“Told You So, Obamacare’s Back”: By Next Fall, HealthCare.gov Is Going To Be A Net Plus For President Obama And Democrats
If one looks just at the raw, bottom-line number the Department of Health and Human Services released Wednesday—365,000 citizens enrolled since October 1—one might be inclined to think it’s not so hot. And it isn’t. That’s 180,000 or so a month, and if you post that number against the stated goal of 7 million by next spring, the stated goal looks awfully chimerical, and the thing seems a disaster (180,000 times six months, the enrollment period, is just 1.08 million).
Dig a little deeper and things look considerably better. If we could graph it, the bar line of enrollment would make for a pretty impressive ski slope: After just 27,000 people signed up in the whole of October, The New York Times reported over the weekend, about 100,000 people signed up in November, and then, in the first week of December alone, 112,000 chose plans. The Los Angeles Times put out slightly different numbers Wednesday but agreed on the trend. From an obviously atrocious starting place, enrollment is essentially quadrupling. If that pace were to continue, the 7 million figure would be cleared in March.
I still wouldn’t quite bet on that. But I would definitely and unflinchingly bet on the central proposition I argued last week: By next fall, HealthCare.gov is going to be a net plus for Obama and the Democrats.
Wishful thinking? You can call it that if you want to. But I warn you I’m not usually a wishful thinker. Like most partisans on either side, I tend to expect the worst. It’s usually a wise insurance policy; you’re rarely disappointed. I write such things only when I really think them, like the time in August 2012 when I wrote a column suggesting that Obama could very well win about 330 electoral votes. He won 332, which most anyone else would have said when I wrote that piece was crazy.
I had a hunch then, and I have one now. And my bet is based on a lot more than enrollment numbers. It’s based on the numbers of people who are benefiting and will benefit from aspects of the law. These aren’t in the thousands. They’re in the millions. About 70 million citizens will enjoy free—free—preventive care for a range of services that typically weren’t covered at all before or at best were covered and required a co-pay. About half of them are Medicare recipients (= old people = voters). Preventive care, as you may know, is something our system hasn’t been doing very well. Now it will.
More than 100 million Americans live with what the insurance companies would define as pre-existing conditions. Over these next few months, as their symptoms flare up or especially if they worsen, requiring lengthy hospital stays and intense treatment, they’re going to be seeing that they don’t have to fret about money or whether they’re going to continue to be covered anymore. Mental-health coverage is going to be improved dramatically for up to 60 million Americans. Nearly 7 million senior citizens are going to find in the coming months that they’re no longer screwed by the doughnut-hole prescription-drug problem that was created by the Bush Medicare Part D law of 2003 and corrected by Obamacare. It is saving these 7 million seniors an average of $1,000 a year, which for many of these folks is probably a reasonable chunk of their income.
I could go on. The thing is that all this isn’t going to make the papers and the cable channels much. There isn’t a lot of inherent news value in a free cervical-cancer screening or a prescription-drug refill. But these millions of people live real lives, not on TV, and they and their families and friends will know what has happened.
You see that I’m not making a Beltway/political argument. Washington, D.C., will, I can promise you, be the last city in the United States to change its mind about Obamacare. Once a notion becomes conventional wisdom in this town and rocks a president’s poll numbers the way the disastrous rollout so clearly has, it takes a typhoon to dislodge it. Or a hurricane—remember how Karl Rove was making the United States a conservative country until Katrina came along and sent Bush’s approval numbers down there in the range of curdled milk?
The rollout won’t be a hurricane. It will be a calm rain, a steady shower of reality across the country that may never achieve quite enough force to trump inside-the-Beltway perception but will be strong enough to change many people’s minds around the country.
Fixes still need to be made. But now, as opposed to a month ago, one can feel as if they will be made. And without excusing the bollixing up of the rollout, of which I’ve written very critically, one can also say now that in historical context, this is all happening pretty fast. Remember, the original Social Security legislation was passed in 1935. And when did the first check go out? Not until 1940. Can you imagine a five-year lag in today’s media world? Roosevelt, and more important the program itself, would have been torn to pieces. I think in two more years’ time, and indeed less than that, many millions of Americans will see that what they thought was decent health insurance before the Affordable Care Act was like gaslight before electricity. If that’s wishful thinking, it’s for their sake, not the president’s.
By: Michael Tomasky, The Daily Beast, December 12, 2013
“Keeping Things In Perspective”: In The Republican Battle With Primary “Chaos”, Chaos Still Winning
CNN’s Peter Hamby does some good reporting in a piece on various Republican discussions about the 2016 presidential nominating process. But the natural tendency of a reporter to overhype the significance of his scoop is painfully apparent here. The following is Hanby’s lede with words italicized that add some questionable drama to the proceedings:
A handful of Republican Party officials is quietly advancing a new batch of rules aimed at streamlining a chaotic presidential nominating process that many party insiders viewed as damaging to the their campaign for the White House in 2012, multiple GOP sources told CNN.
In a series of closed-door meetings since August, handpicked members of the Republican National Committee have been meeting with party Chairman Reince Priebus in Washington to hash out details of a sweeping plan to condense the nominating calendar, severely punish primary and caucus states that upend the agreed-upon voting order and potentially move the party’s national convention to earlier in the summer, with late June emerging as the ideal target date.
Compare this account of what’s actually happening with that of the reigning expert on this whole subject, Josh Putnam of Frontloading HQ, who relies in part on Hamby’s factual reporting. I’m not about to go through Putnam’s vast post, but with his usual painstaking detail he examines what is and isn’t happening, and sees a lot less change in the works than Hamby’s adjectives suggest.
The quartet of privileged states (Iowa, New Hampshire, South Carolina and Nevada) retain their privileges and may be able to delay the starting gun for ’16 until early February, though late January is more likely. The “severe” penalty for calendar-jumping has mainly been adjusted to keep small states from moving with light consequences. The early convention idea is colliding with the unwillingness of states holding simultaneous presidential and down-ballot primaries to hold both any earlier than they already do. And it’s important to distinguish between the dates for naming delegates and those for binding them to a candidate.
On top of everything else, all this talk must be coordinated with Democrats, who will have their own open presidential nominating contest in 2016.
Why does the difference in tone between Hamby’s account and Putnam’s matter? Well, it’s not earth-shaking, but Hamby’s approach reinforces the cherished MSM meme that for all the craziness of its “base” and “activists,” the GOP is actually run by a small but powerful cabal of shrewd and pragmatic “insiders” who use their superior procedural knowledge (in venues ranging from Congress to campaigns to the nominating process) to manipulate Republicans into doing their will. Just wait and see: the idea that the nominating process is being “overhauled” will soon merge with the idea that “pragmatists” are preparing to grease the skids for a “pragmatic” presidential nominee, presumably Chris Christie.
Truth is, the Republican presidential nominating process is a long way from being rescued from “chaos,” less because of the relative impotence of supposedly almighty party elites than because states still call the most important shots, and the early states are willing to do whatever is necessary to preserve their outsized power. So let’s keep any “reforms” or “schemes” we hear about–and their alleged consequences–in perspective.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 11, 2013
“The Coverage Could Get A Lot Worse”: Republicans Will Face Intense Pressure Over Unemployment Benefits
On the morning after lawmakers reached a budget deal that doesn’t include an extension in unemployment benefits, chief GOP budget architect Paul Ryan awoke to a raft of home-state headlines that were all about the nearly 100,000 Wisconsinites who stand to get cut off.
“99,000 unemployed Wisconsinites face cuts,” blared one front page. “Jobless benefits at risk for 99K in Wisconsin,” blared another. “99,000 state residents to lose benefits,” blared a third. You can see those and a lot more at this compilation of front pages put together by Dems on the Ways and Means Committee.
The imminent expiration of the Emergency Unemployment Compensation program for 1.3 million Americans is mostly being treated as a fait accompli in Washington. But it looks to be turning into a very resonant issue in local media in states where many thousands of residents will be directly impacted by it. (Dems have created an interactive map showing how many people in each state stand to lose benefits.)
This fact is central to the emerging Dem strategy to increase pressure on Republicans to agree to an extension. House Dems are working to drum up as much local press coverage of the issue as possible, because local coverage can focus directly on how many constituents in a lawmaker’s state stand to be hurt – making it hit home in a way Beltway media coverage can’t.
For instance, articles like this one in the Las Vegas Review-Journal dramatize the plight of a family set to lose benefits, after the mother was laid off last year from her job as a store manager. Headline: “With benefits on block, jobless Nevadans face uncertainty.” Dems hope such coverage pressures Republicans they deem getable, such as Nevada Senator Dean Heller and Rep. Joe Heck.
This strategy includes placing Op ed pieces by Democrats in papers that serve the districts of top Republicans, such as this one by Rep. Sander Levin in the Cleveland Plain-Dealer, the largest paper in John Boehner’s home state. The game plan is granular: One Democrat points out to me that stats are available on how many would lose benefits on the county level, and that Dems are trying to push these numbers into the coverage, because it is tangible for people in local communities. These numbers are already being reflected in local stories like this one.
Now, it’s fair to question whether Democrats did enough to get a UI extension in the budget deal. Perhaps they could have drawn a harder line on the issue and used their leverage (Republicans will need Dems to pass the deal out of the House) more effectively.
But beyond those legitimate points, it needs to be understood that Dems have not given up on getting Republicans to agree to the UI extension. This could either be accomplished through a stand alone bill or an add on during the budget process, and Democrats continue to press Republicans behind the scenes.
Will any of this matter to Republicans? It’s hard to say, since so many are cosseted away in such safe districts that tough headlines may not matter to them. But the public statements from GOP leaders on the extension have seemed tepid, suggesting their opposition isn’t really visceral. It seems like they’d love for this issue to go away. Boehner has said he’s willing to look at an extension if the White House offers a “plan,” which seems like he’s open to some kind of trade. Of course, conservatives who are already scorching GOP leaders over the deal will only get more outraged if they agree to a UI extension, making it that much harder.
Still, the coverage could get a lot worse, once the deadline looms and human interest stories multiply about folks facing the loss of benefits during the holiday season, at a time when reporters have little else to write about. I wouldn’t give up on Republicans agreeing to the extension just yet.
By: Greg Sargent, The Plum Line, The Washington Post, December 11, 2013
“Shining A Light On ALEC’s Power To Shape Policy”: A Slow-Motion Corporate Takeover Of Our Democracy
It’s amazing how a little sunlight will change the behavior of some of the biggest names in corporate America — sunlight here meaning greater transparency and accountability.
It’s also amazing how the U.K.’s The Guardian is covering this changed behavior — and its potential consequences for every American — without much competition from U.S.-based media. It seems that reporters in Washington in particular can’t be bothered.
Over the past several decades, one of the country’s most influential political organizations — the 40-year-old American Legislative Exchange Council — was able to operate largely under the radar. Never heard of it? That’s by design. Founded in 1973 by conservative political operatives, ALEC has been successful in shaping public policy to benefit its corporate patrons in part because few people — including reporters — knew anything about the organization, much less how it went about getting virtually identical laws passed in a multitude of states.
That began to change two years ago when an insider leaked thousands of pages of documents — including more than 800 “model” bills and resolutions, showing just how close ALEC is with big corporate interests and revealing how it goes about getting laws passed to enhance the profits of its sponsors, usually at the expense of consumers.
The Center for Media and Democracy, a nonprofit corporate watchdog organization, sifted through the documents and posted them on a dedicated website, ALECexposed.org. Those bills and resolutions, drafted by or in collaboration with industry lobbyists and lawyers, “reveal the corporate collaboration reshaping our democracy, state by state,” CMD says on the website.
I reviewed all of the health care legislation in the leaked documents and wrote about what I found for The Nation magazine in July 2011. It became clear from my review that health insurers felt one of the best ways to block the profit-threatening provisions of ObamaCare would be to use ALEC to disseminate bills it had helped write to friendly state legislators. It was also clear that ALEC’s staff and membership had been at work for more than a decade on a broad range of issues important to my former industry, from turning over state Medicaid programs to private insurers to letting them market highly profitable junk insurance.
While ALEC-member legislators hail from every state, the organization has been especially successful in getting bills introduced in legislatures controlled by Republicans. As The New York Times noted in an editorial in February, more than 50 of ALEC’s model bills were introduced in Virginia alone last year.
In addition to insurance companies like State Farm and UnitedHealthcare, ALEC’s corporate membership has included big names ranging from ExxonMobil and Wells Fargo to Johnson & Johnson and Kraft. And it has worked closely with groups like the National Rifle Association as well.
It is the organization’s association with the NRA, in fact, that has led to dozens of corporations severing their ties with ALEC, as The Guardian reported.
Soon after the NRA succeeded in pushing a stand-your-ground bill through the Florida legislature — which George Zimmerman used in his defense in the Trayvon Martin case — ALEC adopted it as a model for other states. The group took that action after a 2005 NRA presentation to ALEC’s Criminal Justice Task Force. As The Center for Media and Democracy reported, the corporate co-chair of that task force at the time was Walmart, the country’s largest seller of rifles. Since then, more than two dozen states have passed laws identical or similar to the ALEC/NRA stand-your-ground model legislation.
News coverage of ALEC’s role in getting the controversial law enacted from coast to coast — coupled with CMD-led disclosures about the organization over the past two years — has caused many of ALEC’s longtime corporate members to abandon it, according to The Guardian.
Documents obtained by the British newspaper indicate that since 2011, ALEC has lost more than 60 corporate members, a hit so severe that during the first six months of this year it has “suffered a hole in its budget of more than a third of its projected income.” It has also lost nearly 400 state legislative members during the same time frame.
The organization has launched what it refers to as the “Prodigal Son Project” to woo back companies like Amazon, Coca-Cola, GE, Kraft and McDonald’s that have dropped their membership. Another “prodigal son” ALEC hopes to welcome back: that big retailer and rifle seller, Walmart. The loss of Walmart alone undoubtedly was a major contributor to the budget shortfall, considering the size of the company.
Meanwhile, just blocks from Capitol Hill where many Washington reporters spend their days, ALEC last week held its annual “policy summit,” but very few of those reporters felt the summit was worth their time, despite the fact that Sen. Ted Cruz, R-Texas, and Rep. Paul Ryan, R-Wis., were on the agenda. And despite the fact that even with fewer resources, ALEC is still hugely influential in shaping public policy. As Nancy MacLean, professor of history and public policy at Duke University, noted in a May column for North Carolina Policy Watch, “What ALEC and the companies that provide it with millions in operating funds seek is, in effect, a slow-motion corporate takeover of our democracy.”
That might be a story worth covering.
By: Wendell Potter, Center for Public Integrity, December 9, 2013
“Unless You’re One Of The Unlucky Ones”: Americans Suddenly Discovering How Insurance Works
It’s been said to the point of becoming cliche that once Democrats passed significant health-care reform, they’d “own” everything about the American health-care system for good or ill. For some time to come, people will blame Barack Obama for health-care problems he had absolutely nothing to do with. But there’s a corollary to that truism we’re seeing play out now, which is that what used to be just “a sucky thing that happened to me” or “something about the way insurance works that I don’t particularly like”—things that have existed forever—are now changing into issues, matters that become worthy of media attention and are attributed to policy choices, accurately or not. Before now, millions of Americans had health insurance horror stories. But they didn’t have an organizing narrative around them, particularly one the news media would use as a reason to tell them.
The latest has to do with the provider networks that insurance companies put together. This is something insurance companies have done for a long time, because it enables them to limit costs. If an insurer has a lot of customers in an area, it can say to doctors, “We’ll put you in our provider network, giving you access to all our customers. But we only pay $50 for an office visit. Take it or leave it.” An individual doctor might think that it’s less than she’d like to be paid, but she needs those patients, so she’ll say yes. Or she might decide that she has enough loyal patients to keep her business running, and she wants to charge $100 for an office visit, so she’ll say no.
So every year, doctors move in and out of those private-provider networks, and the insurers adjust what they pay for various visits and procedures, and inevitably some people find that their old doctor is no longer in their network. Or they change jobs and find the same thing when they get new insurance. And that can be a hassle.
But now they have someone new to blame: not the insurance company that established the network, and not the doctor that chose not to be a part of it, but Barack Obama. It’s not just my hassle, it’s a national issue. As Politico reported, “Speaker John Boehner (R-Ohio) said to reporters on Tuesday that the ‘fundamentally flawed’ health care law is ‘causing people to lose the doctor of their choice.’ Chief GOP investigator Darrell Issa has launched a House probe into the doctor claim. And House Republicans have highlighted the physician predicament in their weekly GOP addresses.” So to reiterate: Your insurance company set terms for its network that your doctor didn’t like. Your doctor decided not to be in that network. And that, of course, is Barack Obama’s fault.
Before we move on, there’s something we should note. You know who never loses their doctor? People who have single-payer insurance, that’s who. If you live in pretty much any other industrialized country in the world, you don’t have to worry whether your doctor accepts the national health plan that insures you and everyone else, because every doctor accepts it. Even here in America, there are people who almost never have to worry about losing their doctor: the elderly people who benefit from America’s single-payer plan, Medicare. Despite their constant gripes about payment levels, 90 percent of doctors accept Medicare, because there are just too many Medicare patients and doctors don’t want to be shut out of that business.
“Obamacare will make you lose your doctor!” may be the attack of this week, but conservatives are even trying to blame Barack Obama for the basic way insurance itself works. There’s a lot of talk about what a raw deal Obamacare is, a message that’s being aimed at young people in particular to try to convince them to stay uninsured. As Jonathan Cohn says, “The simplest way to describe Obamacare is as a transfer from the lucky to the unlucky.” That’s not just true of Obamacare, it’s true of insurance generally. All insurance.
The way insurance works is that unless you’re one of the unlucky ones, in purely financial terms, your insurance costs more than you gain from it. Have you ever sat down with all the bills you’ve paid for car insurance and homeowner’s insurance and totalled up all your premiums and all the payouts you’ve received over your lifetime? If you did, it would probably look like you paid a lot but didn’t get much in return. Some people who have had major catastrophes—an accident that totalled their car, a tree falling on their house—come out ahead, but people who haven’t had those things happen to them come out behind. If it wasn’t that way, every insurance company would lose money. But they don’t. They work very hard to set premiums to exceed the amount they spend in payouts (not to mention working hard not to pay out for things they ought to). But as Jonathan Chait says, “Insurance isn’t a kind of gamble where you bet you can beat the house by consuming more in medical care than you pay in premiums and deductibles. It’s protection from risk. People like that protection. They will pay to acquire it.” That applies not just to health insurance but to every kind of insurance. That’s why it’s called “insurance.” (The only exception is life insurance, which works more like an investment.)
The only people who come out ahead in dollars and cents on insurance are those people who have had terrible things happen to them. What the rest of us are buying, as any insurance salesman will tell you, is peace of mind.
To get back to the place we started, it can seem now that people are saying for the first time, “Wait a minute! Insurance is a raw deal! I mean, Obamacare is a raw deal!” And the media are doing their part by running stories that characterize the side effects of the private insurance market, like limited networks of doctors or the fact that less expensive plans have higher deductibles, as something new that’s occurring only because of the Affordable Care Act. But they aren’t. If you want to have a system of private health insurers, that’s how it has worked in the past, and that’s how it will continue to work. If you really want to be free of those problems, you’ll have to wait until you’re 65 and can join the big-government, socialist plan called Medicare.
By: Paul Waldman, Contributing Editor, The American Prospect, December 10, 2013
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