How The Budget Deal Affects The Affordable Care Act
So how does this mammoth budget-cutting deal, with its congressional “supercommittee” affect health reform?
Good question, because lots of people in Washington are asking it too.
More specific answers will become clearer in the next few weeks, but here’s a first version of the road map to both the policy and the politics.
First, understand there are two different processes – and each, separately, aims at cutting more than $1 trillion over the next decade.
The one that you’ve probably heard most about is the “supercommittee” of 12 members of Congress. They are supposed to identify savings by Thanksgiving. Entitlements – Medicare, Medicaid, Social Security and aspects of the Affordable Care Act – are part of their turf. So are taxes and revenue – at least in theory. It’s not so clear that the Republicans see it that way given the public statements of Congressional leaders.
If they agree on some kind of grand deal by Thanksgiving, Congress has to take it or leave it by the end of December, eliminating the usual congressional dilly-dallying. (It looks like dilly-dallying to the casual observer or much of the public, but remember that all that arcane, tedious process IS policy in Congress. If you slow something down, make it go through hoops, amend it, hold it up, etc., it doesn’t become law. That may be good or, depending on your point of view, bad politics.)
If Congress takes any recommendations that the supercommittee agrees on, that’s the law. If the committee fails, or Congress rejects it, then the “trigger” gets pulled. The official name is “sequestration.” That’s a fancy name for automatic cuts – 2 percent across-the-board cuts in Medicare, for instance, affecting all health care providers, doctors, hospitals, etc. It won’t affect beneficiaries – at least not directly.
Medicaid is not subject to the trigger. Neither, according to the preliminary interpretations I’ve received from analysts and congressional staff, are the big, key subsidies in the health care reform law – the Medicaid expansion and the subsidies that will help low-income and middle-income people afford health care in the new state exchanges.
Other parts of the health reform law are, however, subject to automatic cuts. Among them: Cost-sharing subsidies for low-income people. This isn’t the help paying the premium; this is the help with the co-pays when people do get care. But the payments are made to health plans, not directly to beneficiaries so it won’t have the direct impact of discouraging care. It may affect how health plans make decisions about what markets to participate in. Gary Claxton and Larry Levitt at Kaiser Family Foundation explain here.
Also, the supercommittee could have a partial deal – meaning there’s still a trigger, but a smaller one. Maybe they won’t reach agreement on $1.2 trillion to $1.5 trillion in savings, which would avoid the trigger. But maybe they could agree on, say, $500 billion. That means a trigger wouldn’t have to go as deep because some of the savings would already be identified.
To recap – before we go on to the second stage of this process: The “super-committee” can do whatever it wants to health care, Medicare, Medicaid, Social Security, etc. – if it can agree, if it can get the rest of Congress to agree and if the president doesn’t veto it.
Will the Democratic Senate and the Obama White House agree to cuts that eviscerate health reform? Not likely. In fact, the Democrats “won” on very few aspects of the budget/debt deal. Walling off Medicaid and key parts of the health coverage expansion were two of the “wins.” That’s a bright line worth paying attention to as this moves forward.
Does that mean other health-reform related spending will be untouched? Given how many moving parts there are to any spending deal, and the fact that defense and tax policy are also part of the mix, chances are it will be affected. But expect to see that bright line remain visible – maybe not quite as bright, but visible. (The CLASS Act, the voluntary long-term care program created under health reform, is a different story; it’s quite vulnerable.)
The second part is the annual appropriations process. The budget deal provides for cuts – real cuts in spending, not just slowing the rate of growth. Health programs (aspects of the health reform legislation touching on exchange creation, prevention, community clinics, etc., and just about everything else at the Department of Health and Human Services – the FDA, NIH, CDC, etc. – will be subject to these cuts. But this isn’t an across the board process, it’s a line-by-line, or at least category/agency-by-category/agency, process. And there is some horse trading.
It’s safe to say that the Republicans will try to cut discretionary portions of the new health law. That’s not a new political dynamic, it doesn’t arise out of the debt ceiling or the Wall Street woes. It’s what we’ve seen since last fall’s elections and the repeal/defund fights of the past few months. And House Budget Chairman Paul Ryan has publicly tried to insert health care into any potential deal. So expect to see more Republican push to cut, and continued Democratic push back. Will health spending emerge unscathed? It’s too soon to know but, given the amount of savings Congress needs to find –both in this budget deal and in the perennial quest to fund the “doc fix” payments – some cuts are clearly possible. Some of it may affect aspects of exchange establishment, regulation, prevention, public health, etc. But it’s hard to see the Democrats allowing cuts so deep that they basically constitute a side door to repeal.
One further twist – some Republicans are calling for a delay in health reform implementation to save money.”Delay” may sound better to an ambivalent public worried about spending than “repeal.” What’s delayed (if anything), how it’s delayed, how long it’s delayed, and what stopgaps are created in the meantime could have an impact on how many people get covered in 2014.
Assorted committees and government agencies are still examining the new budget law and how it will affect … everything. So the perspective I’ve outlined here – and I’m writing amid all the market turbulence – may change as the economic and political climates change. But the lines in the sand around the trigger – health reform, Medicaid and Social Security – tell us something about where the White House will come down.
By: Joanne Kenen, Association of Health Care Journalists, August 10, 2011
Halting The “Disease Of Republican Compromise”: Intra-GOP Wars Block Path To Debt Ceiling Accord
What if they yield, even a little?
Call it GOP Primary Fear. A major hurdle to breaking the federal debt-ceiling impasse is the worry by House Republicans that they will invite primary election challenges from the right if they give ground to Democrats on the issue of higher tax revenues.
There’s even a verb for it: being “primaried.”
The challenger would not be a Democrat. It would be a fellow Republican, in a spring or summer primary that most voters would ignore. That could leave the field mainly to ideological die-hards, often with tea party ties and little appetite for compromise.
It’s the atmosphere that many House freshmen rode to victory last year, and that cost two GOP senators their party’s nomination.
“They talk about it all the time,” said Mike McKenna, a Republican lobbyist who closely follows the House and politics. If the House cuts a deficit-reduction deal with President Barack Obama, he said, “you’re probably going to see a lot of leadership guys get primaried,” along with rank-and-file Republicans. “It could be an all-time high.”
Such worries are a key reason the GOP-controlled House has refused so far to accept Obama’s debt-and-deficit overture, even though it includes budget concessions that many people never expected from a Democrat. Friday evening, after House Speaker John Boehner abruptly broke off the talks, an exasperated Obama declared: “One of the questions the Republican Party is going to have to ask itself is, `Can they say yes to anything?'”
Boehner blamed Obama for insisting on higher revenues. The package they were closing in on would have cut spending by $3 trillion over 10 years, and slowly started to trim Social Security and Medicare benefits. But to get it through the Democratic-controlled Senate, the deal also needed to include some increase in revenues from taxes aimed mainly at the wealthy, and generating up to $1 trillion over a decade.
That’s the needle Boehner can’t figure out how to thread. He’s been unable to persuade enough fellow Republicans to give just enough on higher revenues, or “tax hikes” — there will be a fierce fight, too, over definitions — to keep Senate Democrats from filibustering the bill to death.
Boehner must also reassure colleagues that they could survive primary challenges.
Obama confronted the issue Friday, at a forum in Maryland. Many House districts, he said, are drawn to be “so solidly Republican or so solidly Democrat that a lot of Republicans in the House of Representatives, they’re not worried about losing to a Democrat. They’re worried about somebody on the right running against them because they compromised. So even if their instinct is to compromise, their instinct of self-preservation is stronger … that leads them to dig in.”
Nearly all congressional Republicans have pledged not to raise taxes, although lawmakers quibble about what that means. Many tea partyers say it bars any action that would lead directly to a net increase in tax revenues. The Senate is almost certain to reject that definition.
Tea party activist Lee Bellinger recently urged colleagues to put lawmakers on notice “before the disease of Republican compromise infects Washington once again.” As early as mid-April, Tea Party Patriots co-founder Mark Meckler told The Hill newspaper he was “getting emails by the hour from people talking about primary challenges” to Republicans who seek budget deals with Democrats.
Rutgers University political scientist Ross Baker said Republican primaries are dominated by “the most ideological voters.” They “track votes and are unforgiving,” he said.
GOP pollster and consultant Wes Anderson said, “If we pass some deal that includes some form of tax increases_ even if we try really hard to couch it in `tax reform, closing loopholes,’ etc. — there are going to be a number of our folks, especially freshmen, who will face primaries. It’s just going to happen.”
Anderson said Boehner’s top staffer is counting votes every day, asking “what kind of deal can we get without losing too many?”
For Boehner, the math doesn’t require reaching the minimum 218 votes needed to pass a bill in the House (or 217, given two seats currently vacant).
If Obama eventually endorses a compromise, it probably will draw scores of House Democrats’ votes. That would allow Boehner to lose 100 or so of his 240 Republicans, and still pass the measure.
But if Boehner wants to remain speaker, he can hardly afford a bigger defection than that. He needs to find the political sweet spot, a compromise that can win the votes of 140 or so House Republicans and most of the Senate’s Democrats.
McKenna estimates that about 40 pro-Boehner House Republicans are politically safe enough to vote for a compromise with no worries. Beyond that, he said, “80, 90, 100 are probably going to vote `yes’ on whatever comes out. And they will be exposed.”
By: Charles Babington (With Contribution by Jim Kuhnhenn), The Associated Press, Yahoo News, July 22, 2011
GOP Wheeling And Dealing May Come Back To Bite Them
Wednesday was the anniversary of the day in 1944 when Democrats nominated Franklin Roosevelt for a fourth term. If he could see the wheeling and dealing in D.C. during the current budget deficit debate, FDR wouldn’t be surprised. Republicans are still trying to kill Social Security, and the GOP is still cozy with bankers, billionaires, and big business.
Tea Party House Republicans, under the leadership of Eric Cantor, are doing everything they can to protect their BFFs on Wall Street from paying their fair share of taxes. If majority Leader (and presumptive peaker) Cantor and the rest of the Tea Party types were really concerned about the budget deficit, they would support President Obama’s effort to save money by ending billions of dollars in wasteful subsidies to big oil and for corporate jets. Tax breaks for corporate jets with full bars don’t stimulate the economy, but they do stimulate corporate jet setters.
Republicans did score one victory this week which may come back and bite them on the butt. President Obama passed over consumer advocate Elizabeth Warren for the job of director of the new federal Consumer Financial Protection Bureau after Senate Republicans said they would filibuster her appointment. Warren’s crime was her fight to protect consumers from the big financial firms that rip off working families. Today is the first anniversary of the Wall Street Reform and Consumer Protection Act which Congress passed to curb predatory behavior by Wall Street.
Warren will return to her home in Massachusetts, and she may run against Republican U.S. Senator and Cosmo centerfold, Scott Brown. If the GOP has any hope of taking control of the Senate next year, Brown must win. But polls show that Brown is vulnerable, and Brown has the chops to show blue collar Democrats that Wall Street is the enemy of the working families who have lost their jobs and then their homes in the wake of the great recession, a downturn caused by big business and the bad boy bankers and billionaires that Warren has fought to regulate.
And one last date for all you American history buffs, Tuesday was the anniversary of the day in 1848 when a pioneering women’s rights convention met in Seneca Falls New York. The convention paved the way for way for women like Elizabeth Warren and Michele Bachmann to run for office. By the way, Representative Bachman, the convention was in Seneca Falls, N.Y., not Seneca Falls, N.H., if anyone asks.
By: Brad Bannon, U. S. News and World Report, July 22, 2011
The New Party Of Reagan: The Gipper Is Winning One For The Democrats
After he switched to the Republican Party in 1962, Ronald Reagan famously quipped: “I didn’t leave the Democratic Party. The party left me.”
Now, the Republican Party is doing the same thing to him — and Democrats are happy to take Reagan back.
At Tuesday morning’s meeting of the House Democrats, caucus chairman John Larson rallied his colleagues for the day’s debt-limit debate by playing an audio recording of the 40th president.
“Congress consistently brings the government to the edge of default before facing its responsibility,” Reagan says in the clip. “This brinkmanship threatens the holders of government bonds and those who rely on Social Security and veterans benefits. Interest rates would skyrocket, instability would occur in financial markets, and the federal deficit would soar. The United States has a special responsibility to itself and the world to meet its obligations.”
“Kind of sums things up,” Larson said, playing the same clip again at a news conference.
Nobody knows what Reagan, who died in 2004, would make of the current fight over the debt limit. But 100 years after Reagan’s birth, it’s clear that the Tea Party Republicans have little regard for the policies of the president they claim to venerate.
Tea Party Republicans call a vote to raise the debt ceiling a threat to their very existence; Reagan presided over 18 increases in the debt ceiling during his presidency.
Tea Party Republicans say they would sooner default on the national debt than raise taxes; Reagan agreed to raise taxes 11 times.
Tea Party Republicans, in “cut, cap and balance” legislation on the House floor Tuesday, voted to cut government spending permanently to 18 percent of gross domestic product; under Reagan, spending was as high as 23.5 percent and never below 21.3 percent of GDP.
That same legislation would take federal spending down to a level last seen in 1966, before Medicare was fully up and running; Reagan in 1988 signed a major expansion of Medicare.
Under the Tea Party Republicans’ spending cap, Reagan’s military buildup, often credited with winning the Cold War, would have been impossible.
No wonder Democrats on Tuesday were claiming the Republican icon as one of their own. After the caucus meeting with the Reagan clip, Rep. Mike Quigley (D-Ill.) began the day’s debate by reading from a 1983 Reagan letter to Congress warning that “the full consequences of a default — or even the serious prospect of default — by the United States are impossible to predict and awesome to contemplate.”
“In the year of his 100th birthday, the Great Communicator might be amazed at how far his own image has shifted from the original,” Quigley charged. “He’d see his most dedicated followers using his name as justification for saying no to honoring our debts. He’d see his legacy used to play chicken with the world’s greatest economic engine.”
Republicans have continued their ritual praise of Reagan during the debt-limit fight. Rep. Trent Franks (Ariz.) claimed that the budget caps would allow America to be “that great city on a hill that Ronald Reagan spoke of.” Marsha Blackburn (Tenn.) invoked Reagan’s belief that “the closest thing to eternal life on Earth is a federal government program.”Kevin Brady (Tex.) cited Reagan’s line that “the nine most terrifying words in the English language are ‘I’m from the government and I’m here to help.’ ” Both Steve King (Iowa) and Bobby Schilling (Ill.) informed the body that they had granddaughters named Reagan.
But while Reagan nostalgia endures, a number of Republicans have begun to admit the obvious: The Gipper would no longer be welcome on the GOP team. Most recently, Rep. Duncan Hunter Jr. (Calif.) called Reagan a “moderate former liberal . . . who would never be elected today in my opinion.” This spring, Mike Huckabee judged that “Ronald Reagan would have a very difficult, if not impossible time being nominated in this atmosphere,” pointing out that Reagan “raises taxes as governor, he made deals with Democrats, he compromised on things in order to move the ball down the field.”
During the debt-limit debate, a procession of Democrats — Vermont’s Peter Welch, Maryland’s Chris Van Hollen, New York’s Paul Tonko, Texas’s Sheila Jackson Lee and Gene Green — claimed Reagan’s support for their position. Reagan is “revered by many Democrats,” said Welch, who praised Reagan for fighting “the absurd notion that America had an option when it came to paying our bills.”
Half a century after he left the party, the Gipper is winning one for the Democrats.
By: Dana Milbank, Opinion Writer, The Washington Post, July 19, 2011
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