“There Won’t Be Any Highs Ahead”: Congress Deserves Public’s Contempt For Its Obsession With Destroying Obamacare
Congress is back—and the House has an ambitious plan for the year ahead. OK, an ambitious plan to cement its place in history as the Do-Nothingest Congress of all time.
The House has scheduled all of 97 days in session before the November elections, with many of them being half days or pro forma ones. And Majority Leader Eric Cantor’s memo to his troops outlining the plan for the year ahead made it clear that there is at most a bare-bones agenda, focused like a laser, yet again, on repealing or further sullying and delegitimizing Obamacare. The only possible good news coming out of that is that the obsessive focus on killing Obamacare may provide the excuse for House leaders to extend the debt ceiling without blackmail this time, by convincing their rank-and-file that it is the best way to avoid distractions and keep the focus on the health insurance law.
The obsession with Obamacare, and the near-universal belief among Republican lawmakers and conservative spinmeisters that the law will collapse spectacularly of its own weight, is fascinating.
Remember that when Sen. Ted Cruz incited the shutdown last year over the demand to defund Obamacare, his argument was that this was the last chance before the law was implemented in January—after which it would be impossible to stop it, because so many Americans would be delighted with its benefits. Cruz told Sean Hannity last July, “If we don’t do it [defund Obamacare] now, in all likelihood, Obamacare will never, ever be repealed. Why is that? Because on January 1, the exchanges kick in, the subsidies kick in; … their plan is to get the American people addicted to the sugar, addicted to the subsidies, and once that happens, in all likelihood, it never gets …”
At which point Hannity agreed, saying, “It’s over—it never gets repealed.”
The awful and bumpy rollout of the plan changed all that; now, for Cruz, Hannity, and everyone else in the right-wing echo chamber, there won’t be any highs ahead, or at least the highs and sugar addictions will be overwhelmed by bad drugs and overdoses.
Which view is right? We don’t know for sure, but there is some interesting evidence in the rollout of the Medicare Part D plan in 2005, via an excellent analysis by Georgetown University’s Center on Health Insurance Reform. The report makes clear that there are many parallels between Part D and Obamacare.
First, both plans passed with substantial partisan tension, which tarnished the initial public views of them. Second, both plans created much confusion in the public, with small proportions of Americans having even a basic understanding of what was in the plans and how they would work. Third, both plans had a lot of time after passage and before they actually took effect to prepare for a massive rollout. Fourth, neither had its website ready to roll when the deadline hit, and both had crashes and long delays to gain access. Fifth, even after the websites became more reliable, other problems persisted, including inadequate call centers and inexperienced navigators at the local level who were unprepared with full or sophisticated answers to questions posed by those trying to sign up. Sixth, supporters of the laws issued cautions when they were first unveiled, warning of glitches ahead and asking the public for understanding and help at ameliorating the problems.
Now for the differences. While Medicare Part D was the subject of serious partisan chicanery—the infamous three-hour vote in the House; the conference committee that barred key Senate Democrats from participating, including Senate Democratic Leader Tom Daschle; the “bait and switch” that in the end took out all the parts of the bill that had made Ted Kennedy an initial partner of the Bush administration—once it was law, most Democrats worked hard to make the plan accessible and workable for seniors, as did Democratic governors and state legislatures.
Of course, the opposite is true of Obamacare. Despite yeoman efforts to make the bill bipartisan—months and months of negotiation by Senate Finance Chairman Max Baucus with Chuck Grassley and other Senate Republicans, starting from a framework devised and endorsed by Grassley—it got not a single GOP vote. But after passage, it has received nothing but yeoman efforts to sabotage it, including from a slew of Republican governors denying insurance to the most needy of their constituents simply to stymie the law’s implementation. And whenever a Republican talks about how to make the law work better, instead of blowing it up (Jack Kingston of Georgia comes to mind), he or she is vilified by partisans and their media acolytes.
Second, the mainstream media reported on the glitches in the Medicare Part D plan but did not jump all over them with front-page or highlighted stories, or repeated and lengthy inquests on Sunday talk shows. The opposite has been true of Obamacare, with an added twist that reflects the new economic and political realities for media, as reported in a piece by Maggie Mahar at healthinsurance.org. Mahar investigated a ballyhooed article in the Fort Worth Star-Telegram titled “Obamacare Stirs Anxiety for Thousands.” The cases of those who were purportedly shafted by Obamacare proved to be false or exaggerated, and three of the four cases cited were tea-party adherents who strongly opposed the law, two of whom had never even checked for prices on the exchanges. After a lengthy stonewall by the paper’s editors, it became clear that no one had fact-checked the piece, which was written by a reporter with no expertise in health policy, under a tight time frame, assigned by an editor who only wanted bad news, not any stories of those who had been helped by the new law. This is more a case of underresourced news outlets eager to report bad news than bias, but it reflects the tougher climate for a law that affects far more people in far more ways than Part D did.
Eight years after its rocky rollout and deep public skepticism, the Medicare Part D plan is widely popular. I have no idea if that will be the case with Obamacare—and if achieving popularity takes any length of time, the political damage, in this November election and maybe even in 2016, will already have been done. What I do know is that there are going to be a whole lot of winners under the Affordable Care Act, and a smaller number, but still a significant one, of losers or those caught up in the inevitable upheaval to the health care system.
And I know if your only legislative or policy plan for 2014, in the face of a sluggish economy, a crisis of long-term unemployment, and a host of other short and long-term problems facing the country, is to bet on the spectacular failure of the health care plan, you deserve the public contempt your Congress is receiving.
By: Norm Ornstein, The National Journal, January 8, 2014
“The GOP’s Poverty Problem”: Views Of Republicans Toward Poor People Run From Active Hostility At Worst, To Indifference At Best
Poverty is all the rage among conservatives this week, and will be for, oh, another few days at least. My guess is that this is happening largely because Democrats have made clear that income inequality is the issue they’ll be pressing from now until the November midterm elections, and Republicans are concerned that it might work. So they’re going to head it off by showing voters that they care about people who are struggling, too. The question is, how do you do that when you’re fighting against extending unemployment benefits, trying to cut food stamps, preventing poor people from getting health insurance through Medicaid, and arguing against increasing the minimum wage?
The answer, it seems, is to make public statements in which the word “poverty” appears. Marco Rubio and Eric Cantor gave speeches on it, Paul Ryan will be doing interviews on it, and you’ll probably be hearing more from Republicans on the topic. Mixed in will be some advocacy for policies they’ve pushed for a long time like school vouchers, and the occasional grand if counterproductive idea, like turning over all federal antipoverty programs to the states.
In seeing this, I couldn’t help but think about one of my favorite tidbits from the 2004 presidential campaign, the Bush website’s “Compassion Photo Album,” which consisted entirely of photos of George and/or Laura Bush hanging out with black and Hispanic people. Put aside how condescending it was to present the very fact of talking to a black person as an exercise in “compassion,” as though they were so pathetic that it took a mighty act of generosity for Bush to deign to place himself amongst them. The point is that things like that, and “compassionate conservatism” in general, were never about winning the votes of minorities. It was about showing moderate white voters that Bush was, in the phrase that was so often applied to him by the press when he first ran in 2000, “a different kind of Republican.” When he weighed in on a 1999 Republican budget proposal by saying, “I don’t think they ought to balance their budget on the backs of the poor,” he wasn’t speaking to poor people, he was showing middle class people that he had a heart.
Republicans are doing the same thing now. The fact is that views in the GOP toward poor people run from active hostility at worst to indifference at best. I’m not saying your average Republican wouldn’t be pleased if cutting the capital gains tax did trickle down to the little guy, but even if it doesn’t, they’re still eager to do it because their hearts are with the wealthy. Conservatives see wealth as an expression of virtue; if you have it, it’s because you work hard and deserve it, and if you don’t, that reflects a defect in your character. That’s why so many of their proposals to address poverty are either of the “tough love” variety—have the government stop helping you as a means of encouraging you to get a firm grip on those bootstraps—or things like “enterprise zones” that involve giving tax breaks and exemptions from environmental regulations to wealthy investors and corporations, in the belief that the largesse will trickle down.
The political problem Republicans are trying to address is that, deny it though they might and protest it with cries of “Class warfare!”, economic populism has always been effective for Democrats. That’s partly because it speaks to people’s genuine sentiments about their own struggles and how society should work, and partly because Republicans are the party of the rich. They’d prefer not to be seen that way, of course. But they just are. So when Democrats say “They’re the party of the rich!”, they don’t have to do a lot of persuading, since it’s what voters already believe. A few speeches about poverty aren’t going to change that.
By: Paul Waldman, Contributing Editor, The American Prospect, January 9, 2014
“Returning To The Days Of Recalcitrance”: Rubio Demands States’ Right To Ignore The Poor
For a senator who likes to hold himself out as the future of the Republican brand, Marco Rubio has come up with a remarkably retrograde contribution to the party’s chorus of phony empathy for the poor: Let the states do it.
All anti-poverty funds should be combined into one “flex fund,” he said in a speech on Wednesday, and then given to the states to spend as they see fit. He actually believes that states will “design and fund creative initiatives” to address inequality.
“Washington continues to rule over the world of anti-poverty policy-making, with beltway bureaucrats picking and choosing rigid nationwide programs and forcing America’s elected state legislatures to watch from the sidelines,” he said. “As someone who served nine years in the state house, two of them as Speaker, I know how frustrating this is.”
Do-nothing legislators in states like Mr. Rubio’s Florida feel frustrated precisely because most federal safety-net programs are designed to limit the ability of states to refuse to help their less fortunate residents. As Lyndon Johnson knew from personal experience in 1964, when he began the War on Poverty, states could not be trusted to properly address the poverty in their midst. Or, to put it another way, certain states could be trusted to yell and scream and fight to the end for their right to do as little as possible.
One of the great achievements of the War on Poverty programs was to extend the safety net to the South, where white legislators saw little reason to spend taxpayer dollars on the basic needs of poor citizens, most of whom were black. Southern lawmakers in Congress fought for the right of governors to veto grants made possible by the Economic Opportunity Act, one of the centerpieces of the War on Poverty, and Southern governors exercised those vetoes repeatedly. But Sargent Shriver, director of the Office of Economic Opportunity, overrode those vetoes, bypassing the governors and sending anti-poverty money directly to the local agencies and community groups that could do some good with it.
If you think those days of recalcitrance are over, take a look at the map of the states that have refused to expand Medicaid under the Affordable Care Act. The list of 25 includes every one of the states that seceded from the union, with the exception of Arkansas, which is doing only a partial expansion. (Virginia is likely to accept the expansion after its newly elected Democratic governor, Terry McAuliffe, takes office later this week.)
But long before “Obamacare” became a curse word among Republicans, most of those same states were already stingy with their spending on Medicaid, which lets states determine who is eligible for the program. The 16 states that restricted Medicaid to those making half or less of the federal poverty line included the usual cast of characters: Texas, Mississippi, Alabama, Georgia, North Carolina, and Virginia. The most generous states — giving Medicaid benefits to those at the poverty line or higher — were clustered in the Northeast and the upper Midwest, along with California.
That’s undoubtedly fine with Mr. Rubio and other Republicans who see nothing wrong with a country that is a patchwork of generosity and indifference.
“It’s wrong for Washington to tell Tallahassee what programs are right for the people of Florida,” Mr. Rubio said. “But it’s particularly wrong for it to say that what’s right for Tallahassee is the same thing that’s right for Topeka and Sacramento and Detroit and Manhattan and every other town, city and state in the country.”
That battle, though, was fought and lost by Southerners 50 years ago, just as they lost a far bloodier states’ rights battle a century earlier. The country long ago came to the conclusion that economic rights, just like voting rights and criminal rights, had to be uniform. As much as it might frustrate Mr. Rubio, people should not be made to suffer just because they were born in an uncaring state.
By: David Firestone, Editors Blog, The New York Times, January 9, 2014
“A Million Here, A Million There”: Millions Of People Have Health Insurance Thanks To Obamacare
The big number in the news this week was 1.1 million – the number of people who signed up for health insurance through Obamacare’s federal insurance marketplace this year. This is an important figure, especially given the fact that it stood at little more than 100,000 at the end of November.
Nevertheless, that 1.1 million figure dramatically understates what the Affordable Care Act has already accomplished. The number we should be talking about is at least 9 million and could be 14 million people who are currently getting coverage under the law.
How many people are currently covered through the law? Start with the 1.1 million who have gotten care through the federal website. If you layer on the number of enrollees who have gotten coverage through state-run exchanges that number tops 2.1 million, Secretary of Health and Human Services Kathleen Sebelius announced Tuesday. Then throw in the 3.9 million people who have gotten health coverage under Obamacare’s Medicaid expansion. Oh and don’t forget about the young adults under 26 who are still covered by their parents’ health insurance plans thanks to the Affordable Care Act. A year-and-a-half ago, the Department of Health and Human Services put the number at 3.1 million but an August study by the Commonwealth Fund, a private foundation that focuses on health policy research, estimated that the figure had reached 7.8 million. Total those numbers and you get a minimum of 9 million Americans covered through Obamacare and a maximum of nearly 14 million.
To borrow Everett Dirksen’s old adage: A million here, a million there, and pretty soon you’re talking about real coverage. This is why Wisconsin Sen. Ron Johnson told the New York Times last week that the Affordable Care Act is “no longer just a piece of paper that you can repeal and it goes away. … We have to deal with the people that are currently covered under Obamacare.”
To be sure there are provisos and qualifications. Obamacare critics will point out that some number of those insured are only replacing coverage they lost thanks to the law disqualifying their plans (of course that will require those same critics to acknowledge that very few of the people losing their health coverage are now bereft); and in the context of 50 million uninsured it’s only a start – but it is a start. And while I’m writing this in the waning hours of 2013, it doesn’t take a great feat of prognostication to know that the first days of 2014 may well bring another round of Obamacare horror stories as people find out that they don’t have coverage they thought they signed up for. The October website disaster’s effects are still being felt – the administration had been aiming for 3.3 million signups by now, for example, so the 2 million figure is well short.
The law’s well-publicized stumbles have certainly taken their toll in polls. Finally clear of its shutdown self-immolation, the GOP seems to be building its 2014 strategy around Obamacare’s flaws. “Ideally, we’d freeze things the way they are in amber until November,” a senior House Republican aide told Time’s Jay Newton-Small last month.
But putting aside for a moment the fact that 11 months is an age and a day in politics, there’s a fundamental flaw in this GOP calculus: Obamacare’s not the cutting issue they seem to think it is. Democratic pollsters Stan Greenberg, James Carville and Erica Seifert surveyed the 86 most competitive House districts and found that the country remains deeply divided on the Affordable Care Act. “Health care is not a wedge issue,” they concluded.
The right’s problem is that it fixates on approval-disapproval numbers without digging into them. So while a CNN/ORC poll conducted in mid-December found that 35 percent favor the law and 62 percent oppose it, only 43 percent oppose the law because it’s too liberal; if you add the 35 percent who favor the law to the 15 percent who dislike it because they wish it did more, the GOP 2014 game plan becomes more puzzling. An early December New York Times/CBS News poll tells the same story: 50 percent oppose the law while only 39 percent approve. But only 42 percent think the law goes too far while a total of 50 percent think it either doesn’t go far enough or is just right.
Those are the figures right now. But in February of last year, the Congressional Budget Office estimated that 7 million people would be covered this year through the exchanges. Is that figure realistic? The Washington Post’s Obamacare guru, Sarah Kliff, reported this week that the health research firm Avalere Health estimated what the pace of enrollments should look like, modeling it off of the 2006 Medicare drug program rollout. Their guess for Obamacare was 2.4 million people by the end of 2013, making the 7 million target plausible.
One factor which will help? The health insurance industry is going all-in on the law. As the Wall Street Journal reported last month, health insurers are fighting for these millions of new customers. The Journal suggested that insurers will spend $500 million on local TV ads in 2014. Here’s my favorite part of the article: “The ad campaigns are a major shift in strategy for health insurers, most of whom have never really had to market directly to consumers aggressively until now.” It’s the free-market flipside of Obama’s infamous promise: If you don’t like your insurer, you don’t have to keep it. A full fight for customers could help the law reach the 7 million mark – bringing the total number of people insured under it to nearly 20 million.
Is the GOP really going to spend the fall campaigning to take health care away from nearly 20 million people?
By: Robert Schlesinger, U. S. News and World Report, January 3, 2014
“The Fight Is History, Done, Finito”: The Affordable Care Act Is Here To Stay
Now that the fight over Obamacare is history, perhaps everyone can finally focus on making the program work the way it was designed. Or, preferably, better.
The fight is history, you realize. Done. Finito. Yesterday’s news.
Any existential threat to the Affordable Care Act (ACA) ended with the popping of champagne corks as the new year arrived. That was when an estimated 6 million uninsured Americans received coverage through expanded Medicaid eligibility or the federal and state health insurance exchanges. Obamacare is now a fait accompli; nobody is going to take this coverage away.
There may be more huffing, puffing and symbolic attempts at repeal by Republicans in Congress. There may be continued resistance and sabotage by Republican governors and GOP-controlled state legislatures. But the whole context has changed.
Now, officials in states that refused to participate in Medicaid expansion will have to explain why so many of their constituents — about 5 million nationwide — remain uninsured when they could have qualified for coverage. More than 1 million of these needlessly uninsured Americans live in Texas, which is targeted by Democrats as ripe for inroads because of its rapidly changing demographics. Will Gov. Rick Perry (R) be forced to reconsider his Obamacare rejectionism? Or will he ultimately be remembered for speeding the state’s transition from red to blue?
Performance of the federal insurance exchange Web site, HealthCare.gov, will continue to improve, if only because the initial flood of applicants is bound to subside. Meanwhile, insurance costs and benefits in states that refused to set up their own exchanges will be compared with those in states that did. There will be questions about how the new law is performing — but no one will be able to pretend it does not exist.
And we will surely hear more stories about individuals taking advantage of the law’s consumer benefits, especially the fact that preexisting conditions can no longer be used to deny coverage. This is life-changing for insurance seekers who suffer from chronic illnesses such as diabetes or who have survived cancer.
Opponents of the law can hardly advocate going back to a system in which those who really need insurance can’t get it. What they can do, and surely will, is make lots of noise by pretending that any problem with anyone’s health insurance is due to the Affordable Care Act. Before Obamacare, millions of Americans had their policies canceled by the insurance companies every year. Millions more had their premiums raised, their coverage reduced or both. Now when these things happen, critics will try to blame the new law.
Increasingly, though, the GOP will sound foolish and irrelevant if it continues to put all of its eggs in the “repeal and replace” basket. The problem is that the Affordable Care Act is a set of free-market reforms based on ideas developed in conservative think tanks. Republicans who want to repeal Obamacare would have to replace it with something suspiciously similar.
If Republicans in Congress would work with the administration to make technical corrections to the Affordable Care Act, they could claim a victory of sorts: Obama gave you this mess and we cleaned it up. But after demonizing the program — and the president — for so long, the party has painted itself into a corner.
Note to the GOP: “We refuse, under any circumstances, to make the law work better for the citizens we represent” is perhaps not the ideal campaign slogan for the midterm election.
The real problem with the ACA, and let’s be honest, is that it doesn’t go far enough. The decision to work within the existing framework of private, for-profit insurance companies meant building a tremendously complicated new system that still doesn’t quite get the job done: Even if all the states were fully participating, only about 30 million of the 48 million uninsured would be covered.
But Obamacare does establish the principle that health care is a right, not a privilege — and that this is true not just for children, the elderly and the poor but for all Americans.
Throughout the nation’s history, it has taken long, hard work to win universal recognition of what we consider our basic rights. Perhaps future legislation will expand and streamline the ACA reforms until everyone is covered. Or perhaps we’ll move toward a single-payer system, possibly by expanding Medicare and Medicaid until they meet in the middle.
I don’t know how we’ll get there, but we’re now on the road to universal health care. There’s no turning back.
By: Eugene Robinson, Opinion Writer, The Washington Post, January 3, 2014
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