“Collaborating With The Enemy”: Can Republicans Be Convinced To Help Improve The Affordable Care Act?
When the Affordable Care Act was passed in early 2010, people made lots of predictions about how its implementation would proceed, in both practical and political terms. While the law’s opponents all agreed that it would be a disaster from start to finish, the law’s supporters were slightly less unanimous, if nevertheless optimistic. Most figured that though there would probably be problems here and there, by and large the law would work as it was intended, enabling millions of uninsured Americans to get coverage and providing all of us a level of health security we hadn’t known before.
And that’s what has happened. But there was one other assumption among the supporters that’s worth examining anew, now that most of us agree the law isn’t going to be repealed. Like every large and complex piece of social legislation, it was said, the ACA would have to be tweaked and adjusted over time. For instance, when it was passed in 1935, Social Security excluded agricultural and domestic workers, just coincidentally shutting most African-Americans out of the program. Those workers were added later on, and other changes were made as well, like adding cost of living adjustments to account for inflation. Medicare, too, has undergone changes both large (like adding a prescription drug benefit) and small. So what are the possibilities for adjusting the ACA in the near future? In the current atmosphere—one not just of intense partisanship, but one in which one party has made venomous opposition to this law the very core of its political identity—can we hope to actually fix the things about the law that might need fixing?
The administration has already made some changes to the law using its executive authority. Most notably, it has delayed the employer mandate; as it stands now, the mandate won’t fully take effect until 2016. As it happens, few people are particularly enthused with the employer mandate in its current form; conservatives have never liked it, and more than a few liberals have their doubts about it. As Mike Konczal recently explained, there’s an alternative:
The employer mandate has been another major roadblock for the ACA. The current “Obamacare” plan requires employers with more than 50 full-time workers to pay a part of the health care costs for employees who work more than 30 hours a week, or pay a fine. This is unpopular with employers, and it fuels larger worries that workers are getting their hours capped or that expanding businesses are hitting a major road bump the moment they reach 50 employees.
As the Roosevelt Institute’s Richard Kirsch writes, the way the final House bill tackled this issue was much smarter: Under the House plan, employers that didn’t provide health care to their employees would pay a percentage of payroll as a tax to cover health care. Consequently, there would be no incentive to juke the number of new hires or their hours. Also, current health insurance premiums don’t vary according to an employee’s income, which discourages employers from hiring lower-wage workers. Charging a percentage of payroll for coverage would help companies cover the costs even as the system moves towards the exchanges.
If you were a Republican who cared about this issue, this would be a perfect opportunity to change the law in a way you’d like. It wouldn’t be giving up something to get half a loaf, it’d be giving up nothing to get half a loaf. Democrats and Republicans could agree to change the mandate, whether it’s to more closely resemble the original House version of the bill, or something else. I’m sure that creative legislators could come up with any number of ways to produce the maximum number of people with employer-sponsored coverage—or even, now that the exchanges seem to be working quite well, devise a new way for employees to use them without employers just getting off the hook for providing coverage.
But we all understand the present reality, which is that no Republican is willing to work with Democrats to improve the ACA, even in ways that address particular complaints conservatives have about the law, because that’s considered collaboration with the enemy and would guarantee you the wrath of the Tea Party and a primary challenge from the right. Within the GOP, changing the law for the better is actually thought to be a terrible sin, while making futile gestures in opposition to the law while tacitly accepting its existence in its current form is thought to be the height of ideological integrity.
It’s possible that over time, as the repeal fantasy looks more and more ridiculous, Republicans will begin to grow more open to legislation making changes to the ACA to improve its operation. That’s what logic would dictate, but anything other than fist-shaking opposition to the ACA may remain politically toxic for a long time in the GOP.
But maybe there’s something Democrats can do to affect that conversation. It’s easy for them to just say:
“If Republicans really cared about improving people’s lives they’d join with us to make improvements, but instead they’d rather just have talking points.” It’s even true. But that doesn’t get you anywhere. So perhaps Democrats could try getting more specific. They could come up with whatever they think is the best way to deal with a weakness in the law, like the current form of the employer mandate. Turn that into a bill. Start moving it through the legislative process in the Senate. Force Republicans to answer specific questions about it, like: “Congressman, you’ve criticized the current employer mandate. Tell me why you think this new proposal isn’t an improvement.”
I’m not naïve enough to think that all Republican opposition to improving the ACA is going to melt before the power of those questions. But it only helps Republicans if they can stay vague in their discussions of the law. The more specific the discussion gets, the harder it is for them. And at least you could introduce the idea of Republicans joining with Democrats to improve the law, which is something barely anyone has brought up until now.
By: Paul Waldman, Contributing Editor, The American Prospect, September 8, 2014
“The Campaign For Liberty”: The War On Obamacare Has Become A War On Minorities And The Poor
Like many eleventh-hour strategies, the right’s final offensive against the Affordable Care Act has a last-gasp quality to it. Where better-laid plans to defeat the ACA in Congress and via Constitutional challenge were fraught with ideological purpose, the challengers in Halbig v. Burwell are engaged in something much smaller. Their argument is merely that if you read a poorly drafted section of the statute out of context, it appears that the law doesn’t contemplate subsidies in states that availed themselves of the federal government’s backstop, Healthcare.gov. Millions of people would lose their health insurance in service of teaching Congress a lesson about the importance of legislative draftsmanship.
That’s not a very becoming political argument, though, so the Halbig supporters have stapled a grandiose claim to their core challenge. Because many of the people who would lose their insurance would also qualify for an exemption from the law’s insurance coverage mandate, they frame it as a principled campaign for liberty.
But many is not all. It’s probably not even most. As University of Michigan law professor Nicholas Bagley noted on Tuesday, a conservative victory in Halbig would eliminate subsidies for everyone, but the hardship exemption would only apply to a subset. Many, many people—those above about 180 percent of the federal poverty level—would still be required to purchase insurance. It would just become more expensive for them. The exemption—the escape hatch to freedom—would only be available to those whose coverage costs more than eight percent of income: the poor, and near-poor. These are the people whose liberty conservatives claim to be fighting for—the people who were only able to purchase insurance because the subsidies made it affordable. The people who, as Bagley writes, would “be free to decline coverage that, without tax credits, they can’t afford anyhow.”
This kind of post hoc appeal to liberty long predates the Affordable Care Act, but it has become particularly salient in the fight against Obamacare as enrollment has grown and weakened traditional tools of opposition. When the Supreme Court made the Affordable Care Act’s Medicaid expansion optional back in 2012, it vouchsafed an old but typically losing conservative argument that using federal spending as an incentive to force state action can be unconstitutionally coercive—a freedom-crushing blow against states’ rights. But the freedom the Court upheld two years ago looks, in effect, an awful lot like the freedom the challengers in Halbig claim to be fighting for. In both cases there’s something conspicuous about the people to whom these strange conceptions of liberty apply.
As of early April, per this Kaiser Family Foundation map, 19 states remained fully unwilling to consider Medicaid expansion. In the weeks since, Wyoming and Tennessee joined Utah and Indiana among GOP-controlled states working toward expanding Medicaid. So the chips are slowly falling. But they are falling along fairly predictable racial and income lines.
Tennessee was a genuine surprise, in that it isn’t lily white, and has fairly high rates of poverty. But the GOP-controlled states that have expanded Medicaid, or are considering Medicaid expansion, are pretty white relative to GOP-controlled states where expansion is out of the question. Deep Southern states, where poverty is most concentrated and black population rates approach 30 percent, aren’t calling up the Department of Health and Human Services in Washington to negotiate a conservative Medicaid expansion compromise. To the contrary, that’s probably where resistance to the expansion runs strongest.
The story won’t be much different if conservatives get their way and ACA subsidies disappear in Healthcare.gov states. If you haven’t caught on by now, the conspicuous thing about the Medicaid freedmen and those who would be freed from the individual mandate is that they’re disproportionately black and poor. ACA rejectionism isn’t enhancing their liberty at all.
But there’s something conspicuous about the Obamacare opponents posing as tribunes for liberty, too. They’re nearly all affluent white people, who take their own health insurance for granted and probably wouldn’t consider themselves liberated if a court or legislature took aim at it for any reason. And though their rhetoric suggests otherwise, they’re waging the final Obamacare battles against poor people and minorities, not on their behalf.
By: Brian Beutler, The New Republic, September 4, 2014
“Another Republican Gives Up Obamacare Fight”: Unfortunately For Corbett, It’s Probably Too Late To Save His Re-Election Campaign
Governor Tom Corbett of Pennsylvania is the latest Republican to retreat from the Obamacare wars.
On Thursday, the federal government approved Governor Corbett’s plan to expand Medicaid in the Keystone State, making it the 27th state in the nation to adopt the controversial provision of the Affordable Care Act. Corbett had initially opposed expanding Medicaid at all, but earlier this year he bowed to mounting political pressure by offering a plan that would expand Medicaid with a number of Republican-friendly conditions, such as a work requirement and the authority to charge premiums for recipients living below the poverty line. Those did not make it into the final deal.
The agreement should be a boon to Pennsylvania’s working poor; at least 500,000 Medicaid-eligible Pennsylvanians will now be able to sign up for coverage starting on January 1. It will also save the state $4.5 billion over the next eight years, according to Corbett (independent studies have pegged the savings to be even higher)
Corbett clearly hopes that the news will provide a political boost as well. The governor’s announcement of the agreement, which calls it “historic,” “innovative,” and “truly a Pennsylvania solution,” is just about the nicest thing that any elected Republican has ever said about the Affordable Care Act. Meanwhile, Medicaid expansion is wildly popular in Pennsylvania. And as of last week, the Republican governors on the ballot in 2014 who have adopted Medicaid expansion were polling an average of 8.5 percent better than those who hadn’t. It’s not hard to understand what prompted Corbett’s change of heart.
Unfortunately for Corbett, it’s probably too late to save his re-election campaign; the terminally gaffe-prone governor trails his Democratic challenger Tom Wolf by 16.6 percent according to the RealClearPolitics polling average. But plenty of other Republicans have also realized that it makes sense to buck the party line on Medicaid expansion. As The Washington Post’s Greg Sargent has documented, GOP senate candidates such as Scott Brown in New Hampshire, Tom Cotton in Arkansas, Joni Ernst in Iowa, Terri Lynn Land in Michigan, and Thom Tillis in North Carolina have tied themselves in knots trying to explain how they would repeal the Affordable Care Act without getting rid of any of the popular parts.
It’s almost as if voters would rather expand health care coverage than burn billions of dollars to thumb their noses at the White House.
Of course, this wasn’t supposed to happen. For over a year, Republicans have been promising that Obamacare would be the anchor that sinks every Democrat on the ballot and sparks a GOP wave in November. Instead, many Republicans are now either embracing sections of the law, or just ignoring it altogether. It appears that we can add this blown prediction to long list of Obamacare disasters that stubbornly refused to materialize.
By: Henry Decker, The National Memo, August 29, 2014
“Obamacare, Beyond The Label”: The Politics Of Obamacare Are Upside-Down
The Affordable Care Act was supposed to be a slam-dunk issue for the Republicans in this fall’s elections. Karl Rove told us so in April, writing that “Obamacare is and will remain a political problem for Democrats.”
So how’s that Obamacare thing working out for the GOP?
The most significant bit of election news over the last week was the decision of Senator Mark Pryor, the embattled Arkansas Democrat, to run an ad touting his vote for the health care law as a positive for the people of his increasingly Republican state.
Pryor’s ad is so soft and personal that it’s almost apolitical. After his dad, the popular former senator David Pryor, tells of his son’s bout with cancer, he notes that “Mark’s insurance company didn’t want to pay for the treatment that ultimately saved his life.” The picture has widened to show Mark Pryor sitting next to his father. “No one should be fighting an insurance company while you’re fighting for your life,” he says. “That’s why I helped pass a law that prevents insurance companies from canceling your policy if you get sick, or deny coverage for pre-existing conditions.”
Who knew a law that critics claim is so dreadful could provide such powerful reassurance to Americans who are ill?
Democrats have never fully recovered from the Obama administration’s lousy sales job for (and botched rollout of) what is, legitimately, its proudest domestic achievement. That’s one reason Pryor doesn’t use the word “Obamacare” in describing what he voted for. Another is that in many of the states with contested Senate races this year, most definitely including Arkansas, President Obama himself is so unpopular that if you attached his name to Social Security, one of the most popular programs in American history would probably drop 20 points in the polls.
So, as the liberal bloggers Greg Sargent, Brian Beutler and Steve Benen have all noted, Republicans would much prefer to run against the law’s name and brand than the law itself. They also really want to avoid being pressed for specifics as to what “repealing Obamacare” would mean in practice.
As one Democratic pollster told me, his focus groups showed that when voters outside the Republican base are given details about what the law does and how it works, “people come around and say, ‘That’s not so bad, what’s everybody excited about?’”
This consultant says of Democrats who voted for the law: “You’re going to be stuck with all the bad about this but not benefit from any of the good unless you advertise” what the Affordable Care Act does. This is what Pryor has decided to do.
In fact, according to Gallup, Arkansas is the No. 1 state in the country when it comes to reducing the proportion of its uninsured since the main provisions of the ACA took effect. The drop was from 22.5 percent in 2013 to 12.4 percent in 2014. The No. 2 state is Kentucky, where the uninsured rate fell from 20.4 percent to 11.9 percent. What they have in common are Democratic governors, Mike Beebe in Arkansas and Steve Beshear in Kentucky, committed to using Obamacare — especially, albeit in different ways, its Medicaid expansion — to help their citizens who lack coverage. Beshear has been passionate in selling his state’s version of Obamacare, which is called kynect.
Kentucky also happens to be the site of another of this year’s key Senate races. Democrat Alison Lundergan Grimes is giving Republican leader Mitch McConnell what looks to be the toughest re-election challenge of his 30-year Senate career.
The Bluegrass State is particularly instructive on the importance of labeling and branding. A Public Policy Polling survey earlier this month found that the Affordable Care Act had a net negative approval rating, 34 percent to 51 percent. But kynect was rated positively, 34 percent to 27 percent. Grimes and the Democrats need to confront McConnell forcefully on the issue he has tried to fudge: A flat repeal of Obamacare would mean taking insurance away from the more than 521,000 Kentuckians who, as of last Friday, had secured coverage through kynect. How would that sit with the state’s voters?
Election results, like scripture, can be interpreted in a variety of ways. You can bet that foes of expanding health insurance coverage will try to interpret every Republican victory as a defeat for Obamacare. But as Mark Pryor knows, the president’s unpopularity in certain parts of the country doesn’t mean that voters want to throw his greatest accomplishment overboard — even if they’d be happy to rename it.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post; The National Memo, August 25, 2014
“Far From The First Time”: Karl Rove Still Can’t Find An Actual Obamacare Victim
Politics is a constantly changing business, but there are still a few things you can count on in every election cycle: like Karl Rove’s dark money group, Crossroads GPS, blowing its donors’ money on misleading, ineffective attack ads.
Since President Barack Obama signed the Affordable Care Act into law in 2010, its opponents have spent over $400 million on television ads attacking it, with Crossroads leading the way. But despite Republicans’ repeated assertions that Obamacare would be the issue that causes Americans to rise up against Democrats and throw them out of office, the torrent of attack ads has actually done little to sway public opinion against the law. In fact, according to a Brookings Institution study, anti-Obamacare ads may have actually increased ACA enrollments by raising awareness about the law and its benefits.
But still, conservative outside spenders are determined to take their anti-health care message directly to the voters. The latest example is a new ad from Crossroads GPS, in which a Colorado woman named Richelle McKim laments that Senator “Mark Udall’s vote for Obamacare has hurt families in Colorado.”
McKim recounts her husband’s decision to start a new business, saying “We knew we needed to find health care. Because we were a single-income family, we couldn’t afford our plan.” Text then flashes across the screen, letting viewers know that “Richelle had to go back to work.”
It seems like a perfect case to make to the suburban women who are likely to decide Senator Udall’s tight re-election battle against Republican congressman Cory Gardner.
It also happens to be totally false.
As Denver television station KDVR reports, McKim has worked constantly over the past six years; from July 2008 through May 2010, she worked from home as the office manager for her husband’s company (which, evidently, wasn’t founded as a response to Obamacare). Since then, she has worked for Anadarko Petroleum and Noble Energy — which have donated $57,550 and $36,000 to Gardner’s campaign, respectively.
By McKim’s own admission, Obamacare didn’t actually drive her back into the workforce, as the ad claims.
“It wasn’t the Affordable Care Act,” she told KDVR. “It was just a financial burden, having a single income for so long.”
And, for good measure, McKim’s husband used to forgo health insurance because he suffers from high blood pressure — a pre-existing condition that made his insurance more expensive until the ACA became law.
This is far from the first time that Obamacare opponents have been forced to stretch the truth, flatly lie, or just give up and use paid actors to tell a scare story. Indeed, it begs the question: If the Affordable Care Act is really such a disastrous boondoggle, why couldn’t Crossroads — or the Koch brothers-backed Americans for Prosperity, or even House Republican Conference chair Cathy McMorris Rodgers — find an actual victim?
In this case, the fact that Obamacare has helped cut Colorado’s uninsured rate by 6 percent might have something to do with it.
By: Henry Decker, The National Memo, August 8, 2014
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