“What Happens If The Dog Catches The Car?”: GOP Faces Health Care Challenge It’s Totally Unprepared For
We don’t yet know what the Supreme Court will do in the King v. Burwell case, but we have a fairly good sense what will happen if the Supreme Court sides with Republicans. In effect, there will be chaos that could do considerable harm to insurers, families, state budgets, the federal budget, hospitals, and low-income children.
It sounds melodramatic, but the fact remains that if the GOP prevails, more Americans will literally go bankrupt and/or die as a result of this ruling.
With this in mind, I couldn’t help but find some sardonic humor in the House Republicans’ request for information from the Obama administration yesterday.
Senior House Republicans are demanding that the Obama administration reveal its contingency plans in the event that the Supreme Court scraps Obamacare subsidies in three dozen states. […]
“Specifically, we are examining the extent to which the Department of Health and Human Services (HHS), and other relevant agencies of the federal government, are preparing for the possible consequences of the Supreme Court’s decision in the case of King v. Burwell,” wrote the lawmakers.
The fact that the GOP lawmakers didn’t appreciate the irony was itself unfortunate, but the simple truth is that the underlying question – what happens if the Supreme Court takes this stupid case seriously and guts the American health care system? – is one Republicans should be answering, not asking.
If we had a normal, functioning political system, represented by two mainstream governing parties, the solution would be incredibly simple. If the Supreme Court said the language in the Affordable Care Act needed clarification, lawmakers would simply approve more specific language before Americans felt adverse consequences. The legislative fix would be quite brief and the whole process could be wrapped up in an afternoon.
No one, in this scenario, would actually suffer.
But in 2015, Americans don’t have the benefits of a normal, functioning political system, represented by two mainstream governing parties. On the contrary, we have a dysfunctional Congress led by a radicalized, post-policy party that has no use for governing, and which welcomes adverse consequences no matter how many Americans suffer.
And the question for them is what they intend to do if, like the dog that catches the car, Republican justices on the Supreme Court rule their way in the King v. Burwell case. Sahil Kapur had a terrific report on this overnight.
Many Republicans would view it as a dream come true if the Supreme Court were to slash a centerpiece of Obamacare by the end of June. But that dream could fade into a nightmare as the spotlight turns to the Republican Congress to fix the mayhem that could ensue.
“It’s an opportunity that we’ve failed at for two decades. We’ve not been particularly close to being on the same page on this subject for two decades,” said a congressional Republican health policy aide who was granted anonymity to speak candidly. “So this idea – we’re ready to go? Actually no, we’re not.”
Republican leaders recognize the dilemma. In King v. Burwell, they roundly claim the court ought to invalidate insurance subsidies in some three-dozen states, and that Congress must be ready with a response once they do. But conversations with more than a dozen GOP lawmakers and aides indicate that the party is nowhere close to a solution. Outside health policy experts consulted by the Republicans are also at odds on how the party should respond.
Republicans could approve a simple legislative fix, but they don’t want to. Republicans could introduce their ACA alternative, but they don’t want to do that, either. They could encourage states to create their own exchange marketplaces, largely negating the crisis, but they don’t want to do that, either.
So what do GOP lawmakers want? They haven’t the foggiest idea.
Kapur talked to a GOP aide who works on health care policy on Capitol Hill who said, “Our guys feel like: King wins, game over, we win. No. In fact: King wins, they [the Obama administration and Democrats] hold a lot of high cards. And we hold what?”
Millions of families who would be screwed by Republican victory in this case will be eager to hear an answer to that question.
By: Steve Benen, The Madow Blog, January 29, 2015
“Even If It Worked, I Would Oppose It”: Republicans Too Often Prioritize Partisan And Ideological Goals Over Practical Ones
As hard as it may be to perceive right-wing neurosurgeon Ben Carson as a credible presidential candidate, he received a very warm welcome at Steve King’s “Iowa Freedom Summit” over the weekend, and Carson arguably delivered one of the more polished presentations of the gathering.
But on the substance of Carson’s remarks, one thing jumped out at me.
On the Affordable Care Act – which Carson has on several occasions compared to slavery – the famous former surgeon said he opposed any government intrusion in health care. “Even if it worked, I would oppose it,” Carson said of Obamacare. “It doesn’t.”
“I don’t believe in taking the most important thing a person has, which is their health and their health care, and putting it in the hands of the government,” he later added….
For a brief argument in a speech, there’s quite a bit to this. We know, for example, that Carson’s mistaken when he says the Affordable Care Act isn’t working; the evidence to the contrary is simply overwhelming. We also know that when it comes to his preferred model, Carson used to believe largely the opposite of what he’s arguing now.
What’s more, when Carson argues that government shouldn’t have a hand in matters related to health care, it would seem to suggest the Republican candidate is against the VA health care system for active-duty and retired military personnel, Medicare, and Medicaid. That’s not too surprising – a guy who draws a parallel between modern American life and Nazis isn’t going to be a moderate – but it’s a pretty extreme position for even today’s GOP.
But the true gem is, in reference to the ACA, “Even if it worked, I would oppose it.”
Regular readers know that I’ve referenced the Republicans’ “post-policy” problem on several occasions, and Carson’s eight-word line seems to summarize the larger issue nicely. While Democrats focus heavily on policy outcomes and the efficacy of policy proposals – as one might expect from a governing party – Republicans too often prioritize partisan and ideological goals over practical ones.
Whether or not tax cuts work, for example, isn’t especially important. Whether the evidence supports climate change doesn’t matter, either. Pick the issue – national security, education, immigration, et al – and for much of today’s GOP, empiricism and efficacy just isn’t that important. What matters instead is an ideological drive to shrink government, regardless of policy outcomes.
I rather doubt Carson intended his comments to be so revealing, but the fact that he’d oppose a Democratic health care reform package built on a Republican model, regardless of whether or not it works, says a great deal.
What’s the basis for a serious policy debate when one side of the argument doesn’t care if policies are effective or not?
By: Steve Benen, The Maddow Blog, January 26, 2015
“There Are Things In It That Scare Me”: For Republicans, Dishonesty Works And Deceit Instills Fear And Uncertainty
There isn’t a democracy on the planet in which even conservative candidates take aim at citizens’ access to health care. At a certain level, the very idea seems a little silly – a national candidate would presumably fail if he or she told their electorate, “Vote for me and I promise to leave some of you behind without access to basic medical care.”
But the United States is the exception. The Republican Party is the only major party in any major democracy that believes citizens are not entitled to medical care as a benefit of citizenship. Louisiana Gov. Bobby Jindal (R), as we discussed yesterday, want the GOP to abandon universal coverage as a worthwhile goal.
The Affordable Care Act may have extended new health security to tens of millions of families, but Jindal and Republicans believe voters should elect them to deliberately take that security away.
In theory, this should be a very tough sell. Why in the world would any Americans consider voting, on purpose, for a platform that could deliberately punish their own family?
The answer, I suspect, has a lot to do with the power of fear.
The New York Times recently published a fascinating piece on Kentucky’s triumphs in implementing the Affordable Care Act, and the article highlighted a woman named Amanda Mayhew. On paper, the piece presents Mayhew as a classic example of an “Obamacare” success story: thanks to the ACA, she been able to receive free, overdue dental care; she was able to see a dermatologist for free; and she received medication to treat depression for free. This one law has made a big, positive difference in her life.
And then came the twist.
“I don’t love Obamacare,” she said. “There are things in it that scare me and that I don’t agree with.”
For example, she said, she heard from news programs that the Affordable Care Act prohibited lifesaving care for elderly people with cancer.
Mayhew went on to tell the NYT that she’s “thankful” for her coverage, she would “gladly give up my insurance today if it meant that some of the things that are in the law were not in place.”
The problem, of course, is that Mayhew has been misled. Despite what she “heard from news programs,” the Affordable Care Act does not prohibit lifesaving care for elderly people with cancer. It actually does the opposite – which is why the law has received the enthusiastic support of the American Cancer Society and AARP.
The Times article featured a well-intentioned woman, whose heart clearly seems to be in the right place, who would sacrifice her own access to medical care in order to scrap provisions in the law that do not actually exist.
And that’s where Republican rhetoric comes into play. For years, the naive among us – a group that I include myself in – have marveled at the extraordinary lies that have been told about the Affordable Care Act. Why, we ask, would the right lie so brazenly to families who urgently need access to doctors and medicine?
Because dishonesty works. Deceit instills fear and uncertainty.
When Republican candidates vow to gut the American health care system and take Americans’ coverage away, there are plenty of voters who are willing to go along because they’re eager to undo those horrible provisions in the law they “heard about” on “news programs.”
The power of deceptive propaganda, backed by billionaires and their powerful elected allies, shouldn’t be underestimated.
The Kaiser Family Foundation recently found that 41% of the country still, even now, believes “a government panel” exists to “make decisions about end-of-life care for people on Medicare.” That’s two out of every five Americans who believe a ridiculous falsehood.
It’s not that these people are bad or dumb. It’s not that they want their neighbors or community to suffer. The issue here is that some wealthy and sophisticated folks launched a con job on the public, and the scam roped in a lot of victims.
Why else would politicians run on a platform of pushing millions of Americans into a position where they’re one ailment away from bankruptcy? It’s because they think they can get away with it – nice, generous folks will sacrifice their own security to prevent imaginary threats from hurting someone else.
By: Steve Benen, The Maddow Blog, January 13, 2015
“Tiresome Assertions”: More Revisionist History About Clinton And Obama
I briefly mentioned Michael Gerson’s “Are Democrats Stuck in 1979?” column yesterday, but wasn’t in a big hurry to smack it down. It’s precisely Gerson’s history as the rare conservative willing on occasion to criticize his party’s extremism that probably makes this sort of claim that the other side is even more extreme inevitable.
But some editor or maybe even a history-conscious intern might have warned Gerson that choosing 1979 as the mythical apogee of Democratic liberalism was a bad idea. That’s a year in which a Democratic president began to prepare for a re-election campaign by pushing for a balanced budget and a big increase in defense spending, even as liberal icon Ted Kennedy headed for a humiliating defeat in the primaries.
In any event, here’s the tiresome assertion that really annoys me as a veteran of the New Democrat thing:
President Obama has now effectively undone everything that Clinton and the New Democrats did in the 1980s and ’90s.
Gerson’s not real specific about this claim, though I assume part of his argument would involve resuscitating the Romney-Ryan campaign’s lie that Obama had “gutted” welfare reform. But what else?
Since Gerson appears to assume that Clinton was strictly about appropriating conservative themes, I guess he cannot come to grips with the fact that the Affordable Care Act was based on the “managed competition” model that a lot of New Democrats preferred to Clinton’s own health care proposal, or that Obama’s “cap-and-trade” proposal was relentlessly and redundantly promoted by the New Democratic think tank the Progressive Policy Institute. Just about everything Obama has proposed on tax policy, education policy, infrastructure policy, trade policy and even national security policy has been right out of the Clintonian playbook. Has Gerson noticed that Obama’s not real popular with people on the left wing of the Democratic Party?
Well, never mind; I guess the Obama-the-lefty construct, threadbare as it is, was necessary for Gerson to set up the heads-we-win tails-you-lose proposition that HRC needs to move the Democratic Party to the right or accept that “the political achievements of her husband [have] been washed away.” I do believe Obama was the first Democrat since FDR to be elected twice with a majority of the popular vote; that ought to count for something.
By: Ed Kilgore, Contributing Writer, Political Animal Blog, January 7, 2014
“24 Health-Care Scandals”: Legislators Who Block Medicaid Expansion Are Stiffing Veterans Out Of Health Care, And Stiffing Workers Out Of Jobs
The scandal over long wait times for veterans in the Department of Veterans Affairs health system has grabbed a lot of headlines and elicited a lot of righteous anger — as it should. America’s veterans deserve so much better.
But as Ezra Klein pointed out in a piece in Vox, there’s another health care scandal that also deserves its share of righteous anger, and it also has a big impact on veterans with health care needs: the self-destructive refusal of lawmakers in 20-plus states to accept federal funds to expand their Medicaid programs.
Klein cataloged “24 health-care scandals that critics of the VA should also be furious about” (that is, the 24 states that have rejected the Medicaid expansion). Thanks to lawmakers’ knee-jerk opposition to expanding health coverage in those states, there are huge numbers of uninsured veterans who should be eligible for coverage, but aren’t: 41,200 veterans in Florida, 24,900 in Georgia, 48,900 in Texas… and the list goes on.
All in all, about 250,000 uninsured veterans are getting stiffed out of eligibility for health coverage by lawmakers who have blocked Medicaid expansion, according to Pew’s Stateline. As it turns out, those lawmakers are also stiffing their own states out of economy-boosting jobs — health care jobs that are overwhelmingly good-paying jobs. Medicaid expansion would create thousands more of these jobs.
Virginia, where Medicaid expansion still hangs in limbo, is a perfect example. According to a report from Chmura Economics & Analytics, Medicaid expansion would create an average of over 30,000 jobs annually in Virginia, including more than 15,000 jobs in the state’s health care sector. An analysis of data on projected job openings and wage levels underscores that these will be good-paying, economy-boosting jobs.
For a single adult in Virginia, less than half of all projected job openings statewide pay above a living wage ($18.59/hour, according to the 2013 Virginia Job Gap Study). However, three out of five health care job openings and close to nine out of 10 health practitioner and technical job openings do.
For a household with two working adults and two children, while less than two out of five projected job openings in Virginia pay median wages above a living wage ($21.99/hour per worker), half of health care job openings and more than seven out of 10 health practitioner and technical job openings do.
Or look at Maine, where Gov. Paul LePage vetoed a bipartisan Medicaid expansion plan passed by the Maine Legislature earlier this year, and too few Republican legislators were willing to break ranks with the Governor to override his veto. There, Medicaid expansion would create over 4,000 jobs by 2016, including more than 2,000 jobs in Maine’s health care sector. As with Virginia, health care jobs beat statewide wage levels in Maine by wide margins.
For a single adult, less than half of all projected job openings in Maine pay above a living wage ($15.18/hour, according to the 2013 Maine Job Gap Study). But two-thirds of health care job openings and almost nine out of 10 health practitioner and technical job openings do. For a household with two working adults and two children, while barely one-third of projected job openings in Maine pay above a living wage ($18.87/hour per worker), almost three-fifths of health care job openings and more than four out of five health practitioner and technical job openings do.
Health care jobs are also overwhelmingly higher-wage jobs in states like Montana and Idaho. But all these states, along with 20 others, have been missing out on these economy-boosting jobs because their legislatures or governors have rejected Medicaid expansion.
State lawmakers who continue to block Medicaid expansion do so at their own peril — both morally and electorally. Because you can only stiff your own constituents — including low-income, uninsured veterans — out of both access to health care and good-paying, economy-boosting jobs for so long before it catches up with you.
Want to really do something to help veterans get access to the health care they need and create good-paying jobs for your constituents at the same time? Two words: expand Medicaid.
By: LeeAnn Hall, Executive Director, The Alliance For A Just Society; The Huffington Post Blog, August 6, 2014
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