“Making The GOP Pay For Medicaid Obstruction”: National Democrats, Especially, Need To Stop Equivocating About The Benefits Of The Law
Jonathan Martin wrote a primer this weekend on why many nervous Democrats won’t take President Obama’s advice – or mine — and run on the Affordable Care Act in the 2014 midterms. To me, it seems like a chicken and egg problem: Vulnerable Democrats won’t run on the ACA because key groups of voters don’t like it. But why should voters like it if even Democrats won’t defend it?
But there is one ACA issue where Republicans seem to be on the defensive, and that’s on the question of Medicaid expansion. Even Georgia Democratic Senate candidate Michelle Nunn and gubernatorial candidate Jason Carter, who have been wishy-washy on the law, support Medicaid expansion – and that’s partly because polls show 59 percent of Georgians support it too. Gov. Nathan Deal has tried to pass the decision off to the state Legislature, which is widely seen as an effort to pass the buck. Kansas Sen. Sam Brownback just managed to do the same thing, on Friday signing a bill that gave the Republican-dominated Legislature the power to decide on Medicaid expansion – but they won’t meet again until 2015.
In Florida, newly minted Democrat Charlie Crist is hitting Gov. Rick Scott hard for his refusal to accept Medicaid funding. Much like in Georgia, 58 percent of Florida voters want to see their state take the federal funds. Crist leads Scott in the latest polling.
And Republican Senate candidates Scott Brown of New Hampshire (it seems wrong not to write Massachusetts, Scott), Tom Cotton of Arkansas and Terri Lynn Land of Michigan have all refused to take a stand on Medicaid expansion, which might make them the biggest cowards of all.
In Louisiana, Democrats are trying to bypass Gov. Bobby Jindal and let state voters decide whether to accept $16 billion in expanded federal Medicaid funding, to cover 242,000 newly eligible Louisianans. The federal funding would create 15,600 new healthcare jobs, according to Families USA. Vulnerable Democratic Sen. Mary Landrieu has been hitting Jindal hard on the issue, and the New Orleans Times-Picayune just called on the state Legislature to back the referendum notion, blaming Jindal’s presidential ambitions for his decision to turn down the funds. Even conservatives, the paper suggested (perhaps with a little sarcasm), ought to back an effort to give voters a say on the matter. What are they afraid of? Well, the Koch-funded Americans for Prosperity, for one thing, which has promised to campaign against Republicans who support Medicaid expansion.
“Like A Drunk In A Bar Fight”: Why Republicans Will Never Stop Lying About Obamacare
Politically speaking, here’s the thing about those melodramatic ads attacking the Affordable Care Act currently running on TV: In terms of actual policy, they’re as futile as the 40-odd votes to repeal the law that House Republicans have already cast.
GOP hardliners are like a drunk in a bar fight threatening to whip somebody twice his size if only his friends would let go of his arms.
It’s all over but the shouting.
Even if Republicans make big gains in the 2014 congressional elections, they can’t possibly win enough votes to overcome a presidential veto. What’s more, chances of capturing the White House in 2016 on a platform of canceling millions of Americans’ health insurance benefits appear so remote as to be downright delusional. Like it or not, the ACA is here to stay.
Indeed, governors and legislatures in previously recalcitrant states including New Hampshire, Tennessee, Pennsylvania, Utah and Virginia are considering Medicaid expansion they’d previously shunned. Despite early signup problems with the federal HealthCare.gov exchange, signups for individual private policies have increased to where it now appears the ACA will come close to meeting its projected goal of 7 million enrollees by the March 31 deadline.
Moreover, for all the predictions of actuarial doom heard on Fox News and elsewhere—supposedly caused by an imbalance of old, sick enrollees versus younger, healthier ones—the Washington Post reported last month that “the Kaiser Family Foundation estimates that if the market’s age distribution freezes at its current level—an extremely unlikely scenario—‘overall costs in individual market plans would be about 2.4 percent higher than premium revenues.’”
That’s a minor problem, but nothing like a “death spiral.”
In terms of affecting health care policy, then, the TV ads are largely symbolic — scripted melodramas calculated to arouse the partisan passions of the GOP “base” in states where control of the U.S. Senate could be determined this fall. Financed by Americans for Prosperity, the Scrooge McDuck-style front group controlled by the Koch brothers and fellow anti-government tycoons, they’re aimed less at killing the Affordable Care Act than convincing voters that Democrats are their enemies.
Maybe that’s why the ad campaign has proven so singularly unpersuasive to skeptics. In Lousiana, where Democratic Sen. Mary Landrieu is up for re-election this fall, AFP has run a commercial featuring a group of actors pretending to be ordinary Louisiana citizens whose health insurance was canceled due to “Obamacare.” But it’s make-believe; a scripted TV drama as fictive as a Viagra advertisment.
In Arkansas, virtually every news program features a pretty, AFP-sponsored actress plaintively begging viewers to remind Democratic Sen. Mark Pryor that health care is about “people,” and that “the law just doesn’t work.” More in sorrow than anger, it seems, because Pryor remains personally popular.
Pryor’s opponent, Koch-financed Rep. Tom Cotton, tells a touching tale about one “Elizabeth, from Pulaski County” whose premiums have allegedly risen 85 percent under the new law “simply because Washington politicians and bureaucrats think they know what’s best for her and her family.”
I found myself wondering what kind of insurance plan the otherwise unidentified Elizabeth used to have, or if she’s like one of those imaginary digitally enhanced hotties that Internet ads assure me are just a mouse-click away.
Supposedly factual AFP ads have proven even less persuasive to skeptical journalists. In Michigan, 49-year-old leukemia patient Julie Boonstra earnestly explained to viewers that her existing health care policy had been canceled due to the Affordable Care Act, implying that she’d also lost her doctor and been broadsided by ruinous costs.
Fact checks by the Washington Post and Detroit News, however, determined that Boonstra hadn’t lost her doctor at all. What’s more, her monthly premiums under the Affordable Care Act cost roughly half what she’d been paying ($571, from $1,100). Her out-of-pocket expenses almost precisely matched those savings — overall, a wash.
A determined opponent of the law, apart from her understandable anxiety about changing insurance carriers while fighting cancer, Boonstra turned out to have suffered no real losses. Not to mention that she now has a policy that can’t be rescinded due to a “previously existing condition.”
And so it goes. Los Angeles Times economics columnist Michael Hiltzik has made a minor specialty out of fact checking these successive tales of woe. It’s left him wondering if there are really any “Obamacare” victims at all.
“What a lot of these stories have in common,” he writes “are, first of all, a subject largely unaware of his or her options under the ACA or unwilling to determine them; and, second, shockingly uninformed and incurious news reporters, including some big names in the business, who don’t bother to look into the facts of the cases they’re offering for public consumption.”
Politically, however, printed facts rarely prevail against televised fictions. Anyway, repealing the Affordable Care Act isn’t the point. It’s inflaming the GOP base and defeating Democrats.
By: Gene Lyons, The National Memo, February 26, 2014
“A Nasty Piece Of Work”: There’s No Getting Rid Of David Vitter, America’s Most Contemptible Senator
I was once shooting the breeze with a Democratic senator I knew fairly well. This was a few years ago, back when the toxic atmosphere wasn’t quite as hideous as it would become. Just on a personal level, I asked: Who on the other side is surprisingly nice, and who’s just a real prick? I don’t remember the surprisingly nice answers, but on the S.O.B. factor the senator’s response was immediate: David Vitter.
He’s a nasty piece of work, the junior senator from Louisiana. He doesn’t seem to like anybody. He loathes senior senator Mary Landrieu, he detests Governor Bobby Jindal, he despises the media. They all pretty much hate him back. And yet, by merely announcing, he immediately became the odds-on favorite to win the governor’s race in 2015. Why?
The announcement may seem surprising to those of us outside the state, but “this was the worst-kept secret in Louisiana,” a political operative with knowledge of the state told me Monday. Vitter has been holding a series of town-hall meetings and tele-town-hall meetings, signaling the obvious intention.
I’ll get to race handicapping in a few paragraphs, but first let’s deal with the only thing most people know about David Vitter (who has not, by the way, distinguished himself in the Senate in any way). I’ve always wondered: How in the world did he survive that hooker business? Not only did he admit he was a client of Deborah Jeane Palfrey’s escort service. She then went and hanged herself. Not over him personally. Over the whole mess, and staring at serious jail time. But still. Extramarital relations are one thing, with a staffer or a woman of accomplishment; politicians almost always slog their way through that. But here we had the guy calling on hookers, and the dead body of the madam. And Vitter skated through it and sailed to reelection two years later. How?
“He hid for a year and a half,” says my operative. At first, when his name was revealed by Hustler in connection to the case, Vitter acknowledged it. He said he’d asked for and received his wife’s and (somewhat presumptuously) God’s forgiveness. After that he would say no more—“out of respect for my family.” Nice touch.
By the time 2010 came around, Palfrey was less important to the state’s voters than the fact that Charlie Melancon, the Democrat who challenged Vitter, had “voted with Barack Obama 98 percent of the time” in Congress. That’s all Vitter said. That, and the forgiveness thing, and the “fact” that illegal immigrants were cutting holes through chain-link fences and being welcomed by bleeding-heart Melanconistas with a brass band and a waiting limousine, as this really vile and racist TV ad of his had it. Vile and racist works down there, so what had seemed at first like a close-ish race became a 19-point whupping.
Ever since, Vitter has been fine, with his approval rating up in the high 50s. I guess all it takes to do that is to be right wing and anti-Obama. And so, he’s the favorite to be the state’s next governor.
But that could change. The declared field so far is no great shakes—the Republican lieutenant governor and a Democratic state representative. Not even any members of Congress yet. But here are a couple of developments to keep an eye on. First, New Orleans Mayor Mitch Landrieu, a Democrat, faces reelection on Feb. 1. He’s expected to roll to an easy win. “If it’s a landslide, he’ll have to consider the governor’s race,” says the operative. Second, there’s Mary Landrieu’s (they’re brother and sister) reelection this fall. That’s expected to be very close. If she loses and is out of a job, might she give it a shot? She and Vitter have the reputation of disliking each other more, maybe a lot more, than any other state’s two U.S. senators. Landrieu v. Vitter for governor would be awesome.
But even if the field doesn’t get a lot stronger, Louisiana politics blogger Robert Mann still thinks Vitter might have a harder time than he did in 2010. It’s not always great to be the front-runner this far out, because everyone below you is attacking you. And, Mann notes, Vitter’s not going to be able to make this race about Obama, who’ll be on the way out in 2015.
There’s an interesting Vitter-Jindal subplot going on here, which is nicely detailed by Marin Cogan at The New Republic, and the issue of whom Jindal might endorse is an interesting one. Though he’s unpopular overall in the state, he’s still in decent shape among the state’s Republicans, so his word might carry some weight. But he’ll be off running for president in 2015 (yes, he still apparently thinks he can do this!).
So Vitter is all in. And even if he somehow loses the governor’s race, it’s no real skin off his nose—he’d remain a senator, because that seat isn’t up until 2016. And running for reelection then, he can just run ads with Hillary Clinton welcoming swarthy illegals with open arms. Easy peasy. One way or another, we’re stuck with this guy for a while.
By: Michael Tomasky, The Daily Beast, January 22, 2014
“Obamacare’s Critical Moment”: It’s Time For Nervous Democrats To Have A Gut Check
At times like this, with the Obama administration weathering yet another controversy regarding the stumbling beginnings of the Affordable Care Act, it’s useful to remind ourselves that this too shall pass. I’ve been plenty critical of how Healthcare.gov has been handled (see here, or here, or here), but eventually it will get fixed, at least to the point at which it works well enough. Likewise, the fears now being experienced by people with individual insurance policies will, by and large, turn out to be unfounded. There will be some who have to pay more than they’ve been paying, but in almost all cases they’ll be getting more too.
But there’s no doubt that this is an escalating problem for the administration. The person who got sold a cheap insurance policy on the individual market because the insurer was confident that either a) they probably wouldn’t get sick any time soon, or b) the policy was so stingy (whether the customer knew it or not) that the insurer wouldn’t have to pay anything even if they did, has now become the victim whom all agree must be made whole. We’re all talking endlessly about Obama’s “If you like your current plan, you can keep it” pledge, but the fact is that if you have one of these junk insurance plans, you only like it if you haven’t had to use it. But no matter—the people on these plans (and not, say, people who are finally getting Medicaid, because they’re poor so who cares) are now the only people that matter. Congress is obsessed with them, the news media is obsessed with them, and Something Must Be Done.
The administration is clearly spooked, and so are Democrats. But everyone needs to take a breath and ask themselves whether what they do in the next couple of weeks is something they’ll be able to live with in a year or five years or twenty years.
No one should be under the illusion that the Republican proposals to “fix” the problem of people on the individual market who want to keep their current plan—one of which could be voted on today in the House—are anything other than an effort to cripple the ACA. Not only would they allow insurers to continue selling junk policies, they would also allow the insurers to deny people coverage because of pre-existing conditions. In other words, the Republicans propose to restore the abysmal status quo ante that led to passage of the ACA in the first place. They’d also have the likely effect of jacking up premiums in the exchange marketplace by allowing the insurers to cherry-pick healthy young people for the now still-legal junk policies, leaving older and sicker people to migrate to the exchanges, where premiums will almost surely skyrocket a year from now once the damage becomes clear. As Igor Volsky puts it, “On the eve of implementing hard fought reforms, lawmakers are essentially considering re-segregating the health care market: healthy uninsured individuals without an offer of employer-sponsored coverage, Medicare or Medicaid will be lured away into subprime policies that include few consumer protections (and probably won’t be there for them should they fall ill); sicker people will find themselves in exchanges that resemble high-risk insurance pools, paying ever-more for coverage.” Any Democrat who votes for something like that should be ashamed of themselves.
There’s a Democratic proposal from Mary Landrieu that’s almost as bad. Meanwhile, House Democrats are threatening the White House that they’ll sign on with the Republican plan if the White House doesn’t come up with some other solution that will allow them to cover their asses. But there may be no way to let people who have junk insurance keep it without undermining the law as a whole. As Ezra Klein says, “Solving a political problem now at the case of worsening a policy problem 10 months from now isn’t a good trade.” And that’s putting it way too mildly. They could easily try to solve a political problem now and give themselves a much worse political problem ten months from now by making it impossible for the law to succeed. If that happens, the fact that they signed on to the measure that all but destroyed the law isn’t going to save them with the voters. Obamacare’s fate is every Democrat’s fate, whether they like it or not.
You can say that Obama made his bed by repeating that “If you like your insurance, you can keep it,” and now he has to sleep in it. I’d have two responses to that. First, plans that were in effect when the ACA passed in 2010 fall under a grandfather clause, so strictly speaking, if you liked the plan you had when the law was passed and you still have it, you can keep it, even if it doesn’t meet the new requirements. But since the individual market is volatile (people move in and out of it frequently) and only plans that haven’t been altered since then fall under the grandfather clause, that’s a small number of people.
But much more importantly, we shouldn’t make a terrible policy choice just because it’s the one that we think would line up most precisely with a rhetorical pledge Barack Obama made three years ago. Yes, he should have said, “If you like your plan you can keep it, so long as it’s a plan that gives real coverage and doesn’t leave you vulnerable to bankruptcy if you get sick or have an accident.” But he didn’t. And today, we should make the policy choice that does the most good for the most people.
It would be nice if you could make an enormous policy change without leaving a single American worse off. But that was never possible. There are millions who are going to benefit from the ACA—people who had no insurance who will now be able to get it for free or for a modest cost, people with pre-existing conditions who couldn’t get coverage but now can, and yes, people who thought they were covered but weren’t and now will be, even if they have to pay a little more. Screwing huge numbers of them over for the sake of a small number of people who have been sold a bill of goods by their insurance company and want to keep their junk plans would be unconscionable.
As Josh Marshall says, it’s time for nervous Democrats to have a gut check. Republicans are positively slobbering at the opportunity they think they have to destroy the ACA. After all that’s happened—after a generation of waiting for health reform, after all the effort it took to pass it, after the Supreme Court case and the election and everything else—are there Democrats who want to find themselves telling their grandchildren, “Well, I helped the Republicans subvert the ACA and deprive millions of Americans of health security, because I was afraid somebody might run an ad against me in my next election”?
My confidence that your average member of Congress in either party fully understands the policy implications of what they might be voting for hovers somewhere near zero. But they need to get up to speed, and then find their moral centers. This is among the most critical moments in the already long and tortured history of this law. They’d better not screw it up.
By: Paul Waldman, Contributing Editor, The American Prospect, November 14, 2013
“What Will Republicans Do?”: Here Comes The Real Government Takeover Of Health Care
For the last few weeks, Republicans have been full of schadenfreude over President Obama’s broken “If you like your plan, you can keep it” promise.
Now, this issue is about to blow up in Republicans’ faces.
Sen. Mary Landrieu (D-La.), who faces a tough re-election fight in a red state next year, has introduced a bill to address the president’s broken promise through greater government control over the individual health insurance market. Her bill would obligate insurers to continue offering all the plans they offer today unless they entirely exit the health insurance business in a state.
What will Republicans do with this proposal? Do they really want a federal law that says health insurers can’t enter or exit specific lines of business?
Rep. Fred Upton (R-Mich.) has introduced a bill in the House that would allow insurers to continue offering plans that would have been prohibited under the Affordable Care Act, but his bill is vulnerable to the criticism that it will still lead to a raft of plan cancellations as insurers choose to discontinue plans because the ACA has changed the financial incentives they face.
If Congress really wants to make sure people can take their plans, it will need to use the heavy-handed Landrieu approach; the light-touch Upton approach won’t work. Erick Erickson (of all people!) understands this; he wrote a piece this morning called “It’s a trap“:
The House, with the help of a good number of Democrats, will pass the Upton plan and send it to the Senate. Harry Reid will substitute the Landrieu plan and send it back to the House. The House will be forced to either vote for the Landrieu plan or be characterized as siding with insurance companies against people.
In one fell swoop, the Democrats will have the GOP on record saving Mary Landrieu’s re-election in Louisiana by casting her as the one who saved Americans’ health care plans, and also getting on record as really being in favor of fixing Obamacare with the use of mandates.
Pretty much. And it’s the comeuppance conservatives are getting for (1) having no health care agenda of their own and (2) endorsing the bizarre idea that health reform should not lead to health plan changes. With no health policy guidestar other than they’re against what the president is for, Republicans are liable to walk into traps like demanding more health insurance regulation than the president wants.
By: Josh Barro, Business Insider, November 13, 2013
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