“Memo To GOP”: The War Over Big Government Health Care Is Over, And You Lost
The federal government has released new data on Medicaid enrollment showing that with the implementation of the Affordable Care Act, six million Americans were added to the program’s rolls. That’s six million low-income people who now have health coverage, who can see a doctor when they need to and who don’t have to worry about whether an accident or an illness will send them spiraling into utter financial ruin.
The numbers reveal something else, too, something that should horrify conservatives: we’re well on our way to health-care socialism.
Okay, that’s an exaggeration. But only a slight one. And at a time when the press is realizing that Republicans are losing their taste for anti-Obamacare bloviating (more on that in a moment), it shows that Bill Kristol’s nightmare has nearly come true.
Back in 1993, Kristol wrote Republicans an enormously influential memo advising that the best approach to Bill Clinton’s health reform plan was not to do everything they could to kill it outright. If any plan managed to pass, he warned, “it will re-legitimize middle-class dependence for ‘security’ on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.”
Now let’s look at where we are today. Prior to ACA implementation, there were just under 59 million people enrolled in Medicaid and CHIP, the program that covers poor children. States that accepted the ACA’s expansion of Medicaid signed up a total of 5.2 million new people. The states that rejected the expansion signed up an additional 800,000; these are “woodwork” enrollees, people who were already eligible under their state’s (often absurdly restrictive) rules, but came out of the woodwork to sign up because of all the attention to health care. Add them in, and there are now 64 million Americans on Medicaid and CHIP.
On top of that, there are now over 52 million seniors on Medicare. There are another 9 million veterans enrolled in the Veterans Health Service.
That’s a total of 125 million Americans getting their insurance from the federal government (or, in the case of Medicaid, a federal-state program). The current U.S. population is 318 million. That means that 39 percent of us, or just under two out of every five Americans, are recipients of government health insurance.
As a liberal, of course, I believe that’s a good thing, though just how good varies from program to program (I’ve spent enough time fighting with private insurance companies to wish I could be insured by the government). Conservatives, on the other hand, view this as a disaster. What they’ve only partly come to terms with is the fact that it’s going to be almost impossible for them to do anything about it.
It’s true that Republicans appear to have realized that while the ACA remains unpopular, the idea of repealing it is even less popular. Which is why, as the November election approaches, they’ve almost stopped trying to elevate the issue. As Sam Baker points out, Republicans passed on the opportunity to use the confirmation of Sylvia Burwell to be HHS secretary as a forum to relitigate the law, and the bills circulating around the Hill on health care are now more likely to be small-bore fixes. Notes Baker: “Anyone who’s been around Capitol Hill and health care for the past four years can see it — the anti-Obamacare fire just isn’t burning as hot as it used to.”
Beyond that, as this blog has documented, multiple Republican Senate candidates are now mouthing support for Obamacare’s general goals and have essentially been reduced to gibberish when trying to explain their “repeal and replace” stance.
But the story is bigger than all of this. Republicans may have to accept that while we may not have the single-payer system liberals want, government still dominates American health care, and that isn’t going to change.
It isn’t just that Republicans could stage another fifty ACA repeal votes in the House and accomplish just as little as the last 50 repeal votes did. Rather, it’s that even if Republicans took back the White House and both houses of Congress, moving people off their government insurance would be next to impossible.
One of the most important lessons of the last 20 years of health reform is this: people fear change. That’s what the Clinton administration found out when their attempt at reform crashed and burned, in large part because the Clinton plan would have meant a change in coverage for most Americans. The Obama administration took that lesson to heart in creating its plan, which was designed to give coverage to people who lacked it but offer only new protections to those who already had insurance. That was also the reason for the false but endlessly repeated “if you like your insurance, you can keep it” assurances — they knew that if most Americans, particularly those with somewhat-secure employer plans, thought they’d have to endure some kind of change, then they’d once again be gripped by fear.
Any Republican plan to unwind the ACA is going to run headlong into people’s fear of change and be stopped in its tracks. Are you going to push 64 million Medicaid and CHIP recipients off their current insurance and onto private plans? Are you going to move away from employer-provided coverage? Are you going to privatize Medicare?
Perhaps, given the right circumstances, Republicans could overcome that fear. But I wouldn’t bet on them finding a way to do it.
By: Paul Waldman, The Plum Line; The Washington Post, June 5, 2014
“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
“A Test Of Ideology”: How Far Will Republicans Go To Deny Healthcare
Texas has a higher proportion of its population living without health insurance than any other state. But like many other states with lots of poor people, it has the misfortune of being governed by Republicans. That explains why yesterday, Governor Rick Perry announced that the state will refuse to accept the federal money offered for expanding Medicaid eligibility to everyone who makes up to 133 percent of the federal poverty level. Perry says that this expansion of Medicaid, which is almost entirely paid for by the federal government, will nevertheless bankrupt the state and put the oppressive boot on the necks of Texans. So he’s happy to keep 25 percent of his population uninsured.
In case you’re wondering, Texas currently sets eligibility for Medicaid at 26 percent of the federal poverty level, which means that if you earn more than $6,000 a year for a family of four, you’re not eligible. That’s not a typo. Six thousand dollars a year for a family of four is what the state of Texas considers too rich to get on Medicaid. Look down the list of eligibility levels, and you find that only Alabama, Arkansas, Indiana, and Louisiana set their eligibility lower. It is just so weird how those poor Southern states are the stingiest with health-care benefits, isn’t it?
It’s possible that eventually, Texas and the other states will come around to the expansion of Medicaid. Sarah Kliff explains how this happened with Medicaid’s enactment in the 1960s and the Children’s Health Insurance Program (CHIP) in the 1990s; conservatives initially resisted, but the money and the opportunity to insure their population eventually became irresistible. One of the key factors then and now is the presence of organized, influential interest groups—particularly the hospitals that have to deliver uncompensated care to the uninsured, costing them billions—that can exert their influence on the government’s decisions.
But the Republicans who resisted and then gave in were different from the Republicans of today, and this will be a test of just how far they’ll go to make a statement about their hatred of the federal government in general and their hatred of Barack Obama in particular. Today’s Republicans are the ones who would turn down a deal offering ten dollars of spending cuts for one dollar of tax increases. But that was a hypothetical question, and this question is very real. There are actual human beings whose lives are at stake. I’d love to hear someone ask Rick Perry this question: Which do you think is worse, someone living without health insurance, or someone getting health insurance through a government program? I’m not sure what he’d say, but his actions say quite clearly that he’d prefer that the person have no health insurance. Of course, we’re not talking about him personally, or his kids, or anybody he knows having to go without insurance. We’re talking about poor people. So screw them.
By: Paul Waldman, Contributing Editor, The American Prospect, July 10, 2012
Governor Walker’s Misleading Claims On Medicaid
Wisconsin Governor Scott Walker painted a misleading picture of Medicaid in his New York Times op-ed on Friday. Medicaid is neither obsolete nor inflexible and changing it to a block grant, as the House Republican budget that Walker supports would do, would significantly harm the millions of seniors, people with disabilities and children who rely on it every day.
Governor Walker says Medicaid is obsolete because it is biased toward covering people in nursing homes rather than their own homes. In fact, Medicaid is moving in precisely the opposite direction. In 1990, just 13 percent of Medicaid spending on long-term care went for care in the community rather than in an institution. By 2009, the figure was 43 percent. That’s a great example of how Medicaid is changing with the times.
Moreover, health reform, (i.e., the Affordable Care Act) provides several new options to speed this trend along and continues funding for the “Money Follows the Person” program, in particular, which moves people from nursing homes back to the community. With health reform’s new options and funding, progress will likely continue. That won’t happen under the House Republican budget plan, which would sharply reduce funding for Medicaid and convert the program to a block grant.
My colleagues, Edwin Park and Matt Broaddus, have shown how risky a block grant is for states. If the House Republican block grant proposal had been in place starting in 2000, their analysis shows, in 2009 Wisconsin would have received 40 percent less in federal funds – nearly $1.6 billion in that year alone. With such a sharp drop in federal funds, the state would have been ill-equipped to deal with a recession or even to meet the ongoing needs of an aging population.
Governor Walker claims the success of the Children’s Health Insurance Program (CHIP) and state Medicaid demonstration projects show that states could do well under a Medicaid block grant, but he’s wrong on both counts:
CHIP, which does operate under a structure similar to a block grant, has a narrower purpose than Medicaid, as noted in a recent brief from the Kaiser Commission on Medicaid and the Uninsured. It covers far fewer children than Medicaid and covers children in families with higher incomes. Moreover, in the past, some state CHIP programs did run short of funds and had to freeze enrollment and set up waiting lists.
As to Medicaid demonstration projects, they allow states to cover people who are ordinarily not eligible for Medicaid (such as low-income, childless adults) or services that aren’t usually covered (such as short-term, or “respite,” care for families with children with complex medical conditions) as long as they don’t spend more federal funds than they otherwise would have received. This is nothing like the Ryan block grant, which would slash the federal funds that states would otherwise get to help them run their programs, not hold federal funds steady.
By: Judy Solomon, Center on Budget and Policy Priorities, April 25, 2011
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 