“Portrait Of A Man Republicans Can’t Trust”: Four Basic Problems Stand Between Chris Christie And The 2016 Nomination
The emergence of Chris Christie as one of America’s most popular national figures comes as a godsend to the Republican Party. Having angrily turned down every opportunity to compromise with an electorate that spurned them a year ago, they now see the enticing chance, in the form of Christie’s all-but-declared presidential candidacy, to right their course without veering left. “The road to Republican political redemption may well run through Trenton, N.J,” says Politico’s Ben White. Savvy operative Ralph Reed, whose ties run from the Grover Norquists of the party to its Christian wing, gave the governor his blessing, seemingly paving the way for Christie to clear the party’s ever-more-stringent ideological purity tests. Christie used his acceptance speech to establish the themes for this run, repeatedly highlighting his support from Democratic constituencies and his record of cutting taxes and spending.
There is only one flaw with the plan: Shepherding Christie through a competitive Republican primary will be vastly more difficult than anybody seems to be figuring at the moment. Four basic, interrelated problems stand between Christie and the 2016 nomination:
1. His ideological deviations are not fake. They’re real. Christie has openly endorsed gun control, called for a path to citizenship for illegal immigrants, and conceded the legitimacy of climate science (“But when you have over 90 percent of the world’s scientists who have studied this stating that climate change is occurring and that humans play a contributing role it’s time to defer to the experts.”)
The largest, and least appreciated, of Christie’s betrayals of party doctrine is his decision to participate in the expansion of Medicaid under Obamacare. Some other Republican governors have made the same decision, but they have all faced unrelenting and bitter opposition from legislators of their party and conservative activists. Unyielding hatred to every aspect of Obamacare, regardless of its practical impact, has become the main doctrinal tenet of conservative thought. That alone could potentially disqualify him.
2. Christie’s popularity is somewhat fluky. Christie has some real political talent. But he has benefitted from his juxtaposition against a corrupt, divided, ineffectual state Democratic Party that consistently allowed him to claim the good government high ground. Even so, Christie’s approval ratings hovered in the low-to-mid-fifties, until he achieved beatification through Hurricane Sandy.
Christie benefitted in two ways from Sandy. One was through the kind of active, sleeves-rolled-up response to disaster that can lend politicians stratospheric approval (like the sort Rudy Giuliani won after 9/11, and sought, unsuccessfully, to leverage into higher office.) Second, and more significantly, Christie defined himself as above partisanship by metaphorically and literally embracing President Obama.
In a bitterly partisan era, Christie’s cooperation and apparently warm personal relations with Obama made him a uniquely appealing figure. In particular, it is the key to his lofty standing in the African-American community: In pointed contrast to the ceaseless rage and contempt displayed by his party, Christie treated the nation’s first black president with open respect and affinity.
Of course, having safely won reelection, Christie can undertake a campaign of vilification against Obama. He’ll have to – the taint of collaboration with the hated Obama, if not scrubbed away, would prove as fatal as Joe Lieberman’s kiss proved to his plane crash of a presidential campaign in 2004.
But in so doing, he’ll undercut the bipartisan appeal that is the source of his national standing, eroding the incentive for party elites to rally around him as the sole electable nominee. It’s not an impossible line to walk, but it will require a very deft touch.
3. Christie lacks a deft touch. The Christie method for retaining the goodwill of his party has been, whatever he loses through policy squishiness, he wins back in personal abuse. In the past I have heavily discounted the possibility that this kind of style can translate beyond New Jersey. It is possible that I am underselling Christie’s personal appeal in states that have not spawned The Sopranos and Jersey Shore. Maybe America is truly ready for a loud, angry man in the White House.
But are Republican voters? They may like the spectacle of Christie heaping verbal punishment upon random Democrats who challenge him. It’s another thing altogether if he gives this treatment to Rand Paul, Ted Cruz, Paul Ryan, Scott Walker, or other fellow partisans. If Christie tries to bully fellow Republicans in good standing, it would seem more likely to confirm the accusation that Christie, not them, is the cultural and ideological alien. And if he can’t use bluster, what tools are available to him? It’s not like Christie can cut legislative deals with his primary opponents the way he did in New Jersey.
It is easy to forget how culturally foreign the northeast is to a Southern-dominated party, and how Christie’s belligerent tone may confirm the worst suspicions about him. Conservative columnist Phillip Klein once reported the frequent murmurings of disapproval he found among primary voters when he was covering Giuliani’s race: “one thing I kept running into among voters in early states when covering the campaign was that his background as a New Yorker was a real turnoff and made voters view him as rude and somehow shady.”
4. Christie may actually be shady. Mitt Romney wanted to make Christie his vice-presidential nominee, but took a close look at what the vetters came up with and, my colleague John Heilemann and Mark Halperin report in their new book, promptly changed his mind. Romney’s prudish disdain for Christie’s weight commanded gossipy attention, but the sheer breadth of the potential issues surrounding Christie suggests serious trouble:
The vetters were stunned by the garish controversies lurking in the shadows of his record. There was a 2010 Department of Justice inspector general’s investigation of Christie’s spending patterns in his job prior to the governorship, which criticized him for being “the U.S. attorney who most often exceeded the government [travel expense] rate without adequate justification” and for offering “insufficient, inaccurate, or no justification” for stays at swank hotels like the Four Seasons. There was the fact that Christie worked as a lobbyist on behalf of the Securities Industry Association at a time when Bernie Madoff was a senior SIA official—and sought an exemption from New Jersey’s Consumer Fraud Act. There was Christie’s decision to steer hefty government contracts to donors and political allies like former Attorney General John Ashcroft, which sparked a congressional hearing. There was a defamation lawsuit brought against Christie arising out of his successful 1994 run to oust an incumbent in a local Garden State race. Then there was Todd Christie, the Governor’s brother, who in 2008 agreed to a settlement of civil charges by the Securities and Exchange Commission in which he acknowledged making “hundreds of trades in which customers had been systematically overcharged.”
That’s … a lot of potential scandals. On top of all that, the report about Christie’s expenses “raised questions for the vetters about Christie’s relationship with a top female deputy who accompanied him on many of the trips.” That detail, published in the book but not the excerpts, seems very potentially troublesome.
All these potential problems – Obamacare, Obama, Christie’s exotic cultural background, and the swirl of scandal – all feed into each other. Collectively they form the portrait of a man Republicans fundamentally can’t trust.
Am I suggesting Republican voters would never trust Christie? No. Under the right circumstances, Christie could overcome his many hurdles. After all, Mitt Romney also possessed enormous ideological baggage, and overcame it. But Romney benefitted from enormous luck: his only opponents were staggeringly incompetent, broke, repellant to the party establishment, or all three. Romney staggered to a drawn-out victory while running virtually unopposed.
Christie seems likely to face off against real opponents with credibility and money. The case they have to make against him is strong.
By: Jonathan Chait, New York Magazine, November 6, 2013
“Once Again, The Pundits Get It Wrong”: The Virginia Election Was A Big Win For Obamacare.
As the Affordable Care Act was about to go fully into effect last month, the New York Times ran a big front-page article highlighting the fact that millions of Americans would go uncovered by the law as a result of the Supreme Court decision making it possible for states to opt out of the expansion of Medicaid. Half of the states have made this choice, creating a confounding scenario in which middle-income people can qualify for subsidies to obtain private coverage but the neediest working poor, who were supposed to be covered by Medicaid, are getting no help at all.
“How can somebody in poverty not be eligible for subsidies?” an unemployed health care worker in Virginia asked through tears. The woman, who identified herself only as Robin L. because she does not want potential employers to know she is down on her luck, thought she had run into a computer problem when she went online Tuesday and learned she would not qualify.
At 55, she has high blood pressure, and she had been waiting for the law to take effect so she could get coverage. Before she lost her job and her house and had to move in with her brother in Virginia, she lived in Maryland, a state that is expanding Medicaid. “Would I go back there?” she asked. “It might involve me living in my car. I don’t know. I might consider it.”
Last night, the prospects for Robin L. and the estimated 400,000 Virginians who would be eligible under a Medicaid expansion brightened considerably. The gubernatorial election was won by Terry McAuliffe, who made the Medicaid expansion such a central part of his campaign that for a time he was even threatening to shut down the state government unless legislators included it in their budget. The expansion, which is now being studied by an ad hoc state panel, still faces big hurdles—the General Assembly remains firmly in Republican control, and the Koch brothers are spending heavily to pressure those Republican state legislators who dare to support the expansion. Still, the odds of the expansion happening are infinitely greater with McAuliffe in the Governor’s Mansion than with the fiercely anti-Obamacare Ken Cuccinelli.
So, the election was a clear win for Obamacare, right? Nope, say the pundits. The fact that Cuccinelli finished closer than recent polling suggested, they say, is a clear sign of strong public opposition to Obamacare, which Cuccinelli made a centerpiece of his campaign in the final days.
From CNN.com:
Virginia was the first swing state to hold an election after the Affordable Care Act website’s troublesome rollout, a controversy that has permeated national news coverage for weeks. Almost 30% of Virginia voters said health care was the most important issue in the race. While Democrat Terry McAuliffe narrowly beat out conservative Republican Attorney General Ken Cuccinelli, analysts credit a GOP focus on Obamacare for boosting Cuccinelli’s vote total. “This is what kept this race close,” CNN’s John King said Wednesday on “New Day.”
And Politico proclaimed: “Obamacare almost killed McAuliffe”:
Exit polls show a majority of voters—53 percent—opposed the law. Among them, 81 percent voted for Cuccinelli and 8 percent voted for Libertarian candidate Robert Sarvis. McAuliffe won overwhelmingly among the 46 percent who support the health care overhaul.
Cuccinelli actually won independents by 9 percentage points, 47 percent to 38 percent, according to exit polls conducted for a group of media organizations. They made up about one-third of the electorate. “Obamacare helped close the gap,” said Richmond-based strategist Chris Jankowski, the president of the Republican State Leadership Committee.
I’m not sure when I last saw such a stark example of election spin and punditry floating away from the substantive reality of governing and its impact on actual people. There is no mention in these accounts of the greatly enhanced prospects for the Medicaid expansion in Virginia as a result of McAuliffe’s win. No, it’s all about the exit polls and what it might mean for Obama and the Democrats. But Obama’s not on the ballot again, ever, and the Democrats aren’t on it again for another year. Who knows what voters will think of Obamacare then—the troubles with the rollout will either have resolved by then or they will not have. All we know right now is that after a very rough patch for the law, the guy who ran strongly in support of it beat a guy who was strongly opposed to it, in the most purple state in the country. And as a result, hundreds of thousands of working poor may get health insurance coverage. How removed from the reality of these people’s lives does one have to be to chalk up such a result as a loss for Obamacare?
By: Alec MacGillis, The New Republic, November 6, 2013
“Obstructing Obamacare Navigators”: The Republican Suppression Syndrome Continues
On August 15th, Jodi Ray, a project director at Florida Covering Kids and Families, a University of South Florida program that works to get uninsured children access to health care, won a federal grant to hire ninety people as health-care “navigators”: workers who will help applicants apply for insurance through the exchanges set up as part of the Affordable Care Act. In states that declined to set up their own exchanges, like Florida, the Department of Health and Human Services awarded funding worth sixty-seven million dollars for outreach efforts to help the uninsured enroll through the federal marketplace. Nearly four million people in Florida are uninsured—the third highest figure in the country—and Ray had six weeks to recruit staff from community-service groups in sixty-four counties across the state, and guide new hires through twenty hours of online federal training attached to her grant.
“But our navigators don’t only have to comply with federal requirements for the training,” Ray said. “We have state requirements that we have to comply with, too.” Last spring, the Florida legislature, apparently concerned that swindlers would land jobs as health-care experts with access to Social Security numbers and tax information, decided that the navigators should undergo fingerprinting and criminal background checks, and barred them from visiting state-run health clinics. Ray preferred not to comment on what the advocacy group Healthcare For America Now calls “navigator-suppression measures.” She only said, “I’m keeping my head down, the noise out, and focusing on what we are supposed to be doing.”
After the government shutdown ended, attention shifted to the blips and seizures bedevilling the federal marketplace’s Web site, healthcare.gov. Thirty-four states, all but seven of them Republican-controlled, chose not to set up their own exchanges, leaving hundreds of millions of dollars in outreach funding on the table, and forcing their residents onto the federally-operated Web site at the center of the current uproar. Twenty-one of those states are also expected to refuse nearly three hundred billion dollars in federal funding to expand Medicaid coverage over the next decade, which would have extended care to more than six million people; a majority of those excluded will likely be African-Americans and single mothers. To compound the effects of their recalcitrance, conservative governors, state legislators, and members of Congress have also passed navigator-suppression measures in thirteen states—Arkansas, Florida, Georgia, Iowa, Illinois, Indiana, Maine, Missouri, Montana, Ohio, Tennessee, Texas, and Wisconsin—home to seventeen million people without insurance who are eligible for coverage under the A.C.A.
Two weeks after Ray received her grant, she was notified by the House Energy and Commerce Committee that she would have to participate in a phone interview with the committee’s staff in September; she was also asked to give written answers to half a dozen questions from the committee and provide “all documentation and communication related to your Navigator grant.” Similar notifications were sent to navigator offices in eleven of the most underinsured states in which residents will need to use the federal health-care exhange—including Texas, Florida, and Georgia, home to about a quarter of the nation’s uninsured. Representative Henry Waxman, a Democrat from California, protested, in an open letter to the committee’s chairman, Michigan Republican Fred Upton, that the requests appeared “to have been sent solely to divert the resources of small, local community groups, just as they are needed to help with the new health care law.”
On September 18th, Darrell Issa, the Republican chairman of the House Committee on Oversight and Government Reform, released a report that singled out Florida as the site of “numerous reports of scam artists posing as navigators and Assisters to take advantage of people’s confusion about ObamaCare.” On October 2nd, Fox News aired footage of volunteers for Get Covered America, a non-profit advocacy campaign, going door-to-door in a Miami suburb to distribute flyers about the new insurance marketplace—but wrongly identified them as federally-funded navigators, giving the impression that these “navigators” were hawking plans like pushy insurance salesmen. Upton linked to the report on his Web site. Ray, who still spends much of her time getting new navigators licensed while the federal government fixes the Web site’s glitches, was reticent about discussing the maelstrom of controversy. “It’s been busy,” she said.
As these tactics jam up early efforts in many states, they also amplify the contrast with successful rollouts in states that have wholeheartedly embraced the new law, like Colorado, Connecticut, New York, Kentucky, and Washington.
Elisabeth Benjamin, who leads New York’s largest team of navigators at the Community Service Society, spent much her early career improving health-care capacity in developing countries like India, Tunisia, and postwar Iraq—where, she said, people often told her, “I don’t understand why you’re in our country. You have a lot of problems with health care and poor people in your country.” Back home, she started a health-law unit at the Legal Aid Society to assist low-income New Yorkers with unforgiving medical bills. In 2008, she unveiled an insurance ombudsman program at C.S.S. to help people at every income level understand their options for medical coverage. “If you need a loaf of bread, it’s a buck,” she said, explaining health care’s central distinction from other forms of assistance. “If you need a transplant, it’s five hundred thousand dollars.”
Around the same time Benjamin was starting her program, Eliot Spitzer, then the governor of New York, proposed statewide health-care reform similar to the law Massachusetts had passed four years earlier. Vermont’s legislature had expanded coverage, and Arnold Schwarzenegger had made national news by calling for a similar program in California. Benjamin joined an affordable-health-care advocacy campaign, Healthcare for All New York, and testified before the New York State Legislature. “We just assumed there would be a state-by-state movement to extend coverage,” Benjamin said. But two years later, the Obama Administration, with the help of a Democrat-controlled House and Senate, passed the Affordable Care Act. New York’s governor, Andrew Cuomo, along with the state legislature in Albany, accepted the expansion of Medicaid, and the state established its own online exchange. After the Supreme Court upheld the constitutionality of Obamacare, in June, 2012, Cuomo released a statement that said, “We look forward to continuing to work together with the Obama administration to ensure accessible, quality care for all New Yorkers.”
That spirit of coöperation has been integral to New York’s early success. Elisabeth Benjamin, in New York, and Jodi Ray, in Florida, offer exactly the same services to people who were previously unable to obtain medical coverage: they help determine voucher amounts, parse available options, and submit applications online, over the phone, or through the mail. But because New York set up its own exchange, the state received twenty-seven million dollars to fund its navigators, while Florida has just eight million dollars for outreach. Benjamin, who is herself a trained navigator, conceded that there were glitches on New York’s Web site the first week, but said that most of them have been resolved. In the second week, she helped enroll a woman who had worked as a home-health-care aid for twenty years, earning around twenty-four thousand dollars annually. Home health care “has to be the hardest job in America—so physically taxing and emotionally draining,” Benjamin said. “And we don’t give them health coverage. Are you kidding me? They’re part of the health-care system.” Benjamin helped find a plan for the woman that costs seventy-two dollars a month. “I was crying,” Benjamin said. “That’s what it’s all about.”
For the A.C.A. to succeed in its goal of providing coverage for all citizens at an overall reduction in cost, a critical mass of people—old and young, sick and healthy—will need to participate in the insurance exchanges. As of October 23rd, New York had enrolled thirty-seven thousand people, more than twice the goal set by H.H.S. for the entire month of October. Florida won’t know how many people have enrolled until H.H.S. releases its figures sometime in November. The Congressional Budget Office has estimated that a total of seven million people nationwide could enroll in the first year. But Dr. Kavita Patel, a health-care-reform expert at the Brookings Institution, and a former policy advisor in the Obama Administration, told me, “If by the end of 2014 there are three million people enrolled, that would be a success.” The politicians who are currently bemoaning the looming failure of Obamacare might consider doing more to help navigators like Jodi Ray make it work.
By: Rob Fischer, The New Yorker, November 1, 2013
“Intentionally Obscuring The Obvious”: Five Things Every American Needs To Know About Health Care Reform
“Discover the obvious,” Jonathan Cohn said on Monday.
Cohn is one of the nation’s foremost health care journalists and the keynote speaker of the journalism portion of “Hearsay or Fact: A Symposium on the Communication of the Affordable Care Act,” hosted by the Center for Healthcare Research and Transformation.
A senior editor at The New Republic and author of Sick: The Untold Story of America’s Health Care Crisis—and the People Who Pay the Price, Cohn decided to use his time to give five rules about reporting on the Affordable Care Act (ACA). His first rule was an admission that people who follow the everyday tribulations related to Obamacare — like wonks in every field — often assume they don’t need to report on “the obvious” and thus fail to report on the issues that matter most to the public.
He pointed to the success of fellow panelist Stephen Brill’s Time magazine cover story “Bitter Pill: Why Medical Bills Are Killing Us” that illuminated the outrageous variation in medical prices and profits from one hospital and one patient to the next, a well-known fact to experts that came as a shock to many Americans.
What’s obvious to everyone about the debate over Obamacare is that the public is confused. Nearly two-thirds of Americans didn’t know in late September that the health care exchanges were opening on October 1 and 67 percent of the uninsured said “they don’t have enough information about the law to know how it will impact their families,” according to the Kaiser Health Tracking Poll. The uninsured, of course, make up this law’s key demographic. They are the people this law is designed to help most, and their participation in the health care marketplaces will determine if the law is a success.
Why are people so confused? Much of what should be “obvious” has become obscured — intentionally.
Democrats passed the ACA with only Democratic votes — and Joe Lieberman. Republicans have responded with an unprecedented effort to scare voters, starve implementation and sabotage the law, an effort that helped doom the launch of Healthcare.gov, which the White House has to own as a greater act of self-sabotage than anything Republicans could have pulled off themselves.
The political battle over the law has overwhelmed any pertinent policy discussion. So it’s no wonder that people can’t even agree on the basic premises that made health reform necessary and an improvement over the current system, with 56 percent of Americans saying they’ve heard more about the politics and the controversies of the law than any discussion of its practical impact.
Here are five “obvious” premises that every American needs to understand so we can begin to have a rational debate on health care reform.
Before The ACA, America’s Health Care System Was Already ‘Socialized’
You should know by now that the United States spends more than any country on health care, even though approximately 50 million citizens have no insurance whatsoever. This is how we ended up with the 46th most efficient health care system in the world.
The Affordable Care Act attempts to fix this in a number of ways, including health care exchanges, subsidies, Medicaid expansion and regulation.
Since 2011, the government has set how much insurance companies have to spend on actual care – 80-85 percent depending on their size — and the minimum standard for the policies they can offer, among several other regulations. So even though private insurers remain in business and the government hasn’t taken control of the medical industry as it has in the United Kingdom, Republicans argue that it’s “a government takeover” of the health care system. Based on this standard, health care has been “taken over” by the government and even “socialized” for decades.
Since 1965, Americans over 65 and under the poverty level were guaranteed basic care, though it took until 1982 before the last state, Arizona, accepted Medicaid. This left America with a single-payer system, with a giant hole mostly made up of Americans under 65 with jobs, and their families.
In 1986, President Ronald Reagan signed a bill that tried to plug that hole — the Emergency Medical Treatment and Active Labor Act. This law states that any hospital that accepts any federal funds — which basically every hospital in America does — cannot turn away any patient, regardless of his or her ability to pay. As this bill provides no reimbursement for this care, the costs of those who can’t pay get passed on to those who can.
In 1996, Congress passed and President Clinton signed the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which mandated guaranteed renewability for all health insurance plans, requiring that an insurer has to offer you renewals of your policy without charging you any more based on any new information it has about your health.
These are three of the key “government takeovers” that helped lead to the broken health care system that we are now attempting to fix, while maintaining a private insurance industry.
The ACA clearly isn’t a one-size-fits-all solution, health economist Thomas Buchmueller pointed out at Monday’s symposium.
That would be a two-page bill that said, more or less, “Everyone is now on Medicare.”
Rich People Get Their Health Care Subsidized By Taxpayers
Single payer is a simple, proven system that would insure all Americans, save lives and cut costs. And it will likely never happen in America as long as the filibuster exists in the Senate. Still, liberals will not stop offering this ideal solution whenever Republicans complain about costs or cancellations.
The right has its own fantasy solution that is about as improbable as single payer: getting rid of the tax exclusion of premiums for employer-sponsored insurance.
As a result of an accident of history, employers and employees do not have to pay taxes on costs of health insurance policies.
Conservatives hate this. “We call the tax exclusion for ESI a tax ‘break,’ but when you think about it, it operates more like a tax hike,” writes the Cato Institute’s director of health policy Michael F. Cannon, another symposium participant. “It coerces workers into handing control over $11,000 of their earnings to their employers, who then choose the workers’ health plans for them.”
John McCain campaigned for president on ending this “tax break,” which costs taxpayers more than the costs of all the subsidies and Medicaid expansion in the ACA, according to symposium participant Dr. John Z. Ayanian. This will never happen because it would be far more disruptive than Medicare for All and — unlike effective single-payer systems around the globe — it has never been proven to work, anywhere.
As a result, taxpayers will continue to help subsidize takers like Ted Cruz, whose family’s $40,000-a-year insurance policy from Goldman Sachs entitles them to a subsidy large enough to put a family of four on Medicaid, though the Cruzes are clearly able to afford their own health insurance.
Republican Arguments Against Obamacare Are Opportunistic And Contradictory
Republicans fought the passage of the ACA by conjuring images of “death panels” pulling the plug on grandma and a “government takeover” that would destroy America.
The problem with these warnings was that approximately 80 percent of Americans get their health insurance through their employers. Most of these people haven’t and likely won’t notice much of a change in their coverage whatsoever, unless they’ve gone in for preventive or reproductive health care and discovered that they didn’t have to pay a co-pay for it.
That’s why Mitt Romney’s continual assertion that President Obama was embracing “European” solutions never made sense to most Americans.
Republicans didn’t seize on the president’s now-disproven promise “If you like your insurance, you can keep it” until late 2013, though it was clear that it never jibed with his other promise to make sure insurance policies met minimum standards.
Now their fixation on cancellation notices boxes them in, in two ways. First, it ignores that their plot to repeal Obamacare would result in as many as 137 million cancellation notices. Second, right-wing policy proposals would force cancellations that target far more than the estimated 5 percent of Americans who are having their plans changed by the ACA.
“Even if free-market health care reformers were able to pass the plan of their dreams — which would involve tweaking the tax code to end the bias in favor of employer-sponsored insurance — it would likely mean a lot of people would get dropped from their current plans,” the Washington Examiner’s Philip A. Klein notes.
The Republicans’ advantage is that they’re so stuck on the “repeal” part of “repeal and replace” that they’ve never actually passed an ACA replacement. Their rhetoric, and the fact that the only real conservative alternative to single payer requires an individual mandate, means any plan they pass would likely end up generating the same criticisms they’re lobbing at the ACA.
We Can’t Go Back To The Pre-Obamacare Health System
Dr. Ayanian pointed out that though the ACA may not be embraced by a majority of the American public, three key policies have: young people staying on their parents’ plans until age 26, closing the Medicare Part D prescription-drug donut hole, and the ending of concerns about pre-existing conditions.
The Republican Study Committee Obamacare replacement plan, which the House has not voted on, provided pre-existing conditions protections, but only for those who are already insured.
The Washington Post’s Jonathan Bernstein puts it simply — repeal “is dead”:
No one is ever going to kick young adults off their parents’ insurance (or change the law so that insurance companies are allowed to do it). No one is going to bring back the various limitations in pre-ACA insurance policies. Some trimming of the new Medicaid rolls might be possible. But no one — no politician who has to face reelection, at least – is going to just toss all those people off their insurance with nothing to replace it.
Beyond all this is simply the Humpty Dumpty-ness of the situation: The old system has been slowly pushed off the wall for three years now, and by this point it’s really beyond repair, whatever the merits or politics of the situation. Garance Franke-Ruta captured some of this in making the point that delaying things would be impractical at this point, but it really goes beyond that. Too many people have already done too many things to make a full reversal even remotely plausible.
Before the ACA became law, millions of Americans lost their insurance, rates were rising faster than the rate of inflation and the federal government was absorbing more and more health care costs. Repealing it would be a nightmare in that it would reveal a broken health care system badly in need of some type of fix.
Republicans Are Hurting Themselves, Their States And The Working Poor To ‘Punish’ Obama
Because the Supreme Court gave them the chance to do it, about two dozen — all Republican — states have completely rejected the Medicaid expansion in the ACA, even though the government will cover 100 percent of the costs of the expansion for the first three years. States could then opt out of the coverage or continue it with the feds’ contribution decreasing to 90 percent by 2020.
Medicaid expansion should be a huge transfer of wealth from rich blue states to poorer red states, as most of America’s public assistance programs are. Instead Texas, with the largest uninsured population in the nation, has rejected expansion, but will still contribute to helping to insure Californians.
By rejecting Medicaid expansion, just four states – Florida, Texas, Georgia, and North Carolina — will leave 5 million poor people with jobs uninsured. This will result in more emergency room visits that the uninsured cannot afford, and higher rates for the insured in those states.
By: Jason Sattler, The National Memo, November 5, 2013
“What If We Just Called It NixonCare?”: Republicans Have No Business Being Upset About Obamacare
House Majority Leader Eric Cantor says Republicans will seek to delay a requirement of the 2010 Affordable Care Act that all Americans obtain health insurance or face a tax penalty. “With so many unanswered questions and the problems arising around this rollout, it doesn’t make any sense to impose this one percent mandate tax on the American people,” Cantor said last week.
While Republicans plot new ways to sabotage the Affordable Care Act, it’s easy to forget that for years they’ve been arguing that any comprehensive health insurance system be designed exactly like the one that officially began October 1st, glitches and all.
For as many years Democrats tried to graft healthcare onto Social Security and Medicare and pay for it through the payroll tax. But Republicans countered that any system must be based on private insurance and paid for with a combination of subsidies for low-income purchasers and a requirement that the younger and healthier sign up.
Not surprisingly, private health insurers cheered on the Republicans while doing whatever they could to block Democrats from creating a public insurance system.
In February 1974, Republican President Richard Nixon proposed, in essence, today’s Affordable Care Act. Under Nixon’s plan all but the smallest employers would provide insurance to their workers or pay a penalty, an expanded Medicaid-type program would insure the poor and subsidies would be provided to low-income individuals and small employers. Sound familiar?
Private insurers were delighted with the Nixon plan but Democrats preferred a system based on Social Security and Medicare and the two sides failed to agree.
Thirty years later a Republican governor, Mitt Romney, made Nixon’s plan the law in Massachusetts. Private insurers couldn’t have been happier although many Democrats in the state had hoped for a public system.
When today’s Republicans rage against the individual mandate in the Affordable Care Act, it’s useful to recall this was their idea as well.
In 1989, Stuart M. Butler of the conservative Heritage Foundation came up with a plan that would “mandate all households to obtain adequate insurance.”
Insurance companies loved Butler’s plan so much it found its way into several bills introduced by Republican lawmakers in 1993. Among the supporters were Senators Orrin Hatch (R-UT) and Charles Grassley (R-IA). Both now oppose the mandate under the Affordable Care Act. Newt Gingrich, who became Speaker of the House in 1995, was also a big proponent.
Romney’s heathcare plan in Massachusetts included the same mandate to purchase private insurance. “We got the idea of an individual mandate from [Newt Gingrich] and [Newt] got it from the Heritage Foundation,” said Romney, who thought the mandate “essential for bringing the health care costs down for everyone and getting everyone the health insurance they need.”
Now that the essential Republican plan for healthcare is being implemented nationally, health insurance companies are jubilant.
Last week, after the giant insurer Wellpoint raised its earnings estimates, CEO Joseph Swedish pointed to “the long-term membership growth opportunity through exchanges.” Other major health plans are equally bullish. “The emergence of public exchanges, private exchanges, Medicaid expansions … have the potential to create new opportunities for us to grow and serve in new ways,” UnitedHealth Group CEO Stephen J. Hemsley effused.
So why are today’s Republicans so upset with an Act they designed and their patrons adore? Because it’s the signature achievement of the Obama administration.
There’s a deep irony to all this. Had Democrats stuck to the original Democratic vision and built comprehensive health insurance on Social Security and Medicare, it would have been cheaper, simpler and more widely accepted by the public. And Republicans would be hollering anyway.
By: Robert Reich, The Robert Reich Blog, October 29, 2013
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