“What If We Just Called It NixonCare?”: Republicans Have No Business Being Upset About Obamacare
House Majority Leader Eric Cantor says Republicans will seek to delay a requirement of the 2010 Affordable Care Act that all Americans obtain health insurance or face a tax penalty. “With so many unanswered questions and the problems arising around this rollout, it doesn’t make any sense to impose this one percent mandate tax on the American people,” Cantor said last week.
While Republicans plot new ways to sabotage the Affordable Care Act, it’s easy to forget that for years they’ve been arguing that any comprehensive health insurance system be designed exactly like the one that officially began October 1st, glitches and all.
For as many years Democrats tried to graft healthcare onto Social Security and Medicare and pay for it through the payroll tax. But Republicans countered that any system must be based on private insurance and paid for with a combination of subsidies for low-income purchasers and a requirement that the younger and healthier sign up.
Not surprisingly, private health insurers cheered on the Republicans while doing whatever they could to block Democrats from creating a public insurance system.
In February 1974, Republican President Richard Nixon proposed, in essence, today’s Affordable Care Act. Under Nixon’s plan all but the smallest employers would provide insurance to their workers or pay a penalty, an expanded Medicaid-type program would insure the poor and subsidies would be provided to low-income individuals and small employers. Sound familiar?
Private insurers were delighted with the Nixon plan but Democrats preferred a system based on Social Security and Medicare and the two sides failed to agree.
Thirty years later a Republican governor, Mitt Romney, made Nixon’s plan the law in Massachusetts. Private insurers couldn’t have been happier although many Democrats in the state had hoped for a public system.
When today’s Republicans rage against the individual mandate in the Affordable Care Act, it’s useful to recall this was their idea as well.
In 1989, Stuart M. Butler of the conservative Heritage Foundation came up with a plan that would “mandate all households to obtain adequate insurance.”
Insurance companies loved Butler’s plan so much it found its way into several bills introduced by Republican lawmakers in 1993. Among the supporters were Senators Orrin Hatch (R-UT) and Charles Grassley (R-IA). Both now oppose the mandate under the Affordable Care Act. Newt Gingrich, who became Speaker of the House in 1995, was also a big proponent.
Romney’s heathcare plan in Massachusetts included the same mandate to purchase private insurance. “We got the idea of an individual mandate from [Newt Gingrich] and [Newt] got it from the Heritage Foundation,” said Romney, who thought the mandate “essential for bringing the health care costs down for everyone and getting everyone the health insurance they need.”
Now that the essential Republican plan for healthcare is being implemented nationally, health insurance companies are jubilant.
Last week, after the giant insurer Wellpoint raised its earnings estimates, CEO Joseph Swedish pointed to “the long-term membership growth opportunity through exchanges.” Other major health plans are equally bullish. “The emergence of public exchanges, private exchanges, Medicaid expansions … have the potential to create new opportunities for us to grow and serve in new ways,” UnitedHealth Group CEO Stephen J. Hemsley effused.
So why are today’s Republicans so upset with an Act they designed and their patrons adore? Because it’s the signature achievement of the Obama administration.
There’s a deep irony to all this. Had Democrats stuck to the original Democratic vision and built comprehensive health insurance on Social Security and Medicare, it would have been cheaper, simpler and more widely accepted by the public. And Republicans would be hollering anyway.
By: Robert Reich, The Robert Reich Blog, October 29, 2013
“Breathtakingly Cynical”: Guess Who Really Wants to Take Away Your Insurance? Republicans!
Republicans are outraged that some Americans must give up their current insurance plans because they don’t satisfy Obamacare’s new regulations for benefits and pricing. Partly they are mad at President Obama, because he repeatedly said people who like their coverage would get to keep it. And that’s fine. As I said yesterday, Obama should have said “most” people, not “all” people. Readers can decide for themselves whether, by the standards of politics, that’s a felony or misdemeanor.
But Republicans are also making a substantive argument here. It’s unconscionable, they say, that lawmakers would force people to give up their current coverage. Just a few minutes ago, during congressional testimony by Health and Human Services Secretary Kathleen Sebelius, an angry Representative Marsha Blackburn from Tennessee practically screamed at the witness: “You’re taking away their choice!”
It’s good politics, I’m sure. It’s also breathtakingly cynical. Republicans have repeatedly endorsed proposals that would take insurance away from many more Americans—and leave them much, much worse off.
Start with the federal budgets crafted by Paul Ryan. You remember those, right? Those proposals passed through the House with unanimous Republican support and were, in 2012, a basis of the Republican presidential platform. Those budgets called for dramatic funding cuts to Medicaid. If Republicans had swept into power and enacted such changes, according to projections prepared by Urban Institute scholars and published by the Kaiser Family Foundation, between 14 and 20 million Medicaid recipients would lose their insurance. And that doesn’t even include the people who are starting to get Medicaid coverage through Obamacare’s expansions of the program. That’s another 10 to 17 million people.
And it’s not just people on Medicaid who would lose coverage if Republicans got their way. While Republicans in Congress have not unified by a single alternative to Obamacare, a building block of virtually every proposal in circulation is to equalize the tax treatment of employer-sponsored insurance and individual insurance—which, in layman’s terms, means making it much more appealing for somebody who gets coverage on the job to buy coverage on his or her own. Typically these proposals would allow insurers selling individual coverage to continue some of their current practices, like charging higher premiums or refusing to cover certain services for people with pre-existing conditions, or offering coverage with serous gaps in benefits. Most experts believe such reforms would hike the cost of employer plans, as only sicker people remained on them, potentially creating a “death spiral” that would lead to fewer employers offering plans. (Even the more optimistic estimates assume erosion of employer-sponsored insurance.)
Note the difference in scale here. Nobody knows exactly how many people are giving up non-group policies because insurers are reacting to Obamacare regulations. But it’s probably in the millions—and still substantially less than the number of people who would lose insurance if Ryan’s proposal for Medicaid became law.
More important, though, look at the kind of change taking place. Almost everybody giving up a non-group policy today has the option to get new insurance either through Medicaid or one of the new Obamacare marketplaces. Some people will pay more for these policies, some will pay less, but everybody will be getting coverage that includes an array of “essential” benefits, limits out-of-pocket spending, and can never be taken away or limited because the policyholder gets sick. In other words, everybody ends up with comprehensive, stable insurance. It may not be the policy he or she has today. But the vast majority of people with non-group market don’t keep the same policy for more than two years anyway.
Under the Republican plan, by contrast, people losing employer insurance would end up in the dysfunctional, non-reformed individual market—the one full of confusing, junk policies that might not cover basic services like maternity or mental health or have huge gaps in coverage. And the people losing Medicaid? They would end up with … nothing at all.
The real issue here isn’t simply Republican opportunism and hypocrisy—although, please, let’s not ignore that either. The real issue is about the true trade-offs of policy. Both sides offer them. With Obamacare, a small number of people lose their current insurance but they end up with alternative, typically stronger coverage. Under the plans Republicans have endorsed, a larger number of people would lose their current insurance, as people migrated to a more volatile and less secure marketplace. Under Obamacare, the number of Americans without health insurance at all will come down, eventually by 30 or 40 million. Under most of the Republican plans, the number of Americans without insurance would rise.
Honest Republicans would justify their policies by arguing that Medicaid is a wasteful, inefficient program not worth keeping—and their changes, overall, would reduce health care spending while maximizing liberty. In other words, forcing people to give up their coverage is worth it. I don’t agree with those arguments, but they are honest. But they should stop pretending that it’s possible to address the problems of American health care without disrupting at least some people’s insurance arrangements—because, after all, they want to do the very same thing.
By: Jonathan Cohn, The New Republic, October 30, 2013
“The Right’s Sickest Obamacare Lie Yet”: Republicans Believe People Who Live In Flat Places Shouldn’t Have To Buy Cars With Brakes
During Congressional hearings with Health and Human Services Secretary Kathleen Sebelius, Congresswoman Marsha Blackburn (R-Tenn.) made an interesting argument that some Americans don’t want quality health insurance. “Some people like to drive a Ford and not a Ferrari,” Blackburn asserted. But that begs the question: What kind of Ford?
As early as 1972, there were reports that when a Ford Pinto was involved in a low-speed collision, the car would spontaneously burst into flames. According to a 1977 investigation by Mother Jones magazine, Ford was aware of the problem — resulting from a flaw in the gas tank design — but instead of paying to recall and redesign the car, Ford decided it would be cheaper to pay for the lawsuits. Ultimately, at least 27 people and as many as 180 people died as a result of Pinto fires. But it took the government forcing Ford to recall the Pinto for the problem to actually be solved.
In 2009, millions of Americans lacked any health insurance whatsoever and millions more had private health insurance metaphorically designed to explode at the hint of any serious illness or pre-existing conditions or exorbitant medical costs. So, in 2009, 14,000 Americans were losing their health insurance every single day. And medical bills were prompting more than 60% of all bankruptcies in our nation. In other words, many health insurance policies were patently dangerous and unsafe.
Now, Congresswoman Blackburn and her ilk might argue that people should have been free to buy the Pinto if they wanted, without government intrusion into personal choices or private business practice — just like they seem to want to argue that Americans should be free to hold onto their inadequate, costly and reckless insurance policies that throw them off at the slightest sign of illness while forcing costs up for the rest of us. But arguably most Americans want to buy cars that are safe. Auto companies didn’t want to install seat belts and airbags, just like Ford didn’t want to fix the Pinto. That was government regulation at work, making us all more safe — even if, in some cases, it made cars more expensive. We ultimately save, in every way imaginable, when the number of traffic deaths are dramatically cut.
This is, in effect, exactly what the Affordable Care Act does with respect to some currently existing, private insurance policies. If those policies don’t meet a new, higher bar of quality coverage, then the government will no longer allow insurance companies to sell them. Instead, the 5 percent of Americans who rely on the individual insurance market for their coverage will have other options, all that provide better quality coverage and many of which are far less expensive. Plus at least half of folks on the individual market will be eligible for subsidies that further bring costs down.
A great example comes from Deborah Cavallaro, who has been making the rounds on television complaining about her current insurance plan being cancelled. Cavallaro had not looked into her other, new options under Obamacare until a Los Angeles Times reporter called. Together, they looked at Cavallaro’s options — and found a “silver” plan for Cavallaro that would cost slightly more in her monthly premium but save her tons in terms of her annual deductible and out-of-pocket costs as well as doctor visit expenses. Plus, thanks to Obamacare, this plan would not be subject to the annual payment caps or pre-existing condition clauses that have been exploding in the faces of consumers for decades. After all, it’s important to remember that in 2009, most Americans were not very satisfied with their insurance plans. People wanted better options and now, thanks to Obamacare, they’ve got ‘em!
Congresswoman Blackburn and her cohort might fire back something about young healthy men being required to pay for good insurance plans that cover maternity — one of 10 basic coverage requirements mandated under the Affordable Care Act, this one designed to undo the history of insurance plans discriminating against women and families. Perhaps Republicans might also argue that Americans who live in really flat places should be able to buy cars without breaks. But that wouldn’t be safe for drivers or the rest of us. And in the case of health care reform in particular, the point here is to bring down costs and raise the quality of care for all of us. Those young, healthy men are going to grow up and have families one day — and then eventually become elderly — and will benefit from an insurance system that keeps costs manageable throughout and doesn’t kick off the elderly or infirm. Just like we all benefit from seatbelts and airbags, even if we never get in an accident.
Nobody is forcing anyone to buy a Ferrari plan in the individual health insurance exchange. At least 6.4 million Americans will pay less than $100 per month for coverage in the Obamacare exchanges — which means there are plenty of Ford’s available. What the Affordable Care Act simply ensures is that those policies will be safe and reliable — and not catch fire when we least expect it.
By: Sally Kohn, Salon, October 31, 2013
“Solely An Oppositional Movement”: Why Winning Elections Is The Last Thing The Tea Party Wants
Keith Humphreys asks a provocative question: Does the Tea Party even want to win elections? This comes up in response to a long article in the National Review by Ramesh Ponnuru and Rich Lowry telling the Tea Party to get its head out of the clouds and start doing things that will help Republicans win. While it’s tricky to ascribe specific desires and intentions to a large, complicated collection of people like the Tea Party, to the extent we can, I think the answer to whether they want to win is pretty clearly no. And there’s a certain logic to it.
The reason is that the Tea Party is an oppositional movement, and oppositional movements only thrive when they’re in the opposition. They can talk all they like about both Republicans and Democrats being part of the problem, and being opposed just to “Washington,” but we all know that at its heart it’s about Barack Obama and everything he represents. If Hillary Clinton or another Democrat becomes president in 2016, most of the anger and resentment that gives the movement life will get transferred to that person, and it will continue. But as I’ve held for a few years now, as a movement the Tea Party has a firm expiration date, which is the inauguration of the next Republican president.
The movement also holds a contempt for compromise of any sort as one of its fundamental pillars, which is fairly easy to stick with when your side is out of power. It’s not like you’re going to be getting much of what you want anyway, so you can scoff at the half-loaves your more reasonable colleagues are offering up. But when there’s a Republican administration the gifts to conservatism will be showering down from every cloud, and they’ll be much tougher to say no to. How about we give you an appointment at the EPA, where you can destroy the agency from the inside instead of railing at it from the street? What say we do the same to the Labor Department? Now that our bills won’t get vetoed, let’s start slashing away at food stamps and CHIP and all those other programs the “takers” suckle on. It’s time to party! In that atmosphere, there’s so much to say yes to that saying no to everything isn’t so attractive anymore.
And when it can’t shout “No!”, the Tea Party will have no more reason for being. Obviously, even if it’s dead as a movement, many of the people who championed it will still be in Congress. But saying no won’t be as attractive for them either. It’s one thing to imagine yourself a brave warrior standing up against Barack Obama and his plan to turn America into a nightmare of socialist misery. It’s another to, say, fight against cuts to Medicaid because you want even bigger cuts to Medicaid. That’s far less romantic.
So no, as a whole the Tea Party doesn’t have much of an interest in winning elections, because if it helped Republicans have a resounding win, it would literally be the last thing the movement ever did.
By: Paul Waldman, Contributing Editor, The American Prospect, October 31, 2013
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