“There Are Things In It That Scare Me”: For Republicans, Dishonesty Works And Deceit Instills Fear And Uncertainty
There isn’t a democracy on the planet in which even conservative candidates take aim at citizens’ access to health care. At a certain level, the very idea seems a little silly – a national candidate would presumably fail if he or she told their electorate, “Vote for me and I promise to leave some of you behind without access to basic medical care.”
But the United States is the exception. The Republican Party is the only major party in any major democracy that believes citizens are not entitled to medical care as a benefit of citizenship. Louisiana Gov. Bobby Jindal (R), as we discussed yesterday, want the GOP to abandon universal coverage as a worthwhile goal.
The Affordable Care Act may have extended new health security to tens of millions of families, but Jindal and Republicans believe voters should elect them to deliberately take that security away.
In theory, this should be a very tough sell. Why in the world would any Americans consider voting, on purpose, for a platform that could deliberately punish their own family?
The answer, I suspect, has a lot to do with the power of fear.
The New York Times recently published a fascinating piece on Kentucky’s triumphs in implementing the Affordable Care Act, and the article highlighted a woman named Amanda Mayhew. On paper, the piece presents Mayhew as a classic example of an “Obamacare” success story: thanks to the ACA, she been able to receive free, overdue dental care; she was able to see a dermatologist for free; and she received medication to treat depression for free. This one law has made a big, positive difference in her life.
And then came the twist.
“I don’t love Obamacare,” she said. “There are things in it that scare me and that I don’t agree with.”
For example, she said, she heard from news programs that the Affordable Care Act prohibited lifesaving care for elderly people with cancer.
Mayhew went on to tell the NYT that she’s “thankful” for her coverage, she would “gladly give up my insurance today if it meant that some of the things that are in the law were not in place.”
The problem, of course, is that Mayhew has been misled. Despite what she “heard from news programs,” the Affordable Care Act does not prohibit lifesaving care for elderly people with cancer. It actually does the opposite – which is why the law has received the enthusiastic support of the American Cancer Society and AARP.
The Times article featured a well-intentioned woman, whose heart clearly seems to be in the right place, who would sacrifice her own access to medical care in order to scrap provisions in the law that do not actually exist.
And that’s where Republican rhetoric comes into play. For years, the naive among us – a group that I include myself in – have marveled at the extraordinary lies that have been told about the Affordable Care Act. Why, we ask, would the right lie so brazenly to families who urgently need access to doctors and medicine?
Because dishonesty works. Deceit instills fear and uncertainty.
When Republican candidates vow to gut the American health care system and take Americans’ coverage away, there are plenty of voters who are willing to go along because they’re eager to undo those horrible provisions in the law they “heard about” on “news programs.”
The power of deceptive propaganda, backed by billionaires and their powerful elected allies, shouldn’t be underestimated.
The Kaiser Family Foundation recently found that 41% of the country still, even now, believes “a government panel” exists to “make decisions about end-of-life care for people on Medicare.” That’s two out of every five Americans who believe a ridiculous falsehood.
It’s not that these people are bad or dumb. It’s not that they want their neighbors or community to suffer. The issue here is that some wealthy and sophisticated folks launched a con job on the public, and the scam roped in a lot of victims.
Why else would politicians run on a platform of pushing millions of Americans into a position where they’re one ailment away from bankruptcy? It’s because they think they can get away with it – nice, generous folks will sacrifice their own security to prevent imaginary threats from hurting someone else.
By: Steve Benen, The Maddow Blog, January 13, 2015
“Time For The Laugh Track!”: Republicans Have A Veto-Proof Math Problem
Behold Washington’s new math.
The first anti-Obamacare bill of the new Congress, the Save American Workers Act of 2015, was written to undo the part of the law that defines “full employment” as holding a job for as little as 30 hours per week. It passed, and on the way, it became even more partisan in color than the 2014 version of the bill. In the last Congress, 18 Democrats voted with every Republican to pass the bill, but Thursday only 12 did, including all but one of the 2014 supporters (not Georgia Rep. Sanford Bishop) and two new Blue Dogs (Florida Rep. Gwen Graham, Nebraska Rep. Brad Ashford).
By turning on the bill, the Democrats made clear that they would sustain the veto already promised by President Obama, and, yes, they have the votes to do so. If every member of the 114th House of Representatives shows up for a vote, 48 Democrats need to join every Republican to override a veto. Three times this week, when the GOP brought forward bills to approve the Keystone pipeline and delay part of the Volcker Rule, the Democrats denied them all but a handful of votes.
Just as interesting as the Republican math problem were the arguments Democrats used to hold back their votes. In its veto message, the White House said the 30-hour work week bill “would significantly increase the deficit” and cited 2014 numbers from the Congressional Budget Office to say it would “increase the budget deficit by $45.7 billion over the 2015 to 2024 period.” In the Senate yesterday, in a conversation with reporters, Illinois Senator Dick Durbin repeatedly mocked Republicans for offering changes to the ACA without offering up the mechanisms to pay for them.
“I’m just not going to buy the premise Republicans now want to sell, that deficits don’t count,” Durbin said. “Since they’re in the majority, they’re going to use dynamic scoring—time for the laugh track!—they’re going to use dynamic scoring to prove that they can cut any tax without an impact on the deficit. That doesn’t work. That’s why we’ve stopped short of repealing the medical device tax, because the payfor has never been explained.”
Of course, the Democrats had a terrible election—no news there—and in the process they watched Republicans leap ahead of them in voter trust on key issues. Republicans pulled into a tie on health care, which had always been a Democratic advantage, and they built huge leads on taxes, the economy, and the deficit. Yet in the months after the election, they watched President Obama’s approval rating tick up, and saw a dynamite series of jobs reports followed by 5 percent GDP growth in the final quarter.
Democrats paid attention to new Majority Leader Mitch McConnell’s maiden speech, and how “the [economic] uptick appears to coincide with the biggest political change of the Obama administration’s long tenure in Washington: the expectation of a new Republican Congress.” To counter that claim, Democrats in Congress want to reframe the GOP’s bills as deficit-busters, and make sure Republicans get none of Barack Obama’s credit if the economy continues to improve.
By: Dave Weigel, Bloomberg Politics, January 9, 2015
“Conservative GOP Governors Are Accepting Obamacare”: Wagging A Finger With One Hand, Holding Out The Other Hand For The Money
Many GOP governors who loudly condemned Obamacare are secretly signing up for the Affordable Care Act’s Medicaid Expansion. And they aren’t just Republicans in Democrat states. A growing number are from Southern conservative states, like Alabama and Tennessee.
Tennessee Governor Bill Haslam announced his state would oppose Obamacare, saying that he would rather have any money sent to his state go to private insurance, according to Bill Barrow with the Associated Press. But after getting reelected, Haslam announced that he had struck a deal that would allow that Medicaid expansion, according to Dave Boucher with The Tennessean.
Ditto Alabama Governor Robert Bentley, who once claimed that “the anything but Affordable Care Act has done nothing to gain our trust,” according to Tom Baxter with Saporta Report. But there was Bentley, after getting easily reelected, claiming “he could support the expansion in the form of a block grant, with a lot of strings attached,” Baxter writes.
In other red states, Republicans are doing the same, wagging a finger at Obamacare with one hand and holding out the other hand for the money. Kansas Governor Sam Brownback condemned GOP Governors for taking the Medicaid expansion money, as noted on his own website. But then, buffeted by a deficit from ill-advised tax cuts, Brownback took the money, calling it something else, in order to balance the budget, according to Salon.
It is unlikely that Representative Mike Pence cast many votes in favor of Obamacare while in Congress. But as Indiana Governor, he’s signed on to the Medicaid expansion, according to Dana Milbank from the Washington Post.
Arizona Gov. Jan Brewer joined her name to the lawsuits challenging the constitutionality of Obamacare. But then, she signed up for the dollars from Washington, DC after dodging a primary challenge, as reported by CBS.
Florida Governor Rick Scott, another Republican, had few kind words for Obama or the ACA. But once it was clear that he wouldn’t face a primary challenger, Scott took the money, according to the Miami Herald, hoping to boost his reelection chances. He was able to hold onto the Governor’s Mansion in Tallahassee as a result.
And it was Ohio Governor John Kasich who called for repealing Obamacare, well, at least most of it. Now he’s saying it is here to stay, as noted by CNN, and other Republicans better get used to it being around.
Michael Hiltzik with the Los Angeles Times is reporting that even Texas is considering the Medicaid expansion, modeled after Utah’s acceptance of the ACA plan.
There are a few reasons for this. While the House of Representatives and Senate can pass repeal after repeal votes, governors have to balance budgets. Also, many of these governors talk the conservative talk to beat back or forestall Tea Party primary challengers. Given that only a dwindling number of these are succeeding, there’s no need to kowtow to this group after reelection. They can use some creative accounting to accept the money, or call it something else so it will have a lower profile (Alabama could call it Bamacare, for example).
Of course, this is bound to infuriate the most conservative members of the Republican Party, but only if they are paying attention. Besides, this is still the party of Jeb Bush, who was linked to a firm that benefited from Obamacare, as reported by The Daily Mail. It’s also the party of Mitt Romney, whose Romneycare had many similarities to Obamacare, according to health expert Brad Burd.
By: John A. Tures, Professor of Political Science at LaGrange College in LaGrange, Ga; The Blog, The Huffington Post, December 31, 2014
“Pretending They’ve Come To The Rescue”: Republicans To Play Blame Game On Obamacare Subsidies?
I’ve been saying for a while now that Republicans could be in a jam if the U.S. Supreme Court announces a decision in June invalidating the insurance premium subsidies for people living in the 36 states utilizing federally establishment exchanges under Obamacare, if only because the immediate impulse of rank-and-file conservatives will be to dance and sing even as millions are in danger of losing affordable health care coverage.
Perhaps behind the scenes conservatives are beginning to plan an education campaign to explain to The Troops via Fox News or other “trusted” sources why they can’t just let the subsidies die. Last week I noted that Ramesh Ponnuru had begun talking about Republicans agreeing to fix the subsidy problem while pivoting (presumably as part of some national “deal”) rapidly to an Obamacare “replacement.” But he didn’t sound terribly confident about selling this strategy to the GOP. Since we’re unlikely to find out where SCOTUS is going until June, there is time for sober reflection on the consequences of taking away the subsidies among a constituency that’s a lot more likely to include a lot of Republican voters than the subjects of a Medicaid expansion. The question is whether it can be effectively and quickly communicated to people who have been told since 2010 that the Affordable Care Act is the work of the devil.
Now one of Ramesh’s reformicon colleagues from National Review, Yuval Levin, has (with his collaborator on one of hte Obamacare “replacement” proposals, James Capretta) written a careful message to conservatives via the Wall Street Journal suggesting they get ahead of the curve:
In essence, if the court rules today’s subsidies illegal, those state officials could face a choice between creating a state exchange (and so reinforcing ObamaCare) or seeing some residents lose coverage they now have. ObamaCare’s opponents in Congress should give them a third option: a viable alternative to the Affordable Care Act.
The first step is to introduce legislation that would allow any state to opt out of all of ObamaCare’s mandates, regulations, taxes and requirements, and instead opt into a far simpler and more flexible alternative system. In that system, state residents not offered health coverage by their employers could receive a federally funded, age-based credit for the purchase of any state-approved health-insurance product—including those bought outside of any exchange and regardless of whether they meet ObamaCare’s coverage requirements.
Anyone who remains continuously insured in this system would be shielded from higher premiums or exclusions from coverage based on an existing condition. This would give consumers a strong incentive to buy coverage without a mandate to do so. All other insurance regulation, however, would happen at the state level.
States that opt for this approach would also be permitted to transform their Medicaid programs into premium-support systems for lower-income households. These would function as add-ons to the credit and allow eligible residents to buy the same kind of coverage everyone else can purchase.
The credit could be large enough to allow anyone to purchase at least catastrophic coverage—enabling the uninsured to be covered and everyone to be protected from the most extreme health expenses. Alternatively, it could be used to supplement the purchase of more comprehensive coverage. In essence, the credit would extend to everyone else the same benefit that many people have long received in the employer system. It would do so without disrupting the employer system, the coverage most Americans have.
What they are describing is pretty much the Burr-Coburn-Hatch “PCARE” proposal offered early this year as a suggested Obamacare “replacement,” with some transitional rules that would let Obamacare subsidies stay in place through the end of 2015. And they think Obama would be forced to accept something like this “solution” since otherwise he, not Republicans, will look like the one standing in the way of restored insurance for the people afflicted by the Court.
It’s all pretty clever, but a comment from Ponnuru shows its central flaw:
My only quibble is with the headline, “Time to Start Prepping ObamaCare Reforms.” What they’re talking about is better described as preparing an exit ramp from Obamacare.
Reforms, “exit ramp,” whatever. Such terms are meant to obscure the fact that such plans would keep Obamacare in place until such time as a new system could be implemented–again, before “the base” can make it all moot by forcing GOP policymakers to celebrate the carnage instead of repairing it. And if I know that and you know that, so too would the president, and I think it’s very predictable that well before congressional Republicans could be united behind such a proposal Obama would let them know the only non-disruptive course of action is to restore the intended subsidy system and then talk about what’s next. Pretending they’ve come to the rescue of people in danger of losing their health insurance by eliminating all the provisions that make it good coverage at an affordable price isn’t likely to work. But nice try.
By: Ed Kilgore, Contributing Writer, Political Animal, The Washington Monthly, December 19, 2014
“Republicans’ Little Act’s Of Vandalism”: The Secret Swipe At Obamacare — And You
Underscoring how much mischief can result when Congress acts in haste and in secret, hidden away in the year-end omnibus spending bill being acted on this week is an attack on a key provision of the Affordable Care Act long targeted by the GOP.
The provision involves risk corridors, which are designed to stabilize insurance premiums in the first few years of the law. The year-end spending bill quietly erodes funding for the provision.
Republicans have chosen to label the provision a “bailout” for insurance companies. I’ve labeled that position the most cynical attack on Obamacare, because those who advance it — notably Sen. Marco Rubio (R-FL) — obviously know it’s a lie. They know it’s actually a consumer protection feature, so calling it “corporate welfare,” as Timothy P. Carney did this week in the Washington Examiner, is a neat bit of disinformation. Adding to the cynicism, the same provision is an essential part of Medicare Part D, which the GOP enacted in 2003.
Here’s another sick irony: One of the raps on the risk corridor provision is that it was “buried deep” in administration explanations of the bill, as Rubio put it. But in fact, the ACA was extensively debated and available for scrutiny by any legislator who chose. The attack on the provision, however, actually is “buried deep” in the year-end spending bill: it’s on page 892 of the 1,603-page bill, which has barely been debated at all.
Let’s see how risk corridors work, and how they’re undermined by the spending bill.
It was well understood that health insurers would have difficulty pricing their plans in the individual market in the first years of the ACA, starting in 2014. Not only would some insurers be entering that market in volume for the first time, but the market itself would be dramatically altered by the flood of new customers and such ACA rules as the prohibition on exclusions for pre-existing conditions. Some insurers will end up setting their premiums too low, and therefore will have to pay out benefits higher than they expected; others will set their rates too high, and will capture a windfall.
Without a safety valve, these miscalculations could have an impact on premiums the following year, as insurers tried to adjust. So insurers that set prices more than 3 percent below a set target get a reimbursement from the government, and those that overprice by the same margin have to pay some of the windfall to the government. Importantly, the arrangement is temporary: it expires after 2016, by which time it’s assumed that insurers will know what they’re doing.
Obviously, this isn’t a “bailout,” since it protects underpricing insurers only on the margins, while also providing a check on profiteering. The Congressional Budget Office, moreover, has projected that over time, the risk-corridor program will produce an $8-billion profit for the government, because overpricing insurers will be paying back more than underpricing insurers collect.
Some smart conservatives acknowledge that risk corridors are a good idea. As Yevgeniy Feyman of the Manhattan Institute informed Forbes readers in January, “Any conservative reform plan for universal coverage will have to use similar methods of risk adjustment. … If you want insurers to participate more broadly in the individual market, you’ll need to offer a carrot to offset the unavoidable uncertainties.”
Nevertheless, Congressional Republicans couldn’t resist taking a swipe at this little-understood provision in the ACA, and Democrats weren’t sufficiently attentive, or caring, to call them out on it. The year-end spending bill forbids the Dept. of Health and Human Services to use any outside government funds to pay out adjustments to insurers. On the face of it, the government can only use surplus coming in from overcharging insurers for that purpose. (That’s the interpretation healthcare expert Tim Jost gives to Dylan Scott of Talking Points Memo.)
For the moment, that makes the provision little more than a symbolic swipe at Obamacare. But that could change, and the CBO projections could be wrong. In that event, the Republicans’ little act of vandalism could end up costing ordinary citizens money. Nice work, GOP. Extra points for pulling it off in the dark.
By: Michael Hiltzik, The Los Angeles Times (TNS); The National Memo, December 16, 2014
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