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“Vitter’s Mind-Boggling Obamacare Crusade”: Cutting Benefits For Congressional Staffers Could Have Real Consequences

For those who oppose President Barack Obama’s health care reform law, there’s a lot to campaign against. Many of the arguments in the health care debate arise from differences in philosophy and opinion about the future of health care in this country. For example, there’s the ongoing discussion over the appropriate size of the federal government’s role in the provision of health insurance.

Some arguments, however, are mind boggling. One Republican senator’s recent campaign seems to fall in this category.

For about two years, Sen. David Vitter of Louisiana has been on a mission to eliminate the employer subsidy that members of Congress and their staffs receive to buy their health insurance. Thanks to a provision added on to the Affordable Care Act during its consideration, members of Congress and their staffs are required, for the most part, to get their health insurance from the exchanges established by the new law. According to Politico, a ruling by the White House allowed members and staffers to retain the employer health insurance subsidy that they had been receiving before the changes in the Affordable Care Act took effect. Vitter objects to the ruling and claims that it effectively gives Congress an “exemption” from the law.

Although Vitter’s effort may be a good talking point, from a policy perspective, it doesn’t make sense. The senator is clearly approaching the issue from the standpoint of good government and making sure that Congress adheres to the laws it passes for the rest of the nation. However, if he is successful, his efforts will not make government better and they will not make Obamacare better or prove a weakness in the law. All he will accomplish is putting a thorn in the side of the staffers who work hard to make Congress run.

For most staffers, the loss of the subsidy would result in a substantial pay cut. As a former congressional staffer myself, I know that’s a cut many won’t be able to afford. Further, the White House’s actions didn’t give congressional staff a new benefit, nor did it “exempt” them from the Affordable Care Act. They are still required to purchase their insurance from the exchange. Additionally, as Sen. Lindsey Graham, R-S.C., pointed out to Politico, Congressional staff “aren’t getting anything that any government workers don’t get.” Or anyone else who works for a large employer, for that matter. Under the health care law, employees of large employers still receive health care subsidized by their employer. Members of Congress and their staff should be treated the same way.

It’s also possible that the senator’s efforts, if successful, could hurt Congress. Faced with a significant reduction in benefits, many staff would probably choose to leave the hill and recruiting for their replacements would become more difficult. Less effective Congressional staff ultimately means a less effective Congress and, at the end of the day, that only hurts the country further. Although it may seem a bit intangible for people outside of Washington, Vitter’s drive to eliminate health care subsidies for members of Congress and their staffers has real consequences for the people who serve the institution and their families. The crusade should be dropped. There are more important things to do than take health care away from government workers.

 

By: Cary Gibson, Government Relations Consultant, Prime Policy Group; Thomas Jefferson Street Blog, U. S. News and World Report, May 15, 2015

May 18, 2015 Posted by | Affordable Care Act, Congressional Staffers, David Vitter | , , , , , , | Leave a comment

“A Bold Truth-Teller”: What If A 2016 GOP Candidate Told The Truth About Obamacare?

If you’re a Republican presidential candidate, there aren’t too many ways you can distinguish yourself from your primary opponents on the issue of health care — I hate Obamacare, you hate Obamacare, we all hate Obamacare. But maybe there’s another way, for someone who has the courage to shift his rhetoric and present themselves as a bold truth-teller.

To put that in context, let’s look at some new developments on the Obamacare front.

A study just out from the Rand Corporation — not exactly a hotbed of socialist thinking — finds that after the coverage provisions in the Affordable Care Act took effect: “we estimate that 22.8 million people became newly insured and that 5.9 million lost coverage, for a net increase of 16.9 million with insurance as of February 2015.”

In addition, a new Gallup poll shows that 43 percent of Americans say they’re satisfied with the government’s work in health care, which doesn’t sound so great until you learn it’s the highest number this question has received since the organization began asking it in 2001.

We already know that all the predictions Republicans made about the ACA — a decline in health coverage, skyrocketing medical spending and premiums, massive job losses — failed to come true. One seemingly sensible response to the facts about Obamacare is to pretend they aren’t true, which is how prominent Republicans have handled things until now. After all, there hasn’t been much punishment for spreading falsehoods about the law, and the public is still woefully uninformed about it. For example, for every American who knows that the law has proven much less expensive than was originally estimated, there are eight who mistakenly believe it ended up being more expensive.

Nevertheless, the good news continues to pile up, and at least some of it may be penetrating to the public, albeit slowly (approval of the law has been ticking up of late). Which could create the opening for a Republican willing to say something different from his peers.

Let’s imagine a presidential candidate who said something like this to GOP primary voters:

“I know that just saying ‘Repeal Obamacare!’ is a good applause line. And believe me, I wish it had never passed. But we’ve had over 50 votes to repeal it in Congress, and it’s still here. Like it or not, it’s becoming entrenched. If we repealed it tomorrow, it would mean that millions of Americans would lose the coverage they’ve got. We can’t object to people losing their plans because of Obamacare, and then say it’s no big deal if a much larger number of Americans lose their coverage when we repeal the law. And Obamacare does a few things that we Republicans favor.

“So instead of just saying ‘Repeal it now!’, I’m going to give you a plan to keep the good things, ditch the bad things, and move toward a better health care system. We’ve spent the last five years banging our heads against the wall over this law, and some of my opponents think more banging is the answer. But I want to solve the problem.”

The Republican who said that would, of course, be branded a traitor by some. But he’d also get a wave of adoring press coverage, in which he’d be characterized as a straight-talking man of courage and the only one willing to have an adult conversation about health care.

The outcome of the King v. Burwell lawsuit could also help make his case. If the Supreme Court rules in Republicans’ favor, millions of Americans will lose their health coverage when subsidies are taken away, and efforts for a legislative fix are uncertain at best. The experience will make it clear even to many Republicans that “Burn it down!” isn’t always the wisest approach.

Yes, a Republican who turned his back on “repeal” to focus on “replace” would be taking a huge risk, since GOP primary voters are not necessarily going to be thoughtful and measured in their response to someone proposing something less than all-out war against Barack Obama and everything he ever touched. But it might just be crazy enough to work.

 

By: Paul Waldman, Senior Writer, The American Prospect; The Plum Line Blog, The Washington Post, May 7, 2015

May 11, 2015 Posted by | Affordable Care Act, GOP Presidential Candidates, Obamacare | , , , , , , | 2 Comments

“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 Rickety Scaffold Of Fictional History”: The Sham Lawsuit That Could Eviscerate Obamacare

Republicans in the House voted on Wednesday to repeal the Affordable Care Act—for the fifty-six time. After four years these show votes have become a tedious joke. But Wednesday’s action had bleaker implications, as it was cast in the shadow of a lawsuit that could undermine the healthcare law in fatal ways.

In a few weeks the Supreme Court will hear oral arguments in King v. Burwell, which contends that the text of the ACA allows the IRS to give subsidies only to people who purchase insurance through exchanges set up by their state, and not to those who rely on the federally run marketplace. If the plaintiffs prevail, some 7 million people in the thirty-four states that have declined to set up their own exchanges would lose the tax credits that subsidize their insurance. Coverage would likely become unaffordable for many of them; without enough people in the marketplace, the law could collapse into a “death spiral.” In human terms, a group of hospitals wrote in a brief supporting the government, a ruling in favor of the plaintiffs “would be a disaster for millions of lower- and middle-income Americans…. The ranks of the uninsured will swell again, with all that portends in the way of untreated illness and overwhelming debt.”

To build their case, the plaintiffs have erected a rickety scaffold of fictional history around a single phrase in the 906-page law. The section of the law in question concerns the calculation of subsidies available to people “enrolled in through an exchange established by the State.” The plaintiffs argue that lacking an explicit reference to subsidies available to people enrolled in the federal exchanges, the text indicates that subsidies are only available in states operating their own. Furthermore, the plaintiffs argue, this was not sloppy writing but instead “reflects a specific choice by Congress” to design the subsidies as a carrot to entice states to establish their exchanges and punish them if they failed to do so.

The lack of structural integrity in the plaintiff’s case has become increasingly obvious in the past week, thanks to a sheaf of briefs filed states, lawmakers, and the healthcare industry. In sum, there’s about zero evidence for the challengers’ version of history, and what proof they do muster is shoddy. For example, one brief cites former Nebraska Senator Ben Nelson, who played a defining role in designing the exchanges. According to the plaintiffs, Nelson thought it was “insufficient to merely allow states the option to establish Exchanges,” hence the need for a stick. But Nelson himself stated recently that he “always believed that tax credits should be available in all fifty states regardless of who built the exchange, and the final law also reflects that belief as well.”

It’s not hard to find conservative lawmakers, like Senate majority leader Mitch McConnell, who will argue now that “the language of the law says…subsidies are only available for states that set up state exchanges.” But the idea that subsidies might be withheld was never articulated by anyone during the congressional debate, nor in the months after the law’s passage—even when states began to signal they would not operate their own exchanges. Instead, the same Republicans who endorse the lawsuit now were passing laws and making statements that affirmed the idea that subsidies would be available in all states. Statements from legislators and state officials that back up the plaintiff’s version of legislative history were made only after the implications of that ambiguous phrase in the ACA began to circulate around right-wing thought shops like the American Enterprise Institute and the Cato Institute.

If Congress did intend to use the subsidies as an incentive for states to set up their own exchanges, the fact that many state officials were clueless about the possible loss of tax credits is perplexing. None of the states “had reason to believe that choosing a federally facilitated exchange would alter so fundamental a feature of the ACA as the availability of tax credits,” reads a brief filed last week by nearly two dozen attorneys general representing red and blue states alike. “Nothing in the ACA provided clear notice of that risk, and retroactively imposing such a new condition now would upend the bargain the states thought they had struck,” it continues. The Washington Post’s Greg Sargent spoke with a number of Republican state officials involved in the implementation of the ACA who confirmed that the possibility of losing subsidies was never part of discussions about whether or not to set up state exchanges.

The court could strike a blow against the ACA without fully accepting the strained version of history offered by the challengers. But as legal scholar Linda Greenhouse describes in The New York Times, doing so would require the justices to set aside their own principles and precedents. “The court has permitted itself to be recruited into the front lines of a partisan war. Not only the Affordable Care Act but the court itself is in peril as a result,” Greenhouse writes. “To reject the government’s defense of the law, the justices would have to suspend their own settled approach to statutory interpretation as well as their often-stated view of how Congress should act toward the states.”

It’s tempting to dismiss the lawsuit as a deeply silly partisan attack, akin to the House GOP’s repeated votes for repeal. Its basis may indeed be fluff. And yet it’s entirely possible that it will be this absurd case—not sabotage by Republicans at the state level; not lawsuits challenging the law on its constitutional merits—that dooms the signature achievement of the Obama years, at an immense human cost.

 

By: Zoe Carpenter, The Nation, February 5, 2015

February 10, 2015 Posted by | Affordable Care Act, House Republicans, King v Burwell | , , , , , , , , | Leave a comment

“Bait And Switch”: Introducing Obamcare Lite; What The New GOP Health Reform ‘Alternative’ Really Tells Us

Plainly wounded by the Plum Line’s mockery, some congressional Republicans have finally unveiled a plan to replace the Affordable Care Act with their own health care reform. Is it serious? It’s certainly serious enough to examine and judge on its merits. Will it become the plan around which Republicans will unite? I doubt it, just because it’s hard to imagine Republicans ever uniting around a plan to do anything proactive on health care, though that’s always possible.

What’s really remarkable about this plan is that for all the claims we’ll hear about how it undoes the tyrannical horror of Obamacare, the Republicans’ version of health care reform has accepted most of the fundamental goals and regulatory paths of the law they so deeply despise. This plan — authored by Senators Richard Burr and Orrin Hatch and Rep. Fred Upton — is little more than Obamacare Lite. Though the devil is in the details — and there are some devilish ones — this tells us that Barack Obama has for all intents and purposes won the health care argument, at least as far as it concerns government’s role in health care.

Here are some of the provisions, which I’ve copied from their synopsis:

  • Ensure NO ONE can be denied coverage based on their pre-existing condition;
  • Prohibit insurance companies from imposing lifetime limits on a consumer;
  • Adopt an age rating ratio that limits the amount an older individual will pay to no more than five times what a younger individual pays (5 to 1) as a baseline, unless a state affirmatively elects to have a different ratio;
  • Require health plans to offer dependent coverage up to age 26, unless a state opts out of this provision;
  • Ensure guaranteed renewability for patients to be able to renew their coverage;
  • Create a new “continuous coverage protection” that rewards individuals moving from one health market to another — regardless of whether in the individual, small group, or large employer markets — by allowing them to get a similar plan at a similar cost and not be rated on health status.

In addition, they would reduce the availability of subsidies from their current 400 percent of the poverty level to 300 percent of the poverty level, and repeal the Medicaid expansion but allow poor people not on Medicaid to get subsidies. The subsidies also would no longer be tied to the actual cost of insurance, and they’d be a tax credit instead of a direct subsidy at the point of sale. There’s also a provision replacing the “Cadillac Tax” on high-value plans with a provision removing the deductibility of employer health care plans that cost over a certain level.

If all that’s making your eyes glaze over, consider it this way: Again and again in the Republican plan, what they do is take a provision or principle in the Affordable Care Act and essentially say, “We want to do that too, we’ll just do it a little less generously.” No denials for pre-existing conditions? It’s in there, but there are some important caveats (which I’ll get to in a moment). No lifetime limits on coverage? In there. Young people up to age 26 can stay on their parents’ plan? Yes, but a state could opt out. Subsidies for middle-class people? In there, just up to 300 percent of the poverty level. Coverage for the poor? Yes, just up to 100 percent of poverty instead of 138 percent. Tax on high-value plans? Yep, just in a different way. Government-set limit on how much insurers could vary premiums by age? Yes, but the ratio would be expanded from 3-1 up to 5-1. A mandated list of “essential health benefits” for all plans? Yes, but the states would determine the list instead of the federal government, with more flexibility.

In all these cases, they aren’t looking for some free-market alternative that will supposedly deliver even better results. They’re accepting government’s role in both regulating insurance and in helping people pay for it; they just want to make the benefits not so attractive.

There are a few exceptions. They would repeal both the individual and employer mandates, which by now even Democrats are not particularly enthusiastic about (at this point I think most Democrats would be happy to junk the employer mandate if they got something in return, though the individual mandate could be a different story). And most significantly, the plan abandons the fundamental coverage guarantee the Affordable Care Act provides, while essentially trying to convince you that’s not what it does.

This is a critical point. Under the ACA, no one will ever be denied coverage because of a pre-existing condition. Ever. Medical underwriting, in which insurers comb through your history to see if they don’t want to cover you or if they should charge you huge premiums, is over. The Hatch-Burr-Upton plan is presented as though it does the same thing. Note that bullet point above: “Ensure NO ONE can be denied coverage based on their pre-existing condition.” In their executive summary, this point is the one sentence in the document that is highlighted in bold.

But actually, it’s not quite true. Their plan has a one-time open enrollment period for the uninsured; if you don’t get coverage during that time, you’re out of luck, and insurers will be free to deny you coverage. If you have coverage now but lose it, say because you lost your job, you’d have a limited amount of time (they don’t specify how long) to enroll in a new plan; if that time expired, you’d also be out of luck.

They would probably argue that they’re putting the responsibility on individuals, and all they have to do is take advantage of it. But that’s a very different thing from a guarantee. And that may be the biggest difference between the Affordable Care Act and this plan. The ACA tries to achieve universal coverage, and this plan doesn’t.

Frankly, that isn’t all that surprising, because universal coverage was never a goal conservatives had for health care. In recent days some of them have been arguing for something similar to this plan — see Michael Strain or Ramesh Ponnuru — and what they say about the subject is that they want universal catastrophic coverage, meaning everyone should have access to a bare-bones plan that will cover them not for ordinary medical expenses but only when a major illness or accident brings those expenses to a level that almost no one could afford. Those catastrophic plans are usually paired with Medical Savings Accounts for people to pay for everything else — a more market-based approach.

But the Hatch-Burr-Upton plan says nothing explicitly about catastrophic plans, and it doesn’t claim universal coverage as a goal. Its approach is that coverage will be there if you’re on the ball enough to get it at the right time. And if you aren’t, tough luck.

So there is something of a bait-and-switch going on. On provision after provision, this Republican plan promises to give all the benefits of the ACA, at least the ones that score highly in polls. It accepts that government will regulate health insurance and help people pay for it, even if that help is substantially less helpful. Looking at that, we might say that Republicans have accepted the ACA’s foundation, and that part of the health care argument is over. But they still aren’t willing to move substantially toward universal coverage. The ACA doesn’t achieve universal coverage either (the reasons why are a topic for another day), but it tries much harder to move down that road. So the new GOP “alternative” to Obamacare tells us that some Republicans, at least, have ceded a whole lot of ground in the broader debate over government involvement in health care, but it appears that’s one bridge they aren’t yet willing to cross.

 

By: Paul Waldman, Senior Writer, The American Prospect; Contributing Writer, The Plum Line, The Washington Post, February 5, 2015

February 7, 2015 Posted by | Affordable Care Act, GOP, Health Reform | , , , , , , , | Leave a comment

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