“Voters Wil Not Forget”: Opposition To Obamacare Will Come Back To Haunt Conservatives
It is truly amazing to me to read through the blogs, the press releases from the Republican anti-Obamacare war room, the phalanx of Koch-brothers’ sponsored think tanks and web sites – one message: FAILURE.
Let’s leave aside that their cagey rhetoric has shifted from “repeal” to “a fix,” but that their policy position remains the same: kill it. Republicans will continue their onslaught against the Affordable Care Act because they believe it is a political attack that will work for them and unite their party, at least in the short run.
They complain about the problems with the website, yet they love that it didn’t work well. They are euphoric when it fails. Do they want it to succeed? Heck no.
They offer up people who have had problems switching their health care plans, with big smiles on their faces. Another Congressional hearing is called for to condemn the ACA, according to the Republicans.
Peter Roff, one of my esteemed colleagues on this blog, publishes a list from the Heritage Foundation on why the ACA will fail (never mind that much of what Heritage called for is in the law, like the individual mandate).
But forget all that. I would cite much of this list as precisely why Obamacare will work (see Roff’s Heritage list here):
- The new plans available under the law will provide better coverage for a better price. This is not a broken promise by the president but the end result. Think about the benefits: no pre existing conditions; no canceling of your plan when you get sick; no caps on coverage; no huge costs for women over what men pay; keeping children on the plan until they are 26.
- There will be more options for consumers to choose from, not less. They won’t be forced into inferior plans.
- The new approach to Medicaid will allow people to shop for and purchase their plans, not arrive in emergency rooms often too late for help and with exorbitant costs. This will be a vast improvement on where we are now. Sadly, many Republican governors want to keep these people from getting insurance by rejecting federal funds to help with the Medicaid expansion.
- The ACA will lead to more stable families with better health care, not penalize people for success or getting married, as Heritage asserts.
- There will be better care for women, more coverage, and it won’t destroy our religious liberties. Pardon the sexism, but that is a “straw man.”
- Probably the most absurd claim from Heritage is that the ACA is a job killer. If we are providing health care to an additional 30-40 million Americans, it will create jobs in the health care field, not kill them. More doctors, more nurses, more ways to care for patients. Businesses will have more productive workers, fewer who are sick and out of work, and costs will decrease as more people are covered.
I do have one prediction for my friend Peter Roff and those Republicans who are staking the political future of their party on killing the ACA: When this succeeds, voters will not forget, and they will remember the horror stories of the old system. The more the focus is on patient care, better treatment through R&D, keeping people healthy, access for millions, the more that Democrats will benefit from the contrast. Republicans should be very careful not to argue too strongly for failure, it will come back to haunt them.
By: Peter Fenn, U. S. News and World Report, December 5, 2013
“Reality Be Damned”: Do Republicans Need A Plan B On ObamaCare?
For years, Republicans have trotted out the same message: ObamaCare is a massive disaster, and the public knows it. And when Healthcare.gov crashed out of the starting gate, that message proved quite resonant.
Yet as ObamaCare begins to turn the corner, Democrats are going back on the offensive, touting the law’s benefits and successes in hopes of boosting support for it — and the party — ahead of the 2014 elections. Republicans, meanwhile, have so far stood by the same critiques, betting that the law will still be seen as a failure come Election Day.
Which raises a thorny question for the GOP: What if ObamaCare works?
Undoubtedly, ObamaCare is now functioning better than it was in October. Though problems remain for the exchange site — the back end is still a mess, often sending bogus or incomplete information to insurers — enrollments are reportedly surging through both the federal and state-run marketplaces.
Good news in hand, the White House and congressional Democrats this week launched a campaign of daily pro-ObamaCare messaging to promote the law ahead of the December 23 enrollment deadline for coverage that kicks in January 1, 2014. Their goal is to present a “raw two-sided picture,” according to Politico, with “Democrats delivering benefits on one side, and Republicans trying to deny them on the other.”
“My main message today is: We’re not going back,” Obama declared in a reboot speech Tuesday.
If ObamaCare keeps improving, the GOP’s “we told you ObamaCare was a mess” pitch could quickly wear thin. And if it does, Republicans will find themselves in need of a new argument or a legislative alternative.
So far, they don’t really have either.
On the messaging front, House Speaker John Boehner (R-Ohio) on Tuesday repeated boilerplate GOP criticisms that the law is “fundamentally flawed,” and that it “continues to wreak havoc on American families, small businesses, and our economy.” Other GOP leaders similarly contended that the law is still a problem-plagued failure.
That the message hasn’t changed despite ObamaCare’s turnaround proves that “Republican complaints of two months ago were purely opportunistic,” wrote Jamelle Bouie over at the Daily Beast.
“For them, it just doesn’t matter if Healthcare.gov is working, since ObamaCare is destined to fail, reality be damned!” he added. “At most, the broken website was useful fodder for attacks on the administration. Now that it’s made progress, the GOP will revert to its usual declarations that the Affordable Care Act is a hopeless disaster.”
The GOP has also yet to offer a credible legislative alternative to ObamaCare. Though there are several Republican bills that would reform the health-care system, they’re generally considered suspect, and none have consensus support within the GOP. Boehner on Tuesday tellingly dodged a question about whether he would even bring up such a bill up for a vote, saying only, “We’ll see.”
Polls have shown that while voters aren’t too keen on the health-care law, they’re willing to give it a chance. Indeed, the first few months of ObamaCare’s disastrous rollout could be a distant memory once coverage and benefits kick in next year.
Which points to another problem for Republicans: Their anti-ObamaCare crusade will be tough to sustain once people begin to see the law’s benefits in action. Mother Jones‘ Kevin Drum sussed out that point, writing, “Once the benefits of a new program start flowing, it’s very, very hard to turn them off.”
By the middle of 2014, ObamaCare is going to have a huge client base; it will be working pretty well; and it will be increasingly obvious that the disaster scenarios have been overblown….
Given all this, it’s hard to see ObamaCare being a huge campaign winner. For that, you need people with grievances, and the GOP is unlikely to find them in large enough numbers. The currently covered will stay covered. Doctors and hospitals will be treating more patients. ObamaCare’s taxes don’t touch anyone with an income less than $200,000. Aside from the Tea Partiers who object on the usual abstract grounds that ObamaCare is a liberty-crushing Stalinesque takeover of the medical industry, it’s going to be hard to gin up a huge amount of opposition. [Mother Jones]
Republicans have so far committed themselves to staunchly opposing ObamaCare no matter what, even producing a playbook for attacking the law from here to November 2014. But if ObamaCare continues to improve, the GOP might need to draw up a new play — or risk getting burned at the polls.
By: John Terbush, The Week, December 4, 2013
“Unsatisfying To The Media And Republicans”: Surprise, Obamacare Now Projected To Cost Hundreds Of Billions Less Than Expected
Amidst the dark skies of the Healthcare.gov launch, some daylight may finally be emerging with respect to one of the critical goals of the Affordable Care Act—bending the cost curve of America’s expensive healthcare system.
According to a New York Times report out Tuesday, the Congressional Budget Office has quietly removed hundreds of billions of dollars from the projected costs of Obamacare, primarily the result of an anticipated decrease in the federal government’s contribution to the Medicaid expansion program along with the projected cost of the subsidy payments to those buying private insurance policies on the healthcare exchanges.
Why the good news?
The more favorable projections are the direct result of the slowing trend in the growth of healthcare spending over the past five years leading to a slowdown in rising costs. While, ten years ago, per-capita spending on healthcare had been growing by an average annual rate of 5 percent, that number was dramatically cut to 1.8 percent during the 2007-2010 period and reduced even further to 1.3 percent in the years following 2010.
Do we have Obamacare to thank for this highly successful “bending” of the cost curve?
Naturally, the answer depends upon who you ask as there simply is no definitive way of knowing—yet.
While most economist believe that the lion’s share of the reduction is due to the sluggish economy—making Americans far more careful when it comes to making decisions regarding when or if to spend money on medical care—others believe that some of the plans built into the ACA designed to get people to spend less may actually be working.
Among Obamacare inventions that do appear to be paying off in lower healthcare costs is the government’s refusal to pay hospitals more when patients are re-admitted within 30 days of their initial discharge. Additionally, new plan designs engineered to reward providers for quality of care rather than for quantity of care may well be paying off in terms of lowering the overall cost of care.
According to the Kaiser Family Foundation—widely regarded as an honest, non-partisan broker when it comes to healthcare issues and analysis—the declining increases in the cost of healthcare is 75 percent the result of economic factors and 25 percent a benefit of the cost cutting measures in the ACA that do, in fact, appear to be working.
Of course, the big question is whether or not these cost lowering provisions of Obamacare will continue to do the job once the economy regains its more typical trajectory.
There are reasons to be hopeful that healthcare spending can be held down once the economy kicks into higher gear.
For starters, while many Americans shopping for new health insurance policies may be decrying the higher deductibles they are discovering in the new offerings, higher deductibles should have a meaningful impact on the decisions people make when determining whether or not a visit to the doctor or agreeing to a given procedure is really necessary. While a $250 deductible will likely not cause a patient to ask how much a suggested CT Scan is going to cost, a $3,000-$5,000 deductible is far more likely to cause the patient to ask a few more questions and make more focused decisions when payment for the test is coming out-of-pocket.
Not surprisingly, there are no shortage of economists and pundits who believe that the ACA will prove inadequate to the task of controlling costs once the economy is in better shape.
Others are more hopeful, believing that the slowdown in costs are very much a result of hospitals and insurance companies understanding that something had to change given the unsustainable trends in rising costs. As a result of a desire to derail out-of-control costs before the costs derailed them, insurers and hospitals became involved in substantial systemic revisions designed to lower healthcare spending even before the government required them to do so.
Discussing whether the current decreases can last when previous periods of cost-curve bending did not, Annie Lowrey writes in her New York Times piece—
“This time may be more durable. Insurance and hospital executives in Massachusetts, Illinois and California, among other places where reforms have gone the furthest, report a consensus that spending growth had become unsustainable, and that expectations that Washington would force changes to the system spurred them to make changes themselves.”
If this is true—and I believe the evidence reveals that it is—these self-imposed changes, in tandem with the changes brought about by elements of Obamacare that don’t receive nearly as much attention as the more hot button issues, may prove to provide lasting changes to the system; changes that will point our cost trajectory in the right direction.
Like most elements of the Affordable Care Act, these issues and results only go to prove that far more time is required before we can even begin to measure the real benefits or detriments of Obamacare.
While this reality may prove unsatisfying to the media, politicians and those in the public who are so emotionally committed to the failure and ultimate death of Obamacare—whether for political purposes or only so that the opponents can experience the satisfaction of having been right—anyone interested in realistic measurement of this dramatic change in our system better settle in for the long run.
It’s going to be awhile until we know how this story ends.
By: Rick Ungar, Op-Ed Contributor, Forbes, December 4, 2013
“When The Worm Turns”: Republican Fallacies On Obamacare, The Greatest Hits
Before the holiday spirit makes Republican-bashing a little unseemly, it’s time to get in a last ornery blast at the party’s Obamacare stance. Republicans have enjoyed themselves immensely during the Affordable Care Act’s bungled rollout, but most of the claims they’re making are preposterous and phony. Since anyone able to take a longer view knows we’ll one day be well past Obamacare’s self-inflicted wounds, I’d like as a public service to catalog the GOP’s shabbiest arguments, so we’ll all have a handy reference once the worm fully turns.
The selective “humanitarian crisis.” Conservatives have warned of the “humanitarian disaster” that will ensue if several million people with cancelled policies are unable to secure new coverage before January 1. But this theoretical woe (which will almost certainly be avoided thanks to Web site fixes and policy extensions) pales next to the much larger humanitarian disaster of America’s nearly 50 million uninsured — a crisis that’s persisted for decades without conservatives caring a whit. I can’t be the only one who finds the right’s sudden concern for a small subset of the uninsured a bit rich.
The bogus oppression of the young and healthy. Another confused conservative trope bemoans the enslavement of younger or healthier Americans, who’ve supposedly been conscripted to subsidize their older, sicker countrymen. “Liberals justify these coercive cross-subsidies as necessary to finance coverage for the uninsured and those with pre-existing conditions,” the Wall Street Journal editorialized last Saturday. “But government usually helps the less fortunate honestly by raising taxes to fund programs.” Actually, the Journal has the American way of health subsidy exactly wrong. Most people aged 19 to 34 who have health coverage get it from their employer. And, as I’ve noted before, at nearly every firm, young people pay the same premiums as employees who are older and get more expensively sick. In other words, Obama’s scheme to rob Peter to fund health care for Paul already exists, at vastly larger scale, in corporate America. And while Obamacare is only hoping to sign up 2 million or so young people, 20 million Americans aged 19 to 34 get their coverage on the job. Where’s the Wall Street Journal’s rant against corporate America’s “coercive cross-subsidies”? And while we’re at it, when will we stop making all those people whose houses don’t burn down subsidize those whose do?
The “men and 55 year old women don’t need maternity care” fallacy. Well, yes, and people whose genes don’t predispose them to cancer (which tests will reveal soon enough) don’t need cancer coverage. As Bob Kocher, a doctor and former senior Obama health care advisor, explained, if one of our goals is to not charge women higher premiums than men, all plans have to cover maternity. Among younger women, moreover, maternity is the biggest driver of costs — so if you allow optional coverage, the plans young people buy would be super-expensive. “For insurance to work, you can’t allow people to opt into benefits like maternity right before they get pregnant,” Kocher adds. “When spread across the population, it’s not expensive.” Sounds like Insurance 101. Which in the social insurance context, conservatives can’t abide.
Insurance “bailout” baloney. Sen. Marco Rubio talks opportunistically (but I repeat myself) of Obama’s pledge to “bail out” health plans if the folks they sign up end up being unduly costly to treat. Once again, conservatives eat their own. Such “risk adjustment” — after-the-fact payments to reflect the actual vs. expected risk experience of health plans — has been a sensible staple of conservative insurance market reforms since George H.W. Bush proposed it in 1992. Little known but true: Before Romneycare begat Obamacare, Bushcare begat Romneycare. Rubio was only 21 then. He must not know. Or care.
The “Obama is taking over one-sixth of the economy” ruse. In the Fox News cocoon, this truth is self-evident. But it makes as much sense as crying that Ben Bernanke is “remaking 6/6ths of the economy” every time the Fed touches interest rates. The fact that health-care spending is 18 percent of GDP doesn’t mean Obama is “remaking” or “taking over” anything. He’s tweaking a dysfunctional corner of the market where 5 percent of us get our health coverage. He’s also testing ideas that health gurus in both parties have long suggested might help reign in future costs.
Worse than these GOP fallacies is the party’s smug sanctimony. It’s as if conservatives have decided to parody the moral preening they loathe in liberals, except that the right is serious. As one pundit lectured, “the administration didn’t care enough to make sure the people of their country were protected. In the middle of a second age of anxiety they decided to make America more anxious.”
Yes, the rollout was botched. But what is this person talking about? Finally assuring that illness in the United States can’t be the cause of financial ruin is the very essence of “protection.” How galling that conservatives can make such hollow charges while putting forward no plan of their own to “protect” anyone from anything!
Or take the pundit who wrote that “extending enrollment periods does nothing but provide Americans more time to contemplate their miserable choices.” Only someone with no empathy — someone who has never tried and failed to get coverage in the individual market — could possibly say such a thing.
I’ve spent a lot of time over the years arguing that we can solve big problems such as providing insurance coverage in ways that honor both liberal and conservative values. It’s entirely doable — John Rawls and Milton Friedman can be reconciled, trust me. Apart from being sound policy, I’ve assumed such approaches would also be necessary, because with power closely divided in the United States, we’d need to strike big cross-party deals to make progress. The breathtaking intellectual and moral dishonesty of those driving the Obamacare debate in the GOP today makes me feel foolish for having tried.
By: Matt Miller, Opinion Writer, The Washington Post, December 4, 2013
“The Blurred Line Between Caricature And Reality”: Republicans Are Nothing If Not Predictable
It’s become a running joke: when Republican get bored with the latest manufactured outrage of the day, they turn to the Benghazi and IRS “scandals” as a standby. Indeed, it’s been widely assumed over the last several weeks that as the Affordable Care Act improves, GOP lawmakers would have no choice but to return to their favorite faux political controversies.
They are nothing if not predictable. Here’s Senate Minority Whip John Cornyn (R-Texas) yesterday:
“Since the terrible tragedy that took four American lives in Benghazi, we’ve had difficulty, to put it mildly, trying to get to the bottom of this,” the second-ranking Senate Republican said during a Google Hangout session he held while the Senate is on recess. ”Now the goal is to talk to the Benghazi survivors – people who were actually there who could tell the truth and expose what happened and hold the people responsible accountable. This has been a cover up from the very beginning.”
And here’s House Oversight Committee Chairman Darrell Issa (R-Calif.) soon after:
The House’s chief investigator says the FBI is stonewalling his inquiry into whether the agency and the Internal Revenue Service targeted conservative group True the Vote for special scrutiny, and Rep. Darrell E. Issa is now threatening subpoenas to pry loose the information from FBI Director James B. Comey Jr.
Mr. Issa, California Republican, and Rep. Jim Jordan, Ohio Republican, are leading the House Oversight and Government Reform Committee’s IRS inquiry. They also said the FBI is refusing to turn over any documents related to its own investigation into the IRS, which began in the days after an auditor’s report revealed the tax agency had improperly targeted tea party groups for special scrutiny.
The White House should probably consider this a good sign. Remember, as recently as last week, congressional Republicans were reluctant to talk about literally any issue other than the Affordable Care Act, afraid that any distraction from the dysfunctional website might let Democrats off the hook. Even the reaction to the “nuclear option” was muted because Republicans wanted all of the political world’s focus solely on health care – and nothing else.
And it now appears that phase is ending and far-right lawmakers are back to Benghazi and the IRS. If that isn’t affirmation of the White House’s health care initiative getting back on track, nothing is.
By: Steve Benen, The Maddow Blog, December 3, 2013
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