“Obamacare, Beyond The Label”: The Politics Of Obamacare Are Upside-Down
The Affordable Care Act was supposed to be a slam-dunk issue for the Republicans in this fall’s elections. Karl Rove told us so in April, writing that “Obamacare is and will remain a political problem for Democrats.”
So how’s that Obamacare thing working out for the GOP?
The most significant bit of election news over the last week was the decision of Senator Mark Pryor, the embattled Arkansas Democrat, to run an ad touting his vote for the health care law as a positive for the people of his increasingly Republican state.
Pryor’s ad is so soft and personal that it’s almost apolitical. After his dad, the popular former senator David Pryor, tells of his son’s bout with cancer, he notes that “Mark’s insurance company didn’t want to pay for the treatment that ultimately saved his life.” The picture has widened to show Mark Pryor sitting next to his father. “No one should be fighting an insurance company while you’re fighting for your life,” he says. “That’s why I helped pass a law that prevents insurance companies from canceling your policy if you get sick, or deny coverage for pre-existing conditions.”
Who knew a law that critics claim is so dreadful could provide such powerful reassurance to Americans who are ill?
Democrats have never fully recovered from the Obama administration’s lousy sales job for (and botched rollout of) what is, legitimately, its proudest domestic achievement. That’s one reason Pryor doesn’t use the word “Obamacare” in describing what he voted for. Another is that in many of the states with contested Senate races this year, most definitely including Arkansas, President Obama himself is so unpopular that if you attached his name to Social Security, one of the most popular programs in American history would probably drop 20 points in the polls.
So, as the liberal bloggers Greg Sargent, Brian Beutler and Steve Benen have all noted, Republicans would much prefer to run against the law’s name and brand than the law itself. They also really want to avoid being pressed for specifics as to what “repealing Obamacare” would mean in practice.
As one Democratic pollster told me, his focus groups showed that when voters outside the Republican base are given details about what the law does and how it works, “people come around and say, ‘That’s not so bad, what’s everybody excited about?’”
This consultant says of Democrats who voted for the law: “You’re going to be stuck with all the bad about this but not benefit from any of the good unless you advertise” what the Affordable Care Act does. This is what Pryor has decided to do.
In fact, according to Gallup, Arkansas is the No. 1 state in the country when it comes to reducing the proportion of its uninsured since the main provisions of the ACA took effect. The drop was from 22.5 percent in 2013 to 12.4 percent in 2014. The No. 2 state is Kentucky, where the uninsured rate fell from 20.4 percent to 11.9 percent. What they have in common are Democratic governors, Mike Beebe in Arkansas and Steve Beshear in Kentucky, committed to using Obamacare — especially, albeit in different ways, its Medicaid expansion — to help their citizens who lack coverage. Beshear has been passionate in selling his state’s version of Obamacare, which is called kynect.
Kentucky also happens to be the site of another of this year’s key Senate races. Democrat Alison Lundergan Grimes is giving Republican leader Mitch McConnell what looks to be the toughest re-election challenge of his 30-year Senate career.
The Bluegrass State is particularly instructive on the importance of labeling and branding. A Public Policy Polling survey earlier this month found that the Affordable Care Act had a net negative approval rating, 34 percent to 51 percent. But kynect was rated positively, 34 percent to 27 percent. Grimes and the Democrats need to confront McConnell forcefully on the issue he has tried to fudge: A flat repeal of Obamacare would mean taking insurance away from the more than 521,000 Kentuckians who, as of last Friday, had secured coverage through kynect. How would that sit with the state’s voters?
Election results, like scripture, can be interpreted in a variety of ways. You can bet that foes of expanding health insurance coverage will try to interpret every Republican victory as a defeat for Obamacare. But as Mark Pryor knows, the president’s unpopularity in certain parts of the country doesn’t mean that voters want to throw his greatest accomplishment overboard — even if they’d be happy to rename it.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post; The National Memo, August 25, 2014
“Paul Ryan’s Stale Ideas On Poverty”: Retreaded Idea’s Surrounded With The Language Of Innovation
Paul Ryan is counting on this: Because he says he wants to preserve a safety net, speaks with concern about poor people and put out a 73-page report, many will elide over the details of the proposals he made last week in his major anti-poverty speech.
The Wisconsin Republican congressman is certainly aware that one of the biggest political difficulties he and his conservative colleagues face is that many voters suspect them of having far more compassion for a wealthy person paying taxes than for a poor or middle-income person looking for a job.
So Ryan gave a well-crafted address at the American Enterprise Institute in which the centerpiece sounded brand spanking new: the “Opportunity Grant.” The problem is that this “pilot program” amounts to little more than the stale conservative idea of wrapping federal programs into a block grant and shipping them off to the states. The good news is that Ryan only proposes “experiments” involving “a select number of states,” so he would not begin eliminating programs wholesale. Thank God for small favors.
Ryan surrounds his retread idea with the language of innovation. “The idea would be, let states try different ways of providing aid and then to test the results — in short, more flexibility in exchange for more accountability,” he declared. “My thinking basically is, get rid of these bureaucratic formulas.”
Who can possibly like those “bureaucratic formulas”? The phrase is another disguise. Among the programs Ryan would block grant are food stamps (now known as the Supplemental Nutrition Assistance Program or SNAP). Food stamps are one of our most valuable initiatives because people are automatically eligible for them when they lose a job or their income drops sharply. Studies have amply documented how important food stamps are to the well-being of children.
For the economy and for the disadvantaged, curtailing SNAP would be devastating. While providing nutrition help to families in desperate need, food stamps also offer an immediate economic stimulus at moments when the economy is losing purchasing power. Economists call such programs “automatic stabilizers.”
Ryan’s block grant would not be nearly as responsive to economic changes. If Congress would have to step in, its reaction would be slow. And the history of Ryan’s own budgets shows that increasing spending for poor people is not exactly a priority on his side of politics.
Food stamps aren’t the only programs that get wrapped into the grant. Housing vouchers go there, too, which could lead to more homelessness. So does money for child care. Ryan says there would be rules barring states from using funding from his Opportunity Grant for purposes other than helping the needy. But it’s not clear from his outline how he’d stop states from using their new flexibility to move spending away from the needy indirectly by substituting block grant money for existing expenditures.
Ryan might reply: You just don’t trust the states! And my answer would be: You’re absolutely right, there are some states I don’t trust to stand up for their poor people. I’d point specifically to the 24 states that are depriving roughly 5 million Americans of health insurance because they refuse to participate in the Medicaid expansion under the Affordable Care Act.
In his speech and report, Ryan movingly described two hypothetical Americans, “Andrea” and “Steven,” and how much they could benefit from intense counseling by a case worker. There may well be something to this, but it’s expensive. How much would states have to cut basic assistance to the poor to hire additional case workers?
And by the way, one of the programs Ryan would eliminate to pay for an undoubtedly positive part of his plan — a roughly $500-a-year increase in the Earned Income Tax Credit (EITC) for childless workers — is the Social Services Block Grant, which helps pay for the kinds of interventions he wants for Andrea and Steven.
There is such a hunger for something other than partisanship that the temptation is to praise the new Ryan for being better than the old Ryan and to leave it at that. It’s good that he moved on the EITC and also that he embraced sentencing reform. I also like his suggestion that we re-examine occupational licensing rules.
But forgive me if I see his overall proposal as a nicely presented abdication of federal responsibility for the poor. “Experimenting” with people’s food-stamp money is not something we should sign onto.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, July 27, 2014
“The Big Problem With Paul Ryan’s New Poverty Plan”: Accountability Is Only Required Of Poor People
Today, Rep. Paul Ryan is unveiling his latest idea to change the federal government’s poverty programs. For someone who is constantly saying how concerned he is about poverty, Ryan’s previous budgets have relied an awful lot on slashing benefits to poor people. But this time, he promises that his proposal doesn’t cut benefits, but merely reorganizes them. Some parts of the proposal might be worthwhile. But it’s hard to avoid the conclusion that it’s still driven by the longstanding conservative desire to limit the help we give to the poor.
The centerpiece of the proposal is a consolidation of multiple separate programs into a single block grant that would be given to states; they could decide how to dispense the money, and the federal government’s job would essentially be reduced to oversight. States would choose whether or not to participate.
This sounds reasonable until you start to think about how it would play out. In practice, it’s likely that the states most eager to sign on would be precisely those that aren’t too happy about the ways the federal government provides benefits now. The devil would be in the details; what if a state decided to take its entire block grant and devote it to giving lectures to poor people on why they should get married? There could be a lot of needs going unmet while states implement their ideologically-driven visions of how poverty ought to be addressed.
Ryan’s plan assumes that the same Republican states that rejected the federal government’s offer to insure poor citizens through the expansion of Medicaid — in other words, who would rather see poor people go uninsured than get coverage from the government — are now going to be spectacularly committed and creative in working to help those same poor citizens through their time of need. Color me skeptical.
Ryan insists his plan would hold funding for these programs constant, not cut them. But it’s more complicated than that. Conservatives have long advocated block-granting of poverty programs, always with the justification that states will better deliver assistance to poor Americans if they aren’t hamstrung by requirements from Washington. But there’s little evidence that block granting accomplishes anything other than making it easier for these programs to be cut in future years or simply whittled away by inflation. As Jared Bernstein points out, Temporary Assistance to Needy Families, which we used to call “welfare,” was block-granted in 1996 and has since then seen its value slashed by 30 percent in inflation-adjusted terms.
One of the real dangers of Ryan’s approach is that it would render the programs unable to deal with economic downturns unless Congress stepped in and supplied more money, which would be unlikely as long as Republicans control at least one house. So for instance, right now the food stamp program is an entitlement; if you meet eligibility standards you’re entitled to food stamps. The program can never run out of money in a given year. When the Great Recession hit, millions of Americans found themselves newly out of work and thus eligible for food stamps.
But under Ryan’s program, food stamps would be part of a block grant whose total amount is fixed. If and when another recession hit, states would be flooded with people who needed assistance, but they’d have the same limited sum of money they got at the beginning of the year. So they’d either have to turn people away or find a way to rob Peter to pay Paul, taking money out of other poverty programs to meet the increased need for food.
(There’s a brief discussion of inserting a provision into the plan to account for this kind of eventuality, but it seems neither particularly well thought-out nor nearly adequate to address what could be a major need.)
Ryan’s plan would also require “accountability” from those receiving assistance, in the form of time-limited benefits and work requirements (how you satisfy those requirements when people can’t find work is its own sad story). This too is a hallmark of the Republican approach to poverty programs, in which poor people have to jump through hoops to demonstrate their moral worth to get benefits. “Accountability” is something that is required of poor people, and only poor people. Farmers who get government subsidies don’t have to be “accountable.” Nor do government contractors who waste huge amounts of taxpayer money. Only the poor are forced to pee in a cup or account for their time or endure a hundred other petty humiliations, so we can be sure that if they get any government assistance they have proven themselves to be morally upstanding enough to deserve help.
That isn’t to say there’s nothing worthwhile in Ryan’s proposal. As he writes in a USA Today op-ed, “Right now, you have to go to a bunch of different offices to enroll in a bunch of different programs, often with different paperwork requirements and eligibility standards. Under the Opportunity Grant, you could go to one office and work with one person.” As anyone who has tried to apply for assistance knows, the paperwork requirements seem designed to hold down enrollment by making it as difficult as possible to apply. Streamlining that process would be terrific.
While this plan isn’t going to become law (at least not any time soon), it does serve a political purpose of showing that Republicans are thinking about poverty, and Ryan isn’t the only one in his party trying to revive “compassionate conservatism.” We can give him credit for addressing the issue. If only there was more reason to believe his ideas would do much to help Americans who are struggling.
By: Paul Waldman, Contributing Editor, The American Prospect; Published at The Plum Line, The Washington Post, July 24, 2014
“Paul Ryan’s Glossy New Poverty Plan”: Not Much Doubt What The Effect On Poor People Will Be
Every year or so Paul Ryan comes up with a glossy new plan to deal with poverty or spending on social programs. The plans never go anywhere, but they’re not really intended to: They’re designed to make the Republican Party (and Mr. Ryan himself) appear more thoughtful than it actually is on these subjects.
The one he released today is somewhat better than previous efforts, in that it doesn’t propose massive cuts in overall spending (unlike his House budgets), and would even increase the Earned Income Tax Credit, one of the government’s most successful anti-poverty programs. Democrats have also embraced a larger credit, although unlike Mr. Ryan, they would pay for it by raising taxes on the rich rather than slashing federal nutrition programs that Mr. Ryan thinks are a waste of money.
But the lack of seriousness in the plan is demonstrated by its supposedly big idea: It would combine 11 of the most important federal poverty programs into something called an “opportunity grant” that would be given to the states to spend as they see fit. The eliminated programs would include food stamps, what remains of the welfare system (known as Temporary Assistance to Needy Families), Section 8 housing vouchers, and low-income heating assistance, among others.
This technique should sound familiar. Members of Mr. Ryan’s party have spent years promoting the idea that states can do things better than Washington. As Rick Santorum repeated endlessly in 2012, “Cap it, cut it, freeze it, and block-grant it to the states.” Mr. Ryan’s running mate that year, Mitt Romney, would have turned all of Medicaid into a block grant system dumped onto the steps of 50 state capitols.
Putting programs like food stamps into a block grant means they could not be expanded on a national basis during economic emergencies, when unemployment or poverty soars. If a state were to have a budget crisis, perhaps due to tax cuts, social spending would be the first to go.
The broader problem is the sharp division between the states, which exposes the gap between Mr. Ryan’s attempt at high-mindedness and the petty grievances of the Republican majority. The proponents of these consolidation ideas know that while blue states would shoulder their responsibilities and protect their poorest residents, many red states would not. If Washington were not in the anti-poverty business, Republicans would have an opportunity to reduce spending on social programs in about half the country.
The attitude of red states toward social spending has been made brutally clear by their reaction to the Affordable Care Act. In 36 states, lawmakers refused to set up health care exchanges, putting the insurance subsidies for poor people at risk if a recent court decision is upheld. And only 27 states, including the District of Columbia, have agreed to expand their Medicaid programs. The effect on lowering the number of uninsured people in states with expanded programs is clear, but lawmakers elsewhere don’t care.
In Florida, the Republicans who rule the state have not created exchanges or expanded Medicaid, and have offered nothing to the 760,000 state residents with no insurance. The state has even banned volunteers who were helping poor people sign up for the federal exchange. The president of the Florida Senate, Don Gaetz, summed up the prevailing attitude perfectly this week: “As long as I serve in the Senate, I will never support the state of Florida serving as the instrument by which individuals and businesses are forced into a federal mandate to purchase a health insurance product they may not want.”
Mr. Ryan would never say so, but the real effect of his plan is to turn over a series of highly successful federal poverty programs into the hands of Don Gaetz and other anti-government ideologues. There’s not much doubt what the effect on poor people would be.
By: David Firestone, Taking Note, The Editorial Page Editors Blog; The New York Times, July 24, 2014
“Creating Two Different Nations”: The Deepening Divide Between Red And Blue America
Halbig v. Burwell, the case in which opponents of the Affordable Care Act won a dramatic if temporary victory yesterday, has profound implications for millions of Americans’ health care. But it’s also a demonstration of a trend that is determining more and more of what our politics and our country are going to look like in future years.
We talk a lot about America being divided ideologically, with liberals and conservatives increasingly distrustful and dismissive of each other. But we’re also in the process of creating two different nations, where stepping across a state border means entering a society with profoundly different laws and policy goals. And Republicans may have just stumbled on a way to use the federal government to increase that division.
Both parties are driving this broad movement. In many Republican-controlled states, it’s now all but impossible for a woman to get an abortion; people are encouraged by the state government to bring their guns to church and into bars; and taxes are whittled away while social services are slashed. Democrats too have gotten more aggressive in places they control, on issues like raising the minimum wage, same-sex marriage, and legalizing marijuana.
But the challenges to the ACA have shown the Republicans a new path, a kind of federalized federalism, where they can not only make Red America a more conservative place through state laws, but exempt Red America from federal laws they don’t like.
This wasn’t part of a carefully laid-out plan. Initially Republicans were just using any and every means they could find to undermine the ACA, with the goal of destroying it completely. Though they failed to do that, they won their first significant (if partial) victory when the Supreme Court ruled that states could opt out of the law’s expansion of Medicaid, which meant that we have two different countries when it comes to health coverage for poor people. If you’re poor and you live in a blue state or one of the few red states that has accepted the expansion, you can get free health insurance. If not, you’re out of luck. See, for instance, this vivid New York Times article about the city of Texarkana, which lies half in Texas and half in Arkansas; whether you get health insurance is determined by which side of town you live in.
In the Halbig case, conservatives located a drafting error and pursued it for no reason other than that it looked like a promising vehicle for Republican-appointed judges to strike a blow at the law. Creating two different countries when it comes to the ACA wasn’t really the goal, but it could be the outcome.
Let’s imagine the Supreme Court upheld the D.C. Circuit panel’s decision. In the states that have already established state exchanges, nothing would change. With a few exceptions (like Kentucky and Idaho) these are blue states. Everywhere else, people would immediately lose the tax credits they received to buy insurance, reverting to the pre-ACA status quo. That means more people without insurance, and a system that is generally more cruel and unforgiving. The states that are Democratic-controlled or divided but haven’t yet set up an exchange, like Pennsylvania, New Jersey, and Maine, would probably move to do so in order to restore those subsidies to their citizens. Once it all shook out, you’d have a situation in which, for all intents and purposes, the most consequential social legislation passed through Congress in nearly half a century was operative in only half the country.
If that were to happen (and maybe even if it doesn’t), Republicans are likely to see a new means to accomplish their policy goals on any number of issues. If you can’t repeal a federal law you don’t like, maybe you can have it apply only to Blue America. Get a few creative lawyers together, and you can come up with a rationale for a lawsuit to allow states to opt out of almost any law; few can deny now that no matter how thin the legal reed you hang such a suit on, there will always be conservative judges who will embrace your logic. We could see a proliferation of opt-out amendments in Congress, as each significant piece of legislation is accompanied by an effort to give Republican states the ability to exempt themselves.
And don’t be surprised if perpetually vulnerable red state Democrats end up supporting those amendments from time to time, so they can give their party the votes it needs to pass bills, but also tell the folks back home that they stood up for states’ rights.
In 1932, Justice Louis Brandeis wrote in a dissenting opinion:
It is one of the happy incidents of the federal system that a single courageous state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.
But the assumption has always been that when states act as laboratories of democracy, they’re exploring different ways to arrive at common goals. Increasingly, liberals and conservatives can agree only on the most abstract goals, like prosperity and freedom, but on almost none of the specifics. With the ACA as an example, Washington could become the new laboratory of division, where federal legislation and federal lawsuits become the means to drive Red America and Blue America further apart.
By: Paul Waldman, Contributing Editor, The American Prospect; Published in The Plum Line, The Washington Post, July 23, 2014
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