“GOP Irrational Hostility”: A Mean-Spirited Interpretation Would Deny Millions Health Care Coverage
Millions of Americans only recently rescued from worry and hardship by acquiring health insurance now face losing it because Obamacare’s foes won’t end their obsessive opposition.
The latest threat to the Affordable Care Act is a Supreme Court case, due to be decided this spring, that will determine whether all Americans are eligible for the subsidies that make coverage affordable. The Court should allow working families all across the country to keep their life-saving subsidies.
The case turns on the kind of technicality that only a lawyer could love. The law says citizens are eligible for subsidies purchased through health-insurance exchanges established “by the State.”
Because of intense ideological hostility, 36 state governments betrayed their uninsured residents and refused to set up exchanges. In those cases, the law called for the federal government to set up exchanges for the states.
Obamacare’s implacable enemies are arguing that only Americans who were lucky enough to live in the 14 states that set up their own exchanges are eligible for subsidies, thereby excluding those who live in two-thirds of our country.
Since 85 percent of purchasers need subsidies to make insurance affordable — the subsidies cut monthly premiums on average from $346 to $82 — that nonsensical, mean-spirited interpretation would deny millions of working Americans decent health insurance.
That’s not what Congress intended when it passed the most sweeping reform of American health care in nearly 50 years. It didn’t mean to punish millions of citizens by denying them health insurance because of what state they live in. The architects of reform — the chairmen of the relevant committees — confirmed this obvious truth in a recent op-ed.
And it’s not only the five million Americans losing coverage who will suffer if the Supreme Court rules against national subsidies. The whole system will risk collapse as healthier enrollees succumb to the cost squeeze first and drop out, leaving sicker, more desperate, more expensive clients behind. Other components of the law — such as the one requiring large employers to offer coverage to their workers — could also be questioned in states that didn’t establish their own exchanges.
Trying to downplay the impact of a potential decision that would cut off millions of Americans from their health insurance, some Obamacare opponents claim states would quickly set up their own exchanges in response.
But there’s no sign that irrational hostility has weakened much to the law — even as millions of Americans experience its benefits, and besides, the vast majority of state legislatures will be out of session by the time the High Court rules in June, so no quick fix will be available.
Another answer would be to change the health-care law to remove any uncertainty about who’s eligible for subsidies, but of course the new GOP majority in Congress is too busy trying to repeal the law altogether to usefully amend it.
Indeed, the current legal attack on the Affordable Care Act is only part of an unrelenting five-year campaign of opposition, one that will presumably continue regardless of the Supreme Court’s decision in this case. There’s no clear historical precedent for so much time, effort and emotion being poured into resisting an improvement in the material well-being of fellow citizens.
Think how American health care could be improved if all that angry passion was redirected into fruitful cooperation! Not even its biggest supporters are content with the Affordable Care Act as it is. Health care is still too expensive, too many people are still left out, health outcomes are still disappointing.
But we can’t address those problems until fiery Obamacare opposition cools. The Supreme Court can help the process along by acknowledging that Congress intended for all Americans — not just those living in certain states — to have access to affordable health care.
By: William Rice, The National Memo, February 12, 2015
“Hurting A Large Number Of Their Own”: Republican Refusal To Expand Medicaid Could Come Back To Haunt Them
Republican legislatures in state after state, from Tennessee to Wyoming, are rejecting the Medicaid expansion of the Affordable Care Act for no other reason than pure spite against poor people:
On Friday, the Wyoming Senate shot down Gov. Matt Mead’s expansion plan, and a House committee then pulled its bill. The double whammy effectively killed the state’s chances of enacting the Obamacare option this year.
Lawmakers there acted just days after the Tennessee Legislature shot down an expansion proposal by Gov. Bill Haslam. Together, the two rejections diminish the momentum that Medicaid expansion supporters were enjoying last month, when Indiana Gov. Mike Pence won federal approval of his particular plan and Arkansas Gov. Asa Hutchinson agreed to extend that state’s “private option” program for 18 months. Both Pence and Hutchinson are also Republicans.
There’s simply no good reason for any of it, even within the confines of conservative economic orthodoxy. The money for the Medicaid expansion comes from the federal government; the states themselves are at no risk of further expense for many years to come if at all. Republican governors are trying to get the funding for the healthcare of their citizens. Better access to healthcare means fewer illnesses, better productivity, and more money in the pockets of the sorts of consumers most likely to spend in the economy. More money for Medicaid creates a virtuous economic circle at no cost to the states.
No doubt there is a great deal of racism in the motivation of conservative state legislators to deny healthcare to their poorest residents. But in fact, the majority of those on Medicaid are not minorities–and poor whites are overwhelmingly Republicans. So even from the jaundiced view of a bigot these GOP legislators are hurting a huge number of their own.
And it’s starting to cause problems for them. Republicans in Kentucky are doing backflips to pretend to their constituents that there’s some big difference between Kynect, Kentucky’s state exchange, and Obamacare. And even now some Republicans are defecting over it:
Former Republican state Sen. Tim Johnson on Wednesday announced he’s switching parties and challenging incumbent Republican Lt. Gov. Tate Reeves this year.
But the noted Elvis impersonator said he won’t be appearing as the King on the campaign trail.
“Why join the Democratic Party and run for lieutenant governor?” Johnson said before a cheering throng of supporters at a Capitol press conference. “I’ll tell you: We are all Mississippians first. Elected officials should be in the business of helping all Mississippians, not picking out who to hurt.”
The Republican Party has relied for decades on cultural and racial resentment to keep them afloat. But there’s only so long a political party can only abuse the entirety its own people without even an eye toward sowing cultural division, without it coming back to haunt them.
By: David Atkins, Political Animal, The Washington Monthly, February 7, 2015
“The Obamacare Plaintiffs And Medicare”: Maybe They’d Love Obamacare If The Hated President’s Name Wasn’t On It
Politico‘s Jennifer Haberkorn scored a bit of a scoop by convincing the chief plantiff in the King v. Burwell litigation, David King, to let her into his Fredericksburg, VA living room, apparently because he didn’t want to leave her shivering on his front doorstep. Most of what she tells about him, though, seems to come from his recent social media expressions rather than from anything he said to her in person:
The man who could cripple Obamacare isn’t shy about telling the world that he thinks the president is an “idiot,” posting altered images of the first lady in Middle Eastern clothing and expressing his hatred for the “Democraps” who enacted the health care law.
Greg Sargent, however, finds something more interesting to examine about King and a couple of his co-plaintiffs:
[I]t’s fascinating that King is less than a year away from qualifying for Medicare. As it happens, Politico reports that two of the other four challengers are 64 and 63, also putting them very close to qualifying. Remember, this lawsuit is all about the plaintiff’s objection to being subjected to the individual mandate’s requirement that they get insurance. The plaintiffs are claiming injury because Virginia is on the federal exchange, which, they say, means they should not be getting the subsidies which are necessary under the law to require them to get insurance under the mandate. Yet three of the challengers are very close to having the mandate canceled for them by Medicare. (One, it should be noted, is 56 years old.)
It would be really interesting to know what these challengers think of Medicare, given their role in a lawsuit that could go a long way towards gutting the coverage guarantee for millions of Americans.
Unfortunately, we cannot answer Greg’s question yet, if ever. Maybe these folk share the not uncommon belief of seniors that Medicare is an “earned benefit” (at most half-true) in contrast to the “welfare” nature of Obamacare (again, at most half-true). Maybe they don’t like Medicare as it is but would like to “reform” it–though the most common Republican proposal for “reform” is to convert Medicare from being a defined government-provided benefit to a means-tested system of public subsidies for private insurance purchases like Obamacare. Maybe they’d love Obamacare if the hated president’s name wasn’t on it. It’s hard to say. But whatever their reasons, they’re willing to force millions of people who aren’t on the brink of qualifying for Medicare into a health care wilderness. No wonder they don’t want to give interviews.
By: Ed Kilgore, Contributing Writer, Political Animal, The Washington Monthly, February 6, 2015
“Same Conservative Talking Points”: Jeb Bush Won’t Win the GOP Primary If He Keeps Giving Bland Speeches Like This One
On Wednesday, Jeb Bush delivered the biggest speech of his young campaign in Detroit, Michigan, where he promised to lay out a positive agenda in the months ahead. “I will offer a new vision,” the former Florida governor said. “A plan of action that is different than what we have been hearing in Washington D.C.” Political analysts quickly tried to parse Bush’s words to discern any hints about that plan of action.
Those hints are hard to find. Read the transcript; it’s an utterly ordinary speech, filled with bromides against liberalism and big government. Bush cited rising income inequality, stagnant wages, and slow growth as problems that demand big solutions. He talked about the opportunity gap and mentioned Uber and deregulation. And he used the downfall of Detroit as a warning sign for the rest of country. Nothing new, in other words.
Bush did try to spin conservative talking points in a more positive, wonky manner. His most notable comments came about halfway through, when he criticized Washington, D.C.—as in, the Obama administration—for “recklessly degrading the value of work, the incentive to work, and the rewards of work.”
We have seen them cut the definition of a full-time job from 40 to 30 hours, slashing the ability of paycheck earners to make ends meet. We have seen them create welfare programs and tax rules that punish people with lost benefits and higher taxes for moving up those first few rungs of the economic ladder.
In the first sentence, Bush is referring to the provision under the Affordable Care Act that requires employers with more than 50 workers to offer health insurance to any employee that works more than 30 hours. Republicans have criticized the rule as incentivizing employers to reduce their workers’ hours below that threshold. They have suggested changing the definition of a full-time employee to 40 hours per week—a change that the Congressional Budget Office says would increase the deficit and lower the number of Americans with health insurance. Even some conservatives like Yuval Levin, the editor of National Affairs, have come out against it. But it’s a good sound bite—one that shows Bush is aware of ongoing policy arguments in Washington—so he jumped on it.
“Instead of a safety net to cushion our occasional falls,” he added, “they have built a spider web that traps people in perpetual dependence. We have seen them waive the rules that helped so many people escape welfare.”
I had not heard any politician compare the safety net to a “spider web” before, and based on a quick Google search, Bush has not made the comparison before either. It’s reminiscent of Representative Paul Ryan’s analogy of the safety net as a “hammock” that traps the poor in poverty, an analogy that has been harshly criticized. But while a hammock evokes images of laziness and gives agency to the poor, a spider web suggests that the poor are trapped. With many Americans believing that Republicans don’t care enough for the poor, you can understand why Bush settled on the “spider web” analogy.
But does Bush actually reject the “maker and taker” rhetoric? At the Washington Post, Greg Sargent argues yes—or at least that Bush will do so rhetorically. “Message: Jeb Bush will not be 47-percent-ed. He will not be Mitt-ed,” Sargent writes. “He will present a conservative pro-economic-freedom case without committing the fatal political misstep of showing contempt for those who currently depend on government in any form.” That seems broadly right, at least insofar as we can determine Bush’s rhetorical strategy from one speech. Yet, it’s always a tight line to blame government for making the poor dependent without actually blaming the poor themselves.
And when Bush argues that Obama tried to “waive the rules that helped so many people escape welfare,” he’s harkening back to an old, disproven conservative meme against the administration. During the 2012 election, Mitt Romney argued that Obama was undoing welfare reform by offering states waivers allowing them to forego the welfare work requirements, as long as they accomplished the goal of the law— moving welfare recipients to work. In fact, Republican governors had requested the waivers. The Washington Post fact checker gave Romney four Pinnochios for the baseless assertion. But Bush has brought the attack line back.
Overall, Bush seemed to be trying to use the same conservative talking points and attacks, with a more positive spin. Yet, it’s still hard to look at this speech and see what part of the Republican Party it appeals to, at least compared to his competitors. Florida Senator Marco Rubio has a far more comprehensive agenda at this point. Wisconsin Governor Scott Walker offers a very conservative governing record and has won three statewide races in four years. Many Republican candidates have switched their economic message to focus on wages and inequality, if only to find a new attack against the president as the recovery strengthens.
Granted, this is just one speech. Bush has plenty of time to deliver concrete policy proposals. But there’s something telling about the ordinariness of his speech, of its generic GOP talking points. There’s no natural constituency for his candidacy, at least in the primary. Bush has said that the GOP nominee must be willing to “lose the primary to win the general.” In other words, to avoid taking far-right positions that doom the candidate in the general election.
Thought about in that light, Bush’s speech makes more sense. Spinning conservative talking points in a positive light, while promising a new agenda, is a campaign platform that could appeal to the full electorate. If he somehow emerged as the Republican nominee, he could be a very credible challenger to Hillary Clinton. Yet, the underlying problem remains: He has to win the nomination. His willingness to lose the primary will, in all likelihood, prove self-fulfilling.
This isn’t just his problem, though; it’s the Republican Party’s. The primary electorate makes it hard for a candidate like Bush, who despite being extremely conservative is nonetheless moderate compared to the other candidates, to win. It forces the eventual nominee to move to the right, eventually putting himself in an almost impossible position to win the general election. The complete blandness of Bush’s speech Wednesday only underlines this dynamic.
By: Danny Vinik, The New Republic, February 5, 2015
“Deadly Consequences”: Public Health Experts Have Estimated How Many Americans Will Die If The Supreme Court Repeals Obamacare
When conservative American Enterprise Institute scholar Michael Strain published an article last week titled, “End Obamacare, and people could die. That’s okay.” he made two critical errors: He embedded a genuinely extreme view into a banal one, and then demanded absolution for both without defending the former.
Strain’s larger point is so uncontroversial, it barely needs reprising: Obamacare was not the final word in U.S. health policy, and if Republicans want to replace the Affordable Care Act with a different, less redistributive set of reforms, they should be able to try, without necessarily catching hell for preferring a system that tolerates marginally more avoidable deaths than Obamacare does (especially if they ply fiscal savings into different programs that alleviate poverty, or improve general welfare).
This is an unobjectionable point. Had Strain argued that the Republican presidential nominee should make an Obamacare alternative the centerpiece of his 2016 platform, nobody would have called it immoral. But the premise of his article is that conservatives (including himself, presumably) will be pleased if the Supreme Court intervenes to gut Obamacare, because it would provide Republicans the missing leverage they’ll need to impose a replacement through the political branches.
First comes god from the machine, and only then comes an Obamacare replacement.
If such a dramatic predicate carried no consequences, Strain’s cost-benefit argument would stand on its own. But when you account for the damage the Supreme Court would incur in order to provide Republicans their missing leverage, it collapses completely.
In a brief to the Supreme Court, dozens of public health scholars, along with the American Public Health Association, detail the harm the Court would create by ruling for the challengers in King vs. Burwell. Most of their analysis is rooted in the basic point that stripping insurance away from eight million people would dramatically impede their access to the health system. But they also flesh out the corollary argument that an adverse ruling would have deadly consequences, and ballpark the number of avoidable deaths such a ruling would cause.
“Researchers found that, in the first four years of the [health care reform] law in Massachusetts, for every 830 adults gaining insurance coverage there was one fewer death per year,” the brief reads. “Using the national estimate that 8.2 million people can be expected to lose health insurance in the absence of subsidies on the federal marketplace, this ratio equates to over 9,800 additional Americans dying each year. Although the specific policy context and population impacts of any policy cannot be directly extrapolated from one setting to another, the general magnitude and power of these findings from the Massachusetts study demonstrate that even when approached cautiously, these earlier findings carry enormous public health implications for withdrawing subsidies and coverage from millions of Americans.”
The Massachusetts story wouldn’t unfold precisely in reverse everywhere the subsidies disappeared, but the experience there suggests the Supreme Court ruling would have measurable mortality implications. These costs (read: deaths) couldn’t be paired against the benefits of increased spending on anti-poverty programs. These are the costs conservatives are eager to inflict on others simply to gain the leverage they need to advance an alternative that the status quo forecloses.
Responding to critics in a followup article, Strain brushes this all aside by stipulating that Republicans would never allow all this suffering. “I think it’s very likely that the congressional GOP would enact some sort of replacement if the Supreme Court strikes down Obamacare,” he writes. “They would very likely take measures to address the needs of those who lost their subsidies as a result of the Court’s action.”
To back up his suspicions, he cites a suspiciously limited set of news reports, quoting Republicans who claim to be working on such a plan—or, at least “talking about how to build consensus on a replacement.”
He does not quote from this Wall Street Journal article titled, “Republicans to Block Legislative Fix to Health-Care Law,” or this article by TPM’s Sahil Kapur titled, “Republicans Are At A Loss On What To Do If SCOTUS Nixes Obamacare Subsidies.”
For those who haven’t been keeping score all along, Republicans have spent the past several years cyclically promising and then failing to deliver an Obamacare alternative. They didn’t have an alternative prepared in 2012 when conservatives asked the Court to declare Obamacare unconstitutional. They didn’t have an alternative prepared later in the year, when Mitt Romney was their presidential candidate. They didn’t have an alternative prepared when they shut down the government as part of an ill-fated effort to defund Obamacare. They didn’t run on an Obamacare alternative in 2014. And they don’t have an Obamacare alternative prepared this week, though they’re scheduled to pass another repeal bill on Tuesday.
The story’s a little different today in that the subsidies really could disappear by fiat, harming millions of people, under GOP control of Congress. Republicans genuinely haven’t encountered a motivating force this strong in the five years since Obamacare became law. If in defiance of such a remarkable pattern, Republicans manage between now and June to come up with a workable plan or a stopgap—one that President Obama will sign—they will have filled the hole in Strain’s argument. Five months might seem like a long time in politics, but remember: It took Democrats more than twice that to pass Obamacare, and almost 10 times as long thereafter to implement it.
By: Brian Beutler, The New Republic, February 2, 2015
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