“If Preventing Hospital Layoffs Is So Important”: Maybe Republicans Should Stop Blocking Obamacare Medicaid Expansion
If you received an email this week from your angry uncle who watches Fox News all day, outraged by reports that “Obamacare” is causing layoffs at the Cleveland Clinic, let him know he can relax.
On November 25, The Daily Caller published an article titled, “Top U.S. hospital laying off staff due to Obamacare.” On Fox Business’ Markets Now, host Connell McShane reported on the “massive layoffs.” America’s Newsroom host Bill Hemmer claimed that the Cleveland Clinic was going to “shed workers.” Later, during the America’s News HQ, Fox reporter Chris Stirewalt claimed that the layoffs “rocked the community there in northeastern Ohio.”
But there’s one problem: the Cleveland Clinic is not laying off any employees.
Imagine that. After conservative media ran with this, Media Matters talked to Eileen Sheil, the Cleveland Clinic’s Executive Director of Corporate Communications, who said, “There have been several mis-reports and they keep mentioning that we’re laying off 3,000 employees. We’re not.” The medical facility is offering voluntary retirement to 3,000 eligible employees, but those aren’t “massive layoffs,” and blaming the Affordable Care Act for staffing decisions that have happened elsewhere for years is a stretch.
Indeed, Sheil added that the Clinic supports the law conservative media is so eager to denigrate: “We believe reform is necessary because the current state is unsustainable. The ACA is a step toward that change and we believe more changes will come/evolve as there are still many uncertainties. Hospitals must be responsible and do what we can to prepare and support the law.”
And while this incident offers another reminder about the reliability of conservative media outlets, there’s another angle to keep in mind. Though it doesn’t get as much attention as it should, Medicaid expansion is incredibly important to state hospitals, which will struggle badly in Republican-led states that reject the policy. Indeed, in some states, hospitals may end up closing their doors altogether, at least in part due to the political decision.
And when state hospitals close, there are actual “massive layoffs,” which affect the employees and the economy. It’s one of the reasons so many hospitals lobby Republican officials in “red” states to be more responsible on Medicaid expansion, though their appeals are generally ignored.
So here’s the question for conservative media: when hospital staffs are laid off because Republicans blocked Medicaid expansion, and it’s “Obamacare” that could have saved those jobs, how many reports will we see chastising GOP officials for their callousness and economic recklessness?
Probably not too many. Call it a hunch.
By: Steve Benen, The Maddow Blog, November 27, 2013
“Obscuring The Bigger Picture”: The Republican Tempest Over The Affordable Care Act Diverts Attention From Three Large Truths
Having failed to defeat the Affordable Care Act in Congress, to beat it back in the last election, to repeal it despite more than eighty votes in the House, to stop it in the federal courts, to get enough votes in the Supreme Court to overrule it, and to gut it with outright extortion (closing the government and threatening to default on the nation’s debts unless it was repealed), Republicans are now down to their last ploy.
They are hell-bent on destroying the Affordable Care Act in Americans’ minds.
A document circulating among House Republicans (reported by the New York Times) instructs them to repeat the following themes and stories continuously: “Because of Obamacare, I Lost My Insurance.” “Obamacare Increases Health Care Costs.” “The Exchanges May Not Be Secure, Putting Personal Information at Risk.”
Every Republican in Washington has been programmed to use the word “disaster” whenever mentioning the Act, always refer to it as Obamacare, and demand its repeal.
Republican wordsmiths know they can count on Fox News and right-wing yell radio to amplify and intensify all of this in continuous loops of elaboration and outrage, repeated so often as to infect peoples’ minds like purulent pustules.
The idea is to make the Act so detestable it becomes the fearsome centerpiece of the midterm elections of 2014 — putting enough Democrats on the defensive they join in seeking its repeal or at least in amending it in ways that gut it (such as allowing insurers to sell whatever policies they want as long as they want, or delaying it further).
Admittedly, the President provided Republicans ammunition by botching the Act’s roll-out. Why wasn’t HealthCare.gov up and running smoothly October 1? Partly because the Administration didn’t anticipate that almost every Republican governor would refuse to set up a state exchange, thereby loading even more responsibility on an already over-worked and underfunded Department of Health and Human Services.
Why didn’t Obama’s advisors anticipate that some policies would be cancelled (after all, the Act sets higher standards than many policies offered) and therefore his “you can keep their old insurance” promise would become a target? Likely because they knew all policies were “grandfathered” for a year, didn’t anticipate how many insurers would cancel right away, and understood that only 5 percent of policyholders received insurance independent of an employer anyway.
But there’s really no good excuse. The White House should have anticipated the Republican attack machine.
The real problem is now. The President and other Democrats aren’t meeting the Republican barrage with three larger truths that show the pettiness of the attack:
The wreck of private insurance. Ours has been the only healthcare system in the world designed to avoid sick people. For-profit insurers have spent billions finding and marketing their policies to healthy people – young adults, people at low risk of expensive diseases, groups of professionals – while rejecting people with preexisting conditions, otherwise debilitated, or at high risk of heart disease, diabetes, and cancer. And have routinely dropped coverage of policy holders who become seriously sick or disabled. What else would you expect from corporations seeking to maximize profits?
But the social consequences have been devastating. We have ended up with the most expensive healthcare system in the world (finding and marketing to healthy people is expensive, corporate executives are expensive, profits adequate to satisfy shareholders are expensive), combined with the worst health outcomes of all rich countries — highest rates of infant mortality, shortest life spans, largest portions of populations never seeing a doctor and receiving no preventive care, most expensive uses of emergency rooms.
We could not and cannot continue with this travesty of a healthcare system.
The Affordable Care Act is a modest solution. It still relies on private insurers — merely setting minimum standards and “exchanges” where customers can compare policies, requiring insurers to take people with preexisting conditions and not abandon those who get seriously sick, and helping low-income people afford coverage.
A single-payer system would have been preferable. Most other rich countries do it this way. It could have been grafted on to Social Security and Medicare, paid for through payroll taxes, expanded to lower-income families through Medicaid. It would have been simple and efficient. (It’s no coincidence that the Act’s Medicaid expansion has been easy and rapid in states that chose to accept it.)
But Republicans were dead set against this. They wouldn’t even abide a “public option” to buy into something resembling Medicare. In the end, they wouldn’t even go along with the Affordable Care Act, which was based on Republican ideas in the first place. (From Richard Nixon’s healthcare plan through the musings of the Heritage Foundation, Republicans for years urged that everything be kept in the hands of private insurers but the government set minimum standards, create state-based insurance exchanges, and require everyone to sign up).
The moral imperative. Even a clunky compromise like the ACA between a national system of health insurance and a for-profit insurance market depends, fundamentally, on a social compact in which those who are healthier and richer are willing to help those who are sicker and poorer. Such a social compact defines a society.
The other day I heard a young man say he’d rather pay a penalty than buy health insurance under the Act because, in his words, “why should I pay for the sick and the old?” The answer is he has a responsibility to do so, as a member the same society they inhabit.
The Act also depends on richer people paying higher taxes to finance health insurance for lower-income people. Starting this year, a healthcare surtax of 3.8 percent is applied to capital gains and dividend income of individuals earning more than $200,000 and a nine-tenths of 1 percent healthcare tax to wages over $200,000 or couples over $250,000. Together, the two taxes will raise an estimated $317.7 billion over 10 years, according to the Joint Committee on Taxation.
Here again, the justification is plain: We are becoming a vastly unequal society in which most of the economic gains are going to the top. It’s only just that those with higher incomes bear some responsibility for maintaining the health of Americans who are less fortunate.
This is a profoundly moral argument about who we are and what we owe each other as Americans. But Democrats have failed to make it, perhaps because they’re reluctant to admit that the Act involves any redistribution at all.
Redistribution has become so unfashionable it’s easier to say everyone comes out ahead. And everyone does come out ahead in the long term: Even the best-off will gain from a healthier and more productive workforce, and will save money from preventive care that reduces the number of destitute people using emergency rooms when they become seriously ill.
But there would be no reason to reform and extend health insurance to begin with if we did not have moral obligations to one another as members of the same society.
The initial problems with the website and the President’s ill-advised remark about everyone being able to keep their old policies are real. But they’re trifling compared to the wreckage of the current system, the modest but important step toward reform embodied in the Act, and the moral imperative at the core of the Act and of our society.
The Republicans have created a tempest out of trivialities. It is incumbent on Democrats — from the President on down — to show Americans the larger picture, and do so again and again.
By: Robert Reich, The Robert Reich Blog, November 22, 2013
“The South’s New Lost Cause”: A Mason-Dixon Line Of Health Care Dispair
Before he was immortalized for saving the union, freeing the slaves and giving the best political speech in American history, Abraham Lincoln was just an unpopular new president handed a colossal crisis. Elected with 39.7 percent of the vote, Lincoln told a big lie in his inaugural address of 1861.
“I have no purpose, directly or indirectly, to interfere with the institution of slavery in the states where it exists,” he said, reaching out to the breakaway South. “I believe I have no lawful right to do so, and I have no inclination to do so.”
He was saying to a Confederacy that would enshrine owning another human being in its new constitution: If you like the slaves you’ve got now, you can keep them. It was a lie in the sense that Lincoln made a promise, changed by circumstances, that he broke less than two years later — and probably never meant to keep.
The comparisons of President Obama to Lincoln fade with every day of the shrinking modern presidency. As for the broken-promise scale: Lincoln said an entire section of the country could continue to enslave more than one in three of its people. Obama wrongly assured about five million people that they could keep their bare-bones health plans if they liked them (later amended when it turned out not to be true).
As inapt as those comparisons are, what is distressingly similar today is how the South is once again committed to taking a backward path. By refusing to expand health care for the working poor through Medicaid, which is paid for by the federal government under Obamacare, most of the old Confederacy is committed to keeping millions of its own fellow citizens in poverty and poor health. They are dooming themselves, further, as the Left-Behind States.
And they are doing it out of spite. Elsewhere, the expansion of Medicaid, the health care program for the poor, has been one of the few success stories of Obamacare. It may be too complicated for the one-dimensional Beltway press. Either that, or it doesn’t fit the narrative of failure.
But in the states that have embraced a program that reaches out to low-wage workers, almost 500,000 people have signed up for health care in less than two months time. This is good for business, good for state taxpayers (because the federal government is subsidizing the expansion) and can do much to lessen the collateral damages of poverty, from crime to poor diets. In Kentucky, which has bravely tried to buck the retrograde tide, Medicaid expansion is projected to create 17,000 jobs. In Washington, the state predicts 10,000 new jobs and savings of $300 million in the first 18 months of expansion.
Beyond Medicaid, the states that have diligently tried to make the private health care exchanges work are putting their regions on a path that will make them far more livable, easing the burden of crippling, uninsured medical bills — the leading cause of personal bankruptcy.
And those states aren’t going to turn back the clock and revert to the bad old days, no matter how Republicans try to kill health care reform in the wake of the federal rollout. Many are refusing to accept Obama’s “fix” of allowing people to keep sketchy health care policies. If they follow the pattern of Massachusetts — where a mere 123 people enrolled in the first month of Romneycare, after which it gradually took off — the progressive states could end up with more than 95 percent of their residents insured.
What we could see, 10 years from now, is a Mason-Dixon line of health care. One side (with exceptions for conservative Midwest and mountain states) would be the insured North, a place where health care coverage was affordable and available to most people. On the other side would be the uninsured South, where health care for the poor would amount to treating charity cases in hospital emergency rooms.
Texas, where one in four people have no health care and Gov. Rick Perry proudly resists extending the Medicaid helping hand to the working poor, would be the leading backwater in this Dixie of Despair. In the 11 states of the old Confederacy, only Arkansas and Tennessee are now open to Medicaid expansion.
The South, already the poorest region in the country, with all the attendant problems, would acquire another distinction — a place where, if you were sick and earned just enough money that you didn’t qualify for traditional Medicare, you might face the current system’s version of a death panel.
The only good news is that a handful of political leaders down South have grasped the utter stupidity of refusing to help their own people, or even giving the state exchanges a chance. In this month’s recent special election for a congressional seat in a solidly Republican Louisiana district, a pragmatic businessman, Vance McAllister, beat a Tea Party candidate with the full Obama derangement syndrome. The winner said Obamacare was the law of the land and might as well be applied in Louisiana, the nation’s third poorest state. (It didn’t hurt that he had the backing of a “Duck Dynasty” star.)
But most of the South is defiant — their own Lost Cause for the 21st century.
By: Timothy Egan, Op-Ed Contributor, The New York Times, November 21, 2013
“Ignoring The Elephant In The Room”: No, President Obama’s Policies Are Not Holding Back The Economy
Wall Street Journal columnist Daniel Henninger had fun this week arguing that President Obama’s problems implementing health reform pale next to his problems getting the economy back to health. The attack on Obama’s economic stewardship, however, looks just like the standard conservative attack on health reform: it’s light on sound arguments and ignores the elephant in the room — Republican obstructionism.
First, health care. As the president says, it’s on him that the rollout of HealthCare.gov and the health insurance marketplaces — where individuals can purchase health insurance to avoid the fine for not having it — has been, to put it kindly, rocky. But Republicans have provided no clear alternative to expand access to good quality, affordable health care, and they have made the rollout more difficult.
Many Republican governors and state legislatures have left implementation of their health insurance marketplaces (also known as exchanges) to the federal government rather than do it themselves — hardly the usual position of a party that believes in devolving as much power as possible to the states. And, at the moment, 25 states are not moving forward to implement the Medicaid expansions — which are a very good deal for them — leaving a significant coverage gap among low-income adults and complicating the determination of eligibility for coverage on the exchanges.
Finally, Republican proposals to “fix” the problem would undermine, not improve, health reform. The president’s proposal, while not perfect, is the best on the table.
Like problems with the health care rollout, the problems in the economy are plain to see. Henninger plays fair when he notes that the president did not cause the Great Recession, which is the source of the problems with which we’re still grappling. But, he’s wrong to say it’s the president who “has the economy on lockdown.”
First, he ignores what many economists and policymakers see as the main problem we still face – inadequate demand for goods and services. Second, he cavalierly dismisses the benefits of economic stimulus in such an economy. Third, he insists the main thing holding back the recovery is excessive business regulation. With that mindset, he naturally doesn’t acknowledge the drag on economic activity and job creation from the premature austerity that Congress has imposed on the economy since Republicans regained control of the House in the 2010 mid-term elections and the barriers that Republicans have put in the way of a budget plan that could boost the recovery in the short run while still putting deficits and debt on a sustainable longer-run trajectory.
Just a reminder to all who, like Henninger, parrot the shibboleth that stimulus did not work: the Congressional Budget Office finds that gross domestic product has been higher each year since 2009 than it would have been without the 2009 American Recovery and Reinvestment Act and unemployment has been lower (see chart).
CBO includes a broad range of estimates about the recovery act’s impact to encompass the views of economists who continue to doubt the mounting evidence that stimulus is highly effective under the economic conditions prevailing in recent years. But, that evidence suggests that act’s impact is quite likely much nearer the high than the low estimate.
Here’s what the International Monetary Fund says about that research, the expansionary effects of fiscal policy (tax cuts and increases in government spending) and the “old Keynesian mulitplier” that Henninger mocks: “While debate continues, the evidence seems stronger than before the crisis that fiscal policy can, under today’s special circumstances, have powerful effects on the economy in the short run [and] that fiscal multipliers are larger.”
The powerful effects of fiscal policy in today’s special circumstances work both ways. The economic forecasting firm Macroeconomic Advisers estimates that the economic uncertainty and policy choices to raise taxes and cut spending that we’ve made since 2010 have cost the economy up to a percentage point per year of slower economic growth and up to 2 million jobs.
It’s Republicans whose policy preferences have pulled policy toward greater near-term fiscal austerity through spending cuts; Democratic plans look more like bipartisan proposals for less spending restraint in the short term and more deficit reduction that’s balanced between revenues and spending down the road when the economy is stronger.
It’s Republicans who have the U.S. economy on lockdown.
By: Chad Stone, Chief Economist, Center on Budget and Policy Priorities, U. S. News and World Report, November 22, 2013
“This Is Sabotage, Plain And Simple”: The Unprecedented GOP Efforts To Undermine A Federal Law
Sen. Joe Manchin (D-W.Va.), who’s never been the Affordable Care Act’s biggest fan, appeared on MSNBC yesterday to join the critical chorus. In reference to the Obama administration, the conservative Democrat said, “The bottom line is that they messed up, they messed up royally. There’s no excuse for this.”
The administration’s missteps have been well documented, and officials have earned much of the criticism they’ve received. But to say there’s “no excuse” is to overlook Republican sabotage efforts that have made a real difference.
Todd Purdum recently made the case, for example, that “calculated sabotage by Republicans at every step” is a “less acknowledged cause” of the rollout’s troubles. Jamelle Bouie added this week, “If Republicans have shown anything over the last four years, it’s that they’ll do anything to stop the Affordable Care Act, even if it amounts to legislative sabotage.”
We’ve talked before about the scope of these unprecedented efforts to undermine a federal law, which include blocking necessary resources needed for implementation, public misinformation campaigns, discouraging public-private partnerships, blocking Medicaid expansion, blocking CMS nominees, refusing to create marketplaces, and prohibiting “Navigators” from doing their jobs. But the campaign is arguably intensifying now.
Dana Milbank reports on House Republican leaders who emerged from their weekly meeting yesterday and tried to scare the bejesus out of Americans.
The Republicans’ scary-movie strategy has some logic to it: If they can frighten young and healthy people from joining the health-care exchanges, the exchanges will become expensive and unmanageable. This is sabotage, plain and simple – much like the refusal by red-state governors to participate in setting up the exchanges in the first place.
The quotes from House GOP leaders are rather remarkable. Majority Leader Eric Cantor (R-Va.) said health care reform may lead to identity theft; Speaker John Boehner (R-Ohio) falsely claimed “premiums are going right through the roof”; Majority Whip Kevin McCarthy (R-Calif.) warned that consumers who visit healthcare.gov may become victims of fraud; and Caucus Chair Cathy McMorris Rodgers (R-Wash.) said vulnerable constituents may be put “on the casualty list.”
Milbank added, “Let’s hope the new health-care plans have generous coverage for anti-anxiety medication.”
Let’s not forget that the difference between a lie and a falsehood is intent – if you know the truth and say the opposite because your goal is deceit, you’re lying. And for the most part, congressional Republicans, whose interest in helping provide greater health security for Americans is easily trumped by their interested in destroying a Democratic law, have been reducing to lying.
But for saboteurs, honesty and serious policy debate are easily sacrificed for the larger goal. Indeed, they’re a small price to pay.
Also note, we’re looking at quite a one-two punch from the far-right – on the one hand we see the Koch brothers and their allies urge the uninsured to stay that way on purpose, in order to advance conservatives’ ideological goals, and on the other we see congressional Republicans try to terrify the public in the hopes that people who stand to benefit from “Obamacare” steer clear of the system.
President Obama added yesterday, during an interview with the Wall Street Journal, that if both parties were “invested in success,” the rollout wouldn’t have been quite so rocky. “One of the problems that we’ve had is that one side of Capitol Hill is invested in failure and that makes the kind of iterative process of fixing glitches as they come up and fine tuning the law more challenging,” he added.
There’s no denying that the dysfunctional health care website matters, and the administration’s missteps deserve criticism. But Republican sabotage matters, too.
Kevin Drum recently explained, “No federal program that I can remember faced quite the implacable hostility during its implementation that Obamacare has faced. This excuses neither the Obama administration’s poor decisions nor its timidity in the face of Republican attacks, but it certainly puts them in the proper perspective.”
By: Steve Benen, The Maddow Blog, November 20, 2013
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