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“A Big Split In The Republican Party”: Here Comes The Big Intra-GOP Fight Over Obamacare Subsidies

It’s been obvious for a while that congressional Republicans will be placed in a difficult position if SCOTUS strikes down subsidies for health insurance purchases under the Affordable Care Act in states that did not create their own exchanges. On the one hand, they’ll be blamed for failure to do something about the consequent loss of insurance and/or increases in premiums (at least in states that do nothing about it, either), when a one-sentence law confirming the original understanding virtually everyone had about the universal availability of subsidies would suffice. On the other hand, any reaction to such a SCOTUS decision that does not at least begin with an all-night kegger-and-prayer-vigil in celebration of this blow against tyranny will rile up The Base into a hate frenzy. Theoretically, GOPers could be ready with a full-fledged Obamacare Replacement bill that could be presented to the president on a take-it-or-leave-it basis, but despite having five years to come up with such a creature, that ain’t happening.

So as TPM’s Sahil Kapur explains today, Sen. Ron Johnson has introduced a bill, which the Senate GOP leadership has quietly gotten behind, that would extend the Obamacare subsidies until the end of 2017, in exchange for some key concessions to conservatives that fall vastly short of an alternative structure for health care reform.

The Senate’s top five Republican leaders have cosponsored legislation to extend until 2017 the Obamacare insurance subsidies that may be struck down by the Supreme Court this summer

The legislation, offered by Sen. Ron Johnson (R-WI), one of the most politically vulnerable Senate incumbents in 2016, would maintain the federal HealthCare.gov tax credits at stake in King v. Burwell through the end of August 2017.

The bill was unveiled this week with 29 other cosponsors, including Senate Majority Leader Mitch McConnell (R-KY) and his four top deputies, Sen. John Cornyn (R-TX), John Thune (R-SD), John Barrasso (R-WY) and Roy Blunt (R-MO). Another cosponsor is Sen. Roger Wicker (R-MS), the chairman of the conference’s electoral arm.

Such a move would seek to protect the GOP from political peril in the 2016 elections when Democrats would try to blame the party for stripping subsidies — and maybe insurance coverage — from millions of Americans in three dozen states. A defeat for the Obama administration in a King ruling would likely create havoc across insurance markets and pose a huge problem for Republicans, many of whom have been pushing the Supreme Court to nix the subsidies.

Given the certainty that this proposal will split Republicans, what are the odds Democrats would go along with this semi-“fix.”?

Democrats would probably demand a fix to make the subsidies permanently available if they go down. But they would be hard-pressed to vote down a bill to temporarily extend them if Republicans were to bring it up.

That may depend, however, on what happens to provisions Kapur calls “sweeteners” for conservatives, including elimination of Obamacare’s individual and employer mandates, and perhaps even more crucially, of the ACA’s minimum benefit requirements. Kapur seems to anticipate, and some conservative critics agree, that Republicans would cave on most of these “sweeterners” in exchange for Democrats agreeing to a temporary instead of a permanent extension of subsidies.

But you will note that the cosponsors of Johnson’s bill do not include Ted Cruz, Rand Paul or Marco Rubio, who will likely be focused on the Iowa Straw Poll at the time the decision comes down. There’s also a competing Senate bill from Ben Sasse that would instead of extending the subsidies replace them with simple tax credits for insurance purchasing that would fade away over time. And there are, according to The Hill‘s Sullivan and Ferris, several plans percolating in the House that would replace the subsidies with our without some “bridge” offering temporary relief. You can judge how much consensus there is from this remark by Republican Study Committee co-chair Bill Flores of Texas, who is one of the people working on one of the many plans:

“I’m not saying there should absolutely not be a bridge, I’m not saying there should absolutely be a bridge,” Flores said. “If we start building toward a shore, but we don’t know what that shore is, then the bridge might not work very well.”

I think we can all agree on that. And that is why despite everything you will hear from them before and after SCOTUS rules, there’s probably no group of people more avidly if silently cheering for Obama to win this case than are congressional Republicans.

 

By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, April 24, 2015

April 25, 2015 Posted by | Affordable Care Act, GOP, King v Burwell | , , , , , , | 1 Comment

“A Nightmare For John Boehner”: Why Obamacare Could Help The Democrats In 2014

If some Republicans are sounding just a little bit desperate right now, I think I know why. “Obamacare is not just a broken website,” House Speaker John Boehner sputtered the other day in retreat as it emerged that the website is now working well. “This bill is fundamentally flawed.” He sure hopes he’s right about that—and by the way, Mister, it’s a law, not a bill. But I bet late at night, when he’s having that last smoke and thinking back over his day, he fears that he’s wrong and that the central Republican…“idea,” if you want to call it that, of the last three years—get rid of Obamacare—is going to look awfully stupid to a majority of Americans eight or 10 months from now.

If you haven’t gone to HealthCare.gov just for kicks, I certainly recommend now that you do. Pretend that you’re from a state that didn’t create an exchange, if you aren’t, because if you’re from a state with its own exchange, you’ll just be kicked to the state website, and what you want to test here is the federal one. So just choose a yahoo state that didn’t play ball, where the law was mocked as just so much socialism.

I just did, for the first time in weeks, an hour before scribbling these sentences. I was amazed. It was lightning fast. Explanations were clear and straightforward. Instead of bureaucratese, I encountered something I didn’t expect at all: plain English!

And here’s the key thing. It gave me loads of choices. I pretended to be a 35-year-old man from Kansas with a spouse and child. Without even having to enter my fake income, the site delivered me in a split second to a page with loads of plan options.

Choice. That’s what America’s about. As I heard Sen. Joe Manchin (D-WV) say on Alex Wagner’s show a couple of weeks ago, we’re a nation of shoppers. It’s what we do best. Alas, he is correct. That’s what we want. From TVs to smartphones to flavors of potato chip that have been stretched to include ketchup and dill pickle (who eats those?), we believe that endless options are our right.

How many options? An amazing 42, to be precise. Forty-two plans! That might be more than the number of available potato-chip flavors in America. I would have to think it will shock people, in a highly positive way, to see they have so many choices. And most of all, it will feel…American. Something that offers a person 42 options ain’t socialism, as Americans know in their bones.

The plans ranged from $70 a month, which would have covered only me, to $742 a month for the Rolls-Royce family version, with $0 deductible and $6,500 out-of-pocket. It was an astonishing menu. And take it from a guy who just moved house and has been on the phone and online interminably with private-sector service-providers, mostly but hardly limited to the cable/Internet/phone company: This looked easy. The interface was great, really user-friendly, really clear.

Now, most of these plans weren’t cheap. Health insurance isn’t cheap. For example, a middle-of-the-pack silver plan looked like this: $472 a month; a $7,500 family deductible; a $12,700 out-of-pocket maximum. Those aren’t cheap. But a $10 copay for a doctor’s visit, $75 to see a specialist, and just $15 for a generic prescription. That’s not bad at all.

So yes, Mr. Speaker, it’s more than a website. It’s a chance for people who’ve eschewed insurance for years to buy it and take their kids to a doctor and even to a specialist when needed. Individuals will have to decide for themselves whether that buys them $5,664 in peace of mind (that’s $472 times 12), but I suspect a lot of people will decide that it sure does.

And this is where Republicans, if they’re looking around the corner, might be freaking out. They are going to emphasize the horror stories going forward, and those stories will exist. The Democrats will emphasize the violin stories, and they will exist, too.

But in between the decontextualized disasters and the stories with Hollywood endings will be millions of people to whom nothing particularly dramatic, but something very positive indeed, will have happened. They got insurance, or decent insurance, for the first time in their lives. They went and got their first physical in years. They had that bad back checked out finally. They took their child to an eye doctor and got her glasses. That’s not dramatic enough for a television ad, but any parent will understand that a child going from struggling with reading to being able to read easily at school is plenty dramatic.

I’ve known for a long time the Republicans were on the wrong side of history here. Forty-something million uninsured in this impossibly rich country, and they don’t want to do a thing about it. And don’t fall for their “plans.” They’re unworkable. They’re unworkable because the Republicans aren’t willing to spend the money that experts all say is required to make plans workable. And they aren’t willing to spend the money because spending money acknowledges the existence of a common purpose in this nation, and they certainly can’t acknowledge a common purpose, unless it’s war.

So while I’ve known they were on the wrong side of history, I have feared they were on the right side of the politics. Well, I’m starting to think otherwise. No American who has 42 choices is going to feel like the jackboot of the state is stomping on his neck. And sometime next year, the people in the states that didn’t take Medicaid money are going to start noticing something else: that in a lot of cases, they’re going to be paying more for the same plan that a person in a participating state is paying. How’s that going to go down, Rick Perry?

Mr. Speaker, light up another one. It’s going to be a long night.

 

By: Michael Tomasky, The Daily Beast, December 5, 2013

December 8, 2013 Posted by | Affordable Care Act, Republicans | , , , , , , , | Leave a comment

“We Are All Fragile Beings”: Obamacare Saved My Family From Financial Ruin

House Speaker John Boehner and his tea party friends shut down the U.S. government because of people like me. I am the mother of an insurance hog, someone who could have blown through his lifetime limit of health coverage by the time he was 14. My son has managed to survive despite seemingly insurmountable challenges, and he wears his preexisting condition like a Super Bowl ring.

Mason, now 16, was probably born with his brain tumor. We discovered it six years ago. Biopsies showed a slow-growing mass, which was the good news. The bad news was that the tumor could not be removed because it had grown around essential structures in his brain. Under the care of some of the country’s finest specialists, Mason had frequent scans. There was little we could do between tests but hope for the best. Like other children his age, Mason played basketball, argued with his siblings and avoided cleaning his bedroom. He managed to undergo chemotherapy for eight months without getting too sick. He insisted on finding ways to laugh, saying things like: “I have brain cancer. What’s your problem?” It was an uneasy peace — until the tumor ruptured in December 2010, three years after his initial diagnosis, and Mason suffered a massive cerebral hemorrhage.

Mason spent most of eighth grade in the hospital. In the six months he was hospitalized, he spent 65 days in the pediatric intensive care unit. He underwent four brain surgeries. Halfway through his hospitalization, the Affordable Care Act was passed, alleviating lifetime limits on coverage and saving us from the financial abyss. Mason moved to a rehabilitation hospital where he was retaught the most basic skills — sitting up, eating and standing. We faithfully paid the premiums on the employer-sponsored plan through which our family is covered, along with the rest of our bills, thanking God and whoever else would listen for our good fortune to have coverage.

The biggest fear for families such as mine is that we will lose our health insurance and be rendered uninsurable because one of us has been sick. The Affordable Care Act does away with dreaded clauses barring preexisting conditions. It also enables us to keep Mason on our insurance until he is 26; then, he will be able to purchase his own coverage on an insurance exchange. At least, that was the plan until last Tuesday, when the government was shut down in protest of such excesses.

As far as the brain tumor goes, our family might have drawn the short straw. Maybe our story lacks a certain universal appeal. People might be thinking to themselves, “I’m so sorry that happened to you, but odds are it won’t happen to me.” I hope it doesn’t, really.

But having lived in hospitals with Mason for months, I have seen that bad things — accidents, freak illnesses — happen to smart, cautious and otherwise undeserving people. It’s one thing we all have in common. We are fragile beings. So what is wrong with allowing us to purchase a financial safety net? What’s so un-American about that?

If I could get John Boehner and Ted Cruz on a conference call, I would explain this to them. I would tell them that, while they were busy trying to derail the Affordable Care Act over the past two years, Mason has again learned to walk, talk, eat and shoot a three-point basket.

 

By: Janine Urbaniak Reid, a writer in the San Francisco Bay Area, is working on a memoir about her son’s diagnosis; October 9, 2013; Published in The Washington Post Opinions Section, December 4, 2013

December 5, 2013 Posted by | Affordable Care Act, Obamacare | , , , , , , , | Leave a comment

“Making The Law Look Better”: How Not To Argue Against Obamacare

One of the more talked about pieces in conservative media yesterday came by way of Forbes, and it caused quite a stir. If you missed it, the article, based on American Enterprise Institute research, said the typical American family of four should expect $7,450 in additional health care costs, all because of the Affordable Care Act.

If true, that certainly sounds problematic. With a weak economy and stagnant wages, an average household would struggle to afford those increased costs.

The problem, as Igor Volsky explained, is that the Forbes piece is entirely wrong.

To translate that number to a “typical American family,” [the AEI’s Chris Conover] took “the latest year-by-year projections, divided by the projected U.S. population to determine the added amount per person,” multiplied that result by four and voila: Obamacare will add $7,450 to average health spending for a family of four between 2014 and 2022!

One economist interviewed by ThinkProgress, the Center for Budget and Policy Priorities’ Paul Van de Water, described this calculation as one of the stupidest things he’s read in a long time and likened it to arguing that college costs will increase for a “typical” family if the federal government adopts policies that help lower-income Americans afford college educations. Yes, the nation will spend more on education if more students enroll in colleges and universities, but the “typical” student already attending college won’t; she or he will continuing paying tuition at more or less the same rate, while the newly-enrolled student will presumably benefit from some sort of subsidized tuition rate.

The same is true here. The so-called “typical” family that Conover describes already receives health care insurance through their employer. The existence of 30 million newly-insured people — many of whom will receive tax credits if they purchase insurance in the law’s exchanges — won’t do much to move their premiums in one way or another.

MIT’s Jonathan Gruber went on to Volsky, “This is a typically misleading use of data by opponents of Obamacare.”

I no longer find myself surprised by developments like these. Conservative opponents of the Affordable Care Act have been pushing easily discredited attacks for quite a while, in some cases because conservative wonks just aren’t very good, and in other cases because the right feels justified in making claims they know to be untrue.

But I’m always left with the same question: if “Obamacare” were really so awful, shouldn’t conservative criticism be a lot easier?

Much to the chagrin of the right (and to Politico), most of the news surrounding the Affordable Care Act has been pretty encouraging of late. That said, if the law’s critics want to focus on areas of concern, there are legitimate criticisms they can point to.

We’re already seeing, for example, some glitches in the Obamacare exchanges. As Jonathan Cohn explained, they’re not worth freaking out over, but if you’re a Republican desperate to shine a light on implementation problems, you can seize on something like this to advance a partisan cause.

There are also legitimate concerns about the law pushing private insurers to restrict provider options for those who get coverage through exchanges. If conservatives wanted to jump up and down about this, too, they’d at least be dealing with reality. Does it mean the law is a fiasco, doomed to failure? No. Is it a real problem worthy of attention? Sure.

But our discourse has become so stunted and unproductive that we’re instead stuck with nonsense such as the Forbes piece, which had been thoroughly debunked before close of business. (Of course, if recent history is any guide, the fact that the claims have been discredited won’t stop Republican members of Congress from repeating them on national television every day for the foreseeable future.)

Note to Obamacare’s detractors: when you cling to evidence that’s wrong, you make the law look better, not worse. If the law was as bad as you claim, you’d have real defects to point to, not made-up stuff.

 

By: Steve Benen, The Maddow Blog, September 24, 2013

September 25, 2013 Posted by | Affordable Care Act, Conservatives | , , , , , , | Leave a comment

“Putting The Train Wreck On Hold”: Everything Anti-Obamacare Republicans Predicted Is Proving To Be The Opposite Of Reality

The Affordable Care Act, like every landmark piece of legislation in modern times, has faced its share of trials. Getting it through Congress was nearly impossible, and the law was very nearly killed by the Republican appointees on the U.S. Supreme Court.

But with the law now secure and President Obama re-elected, there’s one more major challenge for “Obamacare” to overcome: the implementation hurdle. As we discussed several weeks ago, this is at least as big a hurdle as the others, and more than a few observers have raised the prospect of a “train wreck.” Even those who generally defend the law are worried.

They are, however, a little less worried today. As Matt Yglesias explained, implementation of the law is “fundamentally” going quite well.

The latest evidence comes to us today from California, America’s largest state and one of the states that’s tried the hardest to actually implement Obamacare. As Sarah Kliff explains, their exchanges are getting set up, and it looks like premiums for “silver” and “bronze” plans are both going to be lower than was previously expected. Far from a “train wreck,” in other words, the biggest single set of clients for the program is getting something like a nice, smooth high-speed train ride.

There was also good news from Oregon recently, where insurers that had initially come in with high premium bids are now asking to resubmit with cheaper offerings in the face of competition. And the Affordable Care Act’s goal of slowing the growth in aggregate health expenditures is also coming true.

Yep, at least for now, everything anti-ACA Republicans predicted — on premiums, on competition, on exchanges, on escalating costs — is proving to be the opposite of reality.

Now, because of state-by-state differences, there will be quite a bit of variety in outcomes. If you live in California or another state dominated by Democratic officials, you’ll likely have a very positive impression of how the law is being implemented, and how it benefits you, your family, and your community.

If you live in, say, Texas, you’re likely to have a very different kind of experience.

As Jonathan Cohn explained this morning:

Unfortunately, millions of uninsured and under-insured Americans live in places like Florida and Texas, where there is far less sympathy — and a great deal more hostility — to the idea of Obamacare. It’s entirely possible that the insurance bids in those states will be a lot higher, precisely because state officials there are doing nothing to help and quite a bit to hurt implementation. But if that happens, blame won’t belong with the heath care law or the federal officials in charge of its management. It will belong with the state officials who can’t, or won’t, deliver to their constituents the benefits that California’s officials appear to be providing theirs.

It’s not necessarily an explicitly partisan matter — I’m not saying that Democrats are necessarily better at health care governance. Rather, the point is, Democrats don’t have an ideological axe to grind when it comes to trying to sabotage federal health care law. Rick Perry, however, does.

To be sure, these red-state residents won’t be left out entirely, and they’ll still benefit from all kinds of consumer protections and expanded access that they’ll really appreciate, even if they don’t yet realize the available benefits. But the full benefits of implementation will elude them for a while in ways blue-state residents won’t have to deal with.

Regardless, the news out of California is a bit of a breakthrough, and heartening news for anyone hoping to see the Affordable Care Act succeed. For more on this, also take a look at the reports this morning from Klein, Krugman, and Beutler.

 

By: Steve Benen, The Maddow Blog, May 24, 2013

May 27, 2013 Posted by | Affordable Care Act, Republicans | , , , , , , , | 1 Comment

   

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