“Completely Ignorant”: Senate Candidate Josh Mandel Offers Most Nonsensical Plan Yet To Cover Pre-Existing Conditions
Republicans who want to repeal the Affordable Care Act—that is, all of them—have a really difficult time explaining how they would preserve popular elements of the legislation, such as the provisions that ban insurers from denying coverage based on pre-existing conditions, or requirements that young people remain covered for longer on their parents’ policy.
In a lunchtime debate on Monday, Josh Mandel, the Republican trying to unseat Senator Sherrod Brown in Ohio, gave easily the most confusing “plan” we’ve heard so far:
Q: How would you, and with specificity please, how would you maintain those benefits without the requirement of people buying insurance?
MANDEL: Well you have to make cuts in the other part of the government. In order to pay to cover folks with pre-existing conditions, to your question, and for younger folks on their parents’ insurance, if there’s leaders in Washington want to do that without Obamacare on the books—you’ve got to make significant cuts. A lot of Republicans will say, don’t touch defense, don’t touch the military. Listen, if we’re going to have a good-faith conversation about strong health care, about a balanced budget, we need to actually make cuts in defense. I mentioned some of my ideas in respect to Europe. Another place I’d like to cut—I mentioned Pakistan but I’d like to get more specific. A few weeks ago, in Egypt, our embassy was overrun. In Libya our ambassador was killed. Why in the world is Sherrod Brown, and other politicians in Washington, voting to give our tax dollars to countries that harbor terrorists, when we need that money here to pay for healthcare, to protect Medicare, to protect Social Security. It doesn’t make any sense. They’re going to hate us without us paying them to do that. We don’t need to pay them to hate us.
Mandel’s answer, which somehow ends up on the embassy deaths in Libya, betrays a complete ignorance of what “Obamacare” does.
What it does not do is simply pay insurers to cover people with pre-existing conditions. The ACA has an individual mandate to buy insurance, which broadens the consumer pool for insurance companies, while also banning insurers from denying coverage to people with pre-existing conditions and using community ratings to ensure everyone is offered fair prices for coverage.
If you repeal the individual mandate in Obamacare, which Mandel indisputably wants to do, then how do you keep people from simply waiting until they get sick to buy coverage for which they cannot be denied—something that would send the health insurance industry into a fatal tailspin?
That’s what the moderator was clearly asking, and Mandel squares that circle by… cutting defense spending.
It’s a completely nonsensical response. (Brown wryly noted that “That was about a specific an answer on healthcare as he’s given throughout the whole campaign.”) Interpreted literally, it seems Mandel is actually proposing a new federal program that would directly subsidize insurers for covering those with pre-existing conditions and young people who want to stay on their parents’ plans—funded by cuts in defense and foreign aid to places like Libya and Egypt.
But since nobody anywhere has proposed anything like that before—most notably, Mandel hasn’t—what’s more likely is that he’s trading on the common misperception of Obamacare as a massive taxpayer-funded boondoggle that simply throws public money at various problems. Under that understanding of Obamacare, I suppose you could re-fund the “pre-existing conditions coverage” line in the federal budget with defense cuts—but that line doesn’t exist. It’s not how the law works.
Mandel either doesn’t understand that, or wants to willfully mislead voters about the legislation and what he could do for them if it’s repealed.
It’s a tough question for Republicans to answer—Mitt Romney has simply declared that he would magically cover people with pre-existing conditions without offering any details. (This lead an economist at the right-wing American Enterprise Institute to say last week that “It’s a complete mystery what [Romney]’s talking about. He’s clearly asserting that he’s got a new policy, but he hasn’t said what it is.”)
Given how ridiculous Mandel sounded while attempting to flesh out a plan, perhaps Mitt is onto something here. But the bottom line remains that Republicans like Mandel and Romney have no serious plan for maintaining coverage for people with pre-existing conditions.
By: George Zornick, The Nation, October 15, 2012
“Tomorrow Is Another Day”: Mitt Romney’s Ever-Changing Opinion On Health Care
Seeking to soften his image, Mitt Romney has this week taken — again — to touting the health care reform law he enacted as governor of Massachusetts, saying it illustrates his “empathy and care about the people of this country.”
While running for president in 2008, and the following year while the Affordable Care Act was still being crafted, Romney was actively evoking ‘Romneycare’ as a model for federal health reform. All that changed after President Obama signed the law in March 2010, at which point repeal became the Republican Party’s raison d’être. Romney quickly latched on to the cause.
That’s when the relationship between the now-Republican nominee and his signature achievement as governor grew complicated. Here’s a timeline.
April 12, 2006: Birth of Romneycare
Massachusetts Gov. Mitt Romney signs health care reform into law.
February 2, 2007: ‘Model for the nation’
Preparing to run for president, Romney touts Romneycare in a Baltimore speech. “I’m proud of what we’ve done,” he says. “If Massachusetts succeeds in implementing it, then that will be a model for the nation.” He repeats this message in multiple media appearances throughout his presidential run.
January 5, 2008: ‘I like mandates’
In a Republican primary debate, Romney defends Romneycare and its individual mandate. “I like mandates. The mandates work,” he says. “If somebody — if somebody can afford insurance and decides not to buy it, and then they get sick, they ought to pay their own way, as opposed to expect the government to pay their way.” He continues to echo this message.
July 30, 2009: Adopt my plan, Mr. President
The national health care debate is raging. Romney takes to USA Today to call on Obama to embrace the tenets of Romneycare. “Obama could learn a thing or two about health care reform from Massachusetts,” he writes, making the case for an individual mandate: “Using tax penalties, as we did, or tax credits, as others have proposed, encourages ‘free riders’ to take responsibility for themselves rather than pass their medical costs on to others.”
The federal law enacted in March 2010 includes the three core planks of Romneycare: guaranteed insurance coverage, an individual mandate and subsidies to help people afford to buy their own policies on a regulated exchange.
March 30, 2010: ‘Different as night and day’
Reading the tea leaves, Romney proceeds to channel his party’s calls to unwind Obamacare and insists that it’s different from his plan.
“People often compare his plan to the Massachusetts plan,” he tells the Boston Globe. “They’re as different as night and day. There are some words that sound the same, but our plan is based on states solving our issues; his is based on a one-size-fits-all plan.”
After initially calling for partial repeal, Romney champions the GOP’s push to fully repeal the Affordable Care Act, describing it as both unconstitutional and damaging to the nation.
May 12, 2011: No apology
Weeks before announcing his presidential bid, and under pressure from conservatives to disavow his greatest political accomplishment, Romney gives a speech defending his law but vowing never to impose it on the nation. “Our plan was a state solution to a state problem and his plan was a federal power grab,” he says.
“I also recognize a lot of pundits are saying I should stand up and say this whole thing was a mistake,” he says at the University of Michigan. “But there’s only one problem with that: It wouldn’t be honest. I, in fact, did what I felt was right for the people of my state.”
June 12, 2011: Obamneycare
One day after his Republican primary opponent Tim Pawlenty derisively conflated the two laws with the moniker “Obamneycare,” Romney defends his version in a debate.
“If I’m elected president I will repeal Obamacare,” he says. “And also, on my first day in office … I will grant a waiver to all 50 states from Obamacare.”
Romney proceeds to avoid mentioning Romneycare for the rest of the primaries, but holds the line on the federal-state distinction each time he’s asked about it.
September 15, 2011: ‘One of my best assets’ against Obama
During a Republican primary debate in South Carolina, Romney explains how he will respond to Obama’s contention that he isn’t a credible critic of the Affordable Care Act.
“That will be one of my best assets if I’m able to debate President Obama,” he says, “as I hope to be able to do by saying, ‘Mr. President, you give me credit for what you’ve tried to copy in some ways. Our bill dealt with 8 percent of our population, the people who aren’t insured and said to them, if you can pay, don’t count on the government, take personal responsibility. We didn’t raise taxes, Mr. President. You raise taxes $500 billion. We didn’t cut Medicare.’”
December 7, 2011: ‘It’s not even perfect for Massachusetts!’
Looking to shore up his primary position, Romney puts more distance between himself and his Massachusetts law than ever before. In an interview with the Washington Examiner’s Byron York, he says he actually had serious concerns about his own bill. As for how many other states should mimic his signature law, he replies: “In its entirety, not very many.”
“It’s not even perfect for Massachusetts,” he says. “At the time we created it, I vetoed several measures and said these, I think, are mistakes, and you in Massachusetts will find you have to correct them over time. But that’s the nature of a piece of legislation of this nature. You’ll see what works, what doesn’t, and you’ll make the changes. But they have not made those changes, and in some cases they made things worse. So I wouldn’t encourage any state to adopt it in total.”
June 28, 2012: Upheld
The Supreme Court upholds the Affordable Care Act, and by now Romney has locked up the presidential nomination. “Our mission is clear,” he says. “If we want to get rid of Obamacare, we’re going to have to replace President Obama.” He does not mention Romneycare.
August 8, 2012: Romneycare revival
Accused in a vicious pro-Obama group’s ad of being responsible for the death of a woman by making decisions at Bain that cost her her health care, the Romney campaign seeks to soften his image by saying the Massachusetts law would have covered her.
“Obviously it is unfortunate when anyone loses their job,” says Romney spokeswoman Andrea Saul on Fox News. “To that point, you know, if people had been in Massachusetts under Gov. Romney’s health care plan they would’ve had health care.”
Conservatives threw a fit, unleashing a torrent of criticism at their nominee’s campaign, with some fearing that Saul’s remarks would cost him the election. The criticism, it turns out, would not silence the campaign’s embrace of the law.
August 26, 2012: ‘Very proud’
Fending off Democratic claims that Republicans are waging a “war on women,” Romney says he’s “very proud” that his Massachusetts law gave health care to many women.
“I’m the guy who was able to get all the health care for all the women and men for my state,” he says on Fox News. “They were talking about it at the federal level. We actually did something and we did it without cutting Medicare and without raising taxes.”
September 8, 2012: I like parts of Obamacare — but not exactly
In an interview on NBC, Romney briefly signals support for two key provisions in Obamacare — guaranteed coverage for preexisting conditions and letting young people remain on a parent’s policy until 26, which were also included in Romneycare.
“I’m not getting rid of all of health care reform,” he says. “Of course there are a number of things that I like in health care reform that I’m going to put in place.”
Soon, his campaign clarifies that he wasn’t expressing solidarity with the Affordable Care Act, but was reiterating support for different versions of the ideas. In the case of preexisting conditions, he wants laws protecting those who have maintained continuous coverage, but not first-time buyers. And he says insurers will adopt the under-26 provision on their own.
September 26, 2012: ‘Empathy and care’
Under fire again from the Obama campaign for his taped remarks deriding 47 percent of Americans as freeloaders, Romney cites Romneycare in a national TV interview as evidence of his compassion for ordinary people.
“Don’t forget — I got everybody in my state insured,” he says on NBC. “One hundred percent of the kids in our state had health insurance. I don’t think there’s anything that shows more empathy and care about the people of this country than that kind of record.”
On the same day, Romney touts Romneycare in a guest article for the New England Journal of Medicine contrasting his vision for health care reform with Obama’s. “Each state will have the flexibility to craft programs that most effectively address its challenges — as I did in Massachusetts,” he writes, “where we got 98 percent of our residents insured without raising taxes.”
By: Sahil Kapur, Talking Points Memo, September 29, 2012
“Trust Me, I’ll Figure It Out”: Mitt Romney Re-Explains Why He Can’t Be Trusted On Health Care
Over the weekend, Mitt Romney muddied the waters about where he stands on health-care reform with a series of vague statements from himself and his campaign about health insurance for people with pre-existing conditions.
His floundering is a subset of a larger problem: He has committed himself to a set of positions that won’t allow for a replacement of Obamacare with something that actually fixes the problem of tens of millions of Americans without health insurance, including those with pre-existing conditions.
Sarah Kliff of the Washington Post describes Romney’s progression on pre-existing conditions:
It started with the Republican presidential candidate saying during an appearance on “Meet the Press” that he liked the Affordable Care Act’s provision that requires insurers to cover preexisting conditions, and would support something similar. Hours later, his campaign clarified he did not, however, support a federal ban against denying coverage for preexisting conditions. Around 10 p.m., the Romney camp had circled back to the same position it held back in March: that the governor supports coverage for preexisting conditions for people who have had continuous coverage.
The “continuous coverage” distinction is key: In order to retain the right to insurance that covers your pre-existing condition, you need to make sure to pay health insurance premiums every month. But often, the reason people lose health insurance because they have lost their job. Telling the recently unemployed to pay out of pocket for continuous coverage, typically at a cost of several hundred dollars a month for an individual or more than $1,000 for a family, is often not viable.
It’s worth noting that the purpose of the continuous coverage requirement is similar to the purpose of the individual mandate: It provides an incentive for healthy people to stay in insurance pools, avoiding a “death spiral” in which only sick people buy insurance.
Unaffordability is not a fatal problem for Romney’s continuous coverage proposal. It could be fixed with a range of subsidies that make it affordable for people to maintain continuous health coverage. Essentially, that’s what Obamacare does, and what Romney’s health plan in Massachusetts did.
For a conservative approach to fix at least part of the affordability problem, see this article from National Affairs by James Capretta and Tom Miller. Capretta and Miller propose to combine a Romney-style proposal on pre-existing conditions with significantly expanded funding for high-risk insurance pools, in hopes of covering up to 4 million uninsured Americans with pre-existing conditions.
But Capretta and Miller estimate that their plan would cost somewhere on the order of $200 billion over 10 years. Where is the indication that Romney plans to make such a significant financial commitment, let alone get one out of a Republican Congress? Romney’s platform is full of expensive promises — restore $700 billion in Medicare cuts, grow defense spending to 4 percent of GDP, cut tax rates. It funds these promises in part by drastically cutting spending on health care for the non-elderly. Implementing something like the Capretta-Miller proposal would be a significant reversal of course.
And what about the tens of millions of Americans who are uninsured not because they have pre-existing conditions but simply because they cannot afford insurance coverage? Romney says he wants to replace Obamacare, but his plans do not signal much help for them.
Romney has talked about leveling the playing field for individual purchasers of insurance, so they would get the same favorable tax treatment as businesses buying insurance for their employees. This would make it easier for individuals to buy their own health plans, but it’s not a substitute for Obamacare-style subsidies. Any way you structure a tax incentive, it’s likely to over-subsidize the wealthy and under-subsidize the poor, leaving huge swaths of America still unable to afford insurance.
Romney hasn’t said exactly how his tax incentive would work. But it would probably be a tax credit (whose value is static across incomes) or a tax deduction (whose value rises with income). In 2008, John McCain proposed a $5,000 per family tax credit for health insurance. Scaled up for health-care inflation, that would likely be closer to $6,000 today.
The average health plan premium for a family is now $15,745. Some middle- and upper-middle-income families can be expected to cover a gap of about $9,000. But poorer people need a larger subsidy if we hope to get them covered.
(It is also worth noting that if Romney plans to convert the existing tax exclusion for employer-provided health care into some other health-care subsidy, he cannot also use it as an area for tax-base broadening to pay for his cuts in tax rates, and he needs a lot of base-broadening to make his tax-cut math work.)
The key to the subsidy structure in both Romney’s Massachusetts plan and Obamacare is that the subsidies decline in value as people’s incomes rise. Under Obamacare, people with incomes up to 133 percent of the poverty line get Medicaid, which has very little cost to the beneficiary. Above that, they get sliding-scale subsidies for private insurance; the poorest beneficiaries pay just 2 percent of their incomes. Middle-income people get smaller subsidies, and wealthy people have to pay their own way.
Republican rejection of the Medicaid expansion is especially problematic, because Medicaid is cheaper than private insurance, and people earning less than 133 percent of the poverty line have almost no money of their own to contribute toward premiums.
Telling these people the federal government will pay 40 percent of their health insurance premiums will not get them insured. The options aside from Medicaid are to provide them private insurance at significantly higher taxpayer cost than in Obamacare, or leave them uninsured. It is easy to guess which option Republicans in Congress would prefer.
Romney doesn’t want to get into these details about who will get what subsidies. But the details are important. They are the difference between expanding health insurance coverage to the vast majority of Americans, and leaving tens of millions of Americans without access to the health care they need. And they are the difference between actually making it possible for people with pre-existing conditions to get the coverage they need, and not making it possible.
As on so many issues, Romney’s line on health reform is essentially, “Trust me, I’ll figure it out.” But uninsured Americans stand to gain a lot from the implementation of Obamacare. They have no particular reason to believe that Romney’s vague alternative would bring them similar benefits.
By: Josh Barro, Bloomberg, September 13, 2012
“Everybody Is A RINO But Me”: The Wind Is Blowing In Just One Direction In The Republican Party
One of the odder phenomena of contemporary political discourse is the regular denial by Republicans that their party has significantly moved to the right in the last few years. No! they insist, it’s Democrats who’ve moved left! (you know, by embracing what used to be Republican policy positions like a a private-sector based system for expanding health insurance via an individual mandate, and a market-based cap-and-trade system for reducing greenhouse gas emissions). You’d think self-conscious conservatives would be a little louder and prouder of their victory over the moderate Republicans of yore (a victory confirmed by the fact that virtually no Republican pol would dare self-identify as “moderate”).
This act of deception finds its most definitive refutation in Republican primaries, where candidates call themselves “conservatives” or “true conservatives” or “constitutional conservatives” with almost every breath, while describing opponents as though they were Jacob Javits reincarnated. Check out this snippet from Dave Weigel about the reaction to the Supreme Court decision on ACA from the two GOP candidates running for the Senate in Texas, which began with the observation that Ted Cruz used to talk about John Roberts as his favorite jurist:
When Roberts helped save “Obamacare,” Cruz immediately blasted the Court for having “abdicated its responsibility to safeguard the Constitution.” He didn’t mention Roberts by name, but he insisted that the decision was more proof that Republicans needed to reject Cruz’s opponent, Lt. Gov. David Dewhurst. “My opponent is, by nature and by over a decade of political office, a conciliator. Now is not a time for conciliation.” Take that, Larry Tribe. Stuff it, Walter Dellinger.
Over to Dewhurst. Cruz has campaigned against him as a liberal sellout — on blogs, he’s become known as “Dewcrist.” Was he going to blow the chance to point out that Cruz’s ally had saved Obamacare? No. “Supreme Court Justice John Roberts,” said Dewhurst, “sold constitutional conservatives down the river.”
Maybe the point is that conservatives can’t admit they’ve taken over the GOP and driven it straight to Goldwater Country (the 1964 Goldwater, not the one who took to criticizing the Christian Right in his older years) because then it would be hard to describe it as a rat’s nest of RINOs that needs to be cleaned out by fill-in-the-blank.
Still, it’s odd. I recall from way, way back a runoff for Lieutenant Governor in Georgia between the famous ax-handle seggie Lester Maddox and a better-educated but still flamboyant right-wing demagogue named Peter Zack Geer. Each of the two race-baiters tried to label each other an “extremist” (Geer won, though Maddox went on to become Governor later after edging out some guy named Jimmy Carter for a runoff spot). Were they around today and running in a Republican primary, I imagine Maddox and Geer would be calling each other “sellouts” and “conciliators.” The wind is blowing in just one direction in the contemporary Republican Party, and it’s not towards the Left Coast.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, July 10, 2012
“Living By Biography”: Mitt Romney Blistered By Conservative Wall Street Journal Editorial Board
This Wall Street Journal editorial is getting a lot of attention this morning for its scathing criticism of the Romney campaign’s equivocations over whether Obamacare’s individual mandate is or isn’t a tax. Yesterday Romney declared that, yes, it is a tax after all — contradicting his campaign’s earlier contention that it wasn’t — and the editorial blasts Romney for squandering a key issue against Obama.
But let’s face it: The skirmishing over whether the mandate is or isn’t a tax probably won’t have much of an impact on the election’s outcome.
That’s why the real news in the Journal editorial — the stuff that should drive the discussion today — is its scalding attack on Romney’s lack of specificity on multiple issues:
The Romney campaign thinks it can play it safe and coast to the White House by saying the economy stinks and it’s Mr. Obama’s fault. We’re on its email list and the main daily message from the campaign is that “Obama isn’t working.” Thanks, guys, but Americans already know that. What they want to hear from the challenger is some understanding of why the President’s policies aren’t working and how Mr. Romney’s policies will do better.
The Journal notes the Obama campaign’s attacks on Romney’s Bain years and offshore accounts, and adds:
All of these attacks were predictable, in particular because they go to the heart of Mr. Romney’s main campaign theme — that he can create jobs as President because he is a successful businessman and manager. But candidates who live by biography typically lose by it. See President John Kerry.
The biography that voters care about is their own, and they want to know how a candidate is going to improve their future. That means offering a larger economic narrative and vision than Mr. Romney has so far provided. It means pointing out the differences with specificity on higher taxes, government-run health care, punitive regulation, and the waste of politically-driven government spending.
The GOP-aligned Journal editoral board is implicitly agreeing that one of the leading critiques of Romney —one being made by the Obama campaign and Dems, but also by more and more media commentators — is entirely legitimate: That he’s refusing to detail his policies with any specificity to speak of on issue after issue.
This goes right to the heart of the central dynamic of this race: The Romney campaign’s gamble that he can edge his way to victory by making this camapign all about Obama, and that along the way, voters won’t notice that he isn’t meaningfully telling us what he would do if elected president. The Journal is calling this out as a non-starter. Does this represent broader GOP establishment opinion? It’s more important than all the short-term skirmishing over whether the mandate is a tax or not.
By: Greg Sargent, The Plum Line, The Washington Post, July 5, 2012
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