“Mitt’s Legacy”: Health Reform Worked In Massachusetts
On February 8 the Center for American Progress hosted an event featuring Massachusetts Attorney General Martha Coakley, where she discussed the success of the Massachusetts health care reform law signed by former Gov. Mitt Romney (R) in 2006.
Attorney General Coakley discussed the framework of the law and explained how it’s played an essential role in providing unparalleled access to health care coverage for Massachusetts residents. She and CAP President Neera Tanden also discussed why the Affordable Care Act’s adoption of the Massachusetts framework fits comfortably within the United States’ constitutional authority.
In her introductory remarks, Tanden said that “the Massachusetts law, though sometimes maligned in our national debates, is actually an incredible success story, and has really demonstrated to the country how effective health care reform can be, and the Affordable Care Act can be.”
She mentioned the new CAP report “The Case for the Individual Mandate in Health Care Reform,” and said that Massachusetts’s embracing of the individual mandate in addition to its nondiscrimination over preexisting conditions has allowed its health care reform to flourish.
Flourish so much, Tanden said, that “98.1 percent of the state’s residents were insured at the end of 2010, compared to 87.5 in 2006, when the health care law started. Almost every child in the state is insured, and premiums in the individual market dropped 40 percent as the Massachusetts law was fully implemented.”
In her speech, Attorney General Coakley described the Massachusetts health care law, saying that “in some, but not all particulars, the Massachusetts Act of 2006 was really the prototype for what has become the Federal Patient Protection and Affordable Care Act.” Like the Affordable Care Act, Massachusetts’ reform includes a state-operated health insurance exchange, subsidies for low- and moderate-income individuals, and a mandate that all individuals who can afford health insurance purchase coverage, or an individual mandate.
Coakley said, “The law has resulted in the highest health care access rates in the nation, it has improved both access to and affordability of health care for hundreds of thousands of residents, while maintaining a high level of quality, and I think that’s important.
“We don’t talk about quality so much, but it’s part of what we are concerned about. Access, cost, quality: Ensuring two is relatively easy, if you want to do all three, not so much. And this has been, and is still, our challenge and our goal, and as a work in progress, I think the facts demonstrate that rather than our experiment proving a risk to the rest of the country, Massachusetts as a test laboratory has a lot to offer.”
She said, “We’ve seen significant improvements in the care of our residents. From 2006 to 2010, adults from all income groups, but in particular lower-income adults, experienced a significant decline in reported unmet health care needs due to cost. … we also have seen significant overall economic benefits for our state as a result of this.”
In terms of costs, she said, “[w]e’ve seen a sharp decline in the amount of spending on the so-called ‘free care,’ [when an uninsured person visits an ER, for example, and costs get passed on to the insured in higher rates] about $300 million, and that’s 33 percent less than we spent in 2006.” And nongroup or individual insurance premiums cost 40 percent less.
Attorney General Coakley also discussed why she believes the Supreme Court will not overturn the individual mandate. Massachusetts, she said, is giving a very positive endorsement for the mandate, and it is “a constitutional act by Congress.” It would be quite surprising if the Supreme Court overturned “the 70 years of precedent that have been set” by case law establishing what Congress has constitutional authority to regulate, including commerce such as health care.
After her speech, Attorney General Coakley spoke with Tanden about health reform. In response to an audience question about the constitutionality of the mandate, Tanden said that “when you say that people have coverage when they go to the emergency room, that immediately means that they’ll be cost-shifting, and the individual mandate is just a way in which people have the same responsibility for their own health care so they’re not shifting costs anymore.”
As Attorney General Coakley asserted, Massachusetts is an essential—and the only U.S. example—of the importance of the individual mandate in ensuring affordable access to health care for all.
By: Center for American Progress, February 27, 2012
Consistency Is An Over-Rated Virture: What “Left” And “Right” Really Mean
Perhaps my biggest frustration with the U.S. news media (and yes, I am a card-carrying member) is that we permit the two parties to decide what is “left” and what is “right.” The way it works, roughly, is that anything Democrats support becomes “left,” and everything Republicans support becomes “right.” But that makes “left” and “right” descriptions of where the two parties stand at any given moment rather than descriptions of the philosophies, ideologies or ideas that animate, or should animate, political debates.
There is a good reason why we do it this way. It isn’t the media’s job to police political ideologies, and it wouldn’t be a good idea for us to try. But that leaves ordinary voters in a bit of a tough spot.
The reality is that most Americans aren’t policy wonks. They don’t sit down with think-tank papers or economic studies and puzzle over whether it’s better to address the free-rider problem in health care through automatic enrollment or the individual mandate. Instead, they outsource those questions to the political actors — both elected and unelected — they trust.
Unfortunately, those political actors aren’t worthy of their trust. They’re trying to win elections, not points for intellectual consistency. So the voters who trust them get taken for a ride.
Consider the partywide flips and flops of just the past few years:
— Supporting a temporary, deficit-financed payroll-tax cut as a stimulus measure in 2009, as Republican Sen. John McCain and every one of his colleagues did, put you on the right. Supporting a temporary, deficit-financed payroll tax-cut in late 2011 put you on the left. Supporting it in early 2012 could have put you on either side.
— Supporting an individual mandate as a way to solve the health-care system’s free-rider problem between 1991 and 2007 put you on the right. Doing so after 2010 put you on the left.
— Supporting a system in which total carbon emissions would be capped and permits traded as a way of moving toward clean energy using the power of market pricing could have put you on either the left or right between 2000 and 2008. After 2009, it put you squarely on the left.
— Caring about short-term deficits between 2001 and 2008 put you on the left. Caring about them between 2008 and 2012 put you on the right.
— Favoring an expansive view of executive authority between 2001 and 2008 put you on the right. Doing so since 2009 has, in most cases, put you on the left.
— Supporting large cuts to Medicare in the context of universal health-care reform puts you on the left, as every Democrat who voted for the Affordable Care Act found out during the 2010 election. Supporting large cuts to Medicare in the context of deficit reduction puts you on the right, as Republicans found out in the 1990s, and then again after voting for Representative Paul Ryan’s proposed budget in 2011.
— Decrying the filibuster and considering drastic changes to the Senate rulebook to curb it between 2001 and 2008 put you on the right, particularly if you were exercised over judicial nominations. Since 2009, decrying the filibuster and considering reforms to curb it has put you on the left.
— Favoring a negative tax rate for the poorest Americans between 2001 and 2008 could have put you on the right or the left. In recent years, it has put you on the left.
I don’t particularly mind flip-flops. Consistency is an overrated virtue. But honesty isn’t. In many of these cases, the parties changed policy when it was politically convenient to do so, not when conditions changed and new information came to light.
There are exceptions, of course. It’s reasonable to worry about short-term deficits during an economic expansion and consider them necessary during a recession. That’s Economics 101.
But nothing happened to explain the change from 2006, when the individual mandate was a Republican policy in good standing, to 2010, when every Senate Republican, including those who still had their names on bills that included individual mandates, agreed it was an unconstitutional assault on liberty. Nothing, that is, but the Democrats’ adopting the policy in their health-care reform bill.
Flips and flops like these make the labels “left” and “right” meaningless as a descriptor of anything save partisanship over any extended period of time. I could tell you about a politician who supported deficit-financed stimulus policies and cap-and-trade, and I could be describing McCain. Or Newt Gingrich. And I could tell you about another politician who opposed an individual mandate, and who fought deficits, expansive views of executive authority and efforts to reform the filibuster, and be describing Sen. Barack Obama.
Parties — particularly when they’re in the minority — care more about power than policy. Perhaps there’s nothing much to be done about this. And as I said, it isn’t clear that the media, or anyone else, should try. But it puts the lie to the narrative that America is really riven by grand ideological disagreements. America is deeply divided on the question of which party should be in power at any given moment. Much of the polarization over policy is driven by that question, not the other way around.
But the voters who trust the parties don’t know that, and they tend to take on faith the idea that their representatives are fighting for some relatively consistent agenda. They’re wrong.
By: Ezra Klein, The Washington Post, February 24, 2012
The Success Of Mitt Romney’s Health-Care Pander
Last year, at the University of Michigan, Mitt Romney gave a speech on health care to address his prior support for the individual mandate—the linchpin for the Affordable Care Act and Romneycare in Massachusetts. The core of his speech—and of his message on health care since then—was that it’s unacceptable for the federal government to require health insurance for its citizens. As he said:
Our plan was a state solution to a state problem. And his is a power grab by the federal government to put in place a one size fits all plan across the nation.
Of course, this isn’t true. The Affordable Care Act maintains the private health-insurance market and requires people to buy into it if they don’t have insurance or qualify for Medicaid. If the ACA is a “one size fits all” plan, than by dint of similarity, Romneycare is the same.
It’s for that reason that, at the time, I was skeptical of this whole maneuver. There was no way that conservatives could really believe Romney when he made the bogus distinction between his plan and the administration’s. In the same way that discrimination is discrimination, whether it’s practiced by local, state, or federal authorities, if the requirement to purchase health insurance is tyranny, then it’s tyranny everywhere, regardless of how it’s implemented.
As it turns out, I was completely wrong. Not only has Romney escaped any serious harm for his (huge) role in setting the template for “Obamacare” but his constant denunciations of the law have given him credibility with actual conservatives, who now endorse the former Massachusetts governor’s logic on Romneycare. Here’s Ann Coulter, for example:
As The New York Times put it, “Mr. Romney’s bellicose opposition to ‘Obamacare’ is an almost comical contradiction to his support for the same idea in Massachusetts when he was governor there.” This is like saying state school-choice plans are “the same idea” as the Department of Education. […]
As Rick Santorum has pointed out, states can enact all sorts of laws—including laws banning contraception—without violating the Constitution. That document places strict limits on what Congress can do, not what the states can do. Romney, incidentally, has always said his plan would be a bad idea nationally. [Emphasis mine]
It should be said that, before he flipped to the right in preparation for a presidential run, Romney insisted that his plan would make a good model for the country.
That aside, it’s simply incredible to me that conservatives would buy Romney’s ridiculous logic. But it seems that they trust Romney enough on health-care repeal to let the issue slide. Which should put a damper on liberal hopes that, if elected, Romney won’t try to dismantle the Affordable Care Act. For as much as the public is skeptical of politicians—especially presidential aspirants—students of the presidency have found that presidents genuinely try to fulfill the promises they made as candidates.
If you want to know how Mitt Romney will govern, all you have to do is listen to him. And in that case, a President Romney would cater to the rich, return to the bellicose foreign policy of George W. Bush, and dismantle the social safety net, Obamacare included.
By: Jamelle Bouie, The American Prospect, February 2, 2012
RomneyCare: Conservatives Attempt To Rescue Mitt From His Past
Now that Mitt Romney is well and truly inevitable, it is becoming imperative for conservatives to begin the arduous work of explaining why his Massachusetts health care plan is in no way similar to the evil, bureaucratic, freedom-destroying Obamacare monstrosity. Ann Coulter gives it a go, as do Yuval Levin and Ramesh Ponnuru in National Review.
The latter brush aside any purported similarities by quickly noting that “policy experts of various political stripes have claimed that Obamacare is essentially Romneycare taken national.” Right, one of those policy experts is Jonathan Gruber, the guy who designed Romney’s health care plan and then designed Obama’s. Let’s see what he has to say:
He credited Mitt Romney for not totally disavowing the Massachusetts bill during his presidential campaign, but said Romney’s attempt to distinguish between Obama’s bill and his own is disingenuous.
“The problem is there is no way to say that,” Gruber said. “Because they’re the same fucking bill. He just can’t have his cake and eat it too. Basically, you know, it’s the same bill. He can try to draw distinctions and stuff, but he’s just lying.
Any attempt to explain why Romneycare is so vastly different than Obamacare really ought to explain why the economist who designed both plans thinks they’re the same fucking bill.
Coulter, Levin, and Ponnuru all defend Romney by arguing that he was operating within the constraints of a distorted federal system. “There’s not much governors can do about the collectivist mess Congress has made of health care in this country,” writes Coulter. But of course Obama was also operating within the confines of a distorted system, including many interest groups and voters deeply resistant to change.
Levin and Ponnuru urge Romney to vigorously press the argument that his plan has no resemblance to Obama’s. Their advice centers on the one area of difference:
So what, then, should Governor Romney say, if he is the nominee and President Obama suggests that his health-care plan is modeled on the one the Republican enacted? Something, we suggest, like the following:
“Nice try. Your health-care plan, Mr. President, spends a trillion dollars on yet another uncontrollable federal entitlement program and on a massive expansion of a failing Medicaid system. It has an unconstitutional rationing board cut hundreds of billions from Medicare without being answerable to the public, without giving seniors more options, and without using the money to shore up the program or reduce the deficit. It raises hundreds of billions in taxes on employment, investment, and medical research; and after all of that, it wouldn’t even reduce the growth of health-care costs, which is the heart of the problem. And your defense of all that is that it was based on a state program that doesn’t actually do any of those things?
But that is what Romney is already saying, right down to the “nice try.” And what it’s saying, basically, is that Obama was fiscally responsible. Romney, owing to a quirk of federal funding, was able to finance his plan with a windfall grant from Washington, meaning he didn’t need to come up with any painful cuts to cover his insurance expansions. Obama raised taxes and found inefficient spending within the Medicare system to finance covering the uninsured. And one of the biggest elements of his tax increase was a reduction in the tax deduction for expensive private plans – basically, the strongest version Obama could get through Congress of a staple idea urged by conservatives, which is to eliminate the tax code’s favoritism for employer-sponsored insurance.
Now, you could argue that this should go even further, and I’d agree. If you had Republicans willing to continue advocating the health care principles they used to advocate before Obama tried to implement them, you could form a stronger political coalition for tearing up the status quo and combining market pressure with universal coverage. But rational reform is pretty hard when the opposition party is able to convince itself that anything you do, including things they favored just the other day, are the death of freedom.
By: Jonathan Chait, Daily Intel, February 2, 2012
Plaintiffs Challenging Affordable Care Act In The Supreme Court Admit That The Law Is Constitutional
One of the oddest arguments made by the plaintiffs now challenging the Affordable Care Act before the Supreme Court is a claim that, if just one small part of the law is declared unconstitutional, the whole law must fall with it. The overwhelming majority of judges who have heard ACA cases rejected the ridiculous claim that any part of the law is unconstitutional. And, of the handful of judges to strike part of the law down, only one — the guy who included an explicit shout-out to the Tea Partyin his opinion — accepted the legally indefensible position that the whole law must fall.
In their attempt to see the entire Affordable Care Act fall, however, several of the plaintiffs challenging the law committed what should be a fatal blunder — they effectively admit that their entire constitutional challenge to the law is garbage.
The primary attack on the ACA targets its provision requiring most Americans to either carry health insurance or pay slightly more income taxes — the so-called “individual mandate.” This insurance coverage provision exists because without it, the law’s other provisions ensuring that people with preexisting conditions can obtain insurance cannot be implemented. If patients can wait until they get sick to buy insurance, they will drain all the money out of an insurance plan that they have not previously paid into, massively driving up costs for the rest of the plan’s consumers.
This problem doesn’t just make the insurance coverage requirement good policy, it also makes it constitutional. The Constitution doesn’t just give Congress sweeping authority to regulate the national economy, it also authorizes it “[t]o make all laws which shall be necessary and proper for carrying into execution” regulations of interstate commerce. As conservative Justice Antonin Scalia explains, this means that, “where Congress has the authority to enact a regulation of interstate commerce, it possesses every power needed to make that regulation effective.”
So, with this background in mind, consider the following passage from the private plaintiffs’ brief arguing that the entire law must fall if the insurance coverage rule goes down:
The mandate was intended to be a direct subsidy to insurance companies, as compensation for requiring them (in the guaranteed-issue provision) to insure against “risks” that have already come to pass and forbidding them (in the community-rating provision) from using actuarially sound insurance premiums. The mandate thus works to counteract the powerful inflationary impacts of these other provisions, which would otherwise make premiums in the individual insurance market prohibitively expensive, thereby frustrating Congress’ goal of affordable health insurance. And Congress further viewed the mandate as necessary to prevent “adverse selection” to “game” the new insurance rules, which proponents warned would spark a “death spiral” in insurance.
The guaranteed-issue and community-rating requirements thus cannot operate without the mandate in the manner intended by Congress. Rather, “their associated force—not one or the other but both combined—was deemed by Congress to be necessary to achieve the end sought.” To strike the mandate alone would impermissibly eliminate a central quid pro quo of the Act. If the mandate falls, the guaranteed-issue and community-rating regulations must therefore fall with it, as the Government itself has conceded.
So the plaintiffs admit that, without the insurance coverage requirement, premiums will become “prohibitively expensive” and that the ACA’s provisions protecting people with preexisting conditions or who otherwise are highly likely to need health care (what are known as “guaranteed-issue” and “community-rating” laws in the jargon of health policy) “cannot operate without the mandate in the manner intended by Congress.” This is a flat out admission that the Scalia Rule applies in this case. Guaranteed issue and community rating are regulations of interstate commerce, and thus Congress has “every power needed” to make them effective — including the power to enact the insurance coverage requirement.
I discuss this rather breathtaking admission at greater length in an amicus brief I filed Friday on behalf of several health provider organizations, which also includes some more details about why the plaintiffs’ attempt to take out the entire ACA has no basis in law. Ultimately, however, there is no need whatsoever for the justices to consider how much of the law stands or falls without the coverage requirement. The private plaintiffs already gave away the farm when they admitted that their entire legal challenge rests on a crumbling foundation.
By: Ian Millhiser, Think Progress, January 30, 2012
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