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“The Equivalent Of Thinking The Iraq War Would Be A Cakewalk”: Why The GOP Presidential Candidates Can’t Reform Health Care

In the last few days, Scott Walker and Marco Rubio released health care plans, and other Republican candidates are sure to follow soon. Most will probably be pretty similar, even if some are more fully fleshed out than others.

But they’ll all share one feature, the thing that tells you that they aren’t even remotely serious about this issue: they will take as their starting point that the entire Affordable Care Act should be repealed.

I say that that shows they aren’t serious not because I think the ACA has done a great deal of good, though I do think that. I say it because it shows that they’re completely unwilling to grapple with both the health care system as it exists today, and how incredibly disruptive the wholesale changes they’re proposing would be. Walker’s plan even says, “unlike the disruption caused by ObamaCare, my plan would allow for a smooth, easy transition into a better health care system.” This is the health care equivalent of thinking the Iraq War would be a cakewalk.

The reality is that repealing the ACA now that it has been implemented would mean a complete and utter transformation of American health care. Republicans have often lamented that the law was so terribly long and included many different rules and regulations — yet now they act as though the law amounts to just a couple of rules here and there that can therefore be tossed out without too much trouble. But they were right the first time: the law is indeed complex, and has brought hundreds of changes big and small to American health care, not just in how people get insurance but in how Medicare and Medicaid work, how doctors and hospitals are paid, and in all sorts of other areas.

The ACA established health care exchanges. It brought millions of people into Medicaid, it closed the Medicare prescription drug “doughnut hole.” It gave subsidies to small businesses. It funded pilot projects to explore new means of providing and paying for care, it imposed new regulations on insurance companies. It created new wellness and preventive care programs, it provided new funding for community health centers. It did all that, and much more. You can argue that each one of these was a good or a bad idea, but you can’t pretend that unwinding them all would be anything resembling a “smooth, easy transition.”

We know why every Republican health care plan has to start with repealing the ACA: politics. Republicans have spent the last five years telling their constituents that they’re going to repeal it any day now, and they’ve held over 50 repeal votes in Congress. They’ve refused to admit that a word of it has any merit, even as they try to incorporate some of its more popular reforms (like protections for people with pre-existing conditions) into their own plans. So they’ve backed themselves into a corner where whatever any Republican offers has to start with repeal.

Which is why all their plans, the ones that have been released and the ones yet to come, are absurdly unrealistic. They pretend that it will be no problem to completely transform the American health care system — and there will be no losers in such a transformation, only winners — which shows that they have no intention of actually doing so. In fact, I’d go so far as to say that if a Republican gets elected next November, he’ll be relieved when his health care plan dies in Congress.

Let’s contrast that with how Democrats acted in 2008, when there was a vigorous debate in the presidential primary over health care. The three leading candidates, Barack Obama, Hillary Clinton, and John Edwards, all had very similar plans, similar because they reflected the Democratic consensus on health care reform that had evolved in the decade and a half since Bill Clinton’s reform effort failed. One major disagreement was over whether there had to be an individual mandate — Clinton’s plan had one, and Obama’s didn’t — but when he took office, Obama accepted that the mandate was necessary to make the entire plan work. It wasn’t a fantasy plan that just pandered to liberal hopes, it was something that could actually pass and be implemented.

Whenever liberals told Obama that a single-payer health plan would be far superior to what he was proposing, he would respond that if we were starting from scratch, that would probably be true. But, he’d say, we aren’t starting from scratch, so the ACA has to accommodate itself to the health care system that already exists. The result was a gigantic kludge, new complexity layered on top of an already complex system in an attempt to solve its varied shortcomings. Like all kludges, it seemed like the realistic option given the situation we confronted, but it left us with something that was far from perfect.

A Republican who actually wanted to pass real health care reform would have to approach the problem the same way: by saying that for better or worse, the Affordable Care Act has already affected the system in profound ways, so any realistic plan has to understand what those changes are, and find the most efficient way to keep the ones that are working and change the ones that aren’t. That doesn’t mean that repeal is impossible, just that it would be a spectacular upheaval, one that I promise you Republicans have no genuine appetite for. Remember all the screaming and shouting they did over the people on the individual market whose previous plans didn’t qualify under the new regulations, and who had to shop for new plans? Multiply that by ten or twenty times, because that’s how many people would likely lose their existing coverage if you repealed the ACA in one fell swoop.

And that would be only the beginning. So when any Republican candidate says he or she has a plan to reform health care, take a close look. If it starts with repealing the ACA — and it will — then you’ll know it isn’t serious and it’s never going to happen.

 

By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The PlumLine, The Washington Post, August 20, 2015

August 21, 2015 Posted by | GOP Presidential Candidates, Health Reform, Obamacare, Republicans | , , , , , , | 1 Comment

“Particularly Shameless”: Rick Scott Lied On His Mother’s Grave — And Blew A Hole In The GOP’s Anti-ObamaCare Argument

When it comes to ObamaCare’s expansion of Medicaid, it may seem like a matter of simple logic for states to take the money that’s on offer. It would both help their most vulnerable citizens and pump lots of money into local economies.

Alas, logic and the contemporary Republican Party have little relation to each other, so most GOP-controlled statehouses have turned down the offer. But few have done so in a more clownish manner, or exposed the contradictions in the Republican position more clearly, than Florida Gov. Rick Scott.

Scott has flip-flopped on Medicaid, first opposing it, then supporting it, then opposing it again. This is bad, if not entirely unusual, political behavior. But Scott was particularly shameless, citing his recently deceased mother as his justification for suddenly embracing the expansion in 2013.

As he has now revealed, however, Scott was lying on his mother’s grave. He pretended to embrace the Medicaid expansion to secure a federal waiver for privatizing Florida’s Medicaid system, then quietly dropped his support once the waiver was granted. (The Obama administration’s decision to give the quid without first getting the quo, given who they were dealing with, was not its finest hour.)

So Scott used his deceased mother as a shield to lie about his motives in order to funnel federal taxpayer money to Florida businesses, then reneged on his part of the deal, leaving many poor Floridians to needlessly suffer and in some cases die. All par for the course for Scott, who before entering politics oversaw a massive amount of Medicare fraud as CEO of a large for-profit hospital operator.

At this point, one could say that, rank dishonesty and opportunism aside, at least Scott is standing on principle. He is turning down federal dollars to protect state sovereignty. Not a very attractive principle, but at least a principle, right?

Nope. Before the Affordable Care Act, the federal government made money available to states to create Low-Income Pools (LIP) that would reimburse hospitals that treated patients who couldn’t afford to pay for emergency services. Florida is receiving more than $1 billion a year in federal funds from LIP. The ACA, however, makes the LIP obsolete. It addresses problems of uncompensated hospitals by expanding Medicaid, greatly reducing the number of patients who cannot pay their bills.

The federal government has told Florida that it will not make the LIP funds available, pointing to the Medicaid funding which remains available. But Scott wants to have his cake and eat it, too. Not only is he demanding that the federal funding continue, he has actually filed a frivolous lawsuit arguing that the federal government is obligated to give Florida the LIP money. The Obama administration, having been burned by Scott already, is unmoved.

This lawsuit builds on the Supreme Court’s already shaky holding that allowed states to opt out of the expansion, pushing it to an extreme that would be too absurd even for the Roberts Court. It has virtually no chance of succeeding.

But the decision to file it is instructive. On the one hand, Scott is arguing that taking an extraordinarily good offer from the federal government to insure its poor citizens would be an intolerable intrusion on the sacred sovereignty of the state of Florida. On the other hand, Scott is arguing that Florida has a right to another source of federal tax dollars for health care.

There is, in other words, no actual principle involved here — not even a bad “states’ rights” one. It’s just pure partisan politics, with Florida’s poor people being punished as a result.

As Michael Hilzik of the LA Times observes, Scott’s disgraceful behavior reflects broader trends in Republican governance. The decision of Republican officials at the state level to reject the Medicaid expansion, while misleading their constituents about the dread ObamaCare, continues to have disastrous results for their citizens.

The ensuing mess in Florida — where a huge hole has been blown in the state budget because anti-ACA fanatics won’t take the Medicaid expansion — does at least provide a glimmer of hope for the longer term. Red-state legislators may not particularly care about the many poor people being needlessly denied access to medical care. But they will start to increasingly care about the medical professionals and hospitals who are also being screwed. Once Obama leaves office, it’s likely that more and more states will grudgingly take the federal money.

In the meantime, however, the consequences of misrule in these states will continue to be grim.

 

By: Scott Lemieux, The Week, May 18, 2015

May 19, 2015 Posted by | Low Income Pools, Medicaid Expansion, Obamacare, Rick Scott | , , , , , | 1 Comment

“Sympathy For The Speaker” GOP Leaders Appear To Know They Have A Credibility Problem

I have sympathy (not much, but some) for John Boehner.

When it comes to the Affordable Care Act, the Republican House Speaker is nearly always between a rock and a hard place.

On one hand, he and the GOP leadership must stand against President Barack Obama’s health care law, because the longer it remains on the books, the more likely those who receive its benefits are going to support Democrats, not Republicans.

On the other hand, if someday the Republicans repeal the law, after having returned to the White House with congressional majorities, they will be forced to devise an alternative — an impossibility given the reactionary impulses of today’s GOP.

In the former scenario, Republicans lose.

In the latter scenario, they lose.

So Boehner must thread the needle while hoping his credibility as a GOP leader isn’t badly tarnished, even as rank-and-file Republicans discover through their experience that Obamacare isn’t actually a harbinger of North Korean-style totalitarianism.

Of course, that’s easier said than done. Boehner reiterated the Republican position on health care on the May 3 broadcast of Meet the Press, saying that Obamacare wasn’t working.

“Obamacare made it harder for employers to hire people,” he said. “You can ask any employer in America, ask them whether Obamacare has made it harder for them to hire employees, and they’ll tell you yes.”

When asked why none of the Republican Party’s dire predictions about health care came true, Boehner responded: “You know why there’s more people insured? Because a lot more people are on Medicaid.” He continued, “Giving people Medicaid insurance is almost like giving them nothing, because you can’t find a doctor that will see Medicaid patients. So where do they end up? The same place they used to end up: the emergency room.”

Events later in the week suggested, however, that something wasn’t right about Boehner’s claims. On Wednesday, the largest independent study of its kind was released. It found that nearly 17 million Americans are now covered under the Affordable Care Act.

Some lost coverage (about 6 million), according to the RAND Corporation study, but many more found coverage, with a net gain of 16.9 million. The evidence also contravenes those who say Obamacare encumbers hiring. For one thing, the largest gains (nearly 10 million) were made in employer-run insurance plans. For another, some 80 percent of the working population under the age of 65 saw no change at all in their health care coverage.

That wasn’t the only reason to look askance at Boehner’s claims. Last Friday’s monthly jobs report showed the unemployment rate had dropped to 5.4 percent, the lowest it’s been since May 2008, before Obama won the presidency. Even wages, which have not typically kept pace with inflation, rose by 2.2 percent in the past year.

So something’s wrong with the picture Boehner is painting. If most employers are offering insurance, and if the job market is expanding, why is Boehner saying that the Affordable Care Act has led to less insurance coverage and more unemployment?

GOP leaders appear to know they have a credibility problem. They are shifting their stance against Obamacare from quantity to quality. According to a report in The Hill published after Boehner’s appearance on Meet the Press, the Republicans now concede that Obamacare has covered more Americans but argue that the coverage is inferior. Hence, Boehner’s comment about Medicaid: Doctors don’t take Medicaid, and having it is like having nothing.

Such a shift raises its own question of credibility. Why would a Republican Party that equates tyranny with the presence of government in the lives of individuals be worried about the government’s role in providing quality health care to individuals?

Some might judge this as hypocrisy and thus dismiss the new Republican position as entirely unworthy of scrutiny. There’s merit to that, as Washington wallows in hypocrisy. But hypocrisy can prevent us from seeing what’s really going on. In this case, I wonder if Boehner and the leadership are worried about holding their ranks, as the temptation to defect grows from within.

Over time, the Affordable Care Act will penetrate deeper into the population. The millions of Americans who will benefit from the law will have an incentive to maintain the status quo. They’ll likely support the Democratic Party as long as the Republicans demand repeal of the law. So, as of now, a vote for a Republican, from the point of someone covered by the Affordable Care Act, is a self-destructive vote. And among those millions are conservatives.

Some might argue that in saying things about Obamacare that just aren’t true, Boehner risks alienating conservatives that make up the base of the Republican Party. Why would they trust the House Speaker if he is so consistently wrong? There’s something to that, but a likelier explanation for the GOP’s continued, and shifting, stance against the health care law is that opposition, no matter how contorted, is the best way to keep the conservatives in line.

Given time, more conservatives are going to benefit from the law. And the more they do, they more they will vote their self-interests. And that’s why I have (a little) sympathy for John Boehner.

 

By: John Stoehr, The National Memo, May 16, 2015

May 17, 2015 Posted by | Affordable Care Act, John Boehner, Obamacare | , , , , , , , | 1 Comment

“A Bold Truth-Teller”: What If A 2016 GOP Candidate Told The Truth About Obamacare?

If you’re a Republican presidential candidate, there aren’t too many ways you can distinguish yourself from your primary opponents on the issue of health care — I hate Obamacare, you hate Obamacare, we all hate Obamacare. But maybe there’s another way, for someone who has the courage to shift his rhetoric and present themselves as a bold truth-teller.

To put that in context, let’s look at some new developments on the Obamacare front.

A study just out from the Rand Corporation — not exactly a hotbed of socialist thinking — finds that after the coverage provisions in the Affordable Care Act took effect: “we estimate that 22.8 million people became newly insured and that 5.9 million lost coverage, for a net increase of 16.9 million with insurance as of February 2015.”

In addition, a new Gallup poll shows that 43 percent of Americans say they’re satisfied with the government’s work in health care, which doesn’t sound so great until you learn it’s the highest number this question has received since the organization began asking it in 2001.

We already know that all the predictions Republicans made about the ACA — a decline in health coverage, skyrocketing medical spending and premiums, massive job losses — failed to come true. One seemingly sensible response to the facts about Obamacare is to pretend they aren’t true, which is how prominent Republicans have handled things until now. After all, there hasn’t been much punishment for spreading falsehoods about the law, and the public is still woefully uninformed about it. For example, for every American who knows that the law has proven much less expensive than was originally estimated, there are eight who mistakenly believe it ended up being more expensive.

Nevertheless, the good news continues to pile up, and at least some of it may be penetrating to the public, albeit slowly (approval of the law has been ticking up of late). Which could create the opening for a Republican willing to say something different from his peers.

Let’s imagine a presidential candidate who said something like this to GOP primary voters:

“I know that just saying ‘Repeal Obamacare!’ is a good applause line. And believe me, I wish it had never passed. But we’ve had over 50 votes to repeal it in Congress, and it’s still here. Like it or not, it’s becoming entrenched. If we repealed it tomorrow, it would mean that millions of Americans would lose the coverage they’ve got. We can’t object to people losing their plans because of Obamacare, and then say it’s no big deal if a much larger number of Americans lose their coverage when we repeal the law. And Obamacare does a few things that we Republicans favor.

“So instead of just saying ‘Repeal it now!’, I’m going to give you a plan to keep the good things, ditch the bad things, and move toward a better health care system. We’ve spent the last five years banging our heads against the wall over this law, and some of my opponents think more banging is the answer. But I want to solve the problem.”

The Republican who said that would, of course, be branded a traitor by some. But he’d also get a wave of adoring press coverage, in which he’d be characterized as a straight-talking man of courage and the only one willing to have an adult conversation about health care.

The outcome of the King v. Burwell lawsuit could also help make his case. If the Supreme Court rules in Republicans’ favor, millions of Americans will lose their health coverage when subsidies are taken away, and efforts for a legislative fix are uncertain at best. The experience will make it clear even to many Republicans that “Burn it down!” isn’t always the wisest approach.

Yes, a Republican who turned his back on “repeal” to focus on “replace” would be taking a huge risk, since GOP primary voters are not necessarily going to be thoughtful and measured in their response to someone proposing something less than all-out war against Barack Obama and everything he ever touched. But it might just be crazy enough to work.

 

By: Paul Waldman, Senior Writer, The American Prospect; The Plum Line Blog, The Washington Post, May 7, 2015

May 11, 2015 Posted by | Affordable Care Act, GOP Presidential Candidates, Obamacare | , , , , , , | 2 Comments

“Boehner Struggles With His Failed ACA Predictions”: He Should At Least Try To Discuss The Substance Of The Issue Honestly

House Speaker John Boehner sat down with NBC’s Chuck Todd on “Meet the Press” yesterday, and the host asked a good question about the Republican leader’s failed predictions about the Affordable Care Act. Regrettably, the Speaker couldn’t respond with an equally good answer.

TODD: You made some dire predictions about health care. 2014 you said fewer people would have health insurance. According to plenty of surveys, more people have health insurance today than they did before it went down from – the uninsured rate went down 17 percent to just under 12 percent. You said it would destroy jobs. The first year it was implemented, the country added 3 million jobs. Why…

BOEHNER: Obamacare made it harder for employers to hire people. The economy expands and as a result, you are going to have more employees because businesses have to. But if you can ask any employer in America, and ask them whether Obamacare has made it harder for them to hire employees, they’ll tell you yes. Because it’s a fact.

When you look at – you know why there are more people insured? Because a lot more people are on Medicaid. And giving – you know, we expanded Medicaid in a big way. And giving people Medicaid insurance is almost like giving them nothing. Because there aren’t – you can’t find a doctor that will see Medicaid patients.

The Speaker soon added that, as far as he’s concerned, the Affordable Care Act is “not working.”

Boehner might have a credible argument, if we abandoned the agreed upon meaning of “working.”

Look, I realize that health care policy has never been the Ohio Republican’s strong suit, and the Speaker isn’t a wonk deeply engaged in policy details. I can also appreciate why he’s a little embarrassed about making all kinds of ACA predictions, each of which turned out to be wrong. It’s just not realistic to think Boehner will fess up on national television to getting the entire fight over health care backwards.

There’s just no avoiding the fact, however, that Boehner’s comments on “Meet the Press” were woefully incorrect.

According to the Speaker, “it’s a fact” that the Affordable Care Act has “made it harder for employers to hire people.” There’s simply no evidence to support this. None. The U.S. economy saw a jobs boom coincide with the implementation of the ACA. Indeed, the reform law has actually created plenty of jobs within the health care industry by spurring “unprecedented” levels of “entrepreneurial activity.”

At the same time, Boehner believes the drop in the uninsured rate is the result of Medicaid expansion, but that’s wrong, too – millions of consumers have gained private coverage by way of exchange marketplaces. This is even true of the Speaker’s home state of Ohio, which is prepared to create its own exchange if the Supreme Court makes it necessary.

As for the benefits of Medicaid, coverage through the program is not the practical equivalent of “nothing.” Many Americans who’ve gained health security through Medicaid have benefited greatly from affordable care.

Boehner’s conclusion – that “Obamacare” is “not working” – is only true if one closes their eyes, sticks their fingers in their ears, and refuses to consider the evidence. The law is pushing the uninsured rate to new lows; it’s succeeding in satisfying consumers; the law’s price tag is lower than expected; it’s producing impressive results on premiums and enrollment totals; we’re seeing the lowest increase in health care spending in 50 years; the number of insurers who want to participate in exchange marketplaces keeps growing; there’s reduced financial stress on families, the efficacy of Medicaid expansion is obvious, as is the efficacy of the medical-loss ratio and efforts to reduce medical errors system-wide.

The maligned law is even becoming more popular.

Boehner doesn’t have to like the law. He doesn’t even have to admit he was wrong. But he should at least try to discuss the substance of the issue honestly.

 

By: Steve Benen, The Maddow Blog, May 4, 2015

May 5, 2015 Posted by | Affordable Care Act, John Boehner, Obamacare | , , , , , , , | 1 Comment

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