“Running On Empty”: Republicans Can’t Repeal Or Replace Obamacare, And They’re Too Scared To Fix It
More than three million people have already signed up for health insurance as of last Friday through the exchanges set up by the Affordable Care Act (ACA). That number is growing rapidly, with 15,000 new enrollments a day in California alone.
And the Republican plan to deal with Obamacare generally remains what it has been since 2010 — repeal.
This means the millions of men, women and children covered under plans could either see their plans invalidated by insurance companies no longer required to cover pre-existing conditions or have their Medicaid coverage completely erased. Republicans who spent the last three months screaming about how terrible insurance cancelations are would have to explain what happens next for millions of uninsured Americans.
Repeal is a fantasy, a fundraising opportunity that all Republicans — except the few who take Senator Ted Cruz (R-TX) seriously — know would never happen. And if it did, they would end up owning every aspect of a crumbling health care system the same way Democrats are currently responsible for every splinter in every tongue depressor.
The Washington Post‘s Greg Sargent looks at recent polling and finds that though Americans are largely dissatisfied with the rollout of the Affordable Care Act, they generally support the federal government’s taking a role in getting people affordable health insurance. More importantly, most are still willing to give the law a chance.
“Only 37 percent support repealing Obamacare entirely,” he writes, “while 53 percent say there are good things in the law and that changes are needed to make it work better.”
Republicans are now in what Sargent calls “The GOP Repeal Trap,” which essentially requires them to vow repeal and pray that somehow the law collapses on its own.
While it may seem absurd to those who care about governing, it makes perfect sense strategically because ”replace” is an even bigger fantasy than repeal.
Until it became socialism incarnate, the ACA was the conservative reform to the health care system. So to replace it completely, conservatives would need to go further to the right and destroy the entire employer-provided health insurance paradigm that provides about 85 percent of working adults with their coverage.
That’s what the proposal John McCain ran for president on in 2008 would have done, canceling the insurance of about 20 million Americans, four times the number who had to find new coverage under Obamacare.
Are there conservative fixes that could be made to the ACA that Democrats would be willing to trade for reforms of their own?
Health economist Austin Frakt has listed more than a dozen possible conservative-leaning fixes for the law, starting with their all-time favorite, tort reform, which actually would do very little to lower health care costs but would be a huge win for the right in their never-ending war against trial lawyers.
So why doesn’t some brave Republican — say Governor Chris Christie (R-NJ) — step forward with a set of conservative reforms to the ACA?
The answer is easy: Republican primaries.
Michigan Senate candidate Terri Lynn Land suggested that the law would be fixed and was forced to flip-flop on that position in less than 24 hours, likely in fear that she might end up with a Tea Party challenger. Georgia Senate candidate Rep. Jack Kingston did nearly the exact same thing.
Christie is already saddled with being the only 2016 GOP frontrunner who accepted Medicaid expansion. If he became the face of fixing Obamacare, he would be appealing to the majority of voters but antagonizing if not actually declaring war on those in the base who refuse to accept that Obamacare is here to stay, and also refuse to consider any candidate who tells them what they do not want to hear. (Even if the governor could win the primary backed by the business and more independent wings of his party, he could end up inspiring a Tea Partier to run as a third-party candidate, virtually guaranteeing a Democratic victory in 2016.)
For the foreseeable future, Republican candidates — even those in states and districts President Obama won — are stuck running in the general election with the “problematic” stand of wanting to take health insurance from millions, some of whom may actually show up to vote.
And if they win, they can return to blaming President Obama for never making their repeal fantasy come true. It’s the only safe move.
By: Jason Sattler, The National Memo, December 19, 2013
“A Closer Look At Those Falling Into The Wingnut Hole”: Nearly 80% Of People In The Health Care Coverage Gap Reside In The South
Yesterday the Kaiser Family Foundation released some badly needed data on the characteristics of Americans who fall into what I’ve dubbed the “wingnut hole,” and that others just call the Coverage Gap. These are the people too poor to qualify for Obamacare subsidies for purchasing insurance in the exchanges, but too “rich” to qualify for the Medicaid benefits the drafters of the ACA assumed they would get but that their state governments blocked once the Supreme Court let them make the choice. Here’s the Kaiser Family Foundation’s take on the problem:
Medicaid eligibility for adults in states not expanding their programs is quite limited—the median income limit for parents in 2014 will be 47% of poverty, or an annual income of about $9,200 a year for a family of three, and in nearly all states not expanding, childless adults will remain ineligible. Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults will fall into a “coverage gap” of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits…. Nationwide, nearly five million poor uninsured adults are in this situation.
Who are they? Well, they’re mostly southerners:
The nearly five million poor uninsured adults who will fall into the “coverage gap” are spread across the states not expanding their Medicaid programs but are concentrated in states with the largest uninsured populations…. More than a fifth of people in the coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility. Sixteen percent live in Florida, eight percent in Georgia, seven percent live in North Carolina, and six percent live in Pennsylvania. There are no uninsured adults in the coverage gap in Wisconsin because the state will provide Medicaid eligibility to adults up to the poverty level in 2014.
The geographic distribution of the population in the coverage gap reflects both population distribution and regional variation in state take-up of the ACA Medicaid expansion. As a whole, more people—and in particular more poor uninsured adults— reside in the South than in other regions. Further, the South has higher uninsured rates and more limited Medicaid eligibility than other regions. Southern states also have disproportionately opted not to expand their programs, and 11 of the 25 states not expanding Medicaid are in the South. These factors combined mean nearly 80% of people in the coverage gap reside in the South
They’re also hard to define by race or ethnicity:
The characteristics of the population that falls into the coverage gap largely mirror those of poor uninsured adults. For example, because racial/ethnic minorities are more likely than White non-Hispanics to lack insurance coverage and are more likely to live in families with low incomes, they are disproportionately represented among poor uninsured adults and among people in the coverage gap. Nationally, about half (47%) of uninsured adults in the coverage gap are White non-Hispanics, 21% are Hispanic, and 27% are Black (Figure 3).
And they’re often the people left behind in wave after wave of incremental reforms based on expanding Medicaid and S-CHIP benefits to kids and their parents.
The characteristics of people in the coverage gap also reflect Medicaid program rules in states not expanding their programs. Because non-disabled adults without dependent children are ineligible for Medicaid coverage in most states not expanding Medicaid, regardless of their income, adults without dependent children account for a disproportionate share of people in the coverage gap (76%)…. Still, nearly a quarter (24%) of people in the coverage gap are poor parents whose income places them above Medicaid eligibility levels. The parent status of people in the coverage gap varies by state….due to variation in current state eligibility.
What doesn’t vary state by state is how outrageous it is to exclude the people who by the accident of a court decision fall into the “wingnut gap” of benefits available to people just above them on the income scale. They are for the most part the “working poor,” people with part-time or small-business jobs that don’t come with private health insurance.
They are ineligible for publicly-financed coverage in their state, most do not have access to employer-based coverage through a job, and all have limited income available to purchase coverage on their own.
You can argue that these people are those most in need of the Affordable Care Act, yet most likely to be excluded from its benefits.
These are also people with an unusually large personal stake in the outcome of the 2014 elections–the kind of people conservatives are thinking of when they conclude Obamacare has created a “tipping point” wherein actual or potential beneficiaries of government programs are essentially being bribed into voting Democratic. But if there’s been any growing groundswell of political mobilization of people in the “wingnut hole,” it has been very quiet. So they will likely become objects of anti-redistribution propaganda from the Right without becoming subjects of any major Democratic comeback.
The latest hope for people in the “wingnut hole” has been enthusiasm for securing Medicaid expansion by very broad waivers allowing states to work their will on the Medicaid program as a whole. To be very blunt about it, such “deals” have tended towards broadening the base of people eligible for Medicaid while degrading its benefits, with the federal government paying almost all the cost of implementation and sharing the political risk that it might fail. The situation is a reminder that about a hundred fifty years after the end of the Civil War, southern states are still fighting the “Reconstruction” potential of federal funds to interfere with the region’s grim perpetuation of inequality.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 18, 2013
“Boehner’s New Enemies”: Tea Folk Are Largely Unaffected By Attacks From The Speaker And Other “Establishment” Republicans
I’ve spent quite a bit of time mocking the extraordinary Beltway joy over House Speaker John Boehner’s rebuke to “outside” conservative groups, as representing the millionth decisive setback for the Right in the so-called “civil war’ in the GOP.
But how’s about the grassroots membership of the “outside” groups? Are they in disarray?
Doesn’t much look that way, based on Stephanie McCrumman’s profile of Americans for Prosperity members meeting for dinner in Greenville, SC. If the Kochs continue to provide the money, activists seem to have the time. Here’s my favorite passage:
Dean Allen, who is writing a book called “Rattlesnake Revolution: The Tea Party Strikes!,” said it was people like him who are the future of the party.
“You’ve got to have people in this room excited,” he said, waving a biscuit. “It’s who will open their checkbook, who will put the signs on the road… When we are demoralized we get crap like Obama in the White House.”
Reading this piece, you get the sense that Tea Folk are largely unaffected by attacks from Boehner and other “Establishment” Republicans because they view themselves as perpetually being abused by GOP leaders even as they continue to provide most of the people power and much of the money essential for Republican electoral efforts. They’ll keep on keeping on, despite the general disbelief among political journalists that it’s possible to constantly launch primary purges against elected officials you plan to support loyally in general elections.
All Boehner’s outburst probably means is that grassroots wngnuts will feel invested in the next conservative challenge to the Orange Man’s leadership. And if he does indeed retire at the end of next year, his remarks about conservatives last week won’t represent much of anything at all other than a temporary speed bump in the rightward movement of the Republican Party.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 18, 2013
“No Way Out”: GOP Eyes “Obamacare Trap” Warily
Rep. Marlin Stutzman (R) held an event in his Indiana district this week, at which health care was a major topic of conversation. According to a local press account, not everyone in this Republican area necessarily opposes “Obamacare.”
But Stutzman seemed to realize at the event that simply condemning what he doesn’t like won’t be enough. “What are you replacing it with? That’s what everybody is asking right now,” the congressman said, adding, “There’s several Republican plans that are competing with each other right now just internally. After the first of the year, we are going to try to sort through that.”
That last part was actually rather newsworthy – we didn’t know that House Republicans are planning to finally present their alternative to the Affordable Care Act sometime in 2014. In fact, Byron York reported that intra-party talks are still underway.
[I]n private discussions, House Republicans stress their differences over the details of an Obamacare alternative. For example, there’s no agreement on precisely how to fix the tax inequity for people who don’t receive health coverage at work. There are similar disagreements over all sorts of other points of policy. “Getting unanimity is a tall order for a divided, leaderless party,” says the GOP aide.
As Democrats can attest, getting unanimity is a tall order for a united party with strong leaders, too.
Regardless, while York describes an “Obamacare trap” in which Republican lawmakers struggle with whether to fix or destroy the existing system, the circumstances lead me to believe a very different kind of trap is set.
Let’s say, after five years of effort, House Republicans finally emerge from behind closed doors with a health care reform package they’re proud of and willing to present to the public. What then? The GOP plan will be subjected to some policy scrutiny, which is where the party is likely to run into some trouble.
It’s easy to imagine a side-by-side comparison, in which the Affordable Care Act is tested against the Republican alternative. Which covers more uninsured Americans? Which reduces the deficit more? Which offers the stronger consumer protections? Which is more effective in controlling long-term costs?
I’d bet good money that on all of these questions, the GOP plan will lose – not because Republican policies are necessarily worse than Democratic policies, but because Republicans have already said their approach to health care would eschew regulations and public investments. And while it’s possible to create a health care plan without spending or safeguards, it’s not possible to create a good health care plan without them.
Ultimately, that’s the “trap” GOP officials need to be mindful of. On the one hand, they can continue to offer nothing in the way of an alternative, effectively telling the public they’re not serious about the issue and they prefer to take cheap shots rather than govern. On the other, they can build a consensus around an Obamacare alternative that almost certainly won’t be nearly as good as the ACA. (Remember, the basic framework of the Affordable Care Act was the Republican policy up until a few years ago.)
The trap is set. The question isn’t whether Republicans will fall in, but rather, whether they can get out.
By: Steve Benen, The Maddow Blog, December 18, 2013
“Jesus Wasn’t White, But Santa Definitely Is”: It Also Seems That Santa Is From Mississippi
This past week, Fox News anchor Megyn Kelly and her guests were discussing an article by Aisha Harris in which Harris described how Santa’s consistent depiction as a white man made her feel uncomfortable and excluded as a young black girl in America.
As her panelists began to broach the topic, Kelly made what she clearly thought was an important interjection:
And by the way, for all you kids watching at home, Santa just is white. But this person is maybe just arguing that we should also have a black Santa. But, you know, Santa is what he is, and just so you know, we’re just debating this because someone wrote about it, kids.
And she went on:
Just because it makes you feel uncomfortable doesn’t mean it has to change. You know, I mean, Jesus was a white man too. He was a historical figure; that’s a verifiable fact – as is Santa, I want you kids watching to know that.
So, according to Kelly, Santa is white, and so is Jesus. And I must say, in my opinion, she is half right, which is one more half right than she usually is.
Jesus isn’t white, but Santa definitely is.
Santa is basically a benevolent imaginary character with super powers. And if you’ve seen any superhero movies, those types of characters tend to usually be white. So his whiteness is really no surprise. But if white people want Santa, they can have him. All he ever got me for Christmas was socks and cologne. And you can only have so many bottles of Eternity.
Santa has the complexion of an egg. He is obese, and he rarely speaks in complete sentences. Not only is Santa white, it also seems that he is from Mississippi. The only times they name streets after nonwhites is when they lead civil rights movements, and even then it’s controversial. Santa has a street named after him for no good reason (remember “Santa Claus Lane”?). He is definitely white.
Santa is bit of a loner. Every year, he sits around his house making intricate gadgets with his imaginary assistants for 364 days. Then, he only visits his actual friends for one day. He is white for sure.
Santa makes his darker, subjugated, captive workers put in all the effort while he takes all the credit. As far as I know, those reindeer are not getting paid. Master Santa enjoys the fruits of their hard labor. And what do they get? A song. And it’s only about one of them. What an injustice!
So, Santa is unquestionably white. But what about Jesus? Kelly said that Jesus’ whiteness was a “verifiable fact.” Now, I have a bit of a personal connection here. I am a Palestinian, as was Jesus. He was born in Bethlehem, just south of Jerusalem. Jesus lived most of his life in Nazareth, which also happens to be the city of my origin. But I have never lived in Nazareth because of… well, that’s for another time.
Now it’s very possible that Megyn Kelly may have been a little confused here. If you simply type “Bethlehem” into Wikipedia, chaos ensues. There are Bethlehems all over the place. There’s one in Pennsylvania, one in New York, one in Connecticut, and one in Maryland. And it doesn’t stop there. They even have Bethlehems in England, South Africa, Switzerland, New Zealand, and the Netherlands. This can be quite overwhelming.
If you take a quick look at a map of Bethlehem, Pennsylvania, there’s a town just 9 miles up the road named Nazareth. If you didn’t know any better, you could have thought Jesus grew up in that neighborhood. But that part of eastern Pennsylvania is also just a few miles from New Jersey, and I really can’t imagine Jesus having anything remotely to do with New Jersey.
Now, even if Megyn knew that the Nazareth and Bethlehem we associate with Jesus were halfway across the world, she still could have thought he was white. After all, the United States government defines white people as “original peoples of Europe, North Africa, or the Middle East.” That would make Jesus white, except for the fact that he would not be the kind of white person that Megyn Kelly meant. In other words, I don’t think Megyn Kelly would consider my dad white, or Paula Abdul white, or Ahmed Ahmed white. But Jesus would look much more like any of those people than he would like her.
So Jesus wasn’t white. He didn’t look like Brad Pitt. He looked like Tony Shalhoub. He looked less like the pilgrims, and more like the people the pilgrims stole land from. He was not a White Anglo-Saxon Protestant. He was an Olive Semitic Nazarene Jew.
If Jesus were here today, he would be exactly the kind of guy that most Fox News anchors would be in favor of racially profiling. He would be on the No Fly List (my editor is making me point out that Jon Stewart made a similar joke), not that Jesus needs a plane to fly, but whatever.
And by the way Megyn, if Jesus were here today, he wouldn’t be a Tea Partier or a Republican. In fact, he wouldn’t even be a political conservative. He would believe in his own mantra of “that which you do to the least of my brethren, you do to me.” He would be upset that we spend more money on building monuments to him than we do on feeding our poor. He would be dismayed that we are supporting repressive governments to serve our interests. And he would be disappointed that we spend four times as much on our military than we do on educating our children.
After much criticism of her comments, Megyn Kelly responded with the “I was just joking” defense. “Humor is part of what we try to bring to the show. Sometimes that’s lost on the humorless,” she said of her declaration of Santa’s whiteness. But Megyn is making the same mistake many young comedians make early in their careers. See, a “joke” is a “joke” because it’s “funny.” And you don’t decide if it’s funny, your audience does. Megyn, what you said wasn’t funny. Well, we were laughing, but it wasn’t because you were trying to be funny.
As far as Jesus goes, Kelly did admit that it had been wrong for her to proclaim Jesus’ whiteness. Jesus’ race is “far from settled,” she acknowledged. She couldn’t bring herself to say he wasn’t white.
Megyn, please listen to me. Jesus’ origins are not “far from settled.” He was not white. He was from Palestine, not North Carolina. He was from where I am from, not where you are from. He fought against injustice and inequality. He was from my world, not yours.
White people can have the old, fat, white fantasy figure. But we’ll keep the olive-skinned, liberal, generous, charitable freedom fighter. We know much better what to do with him.
By: Amer Zahr, Time, December 18, 2013
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