“Can’t Stop, Won’t Stop”: GOP Will Never Stop Coming For Obamacare
Obamacare turned 5 on Monday, a birthday achieved despite sustained and repeated efforts to smother the law in its cradle.
The law has taken some hits, including a 2012 Supreme Court decision that buckled the knees of the bill’s backers but seemed to make the Affordable Care Act the settled law of the land.
Now the Supreme Court has again taken up another challenge to the law.
King v. Burwell hinges on whether or not four words buried deep in the text of the law contain the seeds of Obamacare’s destruction by eliminating tax subsidies for people living in states that declined to set up their own insurance exchanges.
But even if they lose again at the court, conservatives say that they will continue to try to undo the law through the courts.
Michael Cannon, a health-policy expert at the Cato Institute, said the most promising challenge to the ACA comes from the state of Maine, which, after the Roberts court ruled in 2012 that the federal government was limited in how much it could compel states to expand Medicaid, sued to roll back its existing Medicaid coverage.
Last year, a federal appeals court ruled against the state, but Gov. Paul LePage has appealed to the Supreme Court, even as Maine’s attorney general has refused to represent the state in its challenge of the law.
Other remaining challenges include Sissel v. U.S. Department of Health and Human Services, which argues the ACA is unconstitutional because it violated the Constitution’s origination clause that states spending bills must originate in the House, not the Senate.
“They are both kind of long shots,” acknowledged Cannon, noting that “the Supreme Court has never struck anything down on origination grounds” and that the House likely lacks standing in its lawsuit against the administration.
If the administration loses King v. Burwell, most health-policy experts predict that it will create a “death spiral” as low-income beneficiaries lose their subsidies in states that did not set up their own exchanges, and insurers are forced to raise rates. But conservatives say they will not delay in kneeing the law into the grave by filing lawsuits in states that set up their own exchanges.
Because many states rushed to do so, conservatives say they expect that governors and their health departments may have violated their state constitutions, and so even residents of those states that believed they were immune from the Burwell decision could face a loss of subsidies as well.
If the Supreme Court decides in favor of the government in King, conservative legal scholars said that what they decide to do in the future to tear down the law depends upon precisely the way in which the judgment is rendered. Halbig v. Burwell mirrors the King case in many respects, but other cases could still go forward, in particular one in Indiana in which several dozen school districts have argued that the employer mandate to provide health insurance puts too much of a burden on state and local governments.
Smaller challenges to the law, meanwhile, continue to mount. Little Sisters of the Poor sued to exempt themselves from the contraceptive mandate. If successful, the suit would allow more organizations to opt out than the Hobby Lobby decision did.
Another challenge, brought by the Goldwater Institute of Arizona, takes aim at the Independent Payment Advisory Board, which was designed to permit the Executive Branch to limit Medicare payments. Even some of the law’s liberal supporters, like former Vermont Gov. Howard Dean, have said that the board should be eliminated or rethought.
Meanwhile, conservative legal scholars say they continue to pore over the text of the law in the hopes that they will find some other legal weaknesses that were not readily apparent. The King case, after all, hinges on four words in the text that were discovered by a legal scholar months after the law was passed.
“This law is so complicated that even those who have read it don’t understand the depths of it,” said John R. Graham, a senior fellow at the conservative National Center for Policy Analysis. “Every time we look at it, we find something else to take to a judge.”
And such lawsuits, he added, help galvanize opposition to the bill years after it has passed.
“They keep the energy up, keep Obamacare on the front pages, keep hope alive.”
Which is necessary, because many conservatives still hope that the law will collapse under its own weight.
“They have really reached the limit of sign-ups. Enrollment is flattening as people see more and more how expensive the coverage is, how high the deductibles are, all the hoops they have to jump through, and they realize it is just not very attractive insurance,” said Grace-Marie Turner of the Galen Institute. She said that many states would be able to opt out of some of the law’s provisions in 2017, and find their own alternatives.
“There is going to be huge momentum going forward to make changes to this law,” Turner said. “I could go on forever about how damaging this law has been to people’s lives. It has to be changed.”
By: David Freedlander, The Daily Beast, March 25, 2015
“Laying It All Out On Medicare”: No Mistaking Paul Ryan’s Policy
The release of a new Paul Ryan budget plan is always the occasion for a lot of ridicule from liberals, for a whole bunch of reasons, and this year’s will be no different. Ryan’s budgets always manage to combine a remarkable cruelty toward poor people with a sunny optimism that draconian cuts to social services will result in a veritable explosion of economic growth, allowing us to balance the budget without taking anything away from the truly important priorities (like military spending) or, heaven forbid, forcing wealthy people to pay more in taxes.
I’m sure there are other people preparing detailed critiques of the Ryan budget, but I want to focus on one thing this brings up: the question of how we talk about Medicare. As he has before in his budgets, Ryan proposes to repeal the benefits of the Affordable Care Act, like subsidies for middle-class people to buy insurance and the expansion of Medicaid, but he’d keep the tax increases and Medicare cuts that the bill included in order to pay for it all, which helps him achieve his “balanced” budget.
Yes, it’s true that when Ryan was running for vice president, he joined Mitt Romney in condemning those very Medicare savings. But nobody really believed he was doing anything at the time but being a team player. So we can give him credit for taking at least a step toward putting his money where his mouth is on Medicare. Sure, it may be couched in some misleading words (the document refers to “strengthening Medicare” no fewer than ten times), but there’s no mistaking the policy.
Because the rest of his party is, to put it kindly, of two minds when it comes to the program. On one hand, they will tell you, Medicare is unsustainable, a ravenous beast that will devour the entire nation’s financial well-being if we don’t find a way to suppress its appetite. In Washington-speak, this is translated as “doing something about entitlements.” We have to Do Something About Entitlements! If you don’t want to Do Something About Entitlements, you’re just not serious about our nation’s fiscal challenges.
On the other hand, Republicans believe that Medicare is utterly sacrosanct, a jewel whose every facet is so perfect that even the most modest attempt to curtail its costs should be met with howls of anguish and outrage. Or at least that’s what they believe at election time, when they’ll air one ad after another condemning Democrats for cutting the Medicare seniors so desperately need. Democrats all over the country have been subjected to ads saying, “Congressman Fnurbler voted to cut $716 billion from Medicare!” over a picture of an elderly couple sitting at the kitchen table, looking over their bills with an engulfing despair, then meeting each other’s eyes in a tragic look that says, “Thanks to Congressman Fnurbler, all is lost. If only we had been able to pay our gas bill so we could stick our heads in the oven and end it all right now.”
Republicans are so deeply opposed to the idea of cutting Medicare that they can’t even stomach anyone trying to see if Medicare is spending its money wisely. Mention the Independent Payment Advisory Board, a component of the ACA that was designed to restrain Medicare costs if they rose too fast, and steam will come out of their ears. (The IPAB would make recommendations to Congress on ways to save money, and Congress would have to act on them. But since Medicare spending has slowed dramatically in the last couple of years, the requirement has yet to kick in, and President Obama hasn’t bothered to appoint anyone to what is still a theoretical board.) They waged a virtual war on comparative effectiveness research, effectively saying that it was dangerous to even ask which competing treatments work well and which don’t.
In other words, most Republicans believe we must, must, must reduce the cost of Medicare—excuse me, Do Something About Entitlements—but are adamantly opposed to every step that has been taken to reduce the cost of Medicare. I’m sure that lots of them are sympathetic to Ryan’s vision, which is to essentially turn the program into a voucher system, in which the government helps you buy private insurance, and over time costs magically go down (and if you’re thinking that sounds a lot like what people are getting on the Obamacare exchanges, any Republican will tell you that it’s totally different because freedom).
So let’s give Paul Ryan some credit. Sure, his numbers might not add up. But when he puts out a budget, there’s no mystery about where he’s coming from and what he wants to do.
By: Paul Waldman, Contributing Editor, The American Prospect, April 1, 2014
“The Death Panels Are Coming”: Conservatives Are Going To Have To Turn Somewhere, And I’m Guessing “Rationing” Will Be On Their Lips
Now that Healthcare.gov seems to be working reasonably well (at least on the consumer end), Republicans are going to have to find something else they can focus on in their endless war against the Affordable Care Act. So get ready for the return of “death panels.”
They never really went away. Those who aren’t immersed in the fantasy world in which conservatives move were reminded of that last week, when chronicler of changed games Mark Halperin, the embodiment of most everything that’s wrong with contemporary political journalism, did an interview with the conservative news organization Newsmax. When the interviewer mentioned “death panels, which will be coming,” Halperin responded, “I agree, it’s going to be a huge issue, and that’s something else about which the President was not fully forthcoming and straightforward.” Halperin didn’t explain what lie he imagines Obama told about death panels (perhaps he thinks that when Obama said the government wouldn’t declare your grandmother unfit to live and have her murdered, he wasn’t telling the truth), but what matters isn’t Halperin’s own ignorance of the law (after all, understanding policy is for nerds, right?), but the fact that it came up in the first place. Which, if you pay attention to places like Newsmax, it still does. A lot.
But wait, you say. Wasn’t this all debunked years ago? Yes, it certainly was. But why should that matter?
It’s important to remember the switcheroo conservatives pulled on the “death panel” issue. They started off complaining that one provision in the law constituted “death panels,” then when their unequivocal lie was exposed and condemned roundly even by neutral observers, they switched to asserting that all along they had been talking about an entirely separate and unrelated provision, and when they say “death panels” they aren’t talking about death, or panels for that matter, but about health care “rationing.”
Here’s how it happened. The ACA originally included a provision allowing doctors to get reimbursed by Medicare for sessions in which they counseled their patients about their end-of-life options and how to make sure their wishes were properly carried out. The problem is that most of the time, when a patient shows up in the hospital in crisis, the staff has no idea what the patient wants if they can’t communicate. Do they want to be resuscitated, or intubated, or have every heroic measure taken until the moment they expire? All of us have different ideas about this, and it’s important that we think about it beforehand. So the ACA said, if a doctor spends a half hour talking to a patient about it, they’ll be paid for their time. It didn’t say what they had to tell them, it just said they could get paid for doing it, because right now if they do that counseling, they’re doing it for free, which makes it much less likely to occur, which is not only bad for the system but bad for individual patients.
So that part of the law said simply that doctors can bill Medicare for the time they spend doing that kind of counseling, just like they do for a physical exam or performing a procedure. To the people who supported it, the idea seemed commonsensical. Wouldn’t you want doctors and patients to have those kinds of conversations? You’d think. But turning that into the “death panel” lie began, as a remarkable number of health care lies have in the last couple of decades, with policy fraudster Betsy McCaughey, who went on Fred Thompson’s radio show in 2009 while the law was being debated and told his listeners, “Congress would make it mandatory—absolutely require—that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner.” That would be terrible! It would also be terrible if our beloved elders were then hurled from hot air balloons hovering over volcanoes, but the law doesn’t require that either.
Unlike most deceptions in politics, which can be justified by pleading that there was some misinterpretation of ambiguous language, or that what the speaker meant just got garbled in the articulation, this was a clear and specific lie—or two lies, in truth—that McCaughey simply made up in her attempt to subvert the law and then repeated multiple times. There was nothing mandatory or required about counseling, every five years or ever, for any patient, and the counseling was not about “how to end their life sooner.”
To continue our story, then Sarah Palin took things the next step, turning a blatant lie (but at least one with some connection to what the law was about) and spinning it out into an extravagant fantasy one can only imagine came from some obscure 1970’s dystopian sci-fi movie she saw at four in the afternoon one day while the snow fell gently in Wasilla. “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel,'” she wrote on her Facebook page, “so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.” 11 The quotation marks were a nice touch, since we in the English-speaking world use them to denote actual quotes from a specific person or document, not just something you make up. For instance, I could write, “I wouldn’t like to go to Sarah Palin’s house, where ‘heroin is given to children’ and ‘homeless men are hunted for sport.'” But that would be extremely misleading, since as far as I know, no one has said those things about Sarah Palin’s house, least of all Palin herself. And thus “death panels” were born.
And of course, the charge was picked up by Fox News, and Rush Limbaugh, and all the other far-flung outlets of the conservative media universe. But then the existence of any such panel was debunked and debunked and debunked again. The fact that the evocative phrase originated with Palin probably made it more difficult for conservatives to make it stick beyond their own self-contained world, since Palin is widely understood to be one of America’s most celebrated nincompoops. In addition, cowardly Democrats removed the provision on end-of-life counseling from the bill (to their unending shame) so even the entirely worthy provision of the law was gone. In response, conservatives cast about, and decided that the “death panels” they so feverishly warned of never referred to end-of-life counseling, but to the Independent Payment Advisory Board (IPAB), which did end up in the final bill and which has the benefit of resembling an actual panel.
In brief: the IPAB is a group of 15 health-care experts appointed by the president and confirmed by the Senate who will make recommendations on how Medicare could save money. Those recommendations are due at the beginning of each year, and Congress has until August to overrule them. If Congress doesn’t, the Secretary of Health and Human Services will implement the recommendations. But the IPAB only makes the recommendations if Medicare’s growth exceeds certain target rates.
Now listen to this part carefully: the text of the ACA prohibits the IPAB from recommending that care be rationed. It also prohibits them from recommending other things, like increasing premiums or cutting benefits. And perhaps most importantly, if Medicare’s growth is modest, IPAB won’t make any recommendations at all. And if things go the way they’ve been going and the way they will if many of the other reforms contained within the ACA succeed (including steps to transition from a purely fee-for-service model in which sicker patients means more revenue for providers to one in which they have incentives to keep people healthy), the IPAB might never have to make cost-cutting recommendations. Although things could change of course, the Congressional Budget Office believes that for the next decade Medicare’s growth is unlikely to be large enough to trigger any IPAB recommendations.
You may wonder why conservatives, who are constantly saying we need to control the cost of Medicare, are so vehemently opposed to the existence of a panel of experts whose job it is to come up with ways to control the cost of Medicare. That just shows how little you understand. IPAB, they will tell you, will ration care, which will kill your grandmother, no matter what the law says. 22These kinds of claims, and a general feeling of hysteria around end-of-life issues, circulates relentlessly throughout the conservative world. You may remember that during the 2012 presidential primaries, Rick Santorum told an audience that in the Netherlands, which has a tightly regulated system of physician-assisted suicide, “people wear different bracelets if they are elderly. And the bracelet is: ‘Do not euthanize me.’ Because they have voluntary euthanasia in the Netherlands but half of the people who are euthanized—ten percent of all deaths in the Netherlands—half of those people are euthanized involuntarily at hospitals because they are older and sick.” This was about as true as if he had said that all Portugese people have ESP or that Mongolia is ruled by a parliament made up of dogs and cats. But he didn’t get his fantasy bracelets and fantasy statistics from nowhere—the idea surely arrived to him via the cretinous version of the “telephone” game that is the conservative information bubble, where such things circulate and mutate until they come out the mouths of candidates for president. Just as a for instance, go on over to National Review and search for IPAB, and you come up with articles with titles like, “AARP Betrays Seniors By Supporting IPAB,” and “IPAB, Obama, and Socialism,” and “New England Journal of Medicine Supports Unamerican Expansion of IPAB.” As I said, once they can no longer complain about healthcare.gov, and once those people who had their junk insurance cancelled turn out to be getting much better insurance, conservatives are going to have to turn somewhere, and I’m guessing “rationing” will be on all their lips.
So what started as “Obama is forcing doctors to encourage their patients to die,” then became “Obama’s death panel will assess individuals one by one and withhold treatment from those they find unworthy, leaving people like Sarah Palin’s kid to plead for their very lives,” ends up as “Obama’s IPAB death panel will force health-care rationing on us.”
I do think that the chances that renewing the “death panel” scare will successfully undermine the ACA are slim. The fact that they don’t exist does matter. If you’re a reporter wanting to write a story about someone who lost their junk insurance and will have to buy real coverage, at least there are individuals you can focus on, even if you do a poor job of telling their stories. But there’s no one you can interview who went before a death panel, or whose relative went before a death panel. Because, to repeat myself, they don’t exist. So this whole discussion is likely to remain very abstract. Eventually, conservatives will find something else to cry wolf about. Did you know that under Obamacare, if you kiss a person with herpes, you could get herpes? That’s right: Obamacare will give you herpes. Pass it on.
By: Paul Waldman, Contributing Editor, The American Prospect, December 2, 2013
“No, The World Didn’t End”: Maybe We’ll All Survive After All
I’m a bit amused at some of the articles dribbling out of Washington at present that find various silver linings for the demise of the filibuster against executive-branch and lower-court-judicial appointments. I mean, we all know it Killed the Senate As We Know It, at which act the angels are still weeping, and it spoiled the great and dignified work of the “gangs” cutting ad hoc deals to avoid this or that filibuster. I know it’s hard to imagine anything that would significantly offset such terrible damage–what will Lindsey Graham do between primary challenges?–but The Hill‘s Elise Viebeck finds one that has the added bonus of giving Republicans a trophy to mount on its wall:
Kathleen Sebelius may become the biggest loser in the Senate’s approval of filibuster reform.
The Health and Human Services (HHS) secretary has kept her job despite the botched rollout of ObamaCare’s insurance exchanges, but it will now be easier for Obama to replace her.
After the Senate’s vote, confirming an executive-branch nominee now takes just 51 Senate votes. Some think that raises the likelihood Sebelius will soon be a former Cabinet member.
“The president’s hands were previously tied,” said John Hudak, a fellow in governance studies at the Brookings Institution, who wrote a piece on the topic Thursday.
“Now, he has more breathing room and he is able to fire whoever he wants at HHS. That’s a very, very appealing approach, whether it fixes the problems with ObamaCare’s rollout or not.”
Better yet, Democrats can approve appointments to the Obamacare Death Panel without Republicans getting their hands dirty with complicity in genocide.
The filibuster vote could also make it easier for Obama to fill the healthcare law’s controversial cost-cutting board, another big advantage for the president.
Known as IPAB, the panel has no members yet is meant to submit its first proposed cuts in January. Any nominees from Obama require Senate confirmation, which is now an easier prospect.
Before Thursday’s vote, Obama’s nominees needed 60 votes to survive procedural motions. Now they need 51.
And hey, maybe the nuclear option shattered the deal-making dreams of “moderate” Republicans, but it might help keep some Democratic “centrists” in the Senate:
Beyond helping Obama, the change could make life easier for some of the Senate Democrats who face tough reelection contests in 2014. The chamber is controlled by 53 Democrats and two Independents who caucus with the majority party.
“Obama now has breathing room among Democrats,” Hudak said.
“He can actually let some of the Democrats who are in tough races off the hook, which has some real electoral implications for those members.”
So see? Maybe we’ll all survive after all.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, November 25, 2013
“Sowing Confusion”: Is There Any Limit To Mitt Romney’s Dishonesty?
The other day, David Bernstein argued that there’s been an “important tipping point” where many national media figures have come to understand that “in the Romney campaign, they are dealing with something unlike the normal spin and hyperbole.” Bernstein suggested they are realizing Romney has crossed into groundbreaking levels of dishonesty.
I wish I were as optimistic. I’d argue that much of the national media is still treating Romney’s nonstop distortions, dissembling, and outright lying as par for the course, as business as usual.
Here’s a test case: The debate over Medicare — and Romney’s embrace of the Paul Ryan plan — is about to dominate the conversation. Romney is moving to get ahead of the story by accusing Obama of being the one who would “end Medicare as we know it.” Here’s the Romney campaign’s statement this morning:
“There are two proposals on the table for addressing the nation’s entitlement crisis. Mitt Romney — along with a bipartisan group of leaders — has offered a solution that would introduce competition and choice into Medicare, control costs, and strengthen the program for future generations. President Obama has cut $500 billion from Medicare to fund Obamacare and created an unaccountable board with rationing power — all while America’s debt is spiraling out of control and we continue to run trillion-dollar deficits.
“If President Obama’s plan is to end Medicare as we know it, he should say so. If he has another plan, he should have the courage to put it forward.”
The claim that Romney supports a solution favored by a “bipartisan group of leaders” is a reference to the plan authored by Ryan and Dem Senator Ron Wyden. The idea that this represents “bipartisan” suppport is laughable. But this type of claim is made on both sides, so put it aside.
More interesting is the assertion that Obama has “cut $500 billion from Medicare” and created an “unaccountable board with rationing power” even as the deficit is “spiraling out of control.” That’s a reference to Obamacare’s efforts to curb spending with $500 billion in savings that are actually wrung from health care providers, not Medicare beneficiaries. That “unaccountable board,” meanwhile, is a reference to the Independent Payment Advisory Board, which is designed to make recommendations for reducing Medicare costs, and explicitly cannot recommend rationing.
Get the trick here? The Romney campaign is accusing Obama of slashing Medicare, and hence “ending Medicare as we know it,” while simultaneously accusing him of failing to curb entitlement spending in ways that pose grave danger to the nation’s finances. This, even as Romney has endorsed a plan that would quasi-voucherize Medicare and end the program as we know it.
This is all about muddying the waters in advance of a debate that could cut badly against Romney. The GOP primary forced him to embrace Ryancare; Dems are going to hammer him over it. So the Romney camp is trying to get out front by blurring lines and sowing confusion over who actually is defending traditional Medicare and who would end the program’s fundamental mission as we know it. The question is whether this, too, will be treated as just part of the game.
By: Greg Sargent, The Washington Post, The Plum Line, March 12, 2012
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