“Let’s Not Forget Medicare Advantage”: Selective Outrage Over Federal Health Care Costs
Knowing I’ve been both a critic of insurance company practices and a supporter of efforts to reform the industry, a FOX news producer reached out last week to get my take on accusations by conservatives that Obamacare will actually result in a bailout of big insurance companies.
Under the headline, “Bailing Out Health Insurers and Helping Obamacare,” The Weekly Standard on Monday urged Republicans to insist that future debt ceiling increases contain a no-bailout provision. The magazine also cited Sen. Marco Rubio’s, R-Fla., bill to repeal a provision of the Affordable Care Act designed to limit potential initial losses of insurers selling policies on the new health insurance exchanges.
I reminded the FOX producer that Republicans have been supporting — and vigorously defending — a much more expensive transfer of taxpayer dollars to private insurers than the one Obamacare foes are now concerned about.
Here’s the issue:
Lawmakers who drafted the Affordable Care Act knew that insurers would be reluctant to participate in the new health insurance exchanges — also called marketplaces — if the government didn’t create a temporary program to protect them against what’s known in the insurance world as adverse selection.
Insurers were concerned, for good reason, that the first people to sign up for coverage through the exchanges would be folks previously shut out of the insurance market — people who were older and sicker than the population at large. Those people couldn’t afford to buy coverage previously because insurers were able to charge them far more than younger, healthier people.
In many cases, insurers refused to sell coverage at any price to prospective customers with preexisting conditions. That’s a big reason why the number of uninsured Americans had reached nearly 50 million when Congress passed the reform law.
So it wasn’t the least bit surprising that the first few million who have signed up for coverage since the exchanges opened on Oct. 1 skew older than many expected. People who have been denied coverage for years are far more motivated to get insurance — and fast — than anyone else. There is not the same pent up demand among the young and healthy.
In anticipation of this, drafters of the reform law established a $25 billion risk fund to insulate insurers from big losses during the first three years. Although the risk fund has always been in the law, conservative pundits apparently just became aware of it.
Yes, $25 billion is a lot of money, but it is pocket change compared to the enormous amount of taxpayer dollars that have been flowing to private insurance companies for nearly three decades to keep them in the Medicare Advantage program, which has had the unwavering support of Republicans.
Republicans have long supported efforts to privatize Medicare, and the Medicare Advantage program is one of the ways they’ve tried to do it. Medicare Advantage is billed as a private alternative to traditional Medicare. When Americans reach 65, they can enroll in traditional Medicare or in a private plan operated by an insurer. If they opt for a private plan, the federal government still picks up the tab and transfers money to the private insurer every month.
As the U.S. Government Accountability Office explains it, the Centers for Medicare and Medicaid Services (CMS) adjusts the monthly payments it sends to private insurers to account for each beneficiary’s health status. As part of this risk adjustment process, CMS assigns each Medicare Advantage beneficiary a risk score — “a relative measure of expected health care costs,” as the GAO puts it.
We’re talking a lot of money here. In 2012 alone, the GAO calculated that the federal government spent about $135 billion on the Medicare Advantage program. The problem for taxpayers is that, according to the GAO, the government has been more than generous over the years to private insurers, having paid them way more than it should have because of shortcomings in how the risk scores are developed.
Interestingly, but not surprisingly, there was no mention of that, or any reference at all to the Medicare Advantage program, the biggest champion of which are Republicans, in The Weekly Standard’s “bail-out” story last week. If they are sincere in their alarm that Obamacare might reward private insurers with an extra $25 billion between now and the end of 2016, they should be apoplectic about the ongoing bailout known as the Medicare Advantage program.
By: Wendell Potter, The Center for Public Integrity, January 20, 2014
“A Gaping Wound In The Republican Psyche”: Obamacare Is No Longer Doomed, It Will Become A Scandal
Obamacare — actual, real, Obamacare, with doctors and cards and everything — has been operational for nearly a week now. It has been … extremely boring. It does not look like Stalinist collectivization. There aren’t even any beheadings. It looks like regular medical insurance, except several million more people now have it than before.
How conservatives will respond next to this mundane new world has become the subject of combative speculation. Greg Sargent predicts Republicans will soon come to terms with the law and begin negotiating for incremental improvements. On the right, Conn Carroll angrily replies that the law’s demise remains “inevitable” and liberals will turn against the law, citing Michael Moore as a harbinger of pro-single-payer liberals who will help Republicans dismantle Obamacare, somehow.
I predict a slightly different outcome than either. Obamacare will neither collapse, nor will Republicans accept its legitimacy, but the nature of their opposition will instead slowly morph. Gleeful predictions of imminent collapse will give way to bitter recriminations at the nefarious tactics used to make the law work. Obamacare will cease to be the something certain to destroy Obama and become something Obama has gotten away with.
In recent weeks, it has begun to dawn on some conservatives that the actuarial death spiral they confidently predicted for years — in which the young and healthy shun the exchanges, leading to sicker and costlier patients and rising prices, in turn driving out the remaining healthy customers — may not actually transpire. It won’t for several reasons, one of them being a set of protections embedded in the law itself called risk corridors and reinsurance, which compensate insurance companies that wind up with a sicker customer base in the first three years of the law’s operation, thus preventing a death spiral.
Republicans, having just learned of these provisions, demand that they be abolished, to hasten the death spirals. Repentant immigration reformer Marco Rubio is at the forefront with a bill to strike them from the law. Obviously Obama would never sign such a bill, but Charles Krauthammer offers a solution: demand he sign it or else refuse to lift the debt ceiling. The program is “a huge government bailout,” argues Krauthammer. This is true in the sense that any cost overrun by a defense contractor is also a huge government bailout — which is to say, it’s not true.
But it feels true, and that is the important thing. The premise that Republicans will seek to alter Obamacare in conservative-friendly ways assumes that the policy design of health-care law is their primary motivating force. Everything about the history of Republican health-care thought suggests the opposite. Just five years ago, Mitt Romney was running on a platform of taking his Massachusetts plan, with its individual mandate, national, provoking only the mildest grumbling on the right.
Obamacare is a gaping wound in the Republican psyche, representing not only the rise of a majority moocher class but a potential symbol of a successful Obama presidency. Health-care reform, George F. Will has ludicrously if representatively declared, amounts to Obama’s “single” achievement. If it lives, it will vindicate his presidency as a liberal Reagan, rather than the reprise of Jimmy Carter (or George W. Bush) Republicans wish him to be.
If and when the law melds into the national fabric, the proximate Republican response will not be to adapt their policy ideas to it, but to denounce it as a kind of stolen law. You can see this spirit creeping out not only in Rubio’s proposal but elsewhere. Eleven Republican attorneys general have denounced Obama’s various administrative maneuvers to make the law functional as illegal. “It was powerful corporate America, with its influential lobbyists, that got an additional year to meet the insurance mandate — when individuals did not,” complains The Wall Street Journal columnist Kimberly Strassel, “It was the unions that got a reprieve from a health-insurance tax — when individuals and small businesses were left to pick up the tab.” The hapless Obamacare is slowly giving way to the devious Obamacare.
In the very long run, Obamacare may become a thing, like Social Security and Medicare, that Republicans initially predict will destroy the fabric of capitalism but eventually accept and then finally swear up and down they will not harm. In the shorter term, it will remain a bloody shirt. Obamacare will be Benghazi or the IRS scandal writ large.
By: Jonathan Chait, Daily Intelligencier, New York Magazine, January 5, 2014
“So Say The American People, And History”: Confirmed, This Is The Worst Congress Ever
Though millions of Americans received Christmas gifts Wednesday, none got the one thing just about everybody wanted. No, not a new iPhone: A new Congress.
Two-thirds of Americans in a CNN poll released Thursday said the current Congress was the worst one in their lifetimes. And it wasn’t just one party or demographic who felt that way.
“That sentiment exists among all demographic and political subgroups. Men, women, rich, poor, young, old — all think this year’s Congress has been the worst they can remember,” CNN Polling Director Keating Holland said.
Three cheers for bipartisanship!
Meanwhile, three-fourths of respondents said lawmakers had “done nothing to address the country’s problems” through the first year of the 113th Congress. That gets at what’s primarily to blame for Congress’ horrible image: Lawmakers didn’t do much of anything this year, and the few things they did do were spectacularly infuriating. Heck, one of Congress’ most notable actions was failing to pass a bill to fund the government and, as a result, shuttering Washington for two weeks.
It’s not just a skewed, subjective view of congressional inaction either. The 113th Congress is statistically on track to be one of the least productive in history.
The 113th Congress passed only 66 laws in its first year, according to GovTrack. That was the lowest tally in four decades, or as far back as GovTrack has reliable data. Worse, only 58 of those bills became law, and many of them did nothing more than name post offices.
Meanwhile, many enormously popular bills fizzled. Nine in ten Americans supported tougher background checks for gun purchases, though Congress spiked gun control legislation. Two-thirds of Americans supported the Senate’s bipartisan immigration bill, but the House refused to take it up this year.
So yes, people aren’t too thrilled with how Congress has been functioning, a sentiment that’s been made clear throughout the year. Polls have found Congress less popular than dog turds and cockroaches, and in November, Congress’ approval rating fell to an all-time low of nine percent, according to Gallup.
Don’t count on that trend turning around any time soon either. Sure, Congress just passed a bipartisan budget agreement before fleeing Washington for the holidays, but that compromise was relatively tiny, and there are other major showdowns looming, including yet another one over the debt ceiling. Oh, and 2014 is a midterm election year, which should make lawmakers even more tepid toward major action.
In other words, the 113th Congress is already one of the most unpopular and least-productive in history, and it’s probably only going to get worse.
By: Jon Terbush, The Week, December 26, 2013
“The GOP’s Fight Has Just Begun”: The Showdown Between The Crisscrossing Divisions Of The Conservative Power Centers
The Republican civil war, like all civil wars, is even messier than it looks. It’s a battle between two different conservative establishments complicated by philosophical struggles across many other fronts. Its resolution will determine whether we are a governable country.
Because the GOP fight is so important, it’s a mistake to dismiss the passage of a real, honest-to-goodness budget through both houses of Congress as a minor event. The deal negotiated by Sen. Patty Murray and Rep. Paul Ryan may be small, but it represents a major recalibration of forces inside the Republican Party.
From the time the Republicans took over the House in 2010, it became a matter of doctrine that conservatives should never reach compromises with Democrats — and especially with President Obama. Compromise came to be seen as a violation of conservative ideals.
Poll after poll has shown that attitudes toward the quest for common ground have become one of the new dividing lines between the parties. Typical was a Pew Research Center survey taken in January, as the new Congress opened. Given a choice pitting elected officials who “make compromises with people they disagree with” against those who “stick with their principles,” 59 percent of Democrats but only 36 percent of Republicans preferred compromise-seekers.
In arriving at a relatively down-the-middle deal with Murray and the Democrats to avoid a government shutdown and further gridlock, Ryan was thus defying what has been the prevailing view among his party’s rank and file. In doing so, the ambitious Wisconsin Republican offered a hint as to where he sees his party moving over the long run.
The Tea Party certainly still wields power in GOP primaries, one reason why only one of the seven Republican Senators facing Tea Party challengers, Lamar Alexander of Tennessee, supported allowing a vote on the deal. But Ryan and House Speaker John Boehner calculated, correctly, that the wreckage from October’s shutdown strategy allowed them to breach the Tea Party’s barrier against deal-making.
Ryan partially hedged his bets. He declined on Meet the Press last Sunday to join Boehner’s robust assault on outside conservative groups and insisted that the GOP would still make demands when an extension of the debt ceiling comes up for a vote early next year.
Nonetheless, when Ryan declared that he had to make a deal because “elections have consequences,” he was making a fundamental concession to the view Obama has been advancing: that with the Democrats still holding the White House and the Senate, compromise is unavoidable if governing is to happen.
Let’s be clear about what this GOP brawl is not. It is not a clash between “conservatives” and “moderates.” Most genuine Republican moderates either lost primaries or were defeated by Democrats. Liberal Republicans, once a hearty breed, disappeared long ago. The Republican Party is unequivocally in conservative hands. What makes the Tea Party rebellion peculiar is that its champions have lifted strategy and tactics to the level of principle.
Nor is this a fight in which “the Republican establishment” is being challenged by its “grassroots” enemies. Boehner denounced conservative fundraising behemoths (they include FreedomWorks, Heritage Action and Americans for Prosperity) because he understands that they now constitute an alternative Republican establishment. Sen. Bob Corker (R-TN), was even more explicit, arguing that “many of the outside groups do what they do solely to raise money.” The new establishment is bolstered by conservative talk show hosts who communicate regularly with Republican loyalists and have challenged the party’s elected leaders for control over its message.
The showdown involving the two conservative power centers is not the only dispute that matters. There are crisscrossing divisions between foreign policy hawks and non-interventionists; between those who care passionately about social issues such as abortion and gay marriage and those who would play them down; between purist libertarians and pro-business pragmatists; and between supporters and opponents of a more open policy on immigration.
These arguments, however, are secondary to the issue of how a conservative opposition should comport itself. The governing wing won this round. But Ryan’s comments on the debt ceiling, coupled with similar remarks from Senate Minority Leader Mitch McConnell, suggest that Republicans will face yet another internal struggle over how much to demand in exchange for expanding the government’s borrowing authority.
If Boehner cedes that decision to the party’s confrontational wing, the gains of this week will evaporate. And given the hostility among conservatives to Obama, the habit of seeing compromise as a form of capitulation could prove very hard to break.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, December 19, 2013
“Hell Bent On Another Crisis”: Will Congress Ever Grasp That The Debt Crisis Is Fake?
As the American people tried to celebrate last year’s holiday season while mourning the loss of 26 lives in Newtown, Connecticut, Congress and the White House were duking it out over the “fiscal cliff.”
Our leaders reached a temporary solution on New Year’s Day that averted some of the self-imposed toxic mix of mandated tax increases and discretionary spending cuts that threatened to trigger a new recession. In the end, they couldn’t agree on a comprehensive deal, so the sequester went into effect two months later with relatively little fanfare.
We’re still living with those $80 billion across-the-board cuts, which slashed research spending, kicked nearly 60,000 kids out of Head Start and forced Meals on Wheels to provide less help for the elderly and others in need.
Now they’re at it again. After October’s government shutdown, a new congressional committee got a Friday, December 13 deadline to reach an agreement on a budget for the 2014 fiscal year — which began more than two months ago. Come January 15, federal spending authority will run out again and we could begin 2014 with another shutdown.
On the surface, the conflict between President Barack Obama and the Republican Party is over how to cut yearly federal deficits, which pile up over time and increase the national debt. Republicans cite a “debt crisis” and construct economic doomsday scenarios to justify their insistence that Medicaid, Medicare and Social Security should be cut.
Obama says no — we need more revenue, and it needs to come from the very wealthy and corporations who don’t pay their fair share in taxes. Besides, the deficit is already much smaller – thanks to the ongoing sequester and two provisions in that New Year’s fiscal deal: a payroll tax cut for all workers and the end of the Bush-era tax cuts for the very richest Americans.
There are a couple of things wrong with this picture. To begin with, while the government is indeed operating at a deficit (albeit a much lower one) and as a consequence piling up debt, there is no debt “crisis.”
According to leading economists like Nobel Prize winner and New York Times columnist Paul Krugman, deficit spending can improve ailing economies, and we should actually have more of it until ours fully recovers from the deepest crisis we’ve seen since the Great Depression.
Secondly, Republicans don’t really care about deficits and debt. After all, they created both — largely through tax cuts for the wealthy and unpaid-for wars during the George W. Bush administration. Their whole argument is a smokescreen for their core agenda — massive wealth transfers from the poor and what’s left of the middle class to the rich — through regressive tax policies and dismantling the safety net.
This isn’t new. It’s been the Republican agenda for at least 30 years.
In 2011, Republicans brought the country to the brink of default for the first time in history by insisting that a raise in the debt ceiling (historically bipartisan and routine) be offset by program cuts. This year, they shut down the government because they didn’t get their way.
Obama has said that strategy won’t work again, and the current need to once again raise the amount the government can borrow is non-negotiable. And he has upped the ante with a new demand that any future cuts be offset by tax increases on the wealthiest and corporations.
We don’t yet know if the latest standoff will trigger a new round of cuts to programs low-income Americans depend on most. Right now the House is asking for a $40 billion cut in food stamps over the next decade, and Medicare and Social Security are always on their hit list.
What we do know is that Republicans seem bent on causing one “crisis” after another, and the country loses in the bargain.
By: Martha Burk, Director of the Corporate Accountability Project for the National Council of Women’s Organizations; Published in The Bill Moyers Blog, December 4, 2013
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