“Pull Harder On Your Bootstraps!”: Excuses, Excuses, For Not Extending Unemployment Insurance
The president on Tuesday called on Congress to extend jobless benefits for the long-term unemployed, saying the insurance program keeps Americans from “falling off a cliff.” But the Republican leadership — convinced that Americans can pull themselves up and out of the ravine by their bootstraps — finds the extension unnecessary.
“Pull harder!” sounds kind of callous, though, especially since the unemployment rate hovers above 7 percent and there are more people looking for work than positions available. So Republicans are finding nicer ways of explaining their objections, and ginning up excuses.
The Washington Post reported yesterday that the Republican leadership sent a “what we talk about when we talk about cutting benefits”-type memo to the rank-and-file, which emphasizes the need for compassion. “For every American out of work, it’s a personal crisis for them and their family,” the memo states. “That’s why House Republicans remain focused on creating jobs and growing the economy.”
Is job creation incompatible with extending unemployment insurance? The memo suggests it is: “Even the non-partisan Congressional Budget Office has found that extending the program will lead to some workers reducing the intensity of their job search and staying unemployed longer.”
By the way, the C.B.O. also estimated in December that “extending unemployment benefits would raise gross domestic product (GDP) and employment in 2014 relative to what would occur under current law.” No mention of that in the memo.
Republicans are also trying to make themselves look better by insisting they’d agree to an extension if the cost were “offset” with cuts to the federal budget. Raising revenue by closing tax loopholes is, naturally, off the table. And what’s on the table, at least so far, is definitely not kosher for Democrats.
Senator Mitch McConnell, the minority leader, suggested paying for the cost of an extension by “lifting the burden of Obamacare’s individual mandate for one year.” It’s true that would save money — according to the C.B.O. — but only because fewer uninsured people would seek and receive Medicaid coverage.
By: Juliet Lapidos, Editor’s Blog, The New York Times, January 8, 2014
“Extending The Hardship Exemption”: You Can Still Have Weak Health Insurance Under Obamacare, For Now
If you liked your old skimpy health plan, you may not be able to keep it. But now you can get a new, somewhat skimpy health plan instead, at least for a little while.
That’s a rough translation of an Obamacare policy change that the Administration announced on Thursday. The change, first reported by Louise Radnofsky of the Wall Street Journal, represents yet another effort to help people about to lose their existing insurance policies, usually because those policies do not comply with the Affordable Care Act’s standards for benefits and pricing. Those old policies left out major benefits, were sold only to people without pre-existing conditions, and so on.
As you know, plan cancellations have been a source of tremendous controversy—and, for the president, immense political grief. Some estimates have suggested several million people received these cancellation notices. The vast majority of those people have already found new coverage, either directly through insurers or through one of the Obamacare exchange websites, according to the Administration. While some are paying more money, others have discovered that the new policies are cheaper—or, at least, are grateful for the extra protection. Lucia Graves of National Journal wrote about some of their stories the other day.
But some people still haven’t found insurance. Administration officials think, based on conversations with state regulators and insurers, that about half a million people fall into this category. That’s half a million people who could, because of the individual mandate, face tax penalties because they have declined to get affordable coverage.
Now, however, people with cancelled policies have a new option. The individual mandate has always contained a hardship exemption: If you qualify for it, you don’t have to pay the penalty and you have access to the cheaper, slightly less comprehensive catastrophic insurance plans otherwise available only to people under 30. The only question with the hardship exemption has been who gets it. The law gives the administration flexibility over that question and, on Thursday, Health and Human Services Secretary Kathleen Sebelius announced that it would apply to people who just lost their policies and are unable to find replacements that cost the same or less money.
HHS made the announcement by posting a guidance and sending a letter to a half-dozen more conservative members of the Senate Democratic caucus. And neither document answers all of the relevant questions, like how strictly the government will apply the new criteria or for how long this exemption will last. (Administration officials say it will be temporary.)
Conceptually, making the change is not so different from allowing more people to have grandfather protection for their existing coverage—after all, it’s basically telling people who have bare-bones coverage now that they can take out bare-bones policies next year. And imposition of the individual mandate was always supposed to be a gradual process. The financial penalty starts out relatively low, but will increase in 2015 and 2016. The administrative flexibility over the hardship exemption was designed to give the administration some leeway over enforcing the mandate, particularly early on, in order to ease the transition to a new and reformed insurance market. (The Massachusetts reforms, which were a model for the Affordable Care Act, also included a hardship exemption and called for increasing penalties over time.)
Administration officials don’t seem to think many people will take up this new option. They are probably right about that. Catastrophic policies aren’t dramatically different in coverage from the “bronze” policies, which cover 60 percent of the typical person’s medical expenses and comply with all Obamacare requirements. But if you buy a catastrophic policy, you’re not eligible for federal tax credits. If you buy a bronze policy, you are. As a result, most lower- and middle-income people would probably still find the bronze policies a better deal.
Still, some people—primarily, the ones who don’t qualify for subsidies—will opt for the catastrophic policies because they will be moderately cheaper. And some people will opt not to get insurance at all. That will mean fewer people in good health paying premiums for the exchange policies. That’s a potential problem for insurers, who count upon those premiums to offset the medical bills of people in poor health. (For health policy wonks: The catastrophic policies are an independent risk pool, separate from other policies in the exchanges. So for every person who selects one of those policies, that’s one fewer person putting premiums into the larger pot of money for the exchange policies.) There’s also a danger that, as Ezra Klein points out, the administration will come under more pressure to pull back on the mandate for other people. “This latest rule change could cause significant instability in the marketplace and lead to further confusion and disruption for consumers,” said Karen Ignani, president of America’s Health Insurance Plans.
Yes, insurers say those sorts of things all the time. And this singular change probably won’t cause serious, irreparable harm, any more than any of the previous ones did. The number of people whose behavior changes is likely to be small and the new system is more resilient than most people realize. But even minor changes can become major if there are enough of them.
Note: This item has been updated. As a friend reminds me, even the catastrophic plans under Obamacare aren’t that skimpy. They still cover all essential benefits, for example, and the actuarial value really isn’t much different from bronze plans.
By: Jonathan Cohn, The New Republic, December 21, 2013
“Plan Beats No Plan”: In This Clash, Democrats Deserve The Victory
“Plan beats no plan.”
That was Tim Geithner’s political axiom in internal White House debates as the president’s team worked to mend the financial meltdown. Today his slogan does duty nicely as a preview of the public’s judgment on the shocking Republican choice to shut down the government over Obamacare.
Communications strategy in politics generally involves people in power crafting messages for less knowledgeable people (the press) to transmit to even less knowledgeable people (voters). (If you doubt this, have a look at the brilliant man-on-the-street segment Jimmy Kimmel did asking people whether they prefer “Obamacare” or “The Affordable Care Act.”). The idea in these messaging wars is to convey “values” that resonate with the public and trump your opponent’s.
Consider the current showdown in this context. President Obama championed a plan through which government will spend hundreds of billions of dollars to help millions of low- and middle-income Americans buy decent private health coverage. As can never be said often enough, Obama’s plan also happens to have been based on a sensible Republican design that Mitt Romney enacted successfully in Massachusetts.
Republicans have no plan — literally, nothing serious whatsoever — to help more than a handful of the roughly 50 million uninsured Americans get such coverage. Yes, the GOP offers little talking points around the edges so that its team has something to say. But all of its “ideas” — from group purchasing for small business to buying coverage across state lines — are pseudo-plans. Nothing the Republican leadership has offered reaches more than 3 million people.
Once you understand this, you understand how deeply disingenuous Republican messaging has been. House Speaker John Boehner delivered a sound bite Monday night: “ We think there ought to be basic fairness for all Americans under Obamacare .” That’s why the GOP wouldn’t budge.
Is Boehner kidding? Is that all they have? By “fairness” Boehner means the law’s individual mandate should be delayed for a year, just like the employer mandate has been put off. To save people from “the harms” of Obamacare, in Sen. Ted Cruz’s (R-Tex.) irritating collegiate debate lingo. Democrats are on the side of big business, you see, while the GOP is fighting for the little guy.
Now, to say that this message is an insult to our intelligence isn’t the end of the discussion, because no one ever lost a political fight by insulting the American public’s intelligence.
But that Republicans are staking the shutdown on this thin gruel is revealing. They’re not saying, “we have a better plan to help Americans achieve health security.” They can’t say that, because the president already enacted the Republican plan. Instead, they’re ginning up a phony “fairness” issue and trying to make it sound real.
But the employer mandate is a sideshow in Obamacare. It’s there for one reason: to keep employer money in the game to reduce the cost on public budgets of extending health-care coverage. Ending the employer role in health-care coverage and shifting these costs to public ledgers would be economically rational — better both for citizens and for businesses. Politically, however, the White House judged this to be untenable.
So let’s stipulate that over time the employer mandate should be scrapped. The individual mandate, by contrast — the “unfairness” the GOP now bemoans — is essential. As conservatives taught us via Romneycare, you can’t move toward universal coverage with private health-insurance plans without requiring everyone to be in the insurance pool (and also without subsidizing folks who need help buying coverage). Without a mandate and subsidies, younger, poorer and healthier folks opt out, making rates spiral. This is Insurance 101.
Trying to equate these mandates as a “fairness” issue is to assume the press and the public are idiots. Crafting a message that works only if people are idiots is a grim way to do politics — and deeply cynical. Republicans hardly have a monopoly on cynical political tactics, but to use cynicism in the service of denying basic health security to millions is morally unattractive, to put it mildly. Not something you want to tell the kids about.
“What did you do today, Daddy?” asks the son of one of these House Republicans in my imagination.
‘Hey, Junior, I twisted truth and logic to make sure millions of poor American workers can still go broke if someone in their family gets seriously ill. . . . Junior, why are you looking at me like that?”
John Boehner may look tanned and rested, but the suave speaker has a Dorian Gray problem. Somewhere in the attic, his likeness in a painting is rotting.
There’s a wonderful poster from World War II in which Churchill exhorts British citizens to “Deserve Victory.”
In this clash, Democrats do.
By: Matt Miller, Opinion Writer, The Washington Post, October 2, 2013
“One Reform, Indivisible”: Republicans Who Deluded Supporters Into Believing Obamacare Wouldn’t Happen Will Pay Personal Price
Recent political reporting suggests that Republican leaders are in a state of high anxiety, trapped between an angry base that still views Obamacare as the moral equivalent of slavery and the reality that health reform is the law of the land and is going to happen.
But those leaders don’t deserve any sympathy. For one thing, that irrational base is a Frankenstein monster of their own creation. Beyond that, everything I’ve seen indicates that members of the Republican elite still don’t get the basics of health reform — and that this lack of understanding is in the process of turning into a major political liability.
On the unstoppability of Obamacare: We have this system in which Congress passes laws, the president signs them, and then they go into effect. The Affordable Care Act went through this process, and there is no legitimate way for Republicans to stop it.
Is there an illegitimate way? Well, the G.O.P. can try blackmail, either by threatening to shut down the government or, an even more extreme tactic, threatening not to raise the debt limit, which would force the United States government into default and risk financial chaos. And Republicans did somewhat successfully blackmail President Obama back in 2011.
However, that was then. They faced a president on the ropes after a stinging defeat in the midterm election, not a president triumphantly re-elected. Furthermore, even in 2011 Mr. Obama wouldn’t give ground on the essentials of health care reform, the signature achievement of his presidency. There’s no way he would undermine the reform at this late date.
Republican leaders seem to get this, even if the base doesn’t. What they don’t seem to get, however, is the integral nature of the reform. So let me help out by explaining, one more time, why Obamacare looks the way it does.
Start with the goal that almost everyone at least pretends to support: giving Americans with pre-existing medical conditions access to health insurance. Governments can, if they choose, require that insurance companies issue policies without regard to an individual’s medical history, “community rating,” and some states, including New York, have done just that. But we know what happens next: many healthy people don’t buy insurance, leaving a relatively bad risk pool, leading to high premiums that drive out even more healthy people.
To avoid this downward spiral, you need to induce healthy Americans to buy in; hence, the individual mandate, with a penalty for those who don’t purchase insurance. Finally, since buying insurance could be a hardship for lower-income Americans, you need subsidies to make insurance affordable for all.
So there you have it: health reform is a three-legged stool resting on community rating, individual mandates and subsidies. It requires all three legs.
But wait — hasn’t the administration delayed the employer mandate, which requires that large firms provide insurance to their employees? Yes, it has, and Republicans are trying to make it sound as if the employer mandate and the individual mandate are comparable. Some of them even seem to think that they can bully Mr. Obama into delaying the individual mandate too. But the individual mandate is an essential piece of the reform, which can’t and won’t be bargained away, while the employer mandate is a fairly minor add-on that arguably shouldn’t have been in the law to begin with.
I guess that after all the years of vilification it was predictable that Republican leaders would still fail to understand the principles behind health reform and that this would hamper their ability to craft an effective political response as the reform’s implementation draws near. But their rudest shock is yet to come. You see, this thing isn’t going to be the often-predicted “train wreck.” On the contrary, it’s going to work.
Oh, there will be problems, especially in states where Republican governors and legislators are doing all they can to sabotage the implementation. But the basic thrust of Obamacare is, as I’ve just explained, coherent and even fairly simple. Moreover, all the early indications are that the law will, in fact, give millions of Americans who currently lack access to health insurance the coverage they need, while giving millions more a big break in their health care costs. And because so many people will see clear benefits, health reform will prove irreversible.
This achievement will represent a huge defeat for the conservative agenda of weakening the safety net. And Republicans who deluded their supporters into believing that none of this would happen will probably pay a large personal price. But as I said, they have nobody but themselves to blame.
By: Paul Krugman, Op-Ed Columnist, The New York Times, August 18, 2013
“Weight Loss, No Exercise”: Four Years Later, The Second Half Of The Republican “Repeal And Replace” Plan
At his press conference late last week, President Obama chided congressional Republicans for voting to repeal the Affordable Care Act several dozen times without offering a credible alternative. “They used to say they had a replacement,” he told reporters. “That never actually arrived, right? I mean, I’ve been hearing about this whole replacement thing for two years — now I just don’t hear about it, because basically they don’t have an agenda to provide health insurance to people at affordable rates.”
Au contraire, Republicans responded.
The 173-member strong Republican Study Committee is on track to roll out legislation this fall that would replace the 2010 Affordable Care Act with a comprehensive alternative, Chairman Steve Scalise told CQ Roll Call on Thursday.
Though it wouldn’t be the first Obamacare repeal-and-replace proposal floated by individual GOP lawmakers in either chamber of Congress, the RSC bill is one that could at least gain traction on the House floor, given the conservative group’s size and influence.
Oh good, it only took four years for House Republicans to come up with a health care plan they like.
So, what’s in it? No one outside the Republican Study Committee actually knows, and even the RSC isn’t altogether sure since the plan isn’t finished. But Scalise, the Louisiana Republican who chairs the RSC, insists some of the popular provisions in “Obamacare” will remain intact, including protections for people with pre-existing conditions.
“We address that to make sure that people with pre-existing conditions cannot be discriminated against,” he told Roll Call. But, he promised the bill would not “put in place mandates that increase the costs of health care and push people out of the insurance that they like,” Scalise said.
In related news, the Republican Study Committee has a weight-loss plan in which everyone eats all the deserts they want and never exercises.
Look, it’s extremely difficult to craft a health care system that protects people with pre-existing conditions while eliminating mandates, scrapping industry regulations, and keeping costs down. Indeed, it’s why Republicans came up with mandates in the first place — the mandates were seen as the lynchpin that made their larger reform efforts work.
Indeed, it’s partly why Democrats used to push so hard to see the GOP alternative. Dems assumed, correctly, that once Republicans got past their talking points and chest-thumping, they’d see that actually solving the problem required provisions that some folks wouldn’t like.
But let’s not pre-judge, right? Maybe the right-wing members of the Republican Study Committee have figured out a creative way to help those who can’t afford coverage and protect those with pre-existing conditions and reduce health care costs and cut the costs for prescription medication and cover preventive care and cut the deficit by hundreds of billions of dollars — just like the Affordable Care Act does. What’s more, maybe they’ll do all of this without raising taxes and/or including elements in the plan that are unpopular.
I seriously doubt it, but I suppose it’s possible.
What seems more likely to me, though, is that the Republican Study Committee will eventually finish and unveil their “Obamacare” alternative and invite side-by-side comparisons between the two approaches — which will in turn make the Affordable Care Act look even better.
By: Steve Benen, The Maddow Blog, August 13, 2013
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