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“We’ll Never Stop Arguing About It”: Obamacare Is Helping A Lot Of People. Not Everyone Thinks That’s Good News

April 21, 2016 Posted by | Affordable Care Act, Conservatives, Obamacare, Republicans | , , , , , , , , | 1 Comment

“Far, Far More Right-Wing”: Marco Rubio Isn’t The Second Coming Of George W. Bush. He’s Much Worse

With his unexpectedly strong third-place showing in the Iowa caucuses, Marco Rubio demonstrated that he’s the Republican establishment’s best shot to scuttle the Donald Trump and Ted Cruz insurgencies. And now, in the aftermath of Iowa, thoughtful critics of that establishment, from the liberal Jonathan Chait to my paleoconservative colleague at The Week Michael Brendan Dougherty, have begun to describe Rubio as the second coming of George W. Bush.

The comparison makes sense in a purely formal way. Like W in 2000, Rubio promises to unite the party’s grumpy, warring factions (which have grown much grumpier and more belligerent over the past 16 years), making Rubio a strong consensus choice within the party. It’s also true that this formal unity would be built out of the same old planks that have formed the party’s platform since Reagan’s first election: deficit-fueled tax cuts for upper-income earners, strident military interventionism abroad, and lots of speeches (but few policies) in support of traditional faith and families.

But this obscures the fact that substantively, Rubio is far, far more right-wing than George W. Bush ever was. That Rubio has a chance of serving as a consensus candidate positioned somewhere near the ideological center of his party is a tribute to just how far right the GOP has lurched since Bush left office seven years ago.

Here are five areas where Rubio clearly and sharply outflanks W on the right.

Bush signed Medicare, Part D into law, vastly expanding drug benefits for millions of Americans. Rubio, by contrast, has promised with great fanfare that he will eagerly work with Congress to repeal the Affordable Care Act, which would strip millions of Americans of health insurance. It’s also true that, like all the Republican presidential candidates, Rubio talks vaguely about replacing the ACA with a wonderful, unspecified market-based alternative. But no informed commentator on either side of the issue expects any Republican proposal to strive for coverage of as many people as the ACA currently does — let alone as many people as it would have covered if a series of Republican governors hadn’t refused to participate in the law’s expansion of Medicaid.

Bush cut taxes drastically. Rubio, meanwhile, would cut them…even more drastically. How much more? His proposed tax cut amounts to more than three times the size of the Bush tax cuts, with nearly half of it going to the top 5 percent of income-earners. These cuts would produce a revenue shortfall of $6 trillion after 10 years. That’s an amount that even staunch conservatives have described as “huge” and “irresponsible.”

Pro-lifers loved Bush, and for good reason. He appointed a string of conservative judges to the bench, and he spoke frequently about how every child, born and unborn, should be “protected in law and welcomed in life.” Yet on abortion, too, Rubio manages to place himself several steps to Bush’s right, refusing to permit exceptions for terminating pregnancies in cases of rape or incest.For all of Bush’s manifest foreign policy failings, he consistently upheld the distinction between the religion of Islam and terrorists who murder in its name. Compare that to Rubio, who has picked up the bad habit common to post-Bush Republicans of speaking much less precisely and responsibly about the supposedly severe danger that Muslims pose to the United States. Rubio has even suggested that the federal government should shut down any place that Muslims gather to be “inspired,” including mosques — a move that would place Rubio on a collision course with several clauses of the First Amendment.

Rubio resembled Bush most closely in the months following the 2012 presidential election, when the junior senator from Florida took on a leadership role in the Senate’s efforts to revive a failed initiative of W’s second term — a reform of the nation’s immigration laws, including a push to devise a path to citizenship for undocumented immigrants. The reform effort failed, and his role in it is now widely presumed to be Rubio’s greatest electoral liability. (Sort of like how the rightward listing GOP treated Mitt Romney’s signature achievement as governor of Massachusetts as a potentially fatal electoral defect during his 2012 presidential campaign.) The result? On immigration, too, Rubio now finds himself far to Bush’s right, railing about the need to close and seal the nation’s southern border before even beginning to talk about any other kind of reform.

The lesson? Don’t oppose Rubio because his presidency would amount to a third term for George W. Bush. Do it because a Rubio presidency would be a whole lot worse.

 

By: Damon Linker, The Week, February 3, 2016

 

 

February 7, 2016 Posted by | Establishment Republicans, George W Bush, GOP Presidential Candidates, Marco Rubio | , , , , , , , , | Leave a comment

“Michigan’s Great Stink”: State Officials Knew They Were Damaging Public Health, Putting Children In Particular At Risk

In the 1850s, London, the world’s largest city, still didn’t have a sewer system. Waste simply flowed into the Thames, which was as disgusting as you might imagine. But conservatives, including the magazine The Economist and the prime minister, opposed any effort to remedy the situation. After all, such an effort would involve increased government spending and, they insisted, infringe on personal liberty and local control.

It took the Great Stink of 1858, when the stench made the Houses of Parliament unusable, to produce action.

But that’s all ancient history. Modern politicians, no matter how conservative, understand that public health is an essential government role. Right? No, wrong — as illustrated by the disaster in Flint, Mich.

What we know so far is that in 2014 the city’s emergency manager — appointed by Rick Snyder, the state’s Republican governor — decided to switch to an unsafe water source, with lead contamination and more, in order to save money. And it’s becoming increasingly clear that state officials knew that they were damaging public health, putting children in particular at risk, even as they stonewalled both residents and health experts.

This story — America in the 21st century, and you can trust neither the water nor what officials say about it — would be a horrifying outrage even if it were an accident or an isolated instance of bad policy. But it isn’t. On the contrary, the nightmare in Flint reflects the resurgence in American politics of exactly the same attitudes that led to London’s Great Stink more than a century and a half ago.

Let’s back up a bit, and talk about the role of government in an advanced society.

In the modern world, much government spending goes to social insurance programs — things like Social Security, Medicare and so on, that are supposed to protect citizens from the misfortunes of life. Such spending is the subject of fierce political debate, and understandably so. Liberals want to help the poor and unlucky, conservatives want to let people keep their hard-earned income, and there’s no right answer to this debate, because it’s a question of values.

There should, however, be much less debate about spending on what Econ 101 calls public goods — things that benefit everyone and can’t be provided by the private sector. Yes, we can differ over exactly how big a military we need or how dense and well-maintained the road network should be, but you wouldn’t expect controversy about spending enough to provide key public goods like basic education or safe drinking water.

Yet a funny thing has happened as hard-line conservatives have taken over many U.S. state governments. Or actually, it’s not funny at all. Not surprisingly, they have sought to cut social insurance spending on the poor. In fact, many state governments dislike spending on the poor so much that they are rejecting a Medicaid expansion that wouldn’t cost them anything, because it’s federally financed. But what we also see is extreme penny pinching on public goods.

It’s easy to come up with examples. Kansas, which made headlines with its failed strategy of cutting taxes in the expectation of an economic miracle, has tried to close the resulting budget gap largely with cuts in education. North Carolina has also imposed drastic cuts on schools. And in New Jersey, Chris Christie famously canceled a desperately needed rail tunnel under the Hudson.

Nor are we talking only about a handful of cases. Public construction spending as a share of national income has fallen sharply in recent years, reflecting cutbacks by state and local governments that are ever less interested in providing public goods for the future. And this includes sharp cuts in spending on water supply.

So are we just talking about the effects of ideology? Didn’t Flint find itself in the cross hairs of austerity because it’s a poor, mostly African-American city? Yes, that’s definitely part of what happened — it would be hard to imagine something similar happening to Grosse Pointe.

But these really aren’t separate stories. What we see in Flint is an all too typically American situation of (literally) poisonous interaction between ideology and race, in which small-government extremists are empowered by the sense of too many voters that good government is simply a giveaway to Those People.

Now what? Mr. Snyder has finally expressed some contrition, although he’s still withholding much of the information we need to fully understand what happened. And meanwhile we are, inevitably, being told that we shouldn’t make the poisoning of Flint a partisan issue.

But you can’t understand what happened in Flint, and what will happen in many other places if current trends continue, without understanding the ideology that made the disaster possible.

 

By: Paul Krugman, Op-Ed Columnist, The New York Times, January 25, 2016

January 31, 2016 Posted by | Flint Michigan, Lead Poisoining, Public Health, Rick Snyder | , , , , , , , | 1 Comment

“An Unhealthy Dose Of Politics”: Gov Matt Bevin Is Letting His Dislike For The President Blind Him To The Success Of Kynect

The New York Times reports that Kentucky Gov. Matt Bevin has informed the Obama administration that he intends to shut down his state’s health insurance exchange. The move will mean that Kentuckians will have to seek health insurance from the federal exchange. The newly-elected Republican governor may also make changes to the state’s Medicaid expansion program. Both moves would fulfill promises that Bevin made on the campaign trail last year.

Health insurance exchanges were established by the Affordable Care Act to serve as a marketplace for individuals who are not covered by the employer-based market. While the law envisioned that these exchanges would be run entirely by the states, in practice there are only 13 state-based exchanges, including the one in Washington, D.C. The rest of the states rely, either in part or entirely, on the federal exchange, Healthcare.gov.

Of the states that chose to run their own exchanges, Kentucky was doing well. The state’s exchange, known as Kynect, has in fact been lauded as one of Obamacare’s best success stories. The Washington Post reports that since it launched, Kynect has cut Kentucky’s uninsured rate in half. While some other states have struggled in their efforts to establish their own state-based exchange, Emily Beauregard, executive director of Kentucky Voices for Health, told the New York Times that “Kynect is working perfectly, and it’s been good for Kentucky.”

If the exchange had not been successful in reducing the state’s uninsured, Bevin’s plan would be justified. However, given Kynect’s effectiveness, Bevin’s plan to dismantle it makes little sense. His decision is driven purely by political motives and not with the welfare of his constituents in mind. Although the Obama administration has promised a “seamless” transition to Healthcare.gov for those who receive coverage through Kynect, there are still bound to be disruptions in coverage. For some, that disruption in coverage could be devastating.

Taking Kynect apart will also cost the state money. According to the Times, the previous governor’s administration estimated it will cost “at least $23 million” to shut it down. There’s also the question of unused grant money, approximately $57 million, which Kentucky might have to repay to the federal government. In contrast, leaving the exchange in place would provide consistency and predictability for its customers and allow the state to continue building on Kynect’s success, perhaps even lowering the state’s uninsured numbers further.

Unfortunately, Bevin is letting his dislike for the president blind him to the success of Kynect and its benefit to his constituents. Kynect has worked well for Kentucky, and the new governor should keep it in place.

 

By: Cary Gibson, Thomas Jefferson Street Blig, U. S. News and World Report, January 15, 2016

January 16, 2016 Posted by | Affordable Care Act, KyNect, Matt Bevin | , , , , , , | 2 Comments

“A Political Disaster Of Unimaginable Proportions”: Why Republicans Wouldn’t Actually Repeal Obamacare

Last week, in a bold example of their governing prowess, congressional Republicans took their 62nd vote to repeal the Affordable Care Act, and this time they actually passed it through both houses and sent it to President Obama to be vetoed. Naturally, they were exultant at their triumph. Speaker Paul Ryan admitted that there is as yet no replacement for the ACA, but they’ll be getting around to putting one together before you know it. The fact that they’ve been promising that replacement for more than five years now might make you a bit skeptical.

What we know for sure is this: If a Republican wins the White House this November, he’ll make repeal of the ACA one of his first priorities, whether there’s a replacement ready or not. To listen to them talk, the only division between the candidates is whether they’ll do it on their first day in the Oval Office, in their first hour, or in the limo on the way back from the inauguration.

But I’ve got news for you: They aren’t going to do it, at least not in the way they’re promising. Because it would be an absolute catastrophe.

Let’s take a brief tour around the consequences of repealing the ACA. First, everyone who benefited from the expansion of Medicaid would immediately lose their health coverage. According to Charles Gaba of acasignups.net, who has been tracking these data as assiduously as anyone, that amounts to about nine million people. Granted, the working poor are not a group whose fate keeps too many Republicans up at night, but tossing nine million of them off their health coverage is at least bound to generate some uncomfortable headlines.

Then there’s all the people who now get their health coverage through the exchanges that the ACA set up. Remember how fake-outraged Republicans were back in the fall of 2013 because some people with crappy health plans got letters from their insurers telling them that they’d have to sign up for a plan that was compatible with the ACA’s new standards? The truth was that some of them would wind up paying more for coverage while others would pay less, but it was the subject of a thousand credulous news stories portraying them all as victims, to Republicans’ unending joy.

Now imagine that ten million people, the number signed up for private coverage through the exchanges, all had their coverage simultaneously thrown into doubt. Think that might cause some bad press for the party and the president who did it?

There’s more. The ACA also allowed young people to stay on their parents’ insurance until age 26; three million took advantage of the provision. They’d likely lose their insurance too. Oh, and if you’re a senior on Medicare? Get ready for the return of the “doughnut hole” in prescription drug coverage, which the ACA closed.

Let’s add in one more element (though there are lots of the ACA’s provisions we don’t have time to discuss). One of the central and most popular provisions of the ACA banned insurance companies from even asking about pre-existing conditions when they offer you a plan. About half of Americans have some kind of condition that in the old days would mean they either could get insurance but it wouldn’t cover that condition, or they couldn’t get covered at all. If you bought insurance in the old days, you remember what a hassle it was to document for the insurer every time you saw a doctor for years prior. You don’t have to do that now, but if Republicans succeed, we’ll be back to those bad old days. So they can look forward to lots of news stories about cancer survivors who now can’t get insurance anymore, thanks to the GOP.

But wait, they’ll say, our phantom replacement plan has a solution: high-risk pools! This is a common element of the various inchoate health-care plans Republicans have come up with. Anyone who knows anything about insurance knows why these are no solution at all. They take all the sickest people and put them together in one pool, which of course means that the premiums to insure them become incredibly high. As I’ve written elsewhere, high-risk pools are the health insurance equivalent of going to a loan shark: You might do it if you’re desperate and have no other option, but you’re going to pay through the nose. So good luck with that.

Even if Republicans could come together around a single replacement plan, that plan would still be a political disaster. The theory behind their health-care ideas is that once we inject some more market magic into health care, everything will be great. But there are a couple of important things to understand about this idea. First of all, their plans don’t even try to achieve anything like universal coverage. It just isn’t one of their goals, and as a consequence, implementing their plans is going to mean a lot more uninsured than we have now, a reversal of the progress the ACA is made, with millions or even tens of millions of people likely to lose coverage. Second, even if the market mechanisms they use were to work out how they predict—and it’s almost certain they won’t, but let’s give them the benefit of the doubt for a moment—it would take a substantial amount of time.

In this, the ACA is direct. You can’t afford coverage? Here’s a subsidy, now you can afford coverage. But under Republican plans, more people shopping around for their health care is, over time, supposed to bring costs down, which will eventually translate to lower premiums. But in the meantime, while we wait for the invisible hand to perform its alchemy, millions upon millions of Americans will get screwed. Think there’s going to be a political backlash?

I suspect that many conservatives understand that, but still think that in the long term, their small-government ideas will leave us with a superior system. But that still leaves them with a political dilemma. On one hand, repealing the ACA would be spectacularly disruptive—in fact, unwinding the law will probably be more disruptive than putting it in place was, now that the entire health-care and health-insurance industries have adapted to it—and there will be millions of people victimized by repeal. It will be a political disaster of unimaginable proportions.

On the other hand, they’ve invested so much emotional, political, and rhetorical energy over the last six years into their opposition to this law that they would seemingly have no choice but to repeal it, no matter the consequences. Liberals may argue that the ACA would have been a lot better if it hadn’t worked so hard to accommodate the market-based character of the American health-care system, but Republicans have been telling their constituents that it’s the most horrific case of government oppression since the Cultural Revolution (or as Ben Carson says, “the worst thing that’s happened to this nation since slavery”). They can’t exactly turn around to the people who elected them and say, “Look, I know we said we’d repeal this thing, but that’s going to be a real mess. How about if we just make some changes to it so it works more like we’d like?”

Or maybe they could. Just look what happened to Matt Bevin, the new governor of Kentucky. He ran on a platform of purging the state of every molecule of that despicable Obamacare, but now that he’s in office, things are looking a little more complicated. That’s because Kentucky is one of the great ACA success stories, where the expansion of Medicaid brought health insurance to a half a million low-income people who didn’t have it, and the state’s health-care exchange, Kynect, was a model of success. So Bevin is now backtracking on his promise, saying that instead of just eliminating the Medicaid expansion he’s going to reform it. And Kynect may get the axe (which would mean just turning it over to the federal government), but that won’t happen for quite some time, if at all.

And that’s what I think we’d see if we actually got a Republican president and a Republican Congress forced to deal with the consequences of what they’ve been promising for so long. Once they have the ability to bring down such a health-care calamity on the public, it’s not going to seem like such a great idea. They’ll say they’re as committed to it as ever, while behind the scenes they’ll be frantically trying to figure out how to do something they can call “repeal” but that won’t actually get rid of all the things people like about the law. I wouldn’t be surprised if we saw a “repeal” bill that, in the name of an effective transition, left much of the law in place, then slowly instituted their market-driven ideas over time. Because there are limits to even what kind of damage an all-Republican government would inflict—if not on the country, then at least on their political fortunes.

 

By: Paul Waldman, Senior Writer, The American Prospect, January 10, 2016

January 14, 2016 Posted by | Affordable Care Act, Obamacare, Republicans | , , , , , , , , | 2 Comments

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