“Obamacare Is For Republicans, Too”: If GOP Governors Think Stonewalling Health Exchanges Hurts Only Democrats, They’re Wrong
Three months from now, Americans will get their first look at whether Obamacare works. The answer will depend a lot on Republican governors and legislatures — and they should want the law’s exchanges to be successful as much as the president does.
The new state insurance exchanges are supposed to start selling health coverage Oct. 1. The idea behind these marketplaces is that allowing apple-to-apple comparisons between health plans will foster competition and lower prices. Most Republican governors and legislatures, however, have resisted running their own exchanges; 19 states have refused to play any role whatsoever.
Continued resistance could hamper an already fraught process. In a report this week, the U.S. Government Accountability Office warned that the federal government is behind schedule in building exchanges in states that have refused to do so. This makes it even more crucial that all states pitch in to help.
Why should Republican opponents of the exchanges change tack now? First, there are the crass politics: Many residents who stand to benefit are their constituents. Federal exchange subsidies are available for people earning between 138 percent and 400 percent of the poverty level, or $32,500 to $94,200 for a family of four. According to 2012 exit polls, 42 percent of people with family incomes between $30,000 and $50,000 voted for Mitt Romney; for those earning between $50,000 and $100,000, the share was 52 percent. If Republican governors think stonewalling exchanges hurts only Democrats, they’re wrong.
Then there are the economic reasons: States with weak exchanges could become less attractive to businesses. John Hickenlooper, the Democratic governor of Colorado, said this week that his state supports its insurance exchange in part to help small businesses, which want healthy and productive workers.
Finally, and most compellingly, there is the human reason – – rather, 25 million human reasons. Well-run exchanges will make getting health insurance easier and more affordable. Even philosophical opponents of the Patient Protection and Affordable Care Act must concede this practical point. Obamacare also happens to be the law of the land.
Some Republican governors have already accepted a role in their exchanges. Iowa and Michigan are partnering with the federal government, while Idaho, Nevada and New Mexico agreed to build their own. It’s too late for other states to follow those courses, but there are still meaningful steps they could take.
One thing they can do is smooth the path for “navigators” – – people or organizations that will help others shop for insurance on the exchanges. Florida requires navigators to register with the state, and Pennsylvania is considering a similar move. This should be fine as long as registration is quick and straightforward.
States should also build solid lines of communication between the exchanges and state-run programs, especially Medicaid. Exchanges can use the information that states keep about people’s income and insurance status to determine whether they’re eligible for subsidies. Easy access to Medicaid databases will mean fewer errors and faster service for people in both programs.
State insurance regulators, who have the authority to approve insurance plans sold on federally run exchanges, can do their part by monitoring the participating insurance plans aggressively enough to keep rates down.
Perhaps the single biggest thing Republican officials could do is simply be ready and willing to address the inevitable hiccups. If states look for ways to stall progress, they’ll find them. Conversely, if governors who oppose the law nonetheless direct their officials to cooperate, the exchanges are more likely to survive those hiccups.
Governors could set a positive tone by reminding their residents that the exchanges are coming. Instead of saying the exchanges “are not going to work,” as Texas Governor Rick Perry did in December, they should encourage their constituents to see whether they’re eligible for subsidies. It doesn’t need to cost the states anything.
By: The Editors, Bloomberg, June 20, 2013
“They Won’t Be Moving On”: What Will Republicans Do if Obamacare Turns Out OK?
Ramesh Ponnuru has a long piece at National Review imploring conservatives to come up with a health-care plan they can swiftly put in place when Obamacare inevitably collapses under the weight of its disastrous big-government delusions. Though I disagree with almost every point Ponnuru makes along the way, from his analysis of what will happen with Obamacare to his recommendations of what a conservative health-insurance system should look like (the fact that anyone, even a free-market dogmatist, thinks catastrophic coverage plus high-risk pools would work out great is just incredible), I’ll give him credit for trying to get his ideological brethren to come up with a proposal to solve what they themselves keep saying is a terrible problem. But alas, his effort is doomed to fail. Why? Because when it comes to health care, conservatives just don’t care. I’ll elaborate in a moment, but here’s the crux of Ponnuru’s argument:
Opponents of Obamacare should plan instead for the likelihood that in its first years of full operation the law will fail in undramatic and unspectacular ways. Premium increases, cost overruns, and the like may keep the law from becoming popular, but they will not prompt the third of the public that supports it to switch sides, or even get its many soft opponents fired up about it. Meanwhile, the administration will spend millions of taxpayer dollars to advertise the law’s benefits. The law’s dogged defenders will explain away all the disappointing developments, and the polls, as the result of continuing opposition in red states. A few conservative lawmakers have speculated that the law will crash so badly that the Democrats will themselves demand repeal in the next couple of years. That is not the way to bet.
Republicans’ confidence that Obamacare will collapse has contributed to their lassitude in coming up with an alternative. It is a perverse complacency. If the program were going to collapse in the next three years, it would be all the more important for Republicans to build the case for a replacement for it. We can be sure that the Left would respond to any such collapse by making the case for a “single payer” program in which the federal government directly provides everyone insurance.
The biggest problem with this kind of appeal is that he will never, ever get anything beyond a tiny number of Republicans to invest any effort in coming up with a health-care plan. That would involve understanding a complex topic, weighing competing values and considerations against one another, and eventually getting behind something that will be something of a compromise. And let me say it again: They. Just. Don’t. Care.
That isn’t to say there are no conservatives who care about health care, because there are a few (like the folks at the Heritage Foundation who came up with the individual mandate!). But they are few and far between on the right. Your typical Republican, on the other hand, cares deeply about issues like taxes and defense policy, and works hard to understand them and come up with ideas for where they should go in the future. But had President Obama not passed health-care reform, they would have been perfectly happy to let the status quo continue indefinitely. They donned their fervent opposition to Obamacare like a new jacket, for reasons of politics, not policy. Sure, it was in many ways a conservative plan, much of whose complexity comes from the fact that it works to expand coverage within the private market. But it was big and important, and it was Obama, and it was a way to articulate their anti-government philosophy, and so they got fired up about it. But it isn’t because health-care policy is something they’re passionate about. Republicans care about taxes whether or not at the moment we happen to be having a big public debate about taxes. But if we weren’t debating health care, they wouldn’t be staying up nights coming up with interesting solutions to health-care problems, because it just isn’t their thing.
Ponnuru doesn’t allow for the possibility that Obamacare will turn out to be something less than a total failure, and he says that conservatives all believe the same thing (though he does differ from some of his allies on whether it will collapse dramatically or simply limp miserably along). But let me suggest another possible scenario: It ends up working pretty well. It doesn’t turn America into a health-care paradise, and there are some implementation problems here and there, and we still have to pay more for our system than other countries do. But people like the fact that their coverage is guaranteed, and the doomsaying turns out not to be borne out. Critically, the middle class and wealthy people who collectively hold political influence discover that their lives haven’t really been changed all that much, except in some ways that are positive. And it becomes hard to get voters too angry about Obamacare.
What will Republicans do then, if the issue doesn’t seem to have much political potency? Will they keep working to come up with new health-care proposals more in line with their values? Or will they move on to some other issues that seem to offer better opportunities to gain political advantage? If you think it’s the former, you’re dreaming.
By: Paul Waldman, Contributing Editor, The American Prospect, June 13, 2013
“Reverse Sticker Shock”: Reality-Based Evidence On Obamacare In California Amidst All The GOP Hysteria
For months now we’ve been told that the Affordable Care Act would produce a cataclysm of skyrocketing health insurance premiums, particularly in the individual insurance markets that the law most affects. Earlier this week alarms were raised particularly in California with the news that three major insurance companies had decided against participating in the health care exchanges that would offer Obamacare coverage.
So it’s a bit of a shock–sort of a reverse sticker shock–today to learn that preliminary assessments of the cost of the new, improved (because subject to new minimum coverage requirements) policies in California once the exchanges are up and running will in most cases be lower than what citizens of this high-cost state are accustomed to paying. TNR’s Jonathan Cohn summarizes the news:
Based on the premiums that insurers have submitted for final regulatory approval, the majority of Californians buying coverage on the state’s new insurance exchange will be paying less—in many cases, far less—than they would pay for equivalent coverage today. And while a minority will still end up writing bigger premium checks than they do now, even they won’t be paying outrageous amounts. Meanwhile, all of these consumers will have access to the kind of comprehensive benefits that are frequently unavailable today, at any price, because of the way insurers try to avoid the old and the sick.
Sarah Kliff of Wonkblog has more details:
Health insurers will charge 25-year-olds between $142 and $190 per month for a bare-bones health plan in Los Angeles.
A 40-year-old in San Francisco who wants a top-of-the-line plan would receive a bill between $451 and $525. Downgrade to a less robust option, and premiums fall as low as $221.
These premium rates, released Thursday, help answer one of the biggest questions about Obamacare: How much health insurance will cost. They do so in California, the state with 7.1 million uninsured residents, more than any other place in the country.
Multiple projections expected premiums to be relatively high.
The Congressional Budget Office predicted back in November 2009 that a medium-cost plan on the health exchange – known as a “silver plan” – would have an annual premium of $5,200. A separate report from actuarial firm Milliman projected that, in California, the average silver plan would have a $450 monthly premium.
Now we have California’s rates, and they appear to be significantly less expensive than what forecasters expected.
On average, the most affordable “silver plan” – which covers 70 percent of the average subscriber’s medical costs – comes with a $276 monthly premium.
Such numbers, it is important to note, do not reflect the actual cost to the estimated 2.6 million Californians who will qualify for Obamacare tax subsidies (available to those with incomes up to 400% of the federal poverty rate).
One of the “horror stories” we’ve been hearing from Obamacare opponents for years now is that the whole scheme will collapse once healthy, low-income young people realize they’ll face large news costs for the kind of minimum high-deductible catastrophic coverage they actually need. They’ll bail, it has been suggested, not only from Obamacare (screwing up the broad-based risk pools that make affordable coverage for older and sicker people possible), but from Obama’s political coalition as well. So this comment from Kliff about the California numbers is worth noting:
For a less robust “bronze” plan, which covers 60 percent of the average beneficiary’s costs, the tax credit could actually cover the entire premium for low-income twenty-somethings.
None of this should really be that surprising; the idea that a broader pool plus competition and guaranteed benefits would provide a better bargain (plus vastly greater security) for consumers in the individual market was central to the entire Affordable Care Act architecture. But it’s taken a while for facts to catch up with all the negative agitprop. It won’t keep House Republicans from voting to repeal the entire law a 38th or 39th or 40th time before the bulk of the Affordable Care Act becomes effective next year. Still, it’s nice to see some reality-based evidence amidst all the hysteria.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, May 24, 2013
The Unending War On Obamacare: Count On Republicans To Stand In The Way Of Fixing Whatever’s Wrong With It
I’m not a historian, so maybe there’s something I don’t know, but it seems to me that there may never have been a piece of legislation that has inspired such partisan venom as the Affordable Care Act. Sure, Republicans hated Medicare. And yes, their rhetoric at the time, particularly Ronald Reagan’s famous warning that if it passed, “We are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free,” was very similar to what they now say about Obamacare. But once it passed, their attempts to undermine it ran more to the occasional raid than the ongoing siege.
I bring this up because Kevin Drum makes an unsettling point today about the future of Obamacare:
No, my biggest concern is what happens after 2014. No big law is ever perfect. But what normally happens is that it gets tweaked over time. Sometimes this is done via agency rules, other times via minor amendments in Congress. It’s routine. But Obamacare has become such a political bomb that it’s not clear that Congress will be willing to fix the minor problems that crop up over time. There’s simply too big a contingent of Republicans who are eager to see Obamacare fail and are actively delighted whenever a problem crops up. This has the potential to be a problem that no other big law has ever had to face.
It’s hard to overstate just how enormous a symbolic presence Obamacare has come to occupy in Republicans’ minds. They’ve invested so much time in not just criticizing it but telling their constituents that it is the worst thing to ever happen to America—and yes, sometimes they literally say things like that—that they’ve lost all moral perspective. To them, trying to fix a feature of the law so that it works better or helps people more would be a horrifying moral compromise, tantamount to sending fur coats to the guards at Stalin’s labor camps in Siberia. If you say to them, “Look, it’s the law now—why don’t we make sure it works as well as possible?” it just won’t register.
Combine that with the fact that in general, congressional Republicans have stopped caring much about policy at all, and they never cared about health care in the first place. They don’t want to know the details of issues; it just isn’t their priority. In the House, conservatives are spending their time clamoring for an opportunity to cast yet another vote to repeal Obamacare. “The guys who have been up here the last two years, we can go home and say, ‘Listen, we voted 36 different times to repeal or replace ObamaCare,” said Mick Mulvaney of South Carolina. “Tell me what the new guys are supposed to say?” Your tax dollars at work.
You can look at this state of affairs and assume that as new difficulties with the law come to light, it will be possible for the Obama administration to address them with administrative action, through the Department of Health and Human Services. And that may be true to an extent. But other changes could require legislation, and it’s a fair bet that no matter what is involved, Republicans in Congress would reject anything having to do with the law that didn’t involve repealing it. You could tell them that there was a typo in the bill which was causing orphans to be turned into Soylent Green and all it would require to fix was a quick voice-vote, and they’d say no, because Obamacare kills freedom.
And let’s not forget, it’s entirely possible that 45 months from now, there will be a Republican president. If that happens, it’s possible that in order to get confirmed, his or her nominee to be secretary of Health and Human Services will have to pledge to Senate Republicans to work every day to dismantle Obamacare. The clock is ticking.
By: Paul Waldman, Contributing Editor, The American Prospect, April 25, 2013
“Bullet Backdrops”: Arkansas Republican “Most Likely Won’t Try To Kill” Lawmakers Who Support Medicaid Expansion
Arkansas may become the first red state to accept the Obamacare Medicaid expansion, which the Supreme Court made optional in its decision last year, if the Department of Health and Human Services accepts its privatized plan.
(Of course, the states turning down Medicaid expansion are generally the ones that need it most.)
The notion of expanding government to improve health care outcomes apparently drove Chris Nogy of the Benton County Republican Committee a little nutty. In a recent newsletter, he encouraged his fellow Republicans to seek “Second Amendment” solutions against those who had voted for the expansion, and expressed dismay that he can’t actually back up these threats:
We need to let those who will come in the future to represent us [know] that we are serious. The 2nd amendment means nothing unless those in power believe you would have no problem simply walking up and shooting them if they got too far out of line and stopped responding as representatives. It seems that we are unable to muster that belief in any of our representatives on a state or federal level, but we have to have something, something costly, something that they will fear that we will use if they step out of line. If we can’t shoot them, we have to at least be firm in our threat to take immediate action against them politically, socially, and civically if they screw up on something this big. Personally, I think a gun is quicker and more merciful, but hey, we can’t.
Nogy’s wife is the group’s secretary and she claims the article was placed in the newsletter without her husband’s approval.
Medicaid expansion will provide health insurance for up to 250,000 Arkansans, ultimately saving dozens if not hundreds of lives, while driving down the costs of the state’s insured — who already subsidize the uninsured through higher rates.
Most of Arkansas’ estimated uninsured 401,100 are working families who simply can’t afford coverage.
Several Arkansas Republicans made it clear that they were appalled by Nogy’s comments.
“I’m embarrassed for the Benton County Republican Committee for including this article in their newsletter,” said State Senator Jon Woods (R). “I would think the Benton County Committee would have better judgment and not allow this to be sent out.”
The Benton County Republican Committee offered a statement:
“The letter was not approved and Mr. Nogy had no authority to submit it through the newsletter. As a committee, we respect the right of our legislators to vote based on their knowledge and feedback from the voters they represent. We will discuss this issue further with our executive committee.”
Nogy later clarified his comments in a letter to KFSM News.
He explained why he is more angry at Republicans than Democrats:
I don’t feel the same way about the Democrats as bullet backstops as I do about the Republicans who joined them. The Democrats were doing what their party told them they had to do because they were elected to do that job.
He concluded by saying that his threats were only meant to attract attention and he “most likely” won’t kill those Republicans who supported the Obamacare provision. He simply thought it was important to put a face behind his threats so lawmakers will take him seriously:
And for the record, I didn’t advocate violence. I mentioned violence to get people’s attention, and it worked. I advocated a serious political and social stand, an assured and significant negative response to any politician who breaks a primary voter/elected official promise contract. We have only one mechanism to maintain the ‘government of the people, by the people, and for the people’, and that is to elect those who promise to do as we demand they do. If we cannot make these people understand that we will not tolerate this kind of breach of contract, then we lose our ability as the people to control the government. And in this age of death threats from nameless, faceless thugs, we need these folks to know that while we most likely won’t try to kill them or harm their families, they should be much more certain of our response than fearful of the actions of those who will not identify themselves.
The contentious battle over expansion has shown that Republicans are eager to take the federal funds without getting any Obama on them. Lawmakers are so afraid to be caught pandering to the president or “takers” that they’ve officially declared that Medicaid expansion is not an entitlement.
Mr. Nogy should be happy to know that another feature of Obamacare is mental health parity.
By: Jason Sattler, The National Memo, April 22, 2013
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