“Self-Interested Plutocracy”: Desperate Republicans Are Terrified That Obamacare Will Succeed
Even acknowledging that our national politics have become increasingly contentious, here’s a development that is really odd: Two billionaire brothers are spending millions of dollars to try to persuade young Americans not to buy health insurance. What’s up with that?
The industrialist Koch brothers, David and Charles, are among the very richest Americans — indeed, among the very richest people on the planet. They are not merely members of the 1 percent; they’re in the topmost fraction of the 1 percent.
That means that they not only can afford to buy health insurance for themselves, but they can also buy physicians, hospitals, medical labs and pharmacies if they choose to do so. They have access to the very best medical care that money can buy — and, in America, that’s the difference between life and death.
But unlike, say, Bill Gates, the founder of Microsoft, the Koch brothers have not concerned themselves with trying to make life a bit more comfortable and pleasant for others. Oh, no. The Koch brothers are the very stereotype of the greedy and selfish hyper-rich, the poster boys for self-interested plutocracy. They want to control the country’s politics — no matter who gets hurt in their grab for power.
That’s why they’ve funded ultraconservative candidates and political causes over the past couple of decades. Their to-do list includes aiding the effort to torpedo the Patient Protection and Affordable Care Act, popularly known as Obamacare. Among the political groups they fund is an outfit called Generation Opportunity, which is running a creepy ad to persuade young women of a lie: that Obamacare comes between a patient and her physician.
The Koch brothers know that the new health care paradigm depends on enlisting healthy young adults — people who tend to take the risk that they don’t need health insurance — into the system. If they don’t sign up, the new exchanges won’t have enough vigorous and youthful Americans to help pay the way for the sick and frail. Insurance companies need to be able to spread the costs around so they don’t go bankrupt trying to care for the ailing.
But the Koch brothers, like most conservatives, want Obamacare to fail. They are not concerned that the new health care law, which would extend insurance to the vast majority for the first time in history, is a “government takeover” of medicine or a “jobs-killer” or a ruinous new entitlement. None of that is true. (See factcheck.org or PolitiFact.com for actual facts about Obamacare.)
Nope, the real concern of most conservatives is that Obamacare will work, proving popular over the long run. Think about it: If they are so certain that the law will collapse under its own weight, why not step aside and allow it to do so? Why do they need to try to defund it and create creepy ads trying to persuade young people not to buy in? Why did they warn the National Football League not to promote the new health care exchanges?
If Obamacare succeeds, the generations-long conservative war against activist government would have lost another major battle, and more voters would be persuaded to vote for progressives. That’s the reason conservatives went all-out to defeat President Clinton’s similar health care proposal during his first term.
As Weekly Standard editor William Kristol, then fresh off his stint as Vice President Dan Quayle’s chief of staff, wrote in 1993: “… the long-term political effects of a successful Clinton health care bill will … relegitimize middle-class dependence for ‘security’ on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests.”
There you have it. They don’t dare allow Obamacare to proceed unimpeded because Americans might come to like it and depend on it, as the elderly like and depend on Medicare. Indeed, conservatives, including Ronald Reagan, fought the creation of Medicare, claiming it was pure socialism.
Meanwhile, the Americans who would suffer most if Obamacare doesn’t succeed are those without health insurance or the promise of decent medical care. That includes the young adults who could be victims of terrible accidents or unforeseen diseases. Not that the Koch brothers care about them.
By: Cynthia Tucker, The National Memo, September 28, 2013
“Wildly Misleading Pernicious Ads”: Sabotaging Health Care, One Lie At A Time
A Koch-brothers funded conservative group, Generation Opportunity, is out with a wildly misleading, pernicious set of ads aimed at sabotaging the Affordable Care Act by discouraging young people from signing up for health insurance exchanges.
One’s aimed at young men, the other at young women. In the “for him” version, an actor tells his doctor that he saw an ad for the Affordable Care Act and “figured, why not?” The doctor tells him to take his pants off, “hop up here, lay down and bend your knees to your chest.” He leaves the room. Then a man wearing an Uncle Sam mask snaps on a blue glove. As if the message weren’t perfectly clear, the ad states: “Don’t let government play doctor.”
The “for her” version is much the same, except in that case Uncle Sam’s performing a gynecological exam.
The ads are as offensive as they are derivative.
During the 2012 campaign, the reproductive rights site Lady Parts Justice released a web video attacking laws requiring women to undergo medically unnecessary ultrasounds before receiving abortions. In that spot, a woman with her feet in stirrups explains that she wants an abortion because she’s “just not emotionally or financially ready to have kids right now.” The doctor, sitting between her legs, responds, “OK, well, just so you know, the law says that before I can do that, I need to do some things to you that you need to pay extra for. You know, just some things that will help you better understand what it is you really want.” These “things” include inserting a camera into her vagina and looking at pictures of what’s inside her uterus.
But that video made sense—states actually did pass laws interfering with the doctor-patient relationship—whereas the Generation Opportunity ads perpetuate outright lies. Young people who sign up for exchanges won’t be getting access to government-run healthcare (if only they were!), but to privately run insurance. Nor does the A.C.A. force doctors to ask patients about their sex lives or perform unwanted exams—as Politifact explained recently. Under the A.C.A., government doesn’t “play doctor,” it merely enables access to doctors who then decide, using their professional judgment, the best course of action.
Signing up for an exchange isn’t an act of political (or sexual) submission. It’s just a way to get insurance if you don’t have a job or your employer doesn’t provide it. The Generation Opportunity crowd surely knows that and obviously doesn’t care because its priority now, as ever, is bringing down President Obama’s signature domestic accomplishment. The group also doesn’t care about the possibility that some number of young people, scared by its ads, will forego access to affordable care, get sick, and go bankrupt paying their medical bills.
By: Julie Lapidos, Opinion Pages Editor’s Blog, The New York Times, September 23, 2013
“The Obamacare Is Falling! The Obamacare Is Falling!”: Here Are The Reasons You Shouldn’t Believe Any Of It
As we approach the full implementation of the Affordable Care Act at the end of the year, confusion still reigns. Most Americans don’t understand what the ACA does or how it works, which is perhaps understandable. It is, after all, an exceedingly complex law, and from even before it passed there was an aggressive and well-funded campaign of misinformation meant to confuse and deceive Americans about it, a campaign that continues to this day and shows no sign of abating. To undo uncertainty and banish befuddlement, we offer answers to a few questions you might have about Obamacare.
What’s Happening When?
The next important date is October 1, when open enrollment for insurance plans on the new exchanges begins. Those who sign up will begin their new insurance on January 1, when the rest of the high-profile components of the law take effect. The individual mandate, requiring everyone to carry insurance or pay a fine, takes effect, as does the rule forbidding insurance companies from denying anyone coverage (or charging them exorbitant premiums) because of pre-existing conditions. In fact, after January 1 the entire notion of the “pre-existing condition” will become nothing but a historical curiosity, a feature of the dark past we’ve moved beyond. Insurance companies will also be forbidden from imposing annual limits on what people are covered for (an accompanying ban on lifetime limits is already in effect). Tax credits for small businesses to offer their employees insurance will be expanded, and millions of low-income Americans will be eligible to be covered through Medicaid. While we talk about January 1, 2014 as the date of full implementation, dozens of provisions have already gone into effect, from free preventive care to expanded coverage for young adults to the closing of the Medicare prescription drug “donut hole” (you can read a comprehensive implementation timeline here if you’re so inclined).
How Many States Are Expanding Medicaid?
There is probably no provision of the ACA that will have a more immediate and profound impact on as many people’s lives as the expansion of Medicaid. In the current system, each state determines how poor you have to be to become eligible for the joint federal-state program, but under the ACA anyone with an income up to 133 percent of the federal poverty level would be eligible. Unfortunately, the Supreme Court declared that states could refuse to accept the expansion, and many states dominated by Republicans couldn’t wait to say “no” to Barack Obama and to their own poor citizens who desperately need insurance, even though the federal government will be picking up almost all of the tab.
The cruel irony is that many of the states refusing the expansion are those that have the largest proportion of poor people who could benefit, and are already the stingiest with Medicaid eligibility. For instance, in Texas, a working adult with children can’t be covered in Medicaid if her income exceeds 25 percent of the poverty level. So a single mother with three children who makes over $5,888 a year is considered too wealthy to get Medicaid. In Alabama it’s 23 percent; in Louisiana it’s 24 percent. These are all states with high rates of poverty, and states where the Republican governors and legislatures have refused to accept the money the federal government is offering to expand Medicaid. In these states, if you’re a middle-income person, you’ll be able to get government subsidies through the new health-care exchanges, but if you’re poor but not quite desperately poor enough to fall below the Scroogian eligibility limits, you’ll get no help at all. These states have essentially cut off their noses to spite Barack Obama’s face, giving up billions in federal money, a reduction in uncompensated care they end up paying for, and a healthier and more productive populace, all so they can give the finger to the President.
When you look at map of which states are accepting the Medicaid expansion, with just a few exceptions it looks a lot like an electoral college map, with Republican states saying no and Democratic states saying yes:
In just the last few weeks, Michigan has decided to accept the expansion, and Pennsylvania has proposed to take the federal money but use it to give low-income citizens private insurance (the Department of Health and Human Services has to approve such a plan). That will bring the total to 25 states plus the District of Columbia accepting the expansion, with another four (Indiana, Tennessee, Ohio, and New Hampshire) still debating the issue. After the Supreme Court’s decision, many predicted that even Republican-dominated states would find the money the government is offering too good to pass up. So far it hasn’t happened, meaning millions of poor Americans who live in Republican states are out of luck. And you’ll be shocked to learn that the poor in these states, mostly in the South, are disproportionately black.
What’s Up With The Exchanges?
Setting up a health-care exchange requires time, effort, and some minimal level of concern for seeing your citizens be able to take advantage of the ACA’s benefits. So it isn’t surprising that nearly all the Republican states that said no to the Medicaid expansion also didn’t choose to bother setting up their own exchange. In the end, 17 states (including D.C.) decided to do it themselves. Another nine are partnering with the federal government on an exchange, leaving 25 states that have left the process entirely to the federal government. This certainly makes HHS’s job harder, but no one yet knows how well those federally-run exchanges will work. All of those 25 have Republican governors, legislatures, or in most cases, both.
One potential pitfall is that in many of those Republican-run states, the state government is taking active steps to sabotage the exchanges, particularly by making the work of the “navigators” as difficult as possible. These are local groups, like universities, hospitals, churches, and the like, who have gotten federal grants and training to help people find their way through the process of getting insurance through the exchange. For example, Georgia is forcing navigators to get special state licenses (the Republican state insurance commissioner pledged to do “everything in our power to be an obstructionist”); Florida has banned them from the grounds of state health facilities. It remains to be seen just how much of an impact the sabotage efforts will have.
Are My Premiums Going To Go Up?
The answer to that question can be summed up as 1) It’s complicated, and 2) It depends. If like most people you get insurance through your employer (or your spouse’s), things probably won’t change for you. Your premiums have risen steadily in recent years, and in the short term, they’ll probably continue to rise. Nevertheless, recent data show a dramatic slowdown in the rate of increase. Last year, premiums rose by 4 percent, half of the 8 percent per year average of the last decade. That mirrors a slowdown in overall health spending. In other words, that curve the ACA was designed to bend is already bending.
If you’re now on the individual market (or uninsured) and you’ll be buying insurance on the exchanges, how much you pay will depend on how old you are, where you live, what your income is, and what plan you choose. If you make less than 400 percent of the poverty level you’ll get a subsidy so that your premium doesn’t rise above a certain percentage of your income; if you want to try to figure out now what it would be, you can read this report to get an idea of what you might pay. While we can’t make any sweeping statements that apply to everybody, there will certainly be a lot of people who find that insurance is more affordable than they thought. On Monday, the Department of Health and Human Services released a report showing that because of the subsidies, 6.4 million people would be able to buy insurance through the exchanges for less than $100 a month. As one Rand Corporation study concluded, “after accounting for tax credits, average out-of-pocket premium spending in the nongroup market is estimated to decline or remain unchanged.” While there are some people who could pay more than they do now—say, young people who make too much to qualify for subsidies, used to have bare-bones insurance, and are now getting one of the more comprehensive plans available through an exchange—overall it doesn’t appear that the threats of “rate shock” will be borne out.
How Many People Are Going To Get Insurance Who Didn’t Have It Before?
This is also a difficult question to answer precisely, because there are a few unknowns. First, over time more states could accept the Medicaid expansion, increasing the number of newly insured people. Second, the fines for those who choose not to carry insurance are quite small, so some people (particularly the young, who are immortal and never get sick) could decide that it’s better to pay a fine that costs less than insurance does, but nobody knows how many of them will. Third, each state will be doing its own outreach to sign people up for the exchanges and for Medicaid; some will inevitably do a better job than others.
All of those variables make precise estimates difficult. One National Bureau of Economic Research experiment to see how uninsured people respond to the cost of getting covered concluded that “75 percent of the uninsured are projected to enroll, implying that 39 million individuals would gain coverage as a result of the law.” The Congressional Budget Office, on the other hand, projects that the ACA will reduce the ranks of the uninsured by 25 million. One thing we can say is that though tens of millions will probably become newly insured, there will still be millions of uninsured people in America. One of the main tasks in coming years will be getting that number as close to zero as we can.
Are There Going To Be Terrible Effects On The Economy?
If you’ve been paying attention to health-care news, you’ve probably seen stories featuring an employer who has 49 employees and says he’d love to hire more people, but since Obamacare’s employer mandate kicks in at 50 employees and he’d have to offer health coverage if he hired anybody else, he won’t do it. It’s quite remarkable how reporters always seem to find that business with just under 50 employees (my suspicion is that the National Federation of Independent Business, a conservative small-business group, finds them, recruits them, and passes them along to journalists). But the truth is that they’re extremely rare. According to the Kaiser Family Foundation, 93 percent of companies that size already offer health benefits, even before the law’s requirements kick in. And the administration has delayed the employer mandate by a year anyway.
Another charge is that employers everywhere are cutting employees’ hours below 30 per week, the level at which the mandate will eventually kick in, so they don’t qualify as full-time. While there are certainly employers who have done this, there’s little evidence it’s happening on a large scale. The number of workers just below that 30-hour cutoff is tiny to begin with and didn’t increase as the original date for the mandate approached. If employers were rushing to cut workers’ hours, those numbers would be large and growing; instead, the opposite is true.
You could condemn an employer who figures out a way to avoid giving her workers health benefits, even if not all of them are as repulsive as John Schnatter, the CEO of Papa John’s, who whined that if he had to give his employees health coverage it could raise the price of a pizza by as much as a shocking 14 cents. But one of the main things the ACA was meant to accomplish was to make those employer decisions less damaging to employees. “Job lock,” where you’re forced to keep a job you’d rather leave in order to hold on to your insurance, will be a thing of the past. And now that affordable insurance will be available to anyone regardless of whether they’ve been sick before, employers can decide to drop insurance without necessarily hurting their employees.
To see how, consider this story. Last week, Trader Joe’s announced that it would no longer be offering coverage for its employees who work less than 30 hours per week. Instead, it will give them $500 and send them to the exchanges. This seemed surprising, since Trader Joe’s is known for being an employee-friendly company. But as the company argues pretty persuasively, employees at that level are likely to get a better deal through an exchange than through their company policy when subsidies are factored in (and of course, the company will save money). We might see this pattern repeated with other employers. But would that be a bad thing? If an employee gets equivalent coverage for less money on an exchange, then they’ve effectively gotten a raise. Companies save money, which allows them to either raise salaries or hire more people. On the other hand, there is a cost to the federal budget of more people getting subsidies, but that may be a cost we’re willing to pay. It may be some time before we know how common an occurrence this is and what effect it’s having on the economy and the budget.
Is Obamacare Going To Make Doctors Quiz Me About Who I’m Sleeping With?
Here’s a good tip: if you read a story with a crazy new allegation about what the Affordable Care Act is going to do to you, there’s a good chance two things are true. First, it’s false. Second, Betsy McCaughey probably had something to do with it. She’s the woman who gave us “death panels,” and her latest bit of crazy is to try to convince you that because of Obamacare, doctors are suddenly being forced to ask you inappropriate questions about your sex life (this is a pattern you’ll become familiar with: she takes an ordinary feature of health care, like the fact that questions about sex are standard practice when taking a medical history, and makes it sound both sinister and a product of Obamacare). You can decide whether this kind of thing is just silly or pernicious and generally despicable (I lean toward the latter), but don’t be surprised if we see a whole round of new allegations like this one. Conservatives failed to stop the ACA from being passed into law, then failed to get it overturned in the Supreme Court, then failed to win the election that would have allowed them to repeal it. They will almost certainly get increasingly desperate after January 1st when the law is implemented and we don’t all suddenly find ourselves standing in breadlines wearing gray sackcloth, our spirits broken by the socialist hellhole into which we’ve descended. So who knows what they’ll come up with.
By: Paul Waldman, Contributing Editor, The American Prospect, September 20, 2013
“Working Together To Screw People Over”: The Republican Team Effort On Obamacare Obstruction
When it comes to the Affordable Care Act, you have to give Republicans credit for sheer sticktoitiveness. They tried to defeat the law, but it passed. They tried to get the Supreme Court to declare it unconstitutional, but that didn’t work. So now, as the open-enrollment period for the exchanges approaches on October 1, they’re thinking creatively to find new ways to sabotage the law. Sure, at this point that means screwing over people who need insurance, but sometimes there’s unavoidable collateral damage when you’re fighting a war.
Their latest target is the Obamacare “navigators.” Because not just the law but the insurance market itself can be pretty complicated, the ACA included money to train and support people whose job it would be to help people get through this new system, answering consumers’ questions and guiding them through the process. Grants have been given to hospitals, community groups, charities like the United Way, churches, and the like in the 34 states that are relying on the federal government to operate their exchanges in whole or in part. You can see the problem: If there are folks out there helping people get health coverage, that will mean that people will get health coverage. And that won’t do.
So Republicans are implementing a joint federal-state subversion campaign. On the federal level, Republicans on the House Energy and Commerce Committee have sent threatening letters to recipients of the navigator grants, demanding copious documentation on everything they’ve done having anything to do with the program (Jonathan Cohn explains here). Not because there’s been any suggestion of fraud or incompetence—don’t forget, at this point all the navigators have been doing is getting ready for open enrollment when they’ll have to start helping people—but on the apparent theory that if you can harass them enough, it’ll keep them from doing their jobs.
Meanwhile, on the state level, Republicans are finding whatever ways they can to get in the navigators’ way. Just get a load of this despicable toad: http://youtu.be/0fm-2J4F4v4
That’s Georgia Insurance Commissioner Ralph Hudgens, a former chemical company salesman and Republican state legislator, who I guess ran for insurance commissioner because he cares so much about people. He explains how when it comes to Obamacare, he’s doing “everything in our power to be an obstructionist.” He then explains, to the laughs and cheers of this Republican crowd, how a new law requires the navigators to get licensed by his department, with the clear implication that they’ll make it as difficult as possible.
In fact, 16 Republican-controlled states have passed laws imposing requirements on the navigators over and above what the federal government is already requiring. And guess who’s writing these laws? Lobbyists for insurance agents and brokers, who worry they’ll lose business if people can just call up a toll-free number and have somebody explain to them how to get insurance on their state’s exchange.
Remember, what they’re trying to do here is make it as hard as possible for people to get insurance. It’s as simple as that. The more people they can keep from getting insurance, in this case by keeping them from getting the information they need to buy insurance on the exchanges, the easier it will be for them to argue that the Affordable Care Act is a failure. And what about the human suffering that will cause if they’re successful? The diseases that go undiagnosed because people avoid going to the doctor, the uninsured families bankrupted when struck with an accident or illness? Too bad. Because screw you, Obama.
By: Paul Waldman, Contributing Editor, The American Prospect, September 4, 2013
“A Thuggish Abuse Of Power”: Republicans’ Devious Plan To Slow Down Obamacare Enrollment
Republican lawmakers who had criticized the Internal Revenue Service (IRS) for improperly targeting conservative nonprofits for additional scrutiny kicked off an investigation last week into community-based groups who received Navigator grants to help uninsured people enroll in the exchanges established by the Affordable Care Act, demanding that the organizations answer detailed questions and produce thousands of reams of documents.
Fifteen Republican members of the House Committee on Energy and Commerce, including Chairman Fred Upton (R-MI), are requesting detailed responses and thousands of pages of documents from approximately 60 percent of Navigator-recipients across the country by Sep. 13.
The tactic is reminiscent of the kind of practices Republicans had condemned over the summer, after news broke that the IRS subjected certain groups applying for 501 C4 nonprofit tax status to long, intrusive, questionnaires about their filings. Upton personally called such tactics a “thuggish abuse of power” and “simply un-American.”
But according to the GOP-backed letter, groups scrambling to begin enrolling individuals in coverage on Oct. 1, will have just two weeks to provide detailed written descriptions of their employees and activities, interactions with the Department of Health and Human Services, and “all documentation and communication related to your grant.”
Last month, the Obama administration distributed $67 million in federal grants to more than 100 hospitals, universities, Indian tribes, patient advocacy groups and local food banks “to help people sign up for coverage in new online health insurance marketplaces.”
The effort is just the latest attempt by Republicans to undermine enrollment in the Affordable Care Act. Republicans on the Energy and Commerce Committee have previously sent letters seeking information to entities tasked with educating the public about the law, opened investigations into public relations companies that had been contracted to promote the law on popular television shows, and warned the National Football League (NFL) and National Basketball Association (NBA) against encouraging enrollment in the law.
An HHS spokesperson strongly condemned the committee’s request to Politico, noting, “This is a blatant and shameful attempt to intimidate groups who will be working to inform Americans about their new health insurance options and help them enroll in coverage, just like Medicare counselors have been doing for years.”
By: Igor Volsky, Think Progress, September 3, 2013
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