“Running On Empty”: Republicans Can’t Repeal Or Replace Obamacare, And They’re Too Scared To Fix It
More than three million people have already signed up for health insurance as of last Friday through the exchanges set up by the Affordable Care Act (ACA). That number is growing rapidly, with 15,000 new enrollments a day in California alone.
And the Republican plan to deal with Obamacare generally remains what it has been since 2010 — repeal.
This means the millions of men, women and children covered under plans could either see their plans invalidated by insurance companies no longer required to cover pre-existing conditions or have their Medicaid coverage completely erased. Republicans who spent the last three months screaming about how terrible insurance cancelations are would have to explain what happens next for millions of uninsured Americans.
Repeal is a fantasy, a fundraising opportunity that all Republicans — except the few who take Senator Ted Cruz (R-TX) seriously — know would never happen. And if it did, they would end up owning every aspect of a crumbling health care system the same way Democrats are currently responsible for every splinter in every tongue depressor.
The Washington Post‘s Greg Sargent looks at recent polling and finds that though Americans are largely dissatisfied with the rollout of the Affordable Care Act, they generally support the federal government’s taking a role in getting people affordable health insurance. More importantly, most are still willing to give the law a chance.
“Only 37 percent support repealing Obamacare entirely,” he writes, “while 53 percent say there are good things in the law and that changes are needed to make it work better.”
Republicans are now in what Sargent calls “The GOP Repeal Trap,” which essentially requires them to vow repeal and pray that somehow the law collapses on its own.
While it may seem absurd to those who care about governing, it makes perfect sense strategically because ”replace” is an even bigger fantasy than repeal.
Until it became socialism incarnate, the ACA was the conservative reform to the health care system. So to replace it completely, conservatives would need to go further to the right and destroy the entire employer-provided health insurance paradigm that provides about 85 percent of working adults with their coverage.
That’s what the proposal John McCain ran for president on in 2008 would have done, canceling the insurance of about 20 million Americans, four times the number who had to find new coverage under Obamacare.
Are there conservative fixes that could be made to the ACA that Democrats would be willing to trade for reforms of their own?
Health economist Austin Frakt has listed more than a dozen possible conservative-leaning fixes for the law, starting with their all-time favorite, tort reform, which actually would do very little to lower health care costs but would be a huge win for the right in their never-ending war against trial lawyers.
So why doesn’t some brave Republican — say Governor Chris Christie (R-NJ) — step forward with a set of conservative reforms to the ACA?
The answer is easy: Republican primaries.
Michigan Senate candidate Terri Lynn Land suggested that the law would be fixed and was forced to flip-flop on that position in less than 24 hours, likely in fear that she might end up with a Tea Party challenger. Georgia Senate candidate Rep. Jack Kingston did nearly the exact same thing.
Christie is already saddled with being the only 2016 GOP frontrunner who accepted Medicaid expansion. If he became the face of fixing Obamacare, he would be appealing to the majority of voters but antagonizing if not actually declaring war on those in the base who refuse to accept that Obamacare is here to stay, and also refuse to consider any candidate who tells them what they do not want to hear. (Even if the governor could win the primary backed by the business and more independent wings of his party, he could end up inspiring a Tea Partier to run as a third-party candidate, virtually guaranteeing a Democratic victory in 2016.)
For the foreseeable future, Republican candidates — even those in states and districts President Obama won — are stuck running in the general election with the “problematic” stand of wanting to take health insurance from millions, some of whom may actually show up to vote.
And if they win, they can return to blaming President Obama for never making their repeal fantasy come true. It’s the only safe move.
By: Jason Sattler, The National Memo, December 19, 2013
“An Ideological Hurdle They Can’t Clear”: Why There’s No Republican Health Care Plan
Where’s the Republican alternative to the Affordable Care Act? The question is generally best suited for milk cartons – it’s pretty clear GOP officials would love to “repeal” the federal health care law, but we’ve been waiting for years to know what they’d “replace” it with.
This observation is an ongoing point of annoyance for the right, which is quick to argue that a variety of Republicans have presented reform plans of their own. Americans for Tax Reform’s Grover Norquist and Patrick Gleason push the argument in a new Politico piece, and Sen. Pat Toomey (R-Pa.) made a related case in the Republicans’ official weekly address over the weekend.
“There are common-sense, bipartisan solutions to our health care problems that don’t require ObamaCare’s wholesale government take-over of the system,” Toomey said. “Now, in a nutshell, we can make insurance more accessible, more affordable, and more responsive to individuals and families. And put patients and their doctors in charge of health care decisions, instead of politicians and government bureaucrats.” […]
Toomey did not mention a specific proposal, but he voiced support for allowing people to transfer insurance from job to job and purchase it across state lines.
And just like that, we’re reminded all over again why Republicans love to attack what exists, but struggle to craft a credible alternative of their own. Toomey still doesn’t quite understand that the Affordable Care Act is not a “wholesale government take-over” of the health care system, and more importantly, can’t get past the “nutshell” phase of the GOP’s rival policy.
In fairness, it’s worth emphasizing that Republicans did present something resembling a health care plan in 2009. Following up on our previous coverage, GOP officials missed a series of self-imposed deadlines in 2009, but eventually threw together a half-hearted joke – the GOP “policy” largely ignored the uninsured, did nothing for those with pre-existing conditions, and offered nothing for those worried about losing coverage when it’s needed most.
As Matt Yglesias noted at the time, the Republican approach to reform sought to create a system that “works better for people who don’t need health care services, and much worse for people who actually are sick or who become sick in the future. It’s basically a health un-insurance policy.” And as ThinkProgress added, the CBO crunched the numbers and found that the Republican alternative would leave “about 52 million” Americans without access to basic medical care.
Pressed for some kind of alternative to Obamacare, this was the best congressional Republicans could do.
Since then, GOP lawmakers have periodically stepped up with alternatives, all of which looked pretty similar. Indeed, a few months ago, when the Republican Study Committee said they’d finally put together an “Obamacare” rival, Ed Kilgore predicted before its unveiling that the policy would feature high-risk pools, interstate sales, tax credits, tort reform, and entitlement reform. A couple of hours later, the RSC unveiled its proposal and it was … exactly what Kilgore predicted it would be.
Months later, Toomey used his party’s weekly address to reiterate support for the same cliches.
The result is a stunted debate. We don’t have two competing approaches to solving a problem that has plagued the nation for decades; we have one party with a solution and another party that hates the solution but has no serious alternative. And this isn’t likely to change anytime soon – NBC’s First Read reported two weeks ago, “House Republicans wouldn’t commit Tuesday to offering their own formal alternative to the Affordable Care Act, instead vaguely describing their preference for a ‘patient-driven health care system.’”
As for why Republicans have no rival plan, as we discussed in September, there’s no great mystery. Every credible, effective solution requires some combination of regulating the private insurance market and investing in broader coverage for consumers. There’s just no way around that, and as a result, GOP officials are left with an ideological hurdle they simply cannot clear.
And so Republicans spin their wheels, condemning a policy that they used to like – remember, the basic ACA blueprint was a conservative approach to health care reform – while pretending to have an alternative they can’t identify in earnest.
By: Steve Benen, The Maddow Blog, December 16, 2013
“Ending Medicare As We Know It”: Here’s Why There Won’t Be A Republican Alternative To Obamacare
Republicans are sick of people saying they don’t have an alternative to Obamacare.
They have plenty!
And not just, “Don’t get sick! And if you do get sick, die quickly,” as Rep. Alan Grayson (D-FL) said in 2009.
The Republican-controlled House of Representatives just hasn’t voted on even one Obamacare alternative because it’s hard to fit stuff in when you only work 28 hours a week and have to squeeze in all those Obamacare repeals.
But they’re going to fix that problem in 2014, says Rep. Tom Price (R-GA).
The congressman has introduced his Obamacare alternative — the Empowering Patients First Act — three times since 2009. Price’s bill has never been given a vote, even though it has 50 co-sponsors, including the eminent Rep. Michele Bachmann (R-MN).
Price told Fox News that after the first of the year, Republican leaders are going to bring forth a bill that will “unite Republicans around health care issues” because “you can’t beat something with nothing.”
This logic runs contrary to Town Hall‘s Conn Carroll, who believes the House GOP won’t coalesce around one plan or, as he calls it, “a villain to run against.”
This has been the GOP strategy since 2010, and don’t expect it to change, despite the assurances the leadership has given to Rep. Price.
Price’s bill has never been scored by the Congressional Budget Office (CBO). But a former Republican head of the CBO scored it independently and found that it saves trillions of dollars over 10 years and will reduce the uninsured population by 29 percent by 2016.
If this is true, why haven’t Republicans even put it up for a vote?
A quick look at H.R. 2300, the current version of Price’s bill, shows you why the GOP likely won’t propose an alternative to Obamacare — ever.
The bill starts off with Republicans’ favorite health care distractions — tort reform and selling across state lines.
If you eliminated every malpractice claim in America, that would only reduce the costs of our health care system by 1 to 1.5 percent – far less than implementing a public option.
Selling insurance over state lines would just give insurers the chance to sell plans from the state with the fewest regulations. The Washington Post‘s Ezra Klein looked at a CBO report on a bill from 2005 that would have made national sales of state insurance plans possible and found “the legislation would not change the number of insured Americans or save much money, but it would make insurance more expensive for the sick and cheaper for the healthy, and lead to more healthy people with insurance and fewer sick people with insurance.”
The real goal of Price’s bill and just about every Republican reform of the health care system is to end the employer-provided health insurance dynamic that most Americans rely upon. Employers get a generous tax break for providing health coverage that Price would then extend to individuals. The 2009 version of his bill did this in a way that would actually have resulted in a huge tax increase.
But the bigger problem with Price’s plan to sever the employer-employee health insurance relationship and create plans that stay with an individual for life is that it would end up in cancelations of current plans — tens of millions of cancelations.
Republicans could argue that these new plans would be better than the existing plans for various reasons — but that’s an argument they know doesn’t work, because they crushed it when Democrats used it to defend the cancelations that happened after the implementation Obamacare.
Price says his plan would cover people with pre-existing conditions, though it doesn’t include an individual mandate or any incentive to prevent insurers from cherry-picking the healthiest consumers.
“In other words, this looks much like the reforms that collapsed in Texas, and in California,” Klein noted. ”Price isn’t learning from past policy mistakes, and so he means to repeat them.”
The biggest problem with Price’s bill is how it reforms existing public health care programs.
If H.R. 2300 became law, anyone could opt out of Medicare or Medicaid and receive a voucher to purchase private insurance.
We have no idea how many people would opt out of Medicare given the fact that few private insurers see people over 65 as the path to prosperity for their business. But when the growth of Medicare costs is far below that of private insurers, all that voucher would end up being is a ticket to pay far more for health care at the time of your life when it will cost you the most.
And if too many beneficiaries opted out, the entire system of dictating costs to providers in exchange for volume could collapse with devastating effects to our deficit and debt.
The worst part for Republicans is the facet of the law that allows Democrats to make a pretty simple case against the GOP’s Obamacare alternative: It ends Medicare as we know it. The GOP could rebut that assertion by saying that Medicare will still exist for those who want it, but a party that has been shedding senior support all year doesn’t want to have that argument.
Any alternative the GOP proposes to replace Obamacare is going to spark negative headlines — even if the GOP manages to evade the tax increases, cancelations and potential problems for Medicare that exist in Price’s bill.
If the Republican leadership makes the mistake of offering an alternative, they’ll dull the sting of their attacks on Obamacare by having to defend some version of a plan they were wise enough to sit on for years.
By: Jason Sattler, The National Memo, December 16, 2013
“Told You So, Obamacare’s Back”: By Next Fall, HealthCare.gov Is Going To Be A Net Plus For President Obama And Democrats
If one looks just at the raw, bottom-line number the Department of Health and Human Services released Wednesday—365,000 citizens enrolled since October 1—one might be inclined to think it’s not so hot. And it isn’t. That’s 180,000 or so a month, and if you post that number against the stated goal of 7 million by next spring, the stated goal looks awfully chimerical, and the thing seems a disaster (180,000 times six months, the enrollment period, is just 1.08 million).
Dig a little deeper and things look considerably better. If we could graph it, the bar line of enrollment would make for a pretty impressive ski slope: After just 27,000 people signed up in the whole of October, The New York Times reported over the weekend, about 100,000 people signed up in November, and then, in the first week of December alone, 112,000 chose plans. The Los Angeles Times put out slightly different numbers Wednesday but agreed on the trend. From an obviously atrocious starting place, enrollment is essentially quadrupling. If that pace were to continue, the 7 million figure would be cleared in March.
I still wouldn’t quite bet on that. But I would definitely and unflinchingly bet on the central proposition I argued last week: By next fall, HealthCare.gov is going to be a net plus for Obama and the Democrats.
Wishful thinking? You can call it that if you want to. But I warn you I’m not usually a wishful thinker. Like most partisans on either side, I tend to expect the worst. It’s usually a wise insurance policy; you’re rarely disappointed. I write such things only when I really think them, like the time in August 2012 when I wrote a column suggesting that Obama could very well win about 330 electoral votes. He won 332, which most anyone else would have said when I wrote that piece was crazy.
I had a hunch then, and I have one now. And my bet is based on a lot more than enrollment numbers. It’s based on the numbers of people who are benefiting and will benefit from aspects of the law. These aren’t in the thousands. They’re in the millions. About 70 million citizens will enjoy free—free—preventive care for a range of services that typically weren’t covered at all before or at best were covered and required a co-pay. About half of them are Medicare recipients (= old people = voters). Preventive care, as you may know, is something our system hasn’t been doing very well. Now it will.
More than 100 million Americans live with what the insurance companies would define as pre-existing conditions. Over these next few months, as their symptoms flare up or especially if they worsen, requiring lengthy hospital stays and intense treatment, they’re going to be seeing that they don’t have to fret about money or whether they’re going to continue to be covered anymore. Mental-health coverage is going to be improved dramatically for up to 60 million Americans. Nearly 7 million senior citizens are going to find in the coming months that they’re no longer screwed by the doughnut-hole prescription-drug problem that was created by the Bush Medicare Part D law of 2003 and corrected by Obamacare. It is saving these 7 million seniors an average of $1,000 a year, which for many of these folks is probably a reasonable chunk of their income.
I could go on. The thing is that all this isn’t going to make the papers and the cable channels much. There isn’t a lot of inherent news value in a free cervical-cancer screening or a prescription-drug refill. But these millions of people live real lives, not on TV, and they and their families and friends will know what has happened.
You see that I’m not making a Beltway/political argument. Washington, D.C., will, I can promise you, be the last city in the United States to change its mind about Obamacare. Once a notion becomes conventional wisdom in this town and rocks a president’s poll numbers the way the disastrous rollout so clearly has, it takes a typhoon to dislodge it. Or a hurricane—remember how Karl Rove was making the United States a conservative country until Katrina came along and sent Bush’s approval numbers down there in the range of curdled milk?
The rollout won’t be a hurricane. It will be a calm rain, a steady shower of reality across the country that may never achieve quite enough force to trump inside-the-Beltway perception but will be strong enough to change many people’s minds around the country.
Fixes still need to be made. But now, as opposed to a month ago, one can feel as if they will be made. And without excusing the bollixing up of the rollout, of which I’ve written very critically, one can also say now that in historical context, this is all happening pretty fast. Remember, the original Social Security legislation was passed in 1935. And when did the first check go out? Not until 1940. Can you imagine a five-year lag in today’s media world? Roosevelt, and more important the program itself, would have been torn to pieces. I think in two more years’ time, and indeed less than that, many millions of Americans will see that what they thought was decent health insurance before the Affordable Care Act was like gaslight before electricity. If that’s wishful thinking, it’s for their sake, not the president’s.
By: Michael Tomasky, The Daily Beast, December 12, 2013
“Unless You’re One Of The Unlucky Ones”: Americans Suddenly Discovering How Insurance Works
It’s been said to the point of becoming cliche that once Democrats passed significant health-care reform, they’d “own” everything about the American health-care system for good or ill. For some time to come, people will blame Barack Obama for health-care problems he had absolutely nothing to do with. But there’s a corollary to that truism we’re seeing play out now, which is that what used to be just “a sucky thing that happened to me” or “something about the way insurance works that I don’t particularly like”—things that have existed forever—are now changing into issues, matters that become worthy of media attention and are attributed to policy choices, accurately or not. Before now, millions of Americans had health insurance horror stories. But they didn’t have an organizing narrative around them, particularly one the news media would use as a reason to tell them.
The latest has to do with the provider networks that insurance companies put together. This is something insurance companies have done for a long time, because it enables them to limit costs. If an insurer has a lot of customers in an area, it can say to doctors, “We’ll put you in our provider network, giving you access to all our customers. But we only pay $50 for an office visit. Take it or leave it.” An individual doctor might think that it’s less than she’d like to be paid, but she needs those patients, so she’ll say yes. Or she might decide that she has enough loyal patients to keep her business running, and she wants to charge $100 for an office visit, so she’ll say no.
So every year, doctors move in and out of those private-provider networks, and the insurers adjust what they pay for various visits and procedures, and inevitably some people find that their old doctor is no longer in their network. Or they change jobs and find the same thing when they get new insurance. And that can be a hassle.
But now they have someone new to blame: not the insurance company that established the network, and not the doctor that chose not to be a part of it, but Barack Obama. It’s not just my hassle, it’s a national issue. As Politico reported, “Speaker John Boehner (R-Ohio) said to reporters on Tuesday that the ‘fundamentally flawed’ health care law is ‘causing people to lose the doctor of their choice.’ Chief GOP investigator Darrell Issa has launched a House probe into the doctor claim. And House Republicans have highlighted the physician predicament in their weekly GOP addresses.” So to reiterate: Your insurance company set terms for its network that your doctor didn’t like. Your doctor decided not to be in that network. And that, of course, is Barack Obama’s fault.
Before we move on, there’s something we should note. You know who never loses their doctor? People who have single-payer insurance, that’s who. If you live in pretty much any other industrialized country in the world, you don’t have to worry whether your doctor accepts the national health plan that insures you and everyone else, because every doctor accepts it. Even here in America, there are people who almost never have to worry about losing their doctor: the elderly people who benefit from America’s single-payer plan, Medicare. Despite their constant gripes about payment levels, 90 percent of doctors accept Medicare, because there are just too many Medicare patients and doctors don’t want to be shut out of that business.
“Obamacare will make you lose your doctor!” may be the attack of this week, but conservatives are even trying to blame Barack Obama for the basic way insurance itself works. There’s a lot of talk about what a raw deal Obamacare is, a message that’s being aimed at young people in particular to try to convince them to stay uninsured. As Jonathan Cohn says, “The simplest way to describe Obamacare is as a transfer from the lucky to the unlucky.” That’s not just true of Obamacare, it’s true of insurance generally. All insurance.
The way insurance works is that unless you’re one of the unlucky ones, in purely financial terms, your insurance costs more than you gain from it. Have you ever sat down with all the bills you’ve paid for car insurance and homeowner’s insurance and totalled up all your premiums and all the payouts you’ve received over your lifetime? If you did, it would probably look like you paid a lot but didn’t get much in return. Some people who have had major catastrophes—an accident that totalled their car, a tree falling on their house—come out ahead, but people who haven’t had those things happen to them come out behind. If it wasn’t that way, every insurance company would lose money. But they don’t. They work very hard to set premiums to exceed the amount they spend in payouts (not to mention working hard not to pay out for things they ought to). But as Jonathan Chait says, “Insurance isn’t a kind of gamble where you bet you can beat the house by consuming more in medical care than you pay in premiums and deductibles. It’s protection from risk. People like that protection. They will pay to acquire it.” That applies not just to health insurance but to every kind of insurance. That’s why it’s called “insurance.” (The only exception is life insurance, which works more like an investment.)
The only people who come out ahead in dollars and cents on insurance are those people who have had terrible things happen to them. What the rest of us are buying, as any insurance salesman will tell you, is peace of mind.
To get back to the place we started, it can seem now that people are saying for the first time, “Wait a minute! Insurance is a raw deal! I mean, Obamacare is a raw deal!” And the media are doing their part by running stories that characterize the side effects of the private insurance market, like limited networks of doctors or the fact that less expensive plans have higher deductibles, as something new that’s occurring only because of the Affordable Care Act. But they aren’t. If you want to have a system of private health insurers, that’s how it has worked in the past, and that’s how it will continue to work. If you really want to be free of those problems, you’ll have to wait until you’re 65 and can join the big-government, socialist plan called Medicare.
By: Paul Waldman, Contributing Editor, The American Prospect, December 10, 2013
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