“Reality Is Starting To Set In”: Is The “Mend It” Period Of The Affordable Care Act’s Evolution Beginning?
All of a sudden, people in Washington seem to want to fix the Affordable Care Act. And regardless of their motivations, that should be—well, maybe “celebrated” is too strong a word, but we can see it as a necessary and positive development. Is it possible that the arguments about whether the ACA was a good idea or should have been passed in the first place are actually going to fade away, and we can get down to the businesses of strengthening the parts of it that are working and fixing the parts that aren’t? It might be so.
Sure, cretinous congressional candidates will continue to display their seriousness by pumping paper copies of the law with bullets, probably for years to come. But with this year’s open enrollment period coming to an end in a few days, a particular reality is starting to set in, namely that, however you feel about the law, millions of Americans have now gotten health insurance because of it. Repealing it would mean taking that insurance away. So let’s look at what people whose political fortunes are dependent on some measure of anti-ACA grandstanding are doing.
First, a group of centrist Democrats, mostly from conservative states, offered a plan to make some changes to the ACA, some of which are more meaningful and reasonable than others. Yes, they’re doing it because they want to give themselves some political cover. But that’s OK. Meanwhile, some Republicans are, for the umpteenth time, crafting a package of things they claim will “replace” the ACA. Of course it’s the same few things they’ve always advocated—make it impossible for people to sue for medical malpractice (AKA “tort reform”), let people buy insurance across state lines, encourage health savings accounts. Nobody who has thought about health care for five minutes thinks those “reforms” would do anything to address real health care challenges, but more importantly, they wouldn’t prevent the massive upheaval that would occur if you repealed the ACA. And that’s a reality that will become increasingly clear: the disruption of taking away the ACA now would be even greater than the disruption the law brought about in the first place.
So if Republicans took over the Senate, there would be a brief period of kabuki, in which they would attempt to pass their reform package, then President Obama would say, “This is a joke” and veto if it passed. Then they’d have to decide if they actually wanted to address their specific complaints about the ACA. And yes, we have to start from the assumption that everything conservatives say about the Affordable Care Act is offered in bad faith (sorry, conservatives, but you’ve earned it). That doesn’t mean, however, that they can’t prove that assumption wrong at some later date.
Democrats should respond by welcoming a more particular debate about the ACA, starting from the presumption that it’s law now and millions of people are dependent on it, so the question is what needs adjustment. Republicans can no longer just shout “This law sucks, because freedom!” It’s too late for that.
And some context is in order. Before the law was even passed, many of its advocates were careful to note that no matter how much care went into its design, adjustments were going to be required as it was implemented. That’s how things always go with complicated laws: conditions change, certain features don’t work the way they were supposed to, and unforeseen challenges emerge. Revising existing legislation is a substantial part of lawmaking, and always has been. For instance, when Social Security was created in 1935, it was written to exclude agricultural and domestic workers, which included most blacks in the South (there’s some debate about whether this was actually done in order to secure the support of Southern segregationists). That didn’t change until the 1950s. Survivor benefits for spouses and children were also added later. Cost of living adjustments were added later. In other words, the most successful and popular social program in American history required a lot of changes and alterations as it evolved, and no one ever expected that the ACA would be any different.
There are going to be changes to the ACA in the coming years, just as there should be. The trick now will be making sure the right changes are made.
By: Paul Waldman, Contributing Editor, The American Prospect, March 28, 2014
“ACA Enrollment Tops 6 Million”: The Imminent Implosion Of The Affordable Care Act Has Been Cancelled
The expectation all along was that health care enrollment through the Affordable Care Act would spike shortly before the March 31 deadline. As of this afternoon, those expectations are very much in line with reality.
More than 6 million people have signed up for health insurance on the new exchanges, a number that signals a tremendous last-minute surge, the White House said Thursday.
President Barack Obama told volunteers and navigators helping sign people up that 1.5 million people visited HealthCare.gov on Wednesday – the highest-traffic day yet. Officials have said they logged more than a million visits each day so far this week.
Remember, this total only refers to consumers who’ve signed up for private coverage through exchange marketplaces. It doesn’t include Americans who’ve gained coverage through Medicaid expansion. For that matter, clearing the 6-million milestone is an important threshold, but there’s still time remaining in the open-enrollment period and it’s not unrealistic to think we’ll see 6.2 million by next week.
“We are seeing near-record numbers of consumers coming to check out their options and enroll in coverage. Yesterday alone, we had 1.5 million visits to HealthCare.gov and took more than 430,000 calls at our 24/7 call center,” said Marilyn Tavenner, head of the Centers for Medicare and Medicaid Services.
As of March 1 – not quite four weeks ago – 4.2 million Americans had enrolled through exchanges, suggesting we’ve seen nearly two million consumers sign up in less than a month.
It’s easy to forget, but this seemed like a pipe dream last fall. In October, the first month of the open-enrollment period, just 106,185 consumers signed up for insurance through an exchange – causing Republicans to not only celebrate, but to openly mock the system by noting a variety of sports venues that hold more than 106,185 attendees.
It was obviously proof, we were told at the time, that the Affordable Care Act itself was “hurtling toward failure.”
Oops.
The enrollment totals must seem literally unbelievable to Republicans, who managed to convince one another that the ACA is not only catastrophically flawed, but on an inevitable road towards imploding.
Indeed, as Paul Krugman noted earlier today, “[P]eople in the GOP are still working with a completely wrong narrative — namely, that Obamacare is failing, and that these are desperate ploys to save a sinking ship. The reality is quite different: enrollments have clearly surged in the final month…. How will the GOP respond when the numbers come in?”
I don’t know the answer to that question, but I suspect it’ll have something to do with Benghazi.
To reiterate a point from early February, those who say they hate “Obamacare” won’t want to hear this, but the imminent implosion of the Affordable Care Act has been cancelled.
What’s more, this is less of a comeback story than a story of normalcy and effective governance. There was a fair amount of panic in November – remember the pieces that predicted “Obamacare may destroy all of liberalism forever”? – but there were plenty of voices counseling patience. There were problems, but they were surmountable. There were elements that were broken, but they could be fixed.
The recent progress, in other words, isn’t some remarkable fluke the White House achieved through a Hail Mary pass. Rather, what we’re seeing now is progress many of us expected to see all along.
By: Steve Benen, The Maddow Blog, March 27, 2014
“David Vitter, God Bless The Koch Brothers”: The Most Patriotic Americans In The History Of The Earth
It stands to reason that Republican politicians are going to celebrate Charles and David Koch. After all, the billionaires’ generosity is critically important in conservative politics right now and may ultimately be the deciding factor in which party has power in Congress.
But Sen. David Vitter (R-La.) is willing to take his appreciation for the Koch brothers to a pretty extraordinary level, as evidenced by a town-hall event in Shreveport this week. American Bridge posted the above video (http://youtu.be/-7mStFMk6og), and for those who can’t watch clips online, the conservative senator told constituents:
“I think the Koch brothers are two of the most patriotic Americans in the history of the Earth. […]
“God bless the Koch brothers. They’re fighting for our freedoms.”
Sure, Republicans are bound to be grateful to the billionaires for saturating the airwaves with anti-Democratic attack ads, but Vitter’s effusive praise seemed a little over the top.
Burgess Everett saw an even longer version of the clip and reported that Vitter, as part of the same discussion, said he’s “not defending big money in politics.”
No, of course not. He’s just grateful that the most patriotic Americans in the history of the Earth are fighting for our freedoms.
It’s worth noting that Louisiana will host two major elections in the next two years: Sen. Mary Landrieu (D) is running for re-election this year, and she’s already facing attack ads from the Koch-financed Americans for Prosperity, and Vitter is running for governor next year, and likely hopes the Kochs’ operation will support his candidacy.
But there’s an even larger context to this: what is it, exactly, the most patriotic Americans in the history of the Earth hope to receive in exchange for their political investments?
The New York Times reports today on the bigger picture.
As [Americans for Prosperity] emerges as a dominant force in the 2014 midterm elections, spending up to 10 times as much as any major outside Democratic group so far, officials of the organization say their effort is not confined to hammering away at President Obama’s Affordable Care Act. They are also trying to present the law as a case study in government ineptitude to change the way voters think about the role of government for years to come.
“We have a broader cautionary tale,” said Tim Phillips, the president of Americans for Prosperity. “The president’s out there touting billions of dollars on climate change. We want Americans to think about what they promised with the last social welfare boondoggle and look at what the actual result is.”
Leaders of the effort say it has great appeal to the businessmen and businesswomen who finance the operation and who believe that excess regulation and taxation are harming their enterprises and threatening the future of the country. The Kochs, with billions in holdings in energy, transportation and manufacturing, have a significant interest in seeing that future government regulation is limited.
Indeed, Wonkblog reported just yesterday that a Koch Industries subsidiary is the biggest lease owner in Canada’s tar sands, covering an area of 1.1 million acres. The piece added, “Separately, industry sources familiar with oil sands leases said Koch’s lease holdings could be closer to 2 million acres.”
This helps bring into sharper focus why the Democratic fight with the Koch brothers has become so important. The dispute isn’t about some misleading AFP attack ads about health care reform; this is about a broader agenda.
As Greg Sargent explained this morning, “The real purpose of the Dem strategy is to create a framework for a broader argument about the true goals and priorities of the actual GOP policy agenda. It’s about tapping into a sense that the economy is rigged against ordinary Americans, and in favor of the one percent, and dramatizing that the GOP’s economic agenda would preserve that status quo, blocking any government policies designed to address stagnant mobility and soaring inequality. Or that, as Jonathan Chait puts it, the GOP has ‘built a policy agenda around plutocracy,’ and its primary ‘organizing purpose is to safeguard the economic interests of the very rich.’”
And it’s against this backdrop that David Vitter proclaims, “God bless the Koch brothers. They’re fighting for our freedoms.”
By: Steve Benen, The Maddow Blog, March 20, 2014
“A Curious Contradiction”: America’s Tough Guys, Sounding Awfully Weak
There’s a curious contradiction that keeps coming up with the situation in Ukraine, and how both Republicans and some in the press are criticizing President Obama. On one hand, there’s agreement in some quarters that Obama is just too weak; depending on your perspective, that’s either because he’s naturally cautious and the country doesn’t have much appetite for foreign adventurism after 12-plus years of pointless, frustrating war or because he’s bent on destroying the United States’ place in the world. The contradiction comes when the same people are asked what sorts of strong, muscular, testosterone-fueled approach might be an alternative, and the displays of toughness they propose sound awfully, well, weak. And even the nostalgic prospect of a new Cold War won’t satisfy.
So look, for instance, at this headline in The Hill: “Republicans demand Obama get tougher with Putin over Ukraine.” Get tough! But read the article and what do you find? “Calls for more muscular actions, from expelling Russia from the Group of Eight to offering military support to Ukraine, came as Russia’s stock market rallied and the ruble gained value a day after Obama authorized an initial round of sanctions meant to punish the Russian economy.” But is expelling Russia from the G-8 really “muscular”? That sounds a lot like economic pressure, which is the kind of exercise of “soft power” that tough guys are supposed to scorn. Noted tough guy John McCain says that the problem is that Obama didn’t bomb Syria, but that doesn’t tell us what sort of super-tough thing McCain would rather do now.
Yes, the call for toughness is kind of reflexive. But one does wonder whether, deep down, a few of Obama’s critics are really hankering for a war. Maybe not a war with Russia, but a war somewhere. After all, it’s been a whole decade since we started one. And unlike a conflict such as the one in Ukraine, a real war would allow people to advocate bombing and shooting and conquering — in other words, genuine tough stuff. Here, for instance, is an editorial by the Weekly Standard’s Bill Kristol lamenting the fact that Iraq and Afghanistan have made the American public “war-weary” and effectively telling them to stop being such wimps and feel that delicious bloodlust once again:
A war-weary public can be awakened and rallied. Indeed, events are right now doing the awakening. All that’s needed is the rallying. And the turnaround can be fast. Only 5 years after the end of the Vietnam war, and 15 years after our involvement there began in a big way, Ronald Reagan ran against both Democratic dovishness and Republican détente. He proposed confronting the Soviet Union and rebuilding our military. It was said that the country was too war-weary, that it was too soon after Vietnam, for Reagan’s stern and challenging message. Yet Reagan won the election in 1980. And by 1990 an awakened America had won the Cold War.
The next president will be elected in 2016, 15 years after 9/11 and 5 years after our abandonment of Iraq and the beginning of the drawdown in Afghanistan. Pundits will say that it would be politically foolish to try to awaken Americans rather than cater to their alleged war-weariness. We can’t prove them wrong. Perhaps it would be easier for a Republican to win in 2016 running after the fashion of Warren Gamaliel Harding in 1920 rather than that of Ronald Wilson Reagan in 1980.
But what would such a victory be worth?
If only those lily-livered voters had the courage of Bill Kristol, to never stop yearning for the glory of war! Sure, it’ll always be a war fought by others, but still.
It’s no wonder they’re feeling troubled. It’d be great to start a new Cold War with Russia, since the last one gave hawks purpose for so many decades. But this one won’t be nearly as kinetic as the last one. Back in the old days, we could confront the Kremlin with guns and bombs, not just the ones we pointed at them, but ones we distributed around the world. We could run proxy wars in Asia and Africa and South America. Every now and again we could invade a tiny country to our south, like Grenada or Panama, just to show the Russkies we weren’t going to take any guff. The sainted Reagan could sell arms to the ayatollah, then use the profits to fund an army trying to overthrow the Nicaraguan government. Now that was showing toughness! At least somebody somewhere was shooting. But these days it’s all imposing sanctions and freezing assets and boycotting economic summits and making statements. How can you feel tough and muscular doing that?
By: Paul Waldman, Contributing Editor, The American Prospect; Published at The Plum Line, The Washington Post, March 19, 2014
“Stripping Away The Rhetoric”: Rebuilding The American Dream, One Insurance Policy At A Time
The Republicans give lots of reasons for their opposition to the Affordable Care Act. Only two really matter.
One is politics. The other is money. More precisely, big-business money.
Like Social Security and Medicare, the expansion of health insurance coverage is making voters more predisposed to support the politicians that championed the law — and they’re all Democrats.
Meanwhile, the more Americans benefit from this new law, the more Republicans are being forced to modify and mellow their rejection of it.
Within a few years, it may become as politically suicidal to openly attack the Affordable Care Act as it would be to call for abolishing Medicare.
Of course, Republicans can’t say they oppose the reform law often called “Obamacare” because it boosts the Democratic Party’s prospects. So they say it violates states’ rights. They say it infringes on individual liberty. They say it hurts small businesses. They say it will cost Americans their jobs.
None of these charges is withstanding scrutiny.
The law was written with states in mind. That’s why states can build their own insurance exchanges. It doesn’t erode individual liberty. The Supreme Court said so. And while it will be some time before we know about the law’s full economic impact, the evidence so far suggests that it puts more money into the pockets of people who will spend it, according to a report by the Congressional Budget Office.
Wasn’t that the same report that said Obama’s expansion of health insurance coverage is killing jobs? Indeed, many news outlets reported exactly that. But that’s a misreading of the report.
The CBO found that some workers — mothers with small children, students, and those close to retirement — have voluntarily left the workplace, because they didn’t need a job to maintain access to quality health care anymore.
Once the Affordable Care Act began to take effect, these workers exercised their newfound economic freedom by choosing to quit. They’re now caring for their kids and grandchildren, focusing on their own education, simply opting to enjoy their golden years, or starting their own businesses.
That’s something to celebrate. The critique that the Affordable Care Act somehow reduces the incentive to work doesn’t stand up to scrutiny.
The voluntary exit of more than 2 million workers from the American labor force will benefit many people. These workers are free to follow their dreams. If they are providing care, they will ease our caregiving deficit. And other Americans seeking work may finally find a job.
At the same time, money saved on health care can be spent on things that small businesses sell. Yes, I know. Republicans claim higher wages are bad for small businesses, and because small businesses are the engine of the economy, Obama’s expansion of health insurance is a job-killer. That’s just wrong.
Wages aren’t the top concern of small businesses. Taxes and poor sales are. So with more money in more pockets, sales receipts should climb.
When you strip away the rhetoric and take a good hard look at what the Affordable Care Act actually does, it sure looks like the new law raises wages and increases workers’ bargaining power.
By: Jonathan Stoehr, Managing Editor, The Washington Spectator; The National Memo, March 17, 2014
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