what they said before, declaring once again that today’s situation is how things will be forevermore. Not long ago, people were saying that the fact that Obama couldn’t get a congressional vote authorizing a bombing campaign in Syria had crippled his presidency. Then the Republicans shut down the government, and people were saying they wouldn’t win another election in our lifetimes. That’s just in the last few months. And now people are saying that Obama’s second term, which has three years left to go, is an unrecoverable disaster.
So let’s try to see things from a less panicky perspective. The rollout has been a mess, but it’s important to remember that this period is all a preparation for the actual implementation of the law. Nothing that’s happening now is permanent. People have gotten cancellation notices, but no one has lost their coverage. The website sucked when it debuted, it sucks slightly less now, but there’s still lots of time for people to sign up for plans that take effect next year. And if things aren’t working properly by December, they’ll probably extend the open enrollment period to a point at which everything’s working. That’s a hassle, sure. But you can’t call the Affordable Care Act a failure until it takes effect and does or does not achieve its goals. That would be like calling your team’s season a failure because they lost a couple of pre-season games.
A few Democrats will probably vote today for the Republican bill that purports to address the problem of cancellations but it’s an attempt to gut the entire ACA. That’s because they’re cowards and fools, who think that they can protect themselves from a momentary political headwind by rushing into the Republicans’ arms. And you know what will happen? Nothing. You can just add this vote to the 47 prior ones repealing the law; it’ll have the same impact. It won’t ever get to the Senate, and even if it did it wouldn’t ever be signed by the President. It isn’t even worth paying attention to.
Here’s what’s going to happen. The administrative fix Obama announced yesterday will temporarily staunch the political bleeding. But it will have very little effect on the actual insurance market, which is a good thing. In some states, insurance commissioners won’t let the insurance companies continue to sell the junk plans we’ve been talking about. In others, insurers won’t want to go back and re-offer the plans they cancelled. Some of the people with the junk plans will end up keeping them, but most of them will end up going to the exchanges. Many will find that they can get subsidies, or even without them find an affordable plan. Some may find that they’re paying more for a plan that offers real insurance. Those in the latter group will grumble, but it won’t be front-page news anymore, because the media are extraordinarily fickle, and they’ve already told that story.
Over the next year, the rest of the law will be implemented. There may be problems here and there, but overall it will probably go reasonably well. There will be plenty of things Democrats can point to in order to convince people that it was a good idea, like the fact that now nobody can be denied coverage because of a pre-existing condition, or the fact that millions of people who couldn’t afford coverage or were denied before now have it. There will also be things Republicans will say to try to convince people it was a terrible idea, like the fact that premiums didn’t plummet, and health care is still expensive, and Obamacare didn’t give every little girl a pony.
And what else will happen in the next year? Other things. The economy may get worse, or it may get better. There may be a foreign crisis. Controversies we can’t yet anticipate will emerge, explode, then disappear. A young singer may move her posterior about in a suggestive manner, causing a nation to drop everything and talk about nothing else for a week. We might start talking about immigration reform again. There’s going to be another budget battle. In other words, all sorts of things could affect the next election, and the election after that.
So yes, this is a difficult period for President Obama, and for the Affordable Care Act. But everyone needs to take a deep breath and remember that things will change. They always do.
By: Paul Waldman, Contributing Editor, The American Prospect, November 15, 2015
“The Burdens Of A Contradictory Message”: Is The Republican Position, “We’d Prefer To Leave You Behind With Nothing”?
On the surface, the Republican strategy on health care is proving to be more effective than they probably could have hoped. After waging a three-year sabotage campaign, the rollout of the Affordable Care Act has gone poorly; Democrats are divided; President Obama’s poll numbers are falling; the media is in a frenzy; the website still doesn’t work; and no one seems to remember the time Republicans shut down the federal government – just last month.
If RNC officials had written a script, it would look something like this.
And in the short term, at least as far as the politics are concerned, it’s quite possible that nothing else will matter. But at some point, I wonder if the political world will pause to consider the Republican message with a little more depth.
A few weeks ago, Matt Miller raised an important point: “What conservative officials, pundits and advocates are screaming is closer to the following: How dare you totally screw up something that we think shouldn’t exist!” Indeed, as we talked about as oversight hearings got underway a few weeks ago, conservatives are complaining about the functionality of a website that they’d just as soon destroy. They’re furious Americans are struggling to sign up for benefits that Republicans don’t want them to have. They’re demanding better performance of a system they’ve spent years deliberately trying to gut, and have no intention of trying to help fix.
The contradiction was more acutely obvious yesterday, with the release of October enrollment numbers: 106,185 consumers signed up for health insurance through an exchange, another 396,261 Americans have gained coverage through Medicaid expansion, and another million consumers were deemed eligible for coverage but have not selected a plan. GOP lawmakers considered this hilarious, noting a variety of sports venues that hold more than 106,185 attendees.
And that’s fine. Indeed, it’s predictable. About 500,000 Americans signed up for health care coverage last month, but because that number was far below the Obama administration’s original projections for the exchange marketplaces, critics of “Obamacare” want to take this opportunity to strut and gloat.
But that was yesterday. Today, I’d love to hear some of those same critics answer a couple of simple questions. First, for those mocking October enrollment numbers, do you wish that number was bigger or smaller? Because at this point, the answer appears to be “both,” which doesn’t make any sense. The Republican line currently seems to be, “We’re outraged that the number was so small, and we wish the totals were zero.”
That plainly doesn’t make any sense.
Second, for the 106,185 Americans who signed up for coverage through an exchange, and the 396,261 Americans who are now insured under Medicaid, is the Republican position, “We’d prefer to leave you behind with nothing?” What about those who sign up for coverage in November? And December?
By: Steve Benen, The Maoow Blog, November 14, 2013
“What A Shocker”: Obamacare Is Working Best In States That Aren’t Trying To Sabotage It
The disappointing Affordable Care Act (ACA) numbers the Department of Health and Human Services (HHS) released on Wednesday revealed that the law is working best in the states that are — shockingly — implementing the law as it was designed.
Of the 106,185 people who have completed an application for health insurance, nearly 75 percent came from 14 states and the District of Columbia that both set up their own exchanges and expanded Medicaid.
Unsurprisingly, California and New York combined for the bulk of the enrollments, 51,769. But the most promising news from the Golden State wasn’t even included in this report.
Peter Lee, the executive director of Covered California, reported Wednesday that as of Tuesday, 60,000 Californians had signed up for insurance. Signups have increased to a rate of almost 2,500 enrollees per day in November. At that pace, the state could be expected to enroll 402,500 people by March 31 but Lee says that he expects to hit a goal of 500,000 to 700,000 people by then, which means he expects the pace to pick up by at least 640 people a day to over 3,000 enrollees.
Lee’s optimism is linked to more than the enrollment numbers. It seems California’s consumers are happy with the state’s website.
“Overall, nearly 70 percent of consumers who completed the survey found the application process easy to complete, and 88 percent of customers visiting CoveredCA.com found the information needed to choose a health plan that was right for them,” Covered California reported in a statement released Wednesday, giving Republicans another reason to hope that California isn’t a bellwether for the rest of the nation.
Red Kentucky is the only state in the union that voted for Mitt Romney and set up its own exchange, thanks in large part to Democratic governor Steve Beshear. The state’s site signed up a total of 32,485 Kentuckians, with 5,586 enrolling in private plans, in its first month of operation. This reduces the state’s uninsured population —estimated at 640,000 — by just over 5 percent.
Of course, it’s not hard for the states to look impressive next to the federal number that is anemically low. And not all the states that set up their own exchanges have succeeded. Oregon’s marketplace is so flawed, they didn’t even have numbers to report for October.
Implementing health care reform was never supposed to be easy.
“It’s like fixing an airplane while it’s in flight, if there is something terribly wrong with the plane,” said Timothy Jost, a health law professor at Washington & Lee University and an expert on the ACA.
And that’s without the unprecedented campaign of sabotage the right has waged. But the obstruction that has threatened the law most has been the combination of a mostly unforced error — Healthcare.gov’s disastrous launch — and Republican states refusing to launch their own exchanges. While the right is thrilled they’ve assisted in this catastrophe, it was the ancillary result of another sabotage strategy that was either masterminded or enthusiastically encouraged by Michael Cannon.
Who?
“Cannon is a health care policy expert at the libertarian Cato Institute,” reports The New Republic‘s Alec MacGillis. “He is also an avowed opponent of the Affordable Care Act, and has for several years now been embarked on a legal crusade that, while a ways from triumphing, may have inadvertently played an outsized role in suppressing the number of states setting up their own exchanges, thereby greatly confounding the law’s implementation.”
Cannon believes he has found a loophole in the law that could end up undoing it in any state that didn’t set up an exchange. With that in mind, he helped successfully convince every state with a Republican governor to reject their right to build their own site.
By opting out, states made the success of the president’s signature legislative accomplishment dependent on one single portal that needed to reach its tentacles into three dozen complex insurance markets at one time.
That — it turns out — is a lot more complicated than the administration expected it to be.
The best state numbers show that the ACA can be implemented with participation rates that are in at least in the same ballpark as Massachusetts’ Romneycare or Medicare Part D.
And there were some other numbers in the HHS report that bode well for reform.
HHS reports that 26,876,527 different users accessed the site and 3,158,436 calls were made to its center. A total of 1,477,853 applications processed to the point of where eligibility could be determined. This shows that the demand for what the marketplace is offering definitely exists.
Clearly and undeniably, the fate of the law now depends most on one thing.
“The October report is clearly disappointing,” Timothy Jost wrote in his blog. ”But the really important reports will be the December report, which will tell us how many will be enrolled for coverage that begins in January, and the March report, which will tell us how many will be enrolled for 2014. If healthcare.gov is up and running by December, there is every reason to believe those reports will be much more promising.”
By: Jason Sattler, The National Memo, November 14, 2013
“Obamacare’s Critical Moment”: It’s Time For Nervous Democrats To Have A Gut Check
At times like this, with the Obama administration weathering yet another controversy regarding the stumbling beginnings of the Affordable Care Act, it’s useful to remind ourselves that this too shall pass. I’ve been plenty critical of how Healthcare.gov has been handled (see here, or here, or here), but eventually it will get fixed, at least to the point at which it works well enough. Likewise, the fears now being experienced by people with individual insurance policies will, by and large, turn out to be unfounded. There will be some who have to pay more than they’ve been paying, but in almost all cases they’ll be getting more too.
But there’s no doubt that this is an escalating problem for the administration. The person who got sold a cheap insurance policy on the individual market because the insurer was confident that either a) they probably wouldn’t get sick any time soon, or b) the policy was so stingy (whether the customer knew it or not) that the insurer wouldn’t have to pay anything even if they did, has now become the victim whom all agree must be made whole. We’re all talking endlessly about Obama’s “If you like your current plan, you can keep it” pledge, but the fact is that if you have one of these junk insurance plans, you only like it if you haven’t had to use it. But no matter—the people on these plans (and not, say, people who are finally getting Medicaid, because they’re poor so who cares) are now the only people that matter. Congress is obsessed with them, the news media is obsessed with them, and Something Must Be Done.
The administration is clearly spooked, and so are Democrats. But everyone needs to take a breath and ask themselves whether what they do in the next couple of weeks is something they’ll be able to live with in a year or five years or twenty years.
No one should be under the illusion that the Republican proposals to “fix” the problem of people on the individual market who want to keep their current plan—one of which could be voted on today in the House—are anything other than an effort to cripple the ACA. Not only would they allow insurers to continue selling junk policies, they would also allow the insurers to deny people coverage because of pre-existing conditions. In other words, the Republicans propose to restore the abysmal status quo ante that led to passage of the ACA in the first place. They’d also have the likely effect of jacking up premiums in the exchange marketplace by allowing the insurers to cherry-pick healthy young people for the now still-legal junk policies, leaving older and sicker people to migrate to the exchanges, where premiums will almost surely skyrocket a year from now once the damage becomes clear. As Igor Volsky puts it, “On the eve of implementing hard fought reforms, lawmakers are essentially considering re-segregating the health care market: healthy uninsured individuals without an offer of employer-sponsored coverage, Medicare or Medicaid will be lured away into subprime policies that include few consumer protections (and probably won’t be there for them should they fall ill); sicker people will find themselves in exchanges that resemble high-risk insurance pools, paying ever-more for coverage.” Any Democrat who votes for something like that should be ashamed of themselves.
There’s a Democratic proposal from Mary Landrieu that’s almost as bad. Meanwhile, House Democrats are threatening the White House that they’ll sign on with the Republican plan if the White House doesn’t come up with some other solution that will allow them to cover their asses. But there may be no way to let people who have junk insurance keep it without undermining the law as a whole. As Ezra Klein says, “Solving a political problem now at the case of worsening a policy problem 10 months from now isn’t a good trade.” And that’s putting it way too mildly. They could easily try to solve a political problem now and give themselves a much worse political problem ten months from now by making it impossible for the law to succeed. If that happens, the fact that they signed on to the measure that all but destroyed the law isn’t going to save them with the voters. Obamacare’s fate is every Democrat’s fate, whether they like it or not.
You can say that Obama made his bed by repeating that “If you like your insurance, you can keep it,” and now he has to sleep in it. I’d have two responses to that. First, plans that were in effect when the ACA passed in 2010 fall under a grandfather clause, so strictly speaking, if you liked the plan you had when the law was passed and you still have it, you can keep it, even if it doesn’t meet the new requirements. But since the individual market is volatile (people move in and out of it frequently) and only plans that haven’t been altered since then fall under the grandfather clause, that’s a small number of people.
But much more importantly, we shouldn’t make a terrible policy choice just because it’s the one that we think would line up most precisely with a rhetorical pledge Barack Obama made three years ago. Yes, he should have said, “If you like your plan you can keep it, so long as it’s a plan that gives real coverage and doesn’t leave you vulnerable to bankruptcy if you get sick or have an accident.” But he didn’t. And today, we should make the policy choice that does the most good for the most people.
It would be nice if you could make an enormous policy change without leaving a single American worse off. But that was never possible. There are millions who are going to benefit from the ACA—people who had no insurance who will now be able to get it for free or for a modest cost, people with pre-existing conditions who couldn’t get coverage but now can, and yes, people who thought they were covered but weren’t and now will be, even if they have to pay a little more. Screwing huge numbers of them over for the sake of a small number of people who have been sold a bill of goods by their insurance company and want to keep their junk plans would be unconscionable.
As Josh Marshall says, it’s time for nervous Democrats to have a gut check. Republicans are positively slobbering at the opportunity they think they have to destroy the ACA. After all that’s happened—after a generation of waiting for health reform, after all the effort it took to pass it, after the Supreme Court case and the election and everything else—are there Democrats who want to find themselves telling their grandchildren, “Well, I helped the Republicans subvert the ACA and deprive millions of Americans of health security, because I was afraid somebody might run an ad against me in my next election”?
My confidence that your average member of Congress in either party fully understands the policy implications of what they might be voting for hovers somewhere near zero. But they need to get up to speed, and then find their moral centers. This is among the most critical moments in the already long and tortured history of this law. They’d better not screw it up.
By: Paul Waldman, Contributing Editor, The American Prospect, November 14, 2013
“What Will Republicans Do?”: Here Comes The Real Government Takeover Of Health Care
For the last few weeks, Republicans have been full of schadenfreude over President Obama’s broken “If you like your plan, you can keep it” promise.
Now, this issue is about to blow up in Republicans’ faces.
Sen. Mary Landrieu (D-La.), who faces a tough re-election fight in a red state next year, has introduced a bill to address the president’s broken promise through greater government control over the individual health insurance market. Her bill would obligate insurers to continue offering all the plans they offer today unless they entirely exit the health insurance business in a state.
What will Republicans do with this proposal? Do they really want a federal law that says health insurers can’t enter or exit specific lines of business?
Rep. Fred Upton (R-Mich.) has introduced a bill in the House that would allow insurers to continue offering plans that would have been prohibited under the Affordable Care Act, but his bill is vulnerable to the criticism that it will still lead to a raft of plan cancellations as insurers choose to discontinue plans because the ACA has changed the financial incentives they face.
If Congress really wants to make sure people can take their plans, it will need to use the heavy-handed Landrieu approach; the light-touch Upton approach won’t work. Erick Erickson (of all people!) understands this; he wrote a piece this morning called “It’s a trap“:
The House, with the help of a good number of Democrats, will pass the Upton plan and send it to the Senate. Harry Reid will substitute the Landrieu plan and send it back to the House. The House will be forced to either vote for the Landrieu plan or be characterized as siding with insurance companies against people.
In one fell swoop, the Democrats will have the GOP on record saving Mary Landrieu’s re-election in Louisiana by casting her as the one who saved Americans’ health care plans, and also getting on record as really being in favor of fixing Obamacare with the use of mandates.
Pretty much. And it’s the comeuppance conservatives are getting for (1) having no health care agenda of their own and (2) endorsing the bizarre idea that health reform should not lead to health plan changes. With no health policy guidestar other than they’re against what the president is for, Republicans are liable to walk into traps like demanding more health insurance regulation than the president wants.
By: Josh Barro, Business Insider, November 13, 2013
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