“The Same Reasonable-Sounding Lies”: What Won’t The GOP Do To Keep The Poor Uninsured?
When it comes to healthcare, Southwest Virginia is a desperate place. Many of the state’s poorest and sickest live in that pocket of coal country between US Route 19 and the Kentucky and Tennessee borders, where it’s so hard to see a doctor that a free mobile health clinic held each July at a county fairground draws hundreds. “Southwest Virginia is one of the worst places we go to,” said Stan Brock, the founder and president of Remote Area Medical, which runs that clinic and others throughout the country.
That corner of Virginia also encompasses the district of Phillip Puckett, who served as a Democratic state senator until Monday, when he suddenly resigned. His decision to step down appears to have been the result of a bribe offered by Republican colleagues bent on stopping the expansion of Medicaid. Puckett’s resignation gave Republicans the one seat they needed to take control of the Senate; it also put him in the running for a paid post on a state tobacco commission that is controlled by some of the very same Republicans. And it cleared the way for the chamber to appoint his daughter to a state judgeship.
By stepping down, Puckett effectively ended a months-long battle over the fate of the 400,000 Virginians who are too poor to buy insurance but don’t meet the state’s restrictive eligibility requirements for Medicaid. The state Senate had been on course to vote to expand the program under the Affordable Care Act, setting up a budget showdown with the Republican-controlled House. But with the GOP now in control of the Senate, both chambers are expected to pass a spending plan on Thursday that does not include the expansion.
The advocacy group ProgressVA called for an investigation of allegations of a quid pro quo between Puckett and Republicans, who deny they made any sort of deal. Puckett cited “recent issues that have developed in our family” as grounds for his resignation, and said he would withdraw his name from consideration for the job on the tobacco commission. Virginia Attorney General Mark R. Herring announced that he does not see an “investigative role” for his office.
The question of what prompted Puckett’s mid-term resignation is tantalizing, and potentially important, but it’s also beside the point. The true scandal is that hundreds of thousands of Virginians—including more than 20,000 of Puckett’s own constituents—will be denied health insurance.
The Medicaid showdown in Virginia was particularly heated because the legislature was so closely split. But Republicans all across the country have gone to insane lengths to keep millions uninsured, or to justify doing so. In Louisiana, for example, the state sued MoveOn.org for a billboard criticizing Governor Bobby Jindal’s opposition to the Medicaid expansion. Republicans in Utah are trying to embed work requirements into a private alternative to the expansion, a stipulation that would likely make the plan unworkable. In Arkansas, Republicans tried to roll back the Medicaid alternative that passed last year by refusing to reauthorize its funding. Although the program was finally re-approved, conservative lawmakers—who are steadily gaining ground in the Arkansas legislature—indicated that they’ll attack it again next year.
For years now Republicans have trotted out the same reasonable-sounding lies to fight the expansion, namely the myth that states can’t afford it. The real callousness that undergirds their ideological campaign was made clear this year, however, by a handful of state senators in Missouri, who gathered on the Senate floor to make it clear that there would be “no path” forward for the expansion. “Why is this somehow our problem?” one lawmaker asked. “It’s not happening,” said another. “Go find something else to do.”
There simply isn’t anything else that the millions of Americans who fall into the coverage gap can do to afford healthcare. Expanding Medicaid won’t fix all of the health problems in Southwest Virginia; a shortage of providers serving rural and low-income patients also challenges the region. But that’s no reason to deny insurance to people, particularly when the costs of doing so will be born almost entirely by the federal government, not the state. The persistence of myriad other issues to be dealt with is simply an indicator that people would be better served if lawmakers spent less time devising elaborate schemes to keep the poor uninsured and found something else to do, themselves.
By: Zoe Carpenter, The Nation, June 10, 2014
“A Vile And Wicked Plot”: How Barack Obama Trapped The GOP On Health Care
Barack Obama has done many dastardly things to Republicans. He regularly ridicules their arguments. He insists on being treated as though he were legitimately the president of the United States. And most cruelly of all, he beat their standard-bearers in two national elections. Is it any wonder they loathe him so? But one thing Obama has done to the GOP has gone unnoticed: he made it impossible for them to be serious about health care policy.
By now you’re well familiar with how the core of the Affordable Care Act—a ban on insurance companies denying coverage for pre-existing conditions (also known as “guaranteed issue”), accompanied by an individual mandate and subsidies for people of moderate incomes to purchase private insurance—was originally a conservative proposal. The idea was that unlike in most other western countries where a large government program like Medicare covers all citizens, you could achieve something close to universal coverage and health security through the use of markets. When Mitt Romney installed it in Massachusetts, it worked quite well and everybody was pleased. But then Barack Obama came along and embraced it, so all good and true conservatives had to conclude that it was not only a terrible idea in practical terms but a vile and wicked plot to rob Americans of their freedom.
And that has left Republicans in a difficult spot. They would very much like to have market-based health care ideas they could rally around, if nothing else than to demonstrate to the public that they sincerely want to fix what’s wrong in America’s health care system. But the theft of the guaranteed issue-plus-mandate-plus-subsidies framework has left them with nothing but unappetizing scraps off the health care table, none of which will do much of anything to address problems like the large number of uninsured Americans.
There’s a ritual people like me have taken to of late. Republicans announce that they’re about to release a health care plan. Then we say sarcastically, “Gee, let me guess. It involves 1) tort reform; 2) letting people buy insurance across state lines; 3) incentives for more use of health savings accounts, and 4) high-risk pools for people with pre-existing conditions” (here’s a recent example). And we’re always right, because those are the Big Four conservative health care ideas, and nobody can come up with anything different.
Here’s the thing about these ideas: neither any of them individually, nor all of them collectively, would even begin to tackle the things that ail the American health care system, the things the Affordable Care Act was meant to address. Tort reform—which means making it difficult or impossible for patients to sue for malpractice—won’t bring down costs like conservatives think it will. We know this because a number of states have enacted the kind of tort reform Republicans advocate for the whole nation, and it had no impact on spending. Realistic assessments of the effect of tort reform on medical spending conclude that if there’s any impact at all, it would be tiny (I discussed this issue at length here).
Letting people buy insurance across state lines would be fine if it was accompanied by national standards for policies; you’ve surely forgotten it by now, but the more liberal House version of the ACA created a national insurance exchange instead of 50 state exchanges, in which you could have bought insurance from anywhere. But a well-regulated system isn’t what conservatives want; they propose to remove the ACA’s regulations and then initiate a race to the bottom, where the least-regulated state would offer cheap insurance to lure customers who wouldn’t realize the limits of what they had bought until they got sick (here’s an explanation of just how bad an idea this is).
As for health savings accounts, we already have them. They’re a great deal for people who are healthy, but not so much when you actually need care. And high-risk pools are a terrible solution as anything other than a temporary stopgap—they put all the sick people in the same pool, meaning covering them is extremely expensive. That’s no help to the tens of millions of Americans with pre-existing conditions.
Which brings us to Louisiana governor Bobby Jindal, who is almost certainly running for president in 2016. There aren’t a lot of Republicans who have a good understanding of health care policy, but Bobby Jindal is one of the ones who do. Back in 1996, at the tender age of 24, he was appointed the head of the Louisiana Department of Health; George W. Bush later made him an assistant secretary of health and human services. So he’s well familiar with this issue, and surely has a reasonably good understanding of which policies are likely to have a large impact and which are likely to make no difference at all.
But Jindal is hamstrung, like all Republicans, by the fact that they can’t advocate anything Barack Obama has ever supported. So when he released a health care plan yesterday, it was a predictable mixture of small-bore proposals (Wellness incentives! Eliminate fraud!), and the Big Four conservative ideas. For good measure, he threw in a version of Paul Ryan’s plan to turn Medicare from an insurance program into a voucher program, where the government would give seniors a certain amount of money and then they’d seek private insurance, with the invisible hand of the market bringing prices down, all previous evidence to the contrary notwithstanding.
In fairness to Jindal, he has tweaked a few things from the standard conservative playbook. He would require insurance companies, once they’ve sold you insurance, to continue your plan even if you get sick—but doesn’t say how he’d protect the tens of millions of Americans with pre-existing conditions who would have trouble getting covered in the first place, other than state high-risk pools. And there are a few smaller features of his proposal that make sense. For instance, he’d change the tax treatment of health insurance so everyone could get the same favorable treatment that people with employer-provided insurance get. That would increase the fairness of the system, even if Jindal’s assertions that it would magically cut the ranks of the uninsured by 9 million and dramatically slow health care spending are absurd on their face.
But if we repealed the ACA and instituted all of Jindal’s proposed reforms, we’d still have all the problems we had before the ACA was passed. And I suspect that if you gave him a truth serum, he’d admit that none of what he proposes would have much of a salutary effect. But that’s where conservatives are. Barack Obama stole the one market-based idea they had that might actually bring us to something close to universal coverage. They have no idea where to go from there, and that’s how it’s going to be for the foreseeable future. They’ll feel the need to keep saying, “We have a plan too!” And when everyone says, “OK, tell us what it is,” it will be the same old thing, and no one will take them seriously.
By: Paul Waldman, Contributing Editor, The American Prospect, April 3, 2014
“Brother, Can You Spare A Dime?”: Bobby Jindal Goes Panhandling
In the post this morning on the Romney donor network, I noted that in the underlying article from WaPo’s Wesley Lowery on that network’s favorite and slightly-less-favorite ‘16ers, there was nary a mention of onetime GOP “savior” Marco Rubio.
But there was another famous name missing from a list that ultimately included non-world-beaters like Mike Pence along with the notation that Mitt’s donors generally love GOP governors: the two-term governor of Louisiana.
I was reminded of that fact in reading a separate piece from National Review’s Eliana Johnson about Bobby Jindal’s preparations for an almost certain presidential run:
Though Jindal skewered Mitt Romney just a week after the 2012 election, he’s now turning to the Romney camp in an effort to beef up his fundraising operation. Sources say he is looking to tap Romney’s vast donor network and has asked Romney’s finance director, Spencer Zwick, for an assist with introductions to some of the Romney campaign’s top givers.
A number of the GOP’s likely Republican presidential candidates, including Rand Paul, are looking to Zwick to make these introductions. That’s in part a rite of passage – presidential contenders always want access to the fundraising list compiled by the previous candidate – and in part because the Romney team, which opted out of the public-financing system, was able to raise over $1 billion, an unprecedented amount for a GOP candidate. Romney and Zwick’s stable of top-dollar donors also has an especially loyal reputation relative to that of other nominees from both parties.
So even as the Romney donor network discusses their relationships with and preferences among a long list of potential 2016 candidates (including Paul, who was mentioned in surprisingly favorable terms in the Lowery piece), Bobby Jindal is looking for ways to invite himself into that world to make a pitch. This is not a good sign for him. Nor is it a particularly good sign, BTW, that he designated himself head of the crusade for “religious liberty” in a Big Speech in California right before said crusade fell into a giant ravine next door in Arizona.
Poor Bobby. Here’s a guy so brilliant and accomplished that you’d think all he’d have to do is stand in front of GOP “invisible primary” audiences with his resume in hand and just say: “Ecce Homo!” Instead he’s running around throwing himself in front of cameras, and seeking access to donor networks, like he’s just another pol. Makes you want to cry.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, February 28, 2014
“GOP’s ‘Damaged-Goods’ Primary”: Why Christie And Walker Are Staring Each Other Down
You’ve got to hand it to Wisconsin Gov. Scott Walker: He’s enduring his current political troubles defiantly, even going on the offensive this weekend by tweaking New Jersey’s embattled Gov. Chris Christie over Bridgegate. Christie’s troubles are “just beginning,” Walker slyly told reporters at a Republican Governors Association event this weekend, while his own, he claims, are behind him. “A Democrat district attorney looked at it and he’s done. It’s done.” Christie, by contrast, has “ the legislature which is not on his side politically, and they’ll probably drag it out for some time.”
In other words: Scott Walker to big GOP establishment donors: “I’m your guy!”
Typically, though, Walker took his claims a little too far: While one investigation into campaign law violations is closed – after six Walker aides and associates were convicted – another is ongoing. And Walker made a big mistake when he tried to feed his “it’s old news” line about his troubles to Fox News’ Chris Wallace. Wallace shot back: “Because of this dump of 25,000 documents, it’s new news to a lot of the people in the state and it’s been big news in local papers in Wisconsin.” (It was actually 27,000 documents, and they showed, among other things, that Walker’s aides set up a secret email system so campaign workers and Walker’s county employees could coordinate their work.)
Then Wallace set to grilling Walker about details, but it turns out Walker doesn’t do details:
WALLACE: In one email that was released this week, your then chief of staff Thomas Nardelli, let’s put this up on the screen, writes campaign and county workers that you wanted to hold daily conference calls, “to review events of the day or of a previous or future day so we can better coordinate sound timely responses,” and in another e-mail county administrative director Cynthia Archer suggests that colleagues should use a private e-mail account. “I use this private account quite a bit to communicate with SKW,” that’s you, “and Nardelli, the former chief of staff.” Question: if county workers were doing nothing wrong, why should they be using a private e-mail account?
WALKER: Well, but that’s exactly to my point. You had a Democratic district attorney spend almost three years looking at every single one of those communications, interviewing people, talking to people and closed the case.
WALLACE: Did you have your own private e-mail account?
WALKER: It’s one of those where I point out district attorney has reviewed every single one of these issues.
WALLACE: But sir, you’re not answering my question.
WALKER: No, because I’m not going to get into 27,000 different pieces of information.
Maybe Walker can be forgiven for thinking his deflection would be accepted in the friendly confines of Fox, but his dodges were so artless they offended Wallace. Beltway pundits may have declared Walker’s troubles a “snooze,” but Chris Wallace wasn’t snoozing on Sunday.
Still, Walker had a better weekend than his 2016 rival Chris Christie. Although the New Jersey governor has ignored the suggestion that he step down as chair of the Republican Governors Association until his bridge troubles are resolved, he kept an unusually low profile as the nation’s governors gathered in Washington this weekend. He only appeared at a couple of official events, seeming “uncharacteristically quite and reserved,” according to Time magazine, and he ditched the media the whole weekend, as he has since his two-hour pity party/press conference over a month ago.
Christie didn’t attend either Sunday night’s White House dinner or Monday’s meeting with the president. Louisiana Gov. Bobby Jindal was slated to lead the Republican delegation visiting Obama as well as the closing press conference. Jindal’s own 2016 hopes have been dashed by his unpopularity in Louisiana, but maybe that’s a sign of Bobbymentum.
So far I’d have to say that Walker is surviving his scandal with more aplomb than Christie, but it’s not over. That other John Doe investigation, into whether Walker’s recall campaign illegally coordinated with outside right-wing groups that flooded the state with money, continues. Reporters and Democratic operatives continue to delve into those 27,000 documents released last week. Walker is brazenly asserting that voters have no right to know more about his staff’s secret email system or other oddities in the new emails, including the racism of his top aides. He seems to think that “unindicted” is the same as “unscathed.” But most people have higher standards than that for their governor and their president.
When even Fox News doesn’t accept that Walker’s troubles are “old news,” that’s bad news for Scott Walker 2016.
By: Joan Walsh, Editor at Large, Salon, February 24, 2014
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