“We’ll Never Stop Arguing About It”: Obamacare Is Helping A Lot Of People. Not Everyone Thinks That’s Good News
In politics there are some issues where liberals and conservatives share the same goal, but disagree about how to achieve it — we all want to have as little crime as possible, for instance, but there are different ideas about how to accomplish that. Then there are issues where the two groups have different goals — liberals want to preserve women’s reproductive rights, and conservatives don’t. And sometimes, there are issues we think fall in the first category, but actually belong in the second.
Health care may just be that kind of issue, where we talk as though we all have the same fundamental goals, but we actually don’t. There’s an interesting article in the New York Times today on a major success of the Affordable Care Act that demonstrates why we’ll never stop arguing about it. Here’s how it begins:
The first full year of the Affordable Care Act brought historic increases in coverage for low-wage workers and others who have long been left out of the health care system, a New York Times analysis has found. Immigrants of all backgrounds — including more than a million legal residents who are not citizens — had the sharpest rise in coverage rates.
Hispanics, a coveted group of voters this election year, accounted for nearly a third of the increase in adults with insurance. That was the single largest share of any racial or ethnic group, far greater than their 17 percent share of the population. Low-wage workers, who did not have enough clout in the labor market to demand insurance, saw sharp increases. Coverage rates jumped for cooks, dishwashers, waiters, as well as for hairdressers and cashiers. Minorities, who disproportionately worked in low-wage jobs, had large gains.
Before we go farther, we should remember that the ACA is a complex piece of legislation that affects every area of American health care, but for now we’re going to talk just about insurance coverage. When liberals see a report like this one, they say, that’s terrific — some of the most vulnerable people in America, and those who had the hardest time getting covered before, now have health insurance. They offer this as practical evidence of the law’s success.
But conservatives (not all conservatives, but many of them) don’t see that as a success at all. If the government is helping an immigrant who washes dishes for a living get health coverage, then to them that means that government is redistributing tax money from deserving people to undeserving people. The two groups look at the same practical effect, and interpret it in opposite ways.
That isn’t to say that the ACA didn’t give benefits to everyone, because it did. Millions of middle-class and even upper-class people were hurt by the fact that insurance companies used to be able to deny you coverage if you had a pre-existing condition, but the ACA outlawed that. And if the payment reforms in the law bring down overall health spending, we all benefit. But the most visible and dramatic parts of the law relate to the tens of millions of Americans who used to be without health coverage but now have it.
This is why Republicans continue to call the ACA a “disaster” and a “catastrophe” despite the good it has done. Liberals hoped that once the law was implemented and its practical effects became clear, the law would become hugely popular. Instead, views of the law divide closely on ideology and partisanship, and that hasn’t changed and won’t change.
That’s because there’s a fundamental clash of values at work, which means that liberals and conservatives will always judge it according to different standards. Because the law did a large amount to bring coverage to those who couldn’t afford it (through both the expansion of Medicaid and subsidies), and because it included a raft of new regulations meant to solve a variety of problems within the health care system, conservatives will always oppose it, whether it succeeds on its own terms or not. To doctrinaire conservatives, a government regulation that accomplishes what it sets out to isn’t a success at all; it’s a moral failure by definition. That’s why liberals will never convince them to support the ACA by pointing to its practical successes.
That isn’t to say that conservatives don’t make practical arguments against the ACA, because they do. But they’re mostly window dressing placed atop their moral objections to government involvement in health care. So yes, they predicted that Obamacare would destroy the economy, and cost millions of jobs, and lead to fewer people with health coverage, and balloon health care spending, and make premiums skyrocket. When they turned out to be wrong about all these things, conservatives didn’t say, “Well gee, I guess this law was a pretty good idea after all.” Because the fundamental moral objection remains, whatever the practical impact.
You can see it in the decision to accept or reject the law’s expansion of Medicaid. The federal government offered states a huge pot of free money to provide coverage to their poor citizens, and though some conservative governors tried to argue that it would be too expensive, those arguments were laughably weak. As one independent analysis after another has shown — from groups like the Rand Corporation, not exactly a bunch of lefties — taking the expansion leads to healthier state finances and better economic growth, on top of helping your state’s constituents. But for many governors, insuring poor people isn’t a moral good at all; just the opposite, in fact. So they were even willing to incur economic damage in order to avoid it (and to give Barack Obama the finger, of course).
Where this all leaves us is that the ACA will never become something we agree on, no matter what it does or doesn’t do in the real world. But even that’s not the whole story, because there are political factors at work. Smart Republicans understand that with each passing year, the law becomes more and more entrenched and harder to unwind, no matter how much they hate it. It’s one thing to keep people from getting insurance, but it’s something quite different, and far more politically dangerous, to take away insurance people already have — and if they really repealed the law, that’s what they would be doing, not just to a few people but to 20 million or so.
That’s why Republicans have so much trouble coming up with their “repeal and replace” plan. It’s not because there aren’t conservative health care wonks who could give them an outline. It’s because any real repeal would be so spectacularly disruptive to the system that it would a political nightmare. Just today there’s an article in The Hill on the efforts of the Republican task force charged with producing the new repeal-and-replace legislation, under the title, “GOP group promises ObamaCare replacement plan — soon.” If you’ve been following this issue, you know that title is a joke. As the piece says:
Coming up with a plan to replace ObamaCare has been an aim for the Republican Party for so long that it’s become a laugh line even in conservative circles. Despite voting more than 50 times in the House to repeal the law, the GOP has not once voted on legislation to take its place.
But every couple of months, they say that they’ll be releasing their plan any day now.
If Republicans actually took the White House and held Congress, my guess is that they’d pass something they called “repeal and replace” but which would leave the ACA largely intact. Just as they propose to privatize Medicare but rush to tell seniors who love it that their own coverage wouldn’t be affected, it would be some kind of time-delayed change that would avoid kicking people who now have insurance off their coverage. And if Hillary Clinton gets elected in the fall, it’ll be another four or eight years before they could even try this. No matter what happens between now and then, conservatives won’t ever decide that the ACA has worked out well, whether it actually did what it was designed to do or not. As far as they’re concerned, the design itself was the problem. But they may decide, as they did with Medicare, that doing away with it isn’t worth the bother — at least not worth bothering to to try all that hard.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Plum Line Blog, The Washington Post, April 18, 2016
“A Political Disaster Of Unimaginable Proportions”: Why Republicans Wouldn’t Actually Repeal Obamacare
Last week, in a bold example of their governing prowess, congressional Republicans took their 62nd vote to repeal the Affordable Care Act, and this time they actually passed it through both houses and sent it to President Obama to be vetoed. Naturally, they were exultant at their triumph. Speaker Paul Ryan admitted that there is as yet no replacement for the ACA, but they’ll be getting around to putting one together before you know it. The fact that they’ve been promising that replacement for more than five years now might make you a bit skeptical.
What we know for sure is this: If a Republican wins the White House this November, he’ll make repeal of the ACA one of his first priorities, whether there’s a replacement ready or not. To listen to them talk, the only division between the candidates is whether they’ll do it on their first day in the Oval Office, in their first hour, or in the limo on the way back from the inauguration.
But I’ve got news for you: They aren’t going to do it, at least not in the way they’re promising. Because it would be an absolute catastrophe.
Let’s take a brief tour around the consequences of repealing the ACA. First, everyone who benefited from the expansion of Medicaid would immediately lose their health coverage. According to Charles Gaba of acasignups.net, who has been tracking these data as assiduously as anyone, that amounts to about nine million people. Granted, the working poor are not a group whose fate keeps too many Republicans up at night, but tossing nine million of them off their health coverage is at least bound to generate some uncomfortable headlines.
Then there’s all the people who now get their health coverage through the exchanges that the ACA set up. Remember how fake-outraged Republicans were back in the fall of 2013 because some people with crappy health plans got letters from their insurers telling them that they’d have to sign up for a plan that was compatible with the ACA’s new standards? The truth was that some of them would wind up paying more for coverage while others would pay less, but it was the subject of a thousand credulous news stories portraying them all as victims, to Republicans’ unending joy.
Now imagine that ten million people, the number signed up for private coverage through the exchanges, all had their coverage simultaneously thrown into doubt. Think that might cause some bad press for the party and the president who did it?
There’s more. The ACA also allowed young people to stay on their parents’ insurance until age 26; three million took advantage of the provision. They’d likely lose their insurance too. Oh, and if you’re a senior on Medicare? Get ready for the return of the “doughnut hole” in prescription drug coverage, which the ACA closed.
Let’s add in one more element (though there are lots of the ACA’s provisions we don’t have time to discuss). One of the central and most popular provisions of the ACA banned insurance companies from even asking about pre-existing conditions when they offer you a plan. About half of Americans have some kind of condition that in the old days would mean they either could get insurance but it wouldn’t cover that condition, or they couldn’t get covered at all. If you bought insurance in the old days, you remember what a hassle it was to document for the insurer every time you saw a doctor for years prior. You don’t have to do that now, but if Republicans succeed, we’ll be back to those bad old days. So they can look forward to lots of news stories about cancer survivors who now can’t get insurance anymore, thanks to the GOP.
But wait, they’ll say, our phantom replacement plan has a solution: high-risk pools! This is a common element of the various inchoate health-care plans Republicans have come up with. Anyone who knows anything about insurance knows why these are no solution at all. They take all the sickest people and put them together in one pool, which of course means that the premiums to insure them become incredibly high. As I’ve written elsewhere, high-risk pools are the health insurance equivalent of going to a loan shark: You might do it if you’re desperate and have no other option, but you’re going to pay through the nose. So good luck with that.
Even if Republicans could come together around a single replacement plan, that plan would still be a political disaster. The theory behind their health-care ideas is that once we inject some more market magic into health care, everything will be great. But there are a couple of important things to understand about this idea. First of all, their plans don’t even try to achieve anything like universal coverage. It just isn’t one of their goals, and as a consequence, implementing their plans is going to mean a lot more uninsured than we have now, a reversal of the progress the ACA is made, with millions or even tens of millions of people likely to lose coverage. Second, even if the market mechanisms they use were to work out how they predict—and it’s almost certain they won’t, but let’s give them the benefit of the doubt for a moment—it would take a substantial amount of time.
In this, the ACA is direct. You can’t afford coverage? Here’s a subsidy, now you can afford coverage. But under Republican plans, more people shopping around for their health care is, over time, supposed to bring costs down, which will eventually translate to lower premiums. But in the meantime, while we wait for the invisible hand to perform its alchemy, millions upon millions of Americans will get screwed. Think there’s going to be a political backlash?
I suspect that many conservatives understand that, but still think that in the long term, their small-government ideas will leave us with a superior system. But that still leaves them with a political dilemma. On one hand, repealing the ACA would be spectacularly disruptive—in fact, unwinding the law will probably be more disruptive than putting it in place was, now that the entire health-care and health-insurance industries have adapted to it—and there will be millions of people victimized by repeal. It will be a political disaster of unimaginable proportions.
On the other hand, they’ve invested so much emotional, political, and rhetorical energy over the last six years into their opposition to this law that they would seemingly have no choice but to repeal it, no matter the consequences. Liberals may argue that the ACA would have been a lot better if it hadn’t worked so hard to accommodate the market-based character of the American health-care system, but Republicans have been telling their constituents that it’s the most horrific case of government oppression since the Cultural Revolution (or as Ben Carson says, “the worst thing that’s happened to this nation since slavery”). They can’t exactly turn around to the people who elected them and say, “Look, I know we said we’d repeal this thing, but that’s going to be a real mess. How about if we just make some changes to it so it works more like we’d like?”
Or maybe they could. Just look what happened to Matt Bevin, the new governor of Kentucky. He ran on a platform of purging the state of every molecule of that despicable Obamacare, but now that he’s in office, things are looking a little more complicated. That’s because Kentucky is one of the great ACA success stories, where the expansion of Medicaid brought health insurance to a half a million low-income people who didn’t have it, and the state’s health-care exchange, Kynect, was a model of success. So Bevin is now backtracking on his promise, saying that instead of just eliminating the Medicaid expansion he’s going to reform it. And Kynect may get the axe (which would mean just turning it over to the federal government), but that won’t happen for quite some time, if at all.
And that’s what I think we’d see if we actually got a Republican president and a Republican Congress forced to deal with the consequences of what they’ve been promising for so long. Once they have the ability to bring down such a health-care calamity on the public, it’s not going to seem like such a great idea. They’ll say they’re as committed to it as ever, while behind the scenes they’ll be frantically trying to figure out how to do something they can call “repeal” but that won’t actually get rid of all the things people like about the law. I wouldn’t be surprised if we saw a “repeal” bill that, in the name of an effective transition, left much of the law in place, then slowly instituted their market-driven ideas over time. Because there are limits to even what kind of damage an all-Republican government would inflict—if not on the country, then at least on their political fortunes.
By: Paul Waldman, Senior Writer, The American Prospect, January 10, 2016
“Has Dr. Ben Finally Stepped In It?”: “We Don’t Need A Department Of Veterans Affairs”
In my TPMCafe column on Ben Carson earlier this week, I noted that he had been pretty vague on a lot of issues even as he had wrapped his extremist philosophy in dog whistles. That’s quite the successful formula, for a while at least, for a stealth wingnut with a powerful biography and a charming manner.
Could be, though, he’s just stepped in a great big cow patty, per Military Times‘ Leo Shane III:
Presidential hopeful Ben Carson’s comments suggesting the Veterans Affairs Department should be eliminated drew quick condemnation from multiple veterans groups, who called the idea short-sighted and ill-informed.
On a national radio show Thursday, Carson said that the country need to re-examine how it cares for veterans but also how to cut back on government bureaucracy.
“There is a lot of stuff we’re doing that doesn’t make any sense,” he said. “We don’t need a Department of Veterans Affairs. Veterans Affairs should be folded in under the Department of Defense.”
Carson said he wants to provide all veterans with health savings accounts to pay for private-sector medical care and reserve defense-run veterans clinics for highly specialized care, like traumatic brain injury treatment and limb replacements.
Ah, yes, the HSA pet rock. But it’s not a welcome idea to the quite conservative VFW:
“To suggest that disabled veterans could be sent out into the economy with a health savings account card overlooks the fact that civilian health care has waiting lists of their own … and presupposes that civilian doctors have the same skill sets as VA doctors, who see veterans of every age and malady every day,” VFW National Commander John Biedrzyck said in a statement.
“(VA) provides an irreplaceable service to the nation’s wounded, ill and injured veterans, and my organization will not let any candidate for any office suggest anything otherwise.”
Them’s fighting words, and other vet groups seem even less pleased:
In a lengthy online essay, Paralyzed Veterans of America Deputy Executive Director Sherman Gillums Jr. called the plan “a misguided notion born from ignorance of what each department does.”
“Those who insist ‘we don’t need a Department of Veterans Affairs’ are likely people who in fact do not need VA care because of good health or cannot access VA care due to ineligibility, as is the case with Dr. Carson,” he wrote.
“However, frustration in reaction to problems in VA combined with ignorance about what VA does and how it works are not the ingredients for a recipe of success where fixing the department is concerned.”
And here’s the thing: this involves the one issue area where Carson can’t say he’s still playing catch-up because he’s been off saving lives for decades. As a physician, health care policy is the one thing he definitely will be expected to “get.”
Politics aside, abolishing the VA health system to shunt veterans (or at least those not picked up by the DoD, which could create another whole set of problems) into the private system is pretty close to the opposite of what we should be doing. As WaMo’s own Phil Longman explained back in 2007, we ought to be making the rest of the health care system more like the VA. No, it’s not perfect; the eligibility system has problems, as well all know; but the actual care it provides at a limited cost remains the best available in the country. And Ben Carson ought to realize that.
By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, September 4, 2015
“Jeb Once Again Turns To His Apple Watch”: A Wrist Gadget As Part Of His Vision For A Replacement Healthcare System
Jeb Bush caused a bit of a stir last week, telling an audience that he intends to destroy the Affordable Care Act, replacing it with a “consumer-driven” system, part of which includes his new Apple Watch.
“On this device in five years will be applications that will allow me to manage my health care in ways that five years ago were not even possible,” he said. “I’ll have the ability, someone will, you know, because of my blood sugar, there’ll be a wireless, there’ll be, someone will send me a signal…. We’ll be able to guide our own health care decisions in a way that will make us healthy.”
Yesterday, campaigning in New Hampshire, the Florida Republican returned to the same subject:
“We’re on the verge of a revolution in this regard, where we’ll be able to know all sorts of things with, you know, devices like this. I got beat up by the left because I showed my, you know, Apple Phone – this device will have the ability to measure your sugar content, to measure your heartbeat, to measure whether you’re taking your drugs in the proper way. And you’ll be able to wirelessly send text messages to your health care provider or to your loved one, or whatever, so that you can get back on track.”
It seems the former governor isn’t entirely clear on why he “got beat up.”
The point isn’t that wearable tech is irrelevant (he said “phone” yesterday, but I assume he meant “watch”). It’s easy to imagine devices that can help people manage chronic conditions like diabetes. Indeed, the Florida Republican makes it sound as if these advancements are on the horizon, but in many instances, the technology already exists.
That’s not the problem. Rather, the area of concern is that Bush intends to scrap the Affordable Care Act, which would eliminate health security for millions of families, and he included a wrist gadget as part of his vision for a replacement system. Sarah Kliff added last week:
Bush endorses the idea of “someone” sending him a signal on his Apple Watch when his blood sugar is low. I like that idea, too! It would help diabetic patients, like Bush, better manage their care.
But here’s the challenge: there is not some army of benevolent people out there monitoring blood sugar. There are health-care providers who do this, and to get signed up for their blood sugar monitoring programs, you typically need health insurance. In this way, the type of consumer-powered health market that Bush describes is one that relies on Americans having access to health services – and using that access to make better decisions about their health care.
Jeb Bush didn’t get “beat up” because he pointed to his fancy gizmo; he got “beat up” because he pointed to his fancy gizmo while making the case against the existing U.S. health care system.
By: Steve Benen, The Maddow Blog, May 22, 2015
“Are ‘Death Panels’ Coming To Scott Walker’s Wisconsin?”: A Scheme To Make Middle-Class Workers Pay Even More For Health Care
Scott Walker could be on the verge of giving Infowars some great conspiracy theory fodder. A move by Wisconsin’s Group Insurance Board to substantially increase how much state employees pay for their health insurance is drawing unqualified and sharp opposition from labor leaders but could once have drawn criticism from Sarah Palin, as well. That’s because the proposal includes “consultations about end-of-life care, which some called ‘death panels,’” as the Wisconsin State Journal put it.
Death panels?! In the great Badger State? Putting Badger Staters to death? How could this be? One may have asked, as some on the right did during the debate over the Affordable Care Act. But here we are, with the Wisconsin state government overseeing what’s set to be the controversy-free implementation of new policies designed to save the state money through its employees’ end-of-life decisions.
Quick background: The Wisconsin state government is having some tough fiscal times, and Walker’s budget proposal suggested substantial cuts in a number of areas, including to the University of Wisconsin system and to K-12 education. The governor’s budget proposal also called for savings of $81 million on the state employees’ group health insurance program. (Remember that in 2011 the governor oversaw the passage of Act 10, which virtually ended collective bargaining for most of the state’s public sector unions.) But the budget wasn’t too specific about how to save that $81 million. Instead, Walker’s proposal directed the state’s Group Insurance Board to work with Atlanta-based Segal Consulting to figure it out.
The most buzzed-about change, the Wisconsin State Journal reported, will require public sector employees to pay twice as much out of pocket for their health care than they do now. These changes are projected to save the state $85 million over the next two years (Wisconsin passes budgets biennially), and most of the savings “will come from increasing out-of-pocket limits and introducing deductibles for the vast majority of state workers who don’t have them,” according to the paper. Individual employees will have new $250 deductibles, and family deductibles will be $500.
The Group Insurance Board voted for the changes on May 19, and unless the legislature’s Joint Finance Committee moves to require legislative approval for the changes, they will go into effect Jan. 1, 2016, according to Mark Lamkins, communications director for the state’s Department of Employee Trust Funds. The board that approved the changes has 11 members, some of whom are Walker appointees. The majority of the Walker appointees on the board voted in favor.
And the change has labor leaders irate.
“What the group insurance board did today is unconscionable,” said Wisconsin AFSCME executive Marty Beil, according to THOnline. “I’d also call it evil that they’re treating state employees at that level. It’s incredible.”
But Walker’s critics on the left aren’t just going after him for increasing public sector employees’ expenditures for their health care. They’ve also targeted him for a tiny provision the board approved that seeks to save a bit of money through end-of-life care. The memo laying out the cost-cutting health-care proposal doesn’t detail how these changes would work, and the State Journal reported that “[e]nd-of-life care consultations, also called advanced care planning or palliative care, would save $292,500.” That’s hardly a hefty sum. Lamkins said the changes would involve “keeping people out of institutions near the end of life, giving them more opportunities to manage their care-treatment plan.”
He added that the change is designed “to ensure that members facing serious illness and survival of less than six months are informed of care options and are able to make treatment decisions based on their individual values and goals of care.”
Reached for comment, Laurel Patrick, a spokeswoman for the governor, pointed out that the phrase “death panels” is nowhere to be found in any of the health care change proposals. But that hasn’t defused liberal ire about the panel’s move.
That’s because Walker has been one of the most outspoken conservative opponents of the Affordable Care Act.
“When Sarah Palin was trying to derail Obamacare over ‘death panels,’ Scott Walker didn’t say a word defending the need for people to have end-of-life counseling and instead on his first day as governor wasted taxpayer dollars suing the federal government over Obamacare,” said Scot Ross, executive director of One Wisconsin Now. “But wrapped in a scheme that would make cash-strapped middle-class workers in Wisconsin pay even more for health care, Team Walker quietly slides this into the mix. The inclusion of the palliative counseling is critical, but Scott Walker would have saved families a lot of grief if he would have stood up to the Tea Party in 2010 instead of this backdoor deal now.”
Robert Kraig, executive director of Citizen Action of Wisconsin, voiced support for Walker’s so-called death panels but said he was frustrated the governor didn’t do more to defend the Affordable Care Act.
“The right, using Sarah Palin, shamelessly tried to call simple voluntary end-of-life consultation a ‘death panel’ early in the debate over Obamacare,” he said. “There’s obviously a great irony that the Walker administration would now come forward with an end-of-life consultation provision. I still have to say that it’s good policy, most likely, it’s just incredible hypocrisy for them to come out with that after Walker has been one of the most disingenuous critics of the ACA.”
It’s doubtful, of course, that any of this will be a problem for Walker’s 2016 ambitions. Nobody ever did poorly with Iowa Republican caucus-goers because critics on the left were too noisy. But the debate highlights one of the tricky aspects of running for president as a governor: that the tiniest provisions in uncontroversial policies can easily become flashpoints for controversy.
By: Betsy Woodruff, The Daily Beast, May 21, 2015
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