“Collaborating With The Enemy”: Can Republicans Be Convinced To Help Improve The Affordable Care Act?
When the Affordable Care Act was passed in early 2010, people made lots of predictions about how its implementation would proceed, in both practical and political terms. While the law’s opponents all agreed that it would be a disaster from start to finish, the law’s supporters were slightly less unanimous, if nevertheless optimistic. Most figured that though there would probably be problems here and there, by and large the law would work as it was intended, enabling millions of uninsured Americans to get coverage and providing all of us a level of health security we hadn’t known before.
And that’s what has happened. But there was one other assumption among the supporters that’s worth examining anew, now that most of us agree the law isn’t going to be repealed. Like every large and complex piece of social legislation, it was said, the ACA would have to be tweaked and adjusted over time. For instance, when it was passed in 1935, Social Security excluded agricultural and domestic workers, just coincidentally shutting most African-Americans out of the program. Those workers were added later on, and other changes were made as well, like adding cost of living adjustments to account for inflation. Medicare, too, has undergone changes both large (like adding a prescription drug benefit) and small. So what are the possibilities for adjusting the ACA in the near future? In the current atmosphere—one not just of intense partisanship, but one in which one party has made venomous opposition to this law the very core of its political identity—can we hope to actually fix the things about the law that might need fixing?
The administration has already made some changes to the law using its executive authority. Most notably, it has delayed the employer mandate; as it stands now, the mandate won’t fully take effect until 2016. As it happens, few people are particularly enthused with the employer mandate in its current form; conservatives have never liked it, and more than a few liberals have their doubts about it. As Mike Konczal recently explained, there’s an alternative:
The employer mandate has been another major roadblock for the ACA. The current “Obamacare” plan requires employers with more than 50 full-time workers to pay a part of the health care costs for employees who work more than 30 hours a week, or pay a fine. This is unpopular with employers, and it fuels larger worries that workers are getting their hours capped or that expanding businesses are hitting a major road bump the moment they reach 50 employees.
As the Roosevelt Institute’s Richard Kirsch writes, the way the final House bill tackled this issue was much smarter: Under the House plan, employers that didn’t provide health care to their employees would pay a percentage of payroll as a tax to cover health care. Consequently, there would be no incentive to juke the number of new hires or their hours. Also, current health insurance premiums don’t vary according to an employee’s income, which discourages employers from hiring lower-wage workers. Charging a percentage of payroll for coverage would help companies cover the costs even as the system moves towards the exchanges.
If you were a Republican who cared about this issue, this would be a perfect opportunity to change the law in a way you’d like. It wouldn’t be giving up something to get half a loaf, it’d be giving up nothing to get half a loaf. Democrats and Republicans could agree to change the mandate, whether it’s to more closely resemble the original House version of the bill, or something else. I’m sure that creative legislators could come up with any number of ways to produce the maximum number of people with employer-sponsored coverage—or even, now that the exchanges seem to be working quite well, devise a new way for employees to use them without employers just getting off the hook for providing coverage.
But we all understand the present reality, which is that no Republican is willing to work with Democrats to improve the ACA, even in ways that address particular complaints conservatives have about the law, because that’s considered collaboration with the enemy and would guarantee you the wrath of the Tea Party and a primary challenge from the right. Within the GOP, changing the law for the better is actually thought to be a terrible sin, while making futile gestures in opposition to the law while tacitly accepting its existence in its current form is thought to be the height of ideological integrity.
It’s possible that over time, as the repeal fantasy looks more and more ridiculous, Republicans will begin to grow more open to legislation making changes to the ACA to improve its operation. That’s what logic would dictate, but anything other than fist-shaking opposition to the ACA may remain politically toxic for a long time in the GOP.
But maybe there’s something Democrats can do to affect that conversation. It’s easy for them to just say:
“If Republicans really cared about improving people’s lives they’d join with us to make improvements, but instead they’d rather just have talking points.” It’s even true. But that doesn’t get you anywhere. So perhaps Democrats could try getting more specific. They could come up with whatever they think is the best way to deal with a weakness in the law, like the current form of the employer mandate. Turn that into a bill. Start moving it through the legislative process in the Senate. Force Republicans to answer specific questions about it, like: “Congressman, you’ve criticized the current employer mandate. Tell me why you think this new proposal isn’t an improvement.”
I’m not naïve enough to think that all Republican opposition to improving the ACA is going to melt before the power of those questions. But it only helps Republicans if they can stay vague in their discussions of the law. The more specific the discussion gets, the harder it is for them. And at least you could introduce the idea of Republicans joining with Democrats to improve the law, which is something barely anyone has brought up until now.
By: Paul Waldman, Contributing Editor, The American Prospect, September 8, 2014
“Oil And Gas”: The Combustible Mix Of Ted Cruz And The House GOP
Congress will have to act fairly soon to approve a new stopgap spending measure, called a “continuing resolution,” to prevent a government shutdown at the end of the month. Leaders in both parties and both chambers seem fairly optimistic – especially now that President Obama has postponed an announcement on immigration executive actions – that an ugly fight can be avoided.
But as we learned during the Republican shutdown last fall, congressional leaders don’t always get what they want.
Sen. Ted Cruz again met with a small group of House Republicans late Tuesday night, this time to discuss over pizza a conservative strategy on the continuing resolution.
While many of the Cruz meetings have seemed to lack a specific agenda or resolution, members trickled out of Tuesday’s nearly two-hour meeting repeating a similar refrain: We want a new expiration date on the CR.
The House GOP leadership seems to have adopted a let’s-not-screw-this-up-again strategy. They’ll advance a “clean” spending measure that will keep the government open through mid-December, then act again during the lame-duck session that will follow the midterm elections. No muss, no fuss.
Cruz isn’t sure he likes that plan. The far-right Texan, for example, yesterday suggested members use “any and all means necessary” to prevent President Obama from using his executive powers to further address immigration policy. In the context of the continuing resolution, that presumably means Cruz would like to see measures added to the spending bill to tie the president’s hands – and if those measures aren’t there, then the spending bill should be blocked, regardless of the consequences.
The senator and his allies also have concerns about the length of the CR and a possible extension of the Export-Import Bank.
Whether their concerns have the traction necessary to shut down the government again is another matter entirely.
The fact remains that most House Republicans appear eager to spend as little time as possible on Capitol Hill before the elections. The goal, in general, is to keep the government’s lights on and get back to the campaign trail. Luckily for the GOP, most voters no longer seem to remember last year’s ridiculous shutdown, and so long as Republicans don’t do it again, they probably won’t face any real consequences for their actions at all.
And so when Cruz interjects to argue that he and his far-right cohorts should do it again, it’s a tough sell for the Texas Republican.
Still, strange things happen when Cruz and House Republicans huddle for private meetings.
As we discussed earlier in the summer, Cruz met privately with a group of House Republicans in late July to urge them to ignore their own leadership and oppose their party’s border bill. Less than a day later, House GOP leaders were forced to pull their preferred legislation – too many of House Speaker John Boehner’s members were listening to Cruz, not him.
It’s part of a growing pattern. Last September, for example, Boehner presented a plan to avoid a government shutdown. Cruz met directly with House Republicans, urged them to ignore their own leader’s plan, and GOP House members followed his advice. A month later, Cruz held another meeting with House Republicans, this time in a private room at a Capitol Hill restaurant.
This year, in April, the Texas senator again gathered House Republicans, this time for a private meeting in his office. In June, less than an hour after House Republicans elected a new leadership team, Cruz invited House Republicans to join him for “an evening of discussion and fellowship.”
In July, as Congress prepared for some 11th-hour legislating before their month-long break, Cruz and House Republicans met to plot strategy, and a week later, they huddled once more.
The Texas Republican doesn’t seem to get along with other senators, but he spends an inordinate amount of time huddling with House Republicans who actually seem to listen to his advice.
This time, though, the odds are against Cruz’s success. Will the House GOP majority really move towards a government shutdown – two months before Election Day – in the hopes of blocking executive actions on immigration that haven’t even been introduced? The fact that Cruz and his allies would consider such a tactic is itself remarkable, but he’s nevertheless likely to lose this round.
By: Steve Benen, The Madow Blog, September 10, 2014
“Grappling With Their Shortsighted Rejection”: The Tough Politics Of Medicaid For Republicans
In the world of Republican politics, there is no surer bet than opposing ObamaCare. But conservative obstruction to the health care overhaul may finally be catching up with a handful of Republican governors running for re-election. Their rejection of ObamaCare’s expansion of Medicaid — the federal health assistance program for the poor and disabled — has been them losing both the argument and voters.
Princeton political scientist Sam Wang recently published an analysis of polling data from this year’s gubernatorial races. It found that Republican incumbents who resisted ObamaCare’s Medicaid expansion — including Wisconsin’s Scott Walker, Pennsylvania’s Tom Corbett, and Kansas’ Sam Brownback — are in much tighter races than those who accepted it. “Republican governors who bucked their party’s stance and accepted the policy are faring better with voters — in these races, an average of 8.5 percentage points better,” Wang discovered.
This shouldn’t be surprising. Setting aside the incendiary politics surrounding ObamaCare and its alleged freedom-killing agenda, the simple truth is that Republican governors have blocked health insurance for nearly six million citizens. And they’ve done so despite the fact that under ObamaCare, the federal government covers all the cost of expanding Medicaid for the next six years, and at least 90 percent of the cost in 2020 and beyond.
Why have Republican governors spurned this incredibly good deal? Their ostensible justification has been disbelief that the federal government would hold up its end of the bargain, leaving states to pick up the tab.
But researchers at the Urban Institute threw cold water on this argument in a study last month. They found that the federal government has almost never reduced funding to the states for Medicaid. In fact, it has not done so since 1981, when President Reagan and Congress imposed a temporary funding cut.
Indeed, Congress has been far more likely to increase funding for state Medicaid programs. It has done so twice in recent memory — in 1997 and in 2005 — boosting state funding even while making other cuts to the program.
The sanctity of the federal commitment to Medicaid has only grown in recent years. As evidence of federal faint-heartedness, conservatives point to an administration proposal floated during 2011 budget negotiations that would have reduced federal Medicaid funding to the states.
But this bad idea was dropped after the states got newfound bargaining power from the Supreme Court’s 2012 decision making the Medicaid expansion entirely voluntary. With the expansion now optional, the administration can ill afford to weaken the financial carrot for red states to buy in. This has also made the administration agreeable to some conservative twists on traditional Medicaid, like using public dollars to enroll people in private health plans in Arkansas and Iowa.
The Urban Institute also quantified how much intransigent red states are losing by resisting ObamaCare. They’re turning down $400 billion in free federal money over 10 years. They will have missed out on over 172,000 new jobs in 2015 alone. And they’ve cost their hospitals $168 million, enough to completely offset ObamaCare’s reimbursement cuts to hospitals for Medicare and Medicaid.
And, of course, these states have also frozen themselves at pre-ObamaCare rates of high uninsurance. “While the number of uninsured in other states fell by 38 percent since September 2013,” the researchers explain, “non-expanding states experienced a decline of just 9 percent.”
As the midterm elections approach, Republican candidates are discovering that the politics around health care reform are becoming unexpectedly complicated. Trailing badly in the polls, Gov. Corbett announced last month that Pennsylvania will expand its Medicaid program. In states that have already expanded their programs, pro-repeal conservative candidates are stumbling to explain how they would handle new Medicaid enrollees.
But this is what happens when you engage with the actual policy implications of health care reform. Conservatives can whip up fear and hostility over an abstract big-government monolith called ObamaCare. But the actual programs contained therein (like expanding public health insurance for the poor) tend to be pretty appealing to voters.
As their arguments are rendered hollow, obstructionist Republicans are paying the electoral price for thwarting these types of programs. When they picked a fight against expanding Medicaid, conservatives chose the wrong bulwark for massive resistance against national health care reform.
By: Joel Dodge, The Week, September 9, 2014
“More Promising Tools Than Brute Force”: Obama Keeps His Options Open On Dealing With Islamic State
President Obama’s strategy against the Islamic State may be hard to pin down — maddeningly so, some complain — but it is likely to work far better than anything his bellicose critics advocate.
Perhaps the president will eliminate any confusion when he addresses the nation Wednesday, but I doubt it. Based on what he told NBC’s Chuck Todd on Sunday’s “Meet the Press,” there may be no way to reduce Obama’s fluid and perhaps deliberately ambiguous thinking to a black-or-white, all-or-nothing dichotomy.
“This is not going to be an announcement about U.S. ground troops. This is not the equivalent of the Iraq war,” Obama said. Later in the interview, he added that “we’re not looking at sending in 100,000 American troops” and that “our goal should not be to think that we can occupy every country where there’s a terrorist organization.”
Clear? Kind of.
We understand that the president will not announce the deployment of U.S. troops in large numbers and that he does not intend for the United States to re-invade and re-occupy Iraq. But we know that U.S. military advisers and Special Operations teams have already been active in both Iraq and Syria. And since Obama described the fight against the Islamic State as “similar to the kinds of counterterrorism campaigns that we’ve been engaging in consistently over the last five, six, seven years,” we can assume there will be some U.S. military presence on the ground, however covert and limited.
A strong believer in multilateralism, the president asserted that “we have, I believe, a broad-based coalition internationally and regionally to be able to deal with the problem.”
True? Again, kind of.
The 10-nation coalition assembled last week to fight the Islamic State — the United States plus Australia and NATO members Britain, France, Germany, Canada, Turkey, Italy, Poland and Denmark — is much less than meets the eye, operationally speaking. Britain, France, Australia and Canada have the will and capacity to project military power overseas. The others, not so much.
As far as regional cooperation is concerned, perhaps Turkey can be counted on to help tear down the Islamic State. But assistance from two key powers in the Middle East that also find themselves threatened by the jihadist group — Iran and Saudi Arabia — promises to be tenuous and situational at best.
To further complicate a situation that already seems hopelessly complicated, every blow against the Islamic State is a blow in favor of Syria’s Bashar al-Assad and his murderous regime. But Obama implied on “Meet the Press” that Assad is a secondary concern and said that, “when it comes to our policy and the coalition that we’re putting together, our focus specifically is on ISIL,” another name for the Islamic State.
In internal administration discussions, Obama has reportedly been skeptic-in-chief about the capabilities of the ostensibly “moderate” Syrian rebels. On Sunday, the president was less than fulsome in his praise of groups such as the Free Syrian Army, which he noted “have been on the defensive.” He said, “We’re going to have to develop a moderate Sunni opposition that can control territory,” indicating that no such opposition now exists.
It all sounds kind of circular and vague, implying there is much that may be planned, or already taking place, that we know nothing about. Obama seems to give himself the option of confronting the Islamic State directly when he chooses, ignoring it when he feels it can be ignored, using airstrikes when he believes they are needed, cooperating with adversarial or unreliable governments only when he believes it is in the U.S. interest to do so.
I don’t know if it will work. But I’m confident that the hawkish alternative — more bombs, more boots, more bluster — would be a tragic failure.
Massive airstrikes in both Iraq and Syria probably would not be enough to destroy the Islamic State without ground support. In Iraq, such support has been inconsistent. In Syria, it could come only from Assad’s brutal army. If U.S. troops are not an option, should we encourage Saudi Arabia and even Iran to deploy their forces? To me, that sounds like fighting a fire with gasoline.
To the hawks, Obama’s cautious, patient, this-could-take-years approach to dealing with the Islamic State will be emotionally unsatisfying. But, given the complexity of the situation, subtlety and indirection are more promising tools than brute force. Locking the United States into the kind of rigid strategy that critics demand would likely ensure only that this crisis sows the seeds of the next one.
By: Eugene Robinson, Opinion Writer, The Washington Post, September 8, 2014
“Pay Close Attention!”: Don’t Be Fooled By New GOP Enthusiasm For Over-The-Counter Birth Control
The hot new trend among Republican candidates is a surprising one, to say the least. As of now there are four GOP Senate contenders who have endorsed making birth control pills available over the counter.
All four — Cory Gardner in Colorado, Thom Tillis in North Carolina, Ed Gillespie in Virginia, and Mike McFadden in Minnesota — oppose abortion rights, and all four oppose the Affordable Care Act’s mandate that insurance policies pay for preventative care, including birth control, with no deductibles or co-pays. Yet these conservative Republicans are touting their deep commitment to easily available birth control. It’s likely that more Republicans will now be asked their position on OTC birth control, and some will embrace it to counter Dem criticism that they’re soldiers in a “war on women.”
The one who has advocated OTC birth control pills most aggressively is Gardner, in large part because he has been the target of relentless criticism from Democrats over his prior support of “personhood” measures granting full legal status to fertilized eggs, which would outlaw not only abortion but some forms of birth control as well. Here’s an ad in which Gardner practically pretends to be Gloria Steinem while a group of women nod and smile their approval.
Democrats telegraphed way back in April that they would make these attacks central in multiple Senate races. The fact that Republicans have come up with this new push-back suggests the Dem attacks may have been working.
The new-found embrace of OTC birth control pills might seem odd, even bizarre. But it makes more sense if you think about it as a fundamentally elitist position. The truth is that conservatives have long been much more concerned with restricting the reproductive choices available to poor and middle class women, while leaving wealthy women free to do pretty much as they please. And allowing birth control pills to be sold over the counter is perfectly in line with that history.
Let’s be clear that making birth control pills available over the counter would be a good thing — but only if insurance continued to pay for it. The cost of the pill can be as much as $600 a year, which is out of reach for many women. And we know that insurance companies seldom reimburse customers for OTC medications. The price of the medication might come down over time if it were sold over the counter, but in the meantime millions of women are dependent on their insurance plans to be able to afford it. By opposing the ACA, all these GOP candidates are putting themselves on record in opposition to requiring insurance companies to pay for any birth control in policies women themselves have bought. And that’s not to mention other forms of contraception, like IUDs, that require a doctor’s care and come with a significant up-front cost.
If you’re well-off, you can afford whatever kind of contraception you like whether your insurance company reimburses for it or not. And abortion restrictions don’t impose much of a burden on you either. The federal government bans Medicaid from paying for abortions, but that only affects poor women. A law mandating a 48-hour waiting period before getting an abortion may be an inconvenience for a wealthy woman, but it can make it all but impossible for a woman without means. In some states, it means taking (unpaid) time off work to travel to one of the state’s few abortion clinics, driving hundreds of miles, and paying for a hotel room.
While they’re going to use a lot of buzzwords like “access” and “choice,” the net effect of the policies these candidates are advocating would be to make birth control less available to women. And I think that’s why we haven’t seen any public blowback from the Christian right on this issue. The articles written about the new Republican enthusiasm for OTC birth control sometimes include a disapproving quote from a representative of the Catholic Church. But none of the bevy of organizations with the word “Family” in their name, which are so vehemently opposed to any kind of reproductive freedom for women, are loudly condemning these candidates. Nor are any of their Republican colleagues. So what does that tell you?
By: Paul Waldman, Contributing Editor, The American Prospect, September 8, 2014
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