“This Did Not Go According To Plan”: McMorris Rogers Gets An Earful On ACA
For much of 2013 and 2014, Republicans were on a quest to discover “Obamacare victims.” GOP officials were convinced the Affordable Care Act was wreaking havoc on families’ lives, and Republicans everywhere were hunting for horror stories.
In nearly every instance, those stories fell apart in the face of routine scrutiny, and most of the “victims” were actually far better off with the ACA than without it. One of the more notable examples arose early last year when Rep. Cathy McMorris Rodgers (R-Wash.), the House Republican Conference chair, used her party’s official response to the State of the Union to introduce America to “Bette in Spokane.”
Predictably, the story unraveled and McMorris Rodgers was pressed for an apology after pushing a misleading story. A year later, the Republican congresswoman hasn’t given up.
Cathy McMorris Rodgers, chair of the House GOP conference, took to Facebook to commemorate the fifth anniversary of the Affordable Care Act by asking to hear real-life horror stories from real people.
This did not go according to plan. McMorris Rodgers generated plenty of responses, most of which were from people who see the ACA as a lifesaver for their families.
I’m not altogether sure what the point of the endeavor was supposed to be. What exactly did the Republican congresswoman hope to accomplish?
But even putting that aside, this little incident should be a reminder to GOP lawmakers that their assumptions about “Obamacare” may not be in line with Americans’ reactions in the real world. In fact, if Republicans on the Supreme Court gut the law, consumers will be looking to folks like McMorris Rodgers to prevent systemic chaos.
Postscript: Wonkette joked, “[O]bviously, the takeaway here is that Obamacare is such a huge failure that the government is paying people to troll Facebook and lie about how much they like the ACA, because liberals are congenital liars, and poor Cathy McMorris Rodgers is a victim of cyberbullying, the end.”
Wonkette was kidding, but I wouldn’t be too surprised if this line took root in conservative media fairly soon, if it hasn’t already.
By: Steven Benen, The Maddow Blog, March 27, 2015
“Can’t Stop, Won’t Stop”: GOP Will Never Stop Coming For Obamacare
Obamacare turned 5 on Monday, a birthday achieved despite sustained and repeated efforts to smother the law in its cradle.
The law has taken some hits, including a 2012 Supreme Court decision that buckled the knees of the bill’s backers but seemed to make the Affordable Care Act the settled law of the land.
Now the Supreme Court has again taken up another challenge to the law.
King v. Burwell hinges on whether or not four words buried deep in the text of the law contain the seeds of Obamacare’s destruction by eliminating tax subsidies for people living in states that declined to set up their own insurance exchanges.
But even if they lose again at the court, conservatives say that they will continue to try to undo the law through the courts.
Michael Cannon, a health-policy expert at the Cato Institute, said the most promising challenge to the ACA comes from the state of Maine, which, after the Roberts court ruled in 2012 that the federal government was limited in how much it could compel states to expand Medicaid, sued to roll back its existing Medicaid coverage.
Last year, a federal appeals court ruled against the state, but Gov. Paul LePage has appealed to the Supreme Court, even as Maine’s attorney general has refused to represent the state in its challenge of the law.
Other remaining challenges include Sissel v. U.S. Department of Health and Human Services, which argues the ACA is unconstitutional because it violated the Constitution’s origination clause that states spending bills must originate in the House, not the Senate.
“They are both kind of long shots,” acknowledged Cannon, noting that “the Supreme Court has never struck anything down on origination grounds” and that the House likely lacks standing in its lawsuit against the administration.
If the administration loses King v. Burwell, most health-policy experts predict that it will create a “death spiral” as low-income beneficiaries lose their subsidies in states that did not set up their own exchanges, and insurers are forced to raise rates. But conservatives say they will not delay in kneeing the law into the grave by filing lawsuits in states that set up their own exchanges.
Because many states rushed to do so, conservatives say they expect that governors and their health departments may have violated their state constitutions, and so even residents of those states that believed they were immune from the Burwell decision could face a loss of subsidies as well.
If the Supreme Court decides in favor of the government in King, conservative legal scholars said that what they decide to do in the future to tear down the law depends upon precisely the way in which the judgment is rendered. Halbig v. Burwell mirrors the King case in many respects, but other cases could still go forward, in particular one in Indiana in which several dozen school districts have argued that the employer mandate to provide health insurance puts too much of a burden on state and local governments.
Smaller challenges to the law, meanwhile, continue to mount. Little Sisters of the Poor sued to exempt themselves from the contraceptive mandate. If successful, the suit would allow more organizations to opt out than the Hobby Lobby decision did.
Another challenge, brought by the Goldwater Institute of Arizona, takes aim at the Independent Payment Advisory Board, which was designed to permit the Executive Branch to limit Medicare payments. Even some of the law’s liberal supporters, like former Vermont Gov. Howard Dean, have said that the board should be eliminated or rethought.
Meanwhile, conservative legal scholars say they continue to pore over the text of the law in the hopes that they will find some other legal weaknesses that were not readily apparent. The King case, after all, hinges on four words in the text that were discovered by a legal scholar months after the law was passed.
“This law is so complicated that even those who have read it don’t understand the depths of it,” said John R. Graham, a senior fellow at the conservative National Center for Policy Analysis. “Every time we look at it, we find something else to take to a judge.”
And such lawsuits, he added, help galvanize opposition to the bill years after it has passed.
“They keep the energy up, keep Obamacare on the front pages, keep hope alive.”
Which is necessary, because many conservatives still hope that the law will collapse under its own weight.
“They have really reached the limit of sign-ups. Enrollment is flattening as people see more and more how expensive the coverage is, how high the deductibles are, all the hoops they have to jump through, and they realize it is just not very attractive insurance,” said Grace-Marie Turner of the Galen Institute. She said that many states would be able to opt out of some of the law’s provisions in 2017, and find their own alternatives.
“There is going to be huge momentum going forward to make changes to this law,” Turner said. “I could go on forever about how damaging this law has been to people’s lives. It has to be changed.”
By: David Freedlander, The Daily Beast, March 25, 2015
“Completely Erroneous Impressions”: The Race Between Slander And Reality On Obamacare
Speaking of million pixel images, Sarah Kliff has an important piece at Vox today about perceptions of Obamacare five years in, and the big takeaway is how little has changed, in no small part because people with no direct experience of the new system have internalized the (mostly negative) propaganda they’ve heard. That is particularly true with respect to completely erroneous impressions of the net cost of Obamacare:
Forty-two percent of Americans think Obamacare has gotten more expensive over the past five years. Only 5 percent of poll respondents hit on the right answer: budget estimates for the Affordable Care Act have consistently fallen since it became a law.
Make no mistake: Obamacare spends a lot of money on its tax credits and Medicaid expansion. It recoups some, but not all, of that new spending with hundreds of billions of dollars in Medicare cuts, which reduce federal health spending. The bulk of the remainder is made up with tax increases. But back when the law was passing, Republicans argued up, down, and sideways that the Congressional Budget Office was sharply underestimating the amount of money Obamacare spends.
In fact, the CBO overestimated the cost of Obamacare — and by quite a lot. In April 2014, it marked down its Obamacare projection by more than $100 billion. Much of the revision comes down to the fact that health-care costs have grown very slowly during 2009, meaning it’s less expensive for the government to help millions of Americans purchase coverage. Just this month, CBO released new projections showing that Obamacare’s subsidies would cost 20 percent less over the next decade than initially expected.
The government is now spending less on health care than CBO had projected back in January 2010 — a projection that didn’t include any Affordable Care Act spending at all.
Another problem is that people attribute to the Affordable Care Act phenomena that would have occurred anyway, especially rising (though more slowly rising) premiums and disruption of individual insurance policies–and even the long, long trend away from fee-for-service medicine delivered by doctors of one’s own choice.
Assuming it is not crippled by the U.S. Supreme Court or repealed by a Republican Congress and president, Obamacare will slowly or surely chip away at the misconceptions. It is, sad to say, a sign of progress that (according to the Vox survey) that only 26% of self-identified Republicans believe in the “death panel” meme. The bigger question is how long it might take for Republican politicians to end their propaganda and treat Obamacare as part of the national landscape–as something to change, not kill–and whether that will precede their next turn in real power.
By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, March 23, 2015
“Forget About Repealing Obamacare”: Too Many “Message” Votes Have Put The GOP In A Bind
If at first you don’t succeed, try, try again? That certainly seems to be the motto of House Republicans. Last week, the House GOP took its 56th vote to repeal the Affordable Care Act, President Barack Obama’s signature health care reform law.
The bill’s prospects for consideration in the Senate are low and the president has repeatedly promised to veto such a measure anyway. After 56 tries, the House votes to repeal the health care law have become so commonplace that hardly anyone in Washington even blinks an eye at them anymore. Even the president says he’s lost count of how many repeal votes there have been. If House Republicans are serious in their quest to roll back the Affordable Care Act, why do they keep pursuing a strategy they know is doomed to fail?
They do it because these multiple repeal votes aren’t a serious attempt to void the health care law. They are merely symbolic message votes. Voting to repeal the Affordable Care Act was a popular campaign message for candidates on the right, and the recent House vote gave them a chance to fulfill their election year promises.
The repeal votes also give the Republican party a platform to continue talking about their opposition to the health law and to highlight its differences with the president. However, too many “message” votes may have also put the party in a bind. After 56 votes on essentially the same piece of legislation, the Republican party has faced criticism, according to The Hill, for failing to articulate an alternative plan. The repeated symbolic votes also expose the party to criticism for failing to lead in a critical policy area. The time spent in fruitless endeavors to repeal the law could have instead been used to negotiate on policies to fix the Affordable Care Act’s weaknesses. When it comes to health care policy, Republicans have simply become the party of no.
It’s time to switch tactics. Following the House votes last week, Sen. Orrin Hatch, R-Utah, Sen. Richard Burr, R-N.C., and Rep. Fred Upton, R-Mich., released a proposal for an alternative health care plan. The proposal is a good first step and perhaps necessary as, for the first time, three House Republicans voted against repeal of the Affordable Care Act in protest of their party’s apparent lack of a plan to replace it.
In addition to putting an actual health care plan on the table, Republicans may also want to consider trying to make changes to the current health care law in pieces. There could be opportunity for negotiation on aspects of the law that remain unpopular, such as the medical device tax, the Medicare Independent Payment Advisory Board and the definition of a full-time work week. Further, the Supreme Court ruling on the King v. Burwell case later this year regarding the legality of the subsidies being provided for the purchase of health insurance on the federal exchanges could provide Republicans with another opportunity to change the law. If the Supreme Court rules against the subsidies, a legislative fix may be necessary. By taking advantage of these opportunities, the party might be able to make the law more palatable for its constituency and improve its credibility in the process.
House Republicans have made their disdain for the Affordable Care Act very clear. A 57th vote to repeal the law will not be necessary, especially since it, too, would be doomed to fail as long as Obama is in office. However, it’s entirely possible we’ll see one. By focusing strictly on repeal of the entire law, Republicans risk giving the impression that they are completely unwilling to engage in meaningful debate on health care policy. The party should instead work to improve the law and continue putting forward ideas to do so.
A great example of this can be found at the state level. Following the Supreme Court’s decision that the Affordable Care Act’s Medicaid expansion was optional, several Republican governors have proposed alternative Medicaid plans to the administration. Some have already been successful in putting their imprint on the president’s initial policy because they came to the table in a serious manner. Republicans at the federal level would do well to follow suit.
By: Cary Gibson, a Government Relations Consultant with Prime Policy Group; Thomas Jefferson Street Blog, U. S. News and World Report, February 10, 2015
“Absurdity Of The Argument Is It’s Greatest Strength”: Republicans Know Their Obamacare Case Is Bogus; Here’s The Proof
On Thursday, the government filed its brief to the Supreme Court in the case that will determine whether Obamacare subsidies disappear in three dozen states. Its argument is comprehensive, but one part of it speaks directly to the political history of the law, and the fact that everybody, including Republicans in Congress who now claim out of convenience that the law plainly limits subsidies to states that set up their own exchanges, always understood it to authorize subsidies everywhere.
The government confines this part of its argument to the legislative debate in the run up to the law’s passage in early 2010, but it could make the point more succinctly (and perhaps convincingly) by fast forwarding to early 2011. These days, Republicans up to and including Senate Majority Leader Mitch McConnell confidently pronounce that “the language of the law says … subsidies are only available for states that set up state exchanges.” But that’s not what they believed four years ago.
When Republicans took over the House in 2011, the political environment in Congress changed dramatically. Obamacare couldn’t be repealed, but it became fair game for damaging modifications, and the GOP took aim at it and other domestic spending programs whenever opportunities to offset the cost of new legislation arose. One of the first things Congress did back then was eliminate an Affordable Care Act provision that would have significantly expanded the number of expenses businesses are required to report to the IRS. Even before the law passed, business associations were livid about the “1099” requirement, and created such an uproar over it that the question quickly became how, not if, it would be repealed. Even Democrats wanted it gone.
The only problem was that the reporting requirement was expected to raise over $20 billion. Under GOP rule, it could only be offset with spending cuts elsewhere in the budget. As it happens, they found those spending cuts elsewhere in the ACA itself. Specifically, Republicans paid for repealing the 1099 provision by subjecting ACA beneficiaries to stricter rules regarding when they have to reimburse the government for subsidy overpayments. Make more money than you anticipated, and the government will claw back your premium assistance come tax season.
The congressional budget office scored the plan as essentially deficit neutral, and Republicans voted for it overwhelmingly. But you see the problem here. If the ACA plainly prohibits subsidies in states that didn’t set up their own exchanges, then there would be no subsidies in those states to claw back. And by April 2011, when the clawback passed, we already knew that multiple states were planning to protest ACA implementation and let the federal government set up their exchanges, including giant states like Florida, which now has a million beneficiaries. They would have needed a different, or additional, pay-for.
Obamacare’s legal challengers might chime in here to insist that their case is impervious to revelations like these. CBO’s analyses were premised on the idea that every state would set up its own exchange, and Republicans (and many Democrats) based their votes on what CBO told them. Other Democrats who actually understood the scheme may have simply pretended not to notice the problem. Nevertheless, they’d say, the law was designed to withhold subsidies from people whose states didn’t establish exchanges, and to ruin the individual and small-group insurance markets in those states, without providing any notice to either. In a perverse way, the absurdity of the challengers’ argument is it’s greatest strength. Because the scheme they insist Congress intentionally created was so far from Congress’ mind, it’s hard to find contemporaneous evidence that Congress absolutely didn’t mean to condition these subsidies. In much the same way, we can’t be sure that Congress didn’t mean to denominate those subsidies in Canadian dollars. A $ isn’t necessarily a $ after all.
But this familiar line of defense crumbles here. It is facially plausible—though incorrect—to posit that at the time the law passed, CBO believed subsidies would be available everywhere because it simply assumed every state would set up an exchange. But that assumption didn’t hold in April 2011. Something else must explain CBO’s 1099-repeal score, and the Republican votes that followed it. What we have in the form of this bill is clear evidence that everyone who voted for it (including every single Republican, save the two GOP congressmen and one GOP senator who weren’t present) understood the Affordable Care Act to provide subsidies everywhere.
Congress repealed the 1099 provision at an important moment—after multiple states announced that they would step back and let the federal government establish their exchanges, but before the IRS issued its proposed rule stipulating that subsidies would be available on both exchanges. The only thing Congress had to go on when it stiffened the clawback mechanism was its own reading of the Affordable Care Act, and Congress behaved exactly as you would expect. It operated with the understanding that subsidies were universal.
Today, many Republicans will tell you that the law plainly forecloses subsidies through the federal exchange. Six senators—John Cornyn, Ted Cruz, Orrin Hatch, Mike Lee, Rob Portman, and Marco Rubio—and nine congressmen—Marsha Blackburn, Dave Camp, Randy Hultgren, Darrell Issa, Pete Olson, Joe Pitts, Pete Roskam, Paul Ryan and Fred Upton—have even filed an amicus brief with the Supreme Court, which begins, “The plain text of the ACA reflects a specific choice by Congress to make health insurance premium subsidies available only to those who purchase insurance from ‘an Exchange established by the State….’ The IRS flouted this unambiguous statutory limitation, promulgating regulations that make subsidies available for insurance purchased not only through exchanges established by the States but also through exchanges established by the federal government.”
All of them, save Cruz, who was elected in 2012, voted for 1099 repeal.
In its brief, the government argues that “it was well understood that the Act gave ‘States the choice to participate in the exchanges themselves or, if they do not choose to do so, to allow the Federal Government to set up the exchanges.’ And it was abundantly clear that some States would not establish their own Exchanges.“ It was more than well understood. Congress actually endorsed that very proposition.
By: Brian Beutler, The New Republic, January 23, 2015
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