“California, Here We Come?”: If Obamacare Can Work For 38 Million People In California, It Can Work For America
It goes without saying that the rollout of Obamacare was an epic disaster. But what kind of disaster was it? Was it a failure of management, messing up the initial implementation of a fundamentally sound policy? Or was it a demonstration that the Affordable Care Act is inherently unworkable?
We know what each side of the partisan divide wants you to believe. The Obama administration is telling the public that everything will eventually be fixed, and urging Congressional Democrats to keep their nerve. Republicans, on the other hand, are declaring the program an irredeemable failure, which must be scrapped and replaced with … well, they don’t really want to replace it with anything.
At a time like this, you really want a controlled experiment. What would happen if we unveiled a program that looked like Obamacare, in a place that looked like America, but with competent project management that produced a working website?
Well, your wish is granted. Ladies and gentlemen, I give you California.
Now, California isn’t the only place where Obamacare is looking pretty good. A number of states that are running their own online health exchanges instead of relying on HealthCare.gov are doing well. Kentucky’s Kynect is a huge success; so is Access Health CT in Connecticut. New York is doing O.K. And we shouldn’t forget that Massachusetts has had an Obamacare-like program since 2006, put into effect by a guy named Mitt Romney.
California is, however, an especially useful test case. First of all, it’s huge: if a system can work for 38 million people, it can work for America as a whole. Also, it’s hard to argue that California has had any special advantages other than that of having a government that actually wants to help the uninsured. When Massachusetts put Romneycare into effect, it already had a relatively low number of uninsured residents. California, however, came into health reform with 22 percent of its nonelderly population uninsured, compared with a national average of 18 percent.
Finally, the California authorities have been especially forthcoming with data tracking the progress of enrollment. And the numbers are increasingly encouraging.
For one thing, enrollment is surging. At this point, more than 10,000 applications are being completed per day, putting the state well on track to meet its overall targets for 2014 coverage. Just imagine, by the way, how different press coverage would be right now if Obama officials had produced a comparable success, and around 100,000 people a day were signing up nationwide.
Equally important is the information on who is enrolling. To work as planned, health reform has to produce a balanced risk pool — that is, it must sign up young, healthy Americans as well as their older, less healthy compatriots. And so far, so good: in October, 22.5 percent of California enrollees were between the ages of 18 and 34, slightly above that group’s share of the population.
What we have in California, then, is a proof of concept. Yes, Obamacare is workable — in fact, done right, it works just fine.
The bad news, of course, is that most Americans aren’t lucky enough to live in states in which Obamacare has, in fact, been done right. They’re stuck either with HealthCare.gov or with one of the state exchanges, like Oregon’s, that have similar or worse problems. Will they ever get to experience successful health reform?
The answer is, probably yes. There won’t be a moment when the clouds suddenly lift, but the exchanges are gradually getting better — a point inadvertently illustrated a few days ago by John Boehner, the speaker of the House. Mr. Boehner staged a publicity stunt in which he tried to sign up on the D.C. health exchange, then triumphantly posted an entry on his blog declaring that he had been unsuccessful. At the bottom of his post, however, is a postscript admitting that the health exchange had called back “a few hours later,” and that he is now enrolled.
And maybe the transaction would have proceeded faster if Mr. Boehner’s office hadn’t, according to the D.C. exchange, put its agent — who was calling to help finish the enrollment — on hold for 35 minutes, listening to “lots of patriotic hold music.”
There will also probably be growing use of workarounds — for example, encouraging people to go directly to insurers. This will temporarily defeat one of the purposes of the exchanges, which was to make price comparisons easy, but it will be good enough as a short-term patch. And one shouldn’t forget that the insurance industry has a big financial stake in the success of Obamacare, and will soon be pitching in with big efforts to sign people up.
Again, Obamacare’s rollout was a disaster. But in California we can see what health reform will look like, beyond the glitches. And it’s going to work.
By: Paul Krugman, Op-Ed Columnist, The New York Times, November 24, 2013
“Less Than American”: It Is In The Public Interest To Have People Assimilated And Participating Stakeholders In Our Democracy
Not so long ago, it seemed the debate over immigration reform was all about borders. Politicians competed to offer the most draconian solutions — higher fences, longer fences, electrified fences, armies of guards, fleets of drones, moats and crocodiles. Never mind that the Border Patrol had already more than doubled in a decade. Never mind that many of those here illegally never hopped a fence but simply overstayed a student or tourist visa. The nativist mythology has us under siege from relentless hordes striding toward Arizona on, in the fevered imagination of Tea Party Congressman Steve King, “calves the size of cantaloupes because they’re hauling 75 pounds of marijuana across the desert.” To pacify the border neurotics, authors of the bill that passed the Senate last summer included $46.3 billion to militarize our southern flank.
Now, with the bill stranded in the House, it seems the immigration debate is all about citizenship. To opponents, the idea of offering 11-plus million undocumented immigrants a pathway to citizenship — even a 13-year slog like the one envisioned by the Senate bill — is anathema, so politically toxic that the measure’s most prominent Republican sponsor, Senator Marco Rubio, pulled back as if he’d put his hand on a lit stove. To proponents of comprehensive reform, or at least to activists on the issue, citizenship is the prize, and nonnegotiable.
It’s beginning to look as if advocates of fixing our broken immigration system will face an unpleasant choice: no bill at all, or a bill that legalizes the foreigners who are already here but does not offer most of them a chance to become citizens. On Capitol Hill several lawmakers are quietly drafting compromises that give the undocumented millions little hope of full membership in America.
The first thing to note is that this is progress. The Republican mainstream view has moved in the last year or so, from Mitt Romney’s “self-deportation” to something considerably less callous. Most Republicans in Congress now say they can live with legalizing the undocumented as long as (a) we don’t call it amnesty and (b) we don’t reward lawbreakers by bestowing the precious gift of citizenship.
The second point that needs making — and my Times colleague Julia Preston made it last week — is that while citizenship is the priority for pro-immigration activists, to immigrants living here as a fearful underclass the aim is not so clear cut. For many of them, the priority is to be made legal, to come out of hiding and live their lives without the threat of deportation, without the risk of exploitation by unscrupulous employers, without wondering whether your spouse will make it home at night.
“The entire narrative behind comprehensive immigration reform has elevated the path to citizenship as this must-have component of an acceptable bill,” said Oscar Chacon, executive director of the National Alliance of Latin American and Caribbean Communities, a network of immigrant organizations that includes many foreigners here without visas. “What you hear from the undocumented is: ‘We like the idea of citizenship, but what really hurts us is that we are vulnerable, that I can’t easily get a job to feed my family, that I can’t drive a car without being at risk, that I want to be able to visit relatives back home and come back safely.”
Just to be clear, I believe (and so does Oscar Chacon) that deliberately creating a class of disenfranchised residents goes against the American grain. There are few precedents for consigning whole categories of people to a sub-citizen limbo, and they are not proud moments in our history. (See the Fugitive Slave Act of 1793 and the Chinese Exclusion Act of 1882.) It is clearly in the public interest to have people become assimilated, taxpaying, participating stakeholders in our democracy. Most Americans polled, including a majority of Republicans, agree that those now in the country illegally should be allowed to eventually apply for citizenship.
If House Speaker John Boehner is willing to brave the fury of his extreme flank and put the matter to a vote, a path to citizenship stands a decent chance of passing the House with a majority of Democrats and a minority of Republicans. You might even think Republicans would want to get immigration settled and off the table so they could begin wooing Hispanic voters on more favorable ground — social issues, taxes, education. But among the people most immersed in this issue, I can’t find many who expect Boehner to suddenly become a statesman and defy his fanatics. In part, let’s be honest, that’s because the Republican stance is, “We protect America from Obama.” It is also in part because they fear newly enfranchised Hispanics will become Democrats — which the Republicans, by opposing citizenship, make a self-fulfilling prophecy.
So it may well be that supporters of immigration reform have to choose between half a loaf and none at all. Half a loaf might include a prospect of citizenship for some undocumented immigrants — the so-called Dreamers, who entered the country as children, and those in the military — but not the majority. If that’s the option, should Democrats swallow hard and take it?
Yes, and here’s why.
First, even without a prospect of citizenship, legalization would make the undocumented much safer from the family-wrecking heartbreak of deportation, which has continued at record numbers under President Obama. It would free them to press for better education for their children, to approach the police when they are victims of crime, to challenge abusive employers, to seek medical care without fear of exposure. Some advocates of citizenship-or-nothing suggest that the president should simply use his prosecutorial discretion to stop deportations altogether, as he has done for the Dreamers and undocumented soldiers. But the public would view that as a grievous abuse of power, and Congress might very well take away his authority. An executive order is no substitute for a protection enshrined in the law.
Second, the legislation has other good things going for it. It puts a little sense into our archaic legal immigration system, and establishes some meaningful protection against future illegal immigration (like holding employers rigorously accountable for assuring their workers have legal status, much more important than fortifying the border.)
Third, this is not the end of the story. We elect a new Congress in 2014, and another in 2016, and so on, and the electoral clout of Hispanics will continue to grow. “I’m a firm believer in the notion of incremental change,” Chacon told me. “The best public policies — look at gay rights — have evolved, they didn’t happen all at once.”
And fourth, even if many undocumented workers never make it to citizenship, the injustice will last for just one generation. Their children are citizens by birth. Young Latinos are reaching voting age at the rate of about 50,000 per month. I suspect many in that rising generation will remember, and punish, the politicians who decided their parents should remain less than American.
By: Bill Keller, Op-Ed Columnist, The New York Times, November 24, 2013
“This Is Sabotage, Plain And Simple”: The Unprecedented GOP Efforts To Undermine A Federal Law
Sen. Joe Manchin (D-W.Va.), who’s never been the Affordable Care Act’s biggest fan, appeared on MSNBC yesterday to join the critical chorus. In reference to the Obama administration, the conservative Democrat said, “The bottom line is that they messed up, they messed up royally. There’s no excuse for this.”
The administration’s missteps have been well documented, and officials have earned much of the criticism they’ve received. But to say there’s “no excuse” is to overlook Republican sabotage efforts that have made a real difference.
Todd Purdum recently made the case, for example, that “calculated sabotage by Republicans at every step” is a “less acknowledged cause” of the rollout’s troubles. Jamelle Bouie added this week, “If Republicans have shown anything over the last four years, it’s that they’ll do anything to stop the Affordable Care Act, even if it amounts to legislative sabotage.”
We’ve talked before about the scope of these unprecedented efforts to undermine a federal law, which include blocking necessary resources needed for implementation, public misinformation campaigns, discouraging public-private partnerships, blocking Medicaid expansion, blocking CMS nominees, refusing to create marketplaces, and prohibiting “Navigators” from doing their jobs. But the campaign is arguably intensifying now.
Dana Milbank reports on House Republican leaders who emerged from their weekly meeting yesterday and tried to scare the bejesus out of Americans.
The Republicans’ scary-movie strategy has some logic to it: If they can frighten young and healthy people from joining the health-care exchanges, the exchanges will become expensive and unmanageable. This is sabotage, plain and simple – much like the refusal by red-state governors to participate in setting up the exchanges in the first place.
The quotes from House GOP leaders are rather remarkable. Majority Leader Eric Cantor (R-Va.) said health care reform may lead to identity theft; Speaker John Boehner (R-Ohio) falsely claimed “premiums are going right through the roof”; Majority Whip Kevin McCarthy (R-Calif.) warned that consumers who visit healthcare.gov may become victims of fraud; and Caucus Chair Cathy McMorris Rodgers (R-Wash.) said vulnerable constituents may be put “on the casualty list.”
Milbank added, “Let’s hope the new health-care plans have generous coverage for anti-anxiety medication.”
Let’s not forget that the difference between a lie and a falsehood is intent – if you know the truth and say the opposite because your goal is deceit, you’re lying. And for the most part, congressional Republicans, whose interest in helping provide greater health security for Americans is easily trumped by their interested in destroying a Democratic law, have been reducing to lying.
But for saboteurs, honesty and serious policy debate are easily sacrificed for the larger goal. Indeed, they’re a small price to pay.
Also note, we’re looking at quite a one-two punch from the far-right – on the one hand we see the Koch brothers and their allies urge the uninsured to stay that way on purpose, in order to advance conservatives’ ideological goals, and on the other we see congressional Republicans try to terrify the public in the hopes that people who stand to benefit from “Obamacare” steer clear of the system.
President Obama added yesterday, during an interview with the Wall Street Journal, that if both parties were “invested in success,” the rollout wouldn’t have been quite so rocky. “One of the problems that we’ve had is that one side of Capitol Hill is invested in failure and that makes the kind of iterative process of fixing glitches as they come up and fine tuning the law more challenging,” he added.
There’s no denying that the dysfunctional health care website matters, and the administration’s missteps deserve criticism. But Republican sabotage matters, too.
Kevin Drum recently explained, “No federal program that I can remember faced quite the implacable hostility during its implementation that Obamacare has faced. This excuses neither the Obama administration’s poor decisions nor its timidity in the face of Republican attacks, but it certainly puts them in the proper perspective.”
By: Steve Benen, The Maddow Blog, November 20, 2013
“Let’s Work The Problem People”: Houston, We’ve Had A Health Care Problem For A Long Time
One of my favorite scenes in a movie is Ed Harris playing NASA ace Gene Kranz at mission control when Apollo 13 was about to burn up. He walks into a room full of engineers and scientists responsible for the mission as they are arguing and screaming at one another. He slams his fist down, quiets the crowd and says, “Let’s work the problem, people.”
That is how I feel about the launch of Obamacare. Fix it. Solve it. Make it work.
The other famous quote from that movie was Tom Hanks as Commander Jim Lovell when he said, “Houston, we have a problem.” The actual quote from Lovell was, “Houston we’ve had a problem.” Now that seems more appropriate for the herculean task of solving America’s health care problems.
We’ve had a problem, all right, for generations. We’ve failed to tackle the critical issue of health care in our country ever since Teddy Roosevelt. How can we justify more than 45 million Americans without health insurance? How can we rationalize a system that charges women twice as much as men? How can we not strike back against a system that would deny people health insurance because they had a pre-existing condition or that kicked them off because they hit a cap or got sick?
How can we possibly not recognize “we’ve had a problem” when costs have risen from $1,000 per person in the United States in 1980 to more than $8,000 in 2010? Costs going up 15 to 20 percent a year and eating up one-sixth of our economy are not sustainable.
The Republicans don’t want to work the problem, they want to sweep it back under the rug. Their goal is to turn this into a political football they can kick around between now and November. Five hearings in three days, more votes to destroy the Affordable Care Act. Not one suggested “fix” coming out of the Republicans in the House of Representatives.
I suggest House Speaker John Boehner and Rep. Darrell Issa watch the scene from Apollo 13 where the scientists react to Ed Harris. They put everything on the table that they have to work with in the space capsule and figure out how to bring the astronauts back safely to earth. They worked the problem; it is time for all concerned to do the same on health care. Mend it, don’t end it.
By: Peter Fenn, U. S. News and World Report, November 15, @013
“Fruits Of Republican Folly”: It Falls To Democrats To Find A Way To Take Advantage Of The Moment
The Republicans badly damaged themselves with their contrived government shutdown and debt crisis, but it remains for the Democrats to drive home their advantage. Will they?
Based on the cost to the Republican brand and the pressure from corporate elites not to harm the economy, the days of shutdowns and games with the debt are probably over for the foreseeable future. If the Tea Party faction tries to repeat these maneuvers, House Speaker John Boehner would likely permit a free vote again, and enough Republicans would vote with Democrats to keep the government open.
The Republicans seem hopelessly split between a Tea Party faction that relishes governing crises and a more mannered corporate faction that kills government softly. But the GOP is still one party when it comes to destroying government as a constructive force in the economy and society.
Since Barack Obama took office, the two Republican factions have complemented each other in a successful “good cop, bad cop” effort to ratchet down public spending. Wall Street creates one sort of crisis; the Tea Party creates another; government takes the hit. Except for the short-lived stimulus of the American Recovery and Reinvestment Act in 2009, this is the first prolonged slump of the postwar era in which government cut rather than expanded public spending.
President Obama’s pivot to deficit reduction in late 2009 was in response to the pressures of the corporate elite, while his several capitulations in the budget cuts since 2010 have been driven by the Tea Party. In effect, the Tea Party and corporate Republicans have executed a pincer movement. Domestic discretionary spending relative to gross domestic product is now below that of the Eisenhower era.
With everything else having been cut, the pressure has shifted to the big social-insurance programs—so-called entitlements—that have thus far been protected. Once again, the corporate right and Tea Party right have called for a grand bargain targeting Social Security and Medicare.
A bargain connotes giving something and getting something. Republicans are disinclined to give anything in exchange for cuts in social insurance, least of all tax increases. Their opening gambit was an improbable offer to shrink Social Security and Medicare in exchange for increases in defense spending.
The Democratic caucuses in both the House and Senate are resolute defenders of Social Security. Polls show that more than 80 percent of Republicans and Democrats alike don’t want Social Security reduced. With Republicans pressing for cuts, defense of Social Security is a clear, bright line that benefits Democrats.
Unless, that is, President Obama chooses to blur it. He has already proposed in his 2014 budget a change in the annual cost-of-living adjustment to Social Security (the chained Consumer Price Index). Although a grand bargain is unlikely, Republicans are pushing a mini-bargain of sequester relief in exchange for cuts in other domestic spending or in Social Security. The chained CPI would yield about $34 billion of deficit reduction per year. This disguised benefit cut would split the Democrats as badly as the government shutdown split the Republicans.
A better mini-bargain would be relief from the depressive impact of the sequester without any offsetting cuts. The Democrats have some leverage here, because the sequester mandates at least $23 billion of defense cuts to take effect in January, requiring cancellation of multiyear weapons contracts dear to key Republican legislators. In exchange for restored military spending, Democrats could demand, and get, $23 billion in social spending. That $46 billion would help stimulate a stagnant economy.
Looking forward to the 2014 midterm, pollsters discern a paradox. Support for the Republican Party is down sharply. In October, Gallup found that 28 percent of those polled approve of the Republicans, down from 38 percent in September and the lowest since Gallup began asking the question in 1992. Yet message testing also shows that large majorities of voters are still inclined to fault “partisan bickering”—blaming both parties—rather than Republican obstruction for the government’s failure to make substantive progress in improving a feeble recovery.
So the shutdown debacle helps the Democrats but only marginally, unless they maximize their moment. Midterm elections are notorious for low turnout. Democrats have a prayer of taking back the House only if they energize their core voters. If President Obama goes into the midterm bragging about how much progress has been made, that won’t resonate with Americans suffering from flat or declining incomes and job insecurity. The Democrats need to stand for restored, broadly shared prosperity, not tinkering, and brand Republicans as the party that would cut your benefits.
Senate Republican leader Mitch McConnell, of all people, has set a fine example. In the deal that opened the government, McConnell sneaked in the only earmark: $3 billion for a dam in Kentucky. If we ramped that up to the whole country based on Kentucky’s share of the economy, the outlay would translate to about $200 billion. Call it the Mitch McConnell Memorial Infrastructure Program—a nice down payment on the public investment America needs.
By: Robert Kuttner, Co-Founder and Co-Editor, The American Prsopect, November 7, 2013
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