“States Of Health”: Obamacare And GOP Obstructionism
Ours can be an unforgiving country. Paul Sullivan was in his fifties, college-educated, and ran a successful small business in the Houston area. He owned a house and three cars. Then the local economy fell apart. Business dried up. He had savings, but, like more than a million people today in Harris County, Texas, he didn’t have health insurance. “I should have known better,” he says. When an illness put him in the hospital and his doctor found a precancerous lesion that required treatment, the unaffordable medical bills arrived. He had to sell his cars and, eventually, his house. To his shock, he had to move into a homeless shelter, carrying his belongings in a suitcase wherever he went.
This week, the centerpiece of the Affordable Care Act, which provides health-insurance coverage to millions of people like Sullivan, is slated to go into effect. Republican leaders have described the event in apocalyptic terms, as Republican leaders have described proposals to expand health coverage for three-quarters of a century. In 1946, Senator Robert Taft denounced President Harry Truman’s plan for national health insurance as “the most socialistic measure this Congress has ever had before it.” Fifteen years later, Ronald Reagan argued that, if Medicare were to be enacted, “one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” And now comes Senate Minority Leader Mitch McConnell describing the Affordable Care Act as a “monstrosity,” “a disaster,” and the “single worst piece of legislation passed in the last fifty years.” Lacking the votes to repeal the law, Republican hard-liners want to shut down the federal government unless Democrats agree to halt its implementation.
The law’s actual manifestation, however, is rather anodyne: as of October 1st, healthcare.gov is scheduled to open for business. A Web site where people who don’t have health coverage through an employer or the government can find a range of health plans available to them, it resembles nothing more sinister than an eBay for insurance. Because it’s a marketplace, prices keep falling lower than the Congressional Budget Office predicted, by more than sixteen per cent on average. Federal subsidies trim costs even further, and more people living near the poverty level will qualify for free Medicaid coverage.
How this will unfold, though, depends on where you live. Governors and legislatures in about half the states—from California to New York, Minnesota to Maryland—are working faithfully to implement the law with as few glitches as possible. In the other half—Indiana to Texas, Utah to South Carolina—they are working equally faithfully to obstruct its implementation. Still fundamentally in dispute is whether we as a society have a duty to protect people like Paul Sullivan. Not only do conservatives not think so; they seem to see providing that protection as a threat to America itself.
Obstructionism has taken three forms. The first is a refusal by some states to accept federal funds to expand their Medicaid programs. Under the law, the funds cover a hundred per cent of state costs for three years and no less than ninety per cent thereafter. Every calculation shows substantial savings for state budgets and millions more people covered. Nonetheless, twenty-five states are turning down the assistance. The second is a refusal to operate a state health exchange that would provide individuals with insurance options. In effect, conservatives are choosing to make Washington set up the insurance market, and then complaining about a government takeover. The third form of obstructionism is outright sabotage. Conservative groups are campaigning to persuade young people, in particular, that going without insurance is “better for you”—advice that no responsible parent would ever give to a child. Congress has also tied up funding for the Web site, making delays and snags that much more inevitable.
Some states are going further, passing measures to make it difficult for people to enroll. The health-care-reform act enables local health centers and other organizations to provide “navigators” to help those who have difficulties enrolling, because they are ill, or disabled, or simply overwhelmed by the choices. Medicare has a virtually identical program to help senior citizens sort through their coverage options. No one has had a problem with Medicare navigators. But more than a dozen states have passed measures subjecting health-exchange navigators to strict requirements: licensing exams, heavy licensing fees, insurance bonds. Florida has attempted to ban them from county health departments, where large numbers of uninsured people go for care. Tennessee recently adopted an emergency rule declaring that anyone who could be described as an “enrollment assister” must undergo a criminal background check, fingerprinting, and twelve hours of course work. The hurdles would hamper hospital financial counsellors in the state—and, by some interpretations, ordinary good Samaritans—from simply helping someone get insurance.
This kind of obstructionism has been seen before. After the Supreme Court’s ruling in Brown v. Board of Education, in 1954, Virginia shut down schools in Charlottesville, Norfolk, and Warren County rather than accept black children in white schools. When the courts forced the schools to open, the governor followed a number of other Southern states in instituting hurdles such as “pupil placement” reviews, “freedom of choice” plans that provided nothing of the sort, and incessant legal delays. While in some states meaningful progress occurred rapidly, in others it took many years. We face a similar situation with health-care reform. In some states, Paul Sullivan’s fate will become rare. In others, it will remain a reality for an unconscionable number of people. Of some three thousand counties in the nation, a hundred and fourteen account for half of the uninsured. Sixty-two of those counties are in states that have accepted the key elements of Obamacare, including funding to expand Medicaid. Fifty-two are not.
So far, the health-care-reform law has allowed more than three million people under the age of twenty-six to stay on their parents’ insurance policy. The seventeen million children with preëxisting medical conditions cannot be excluded from insurance eligibility or forced to pay inflated rates. And more than twenty million uninsured will gain protection they didn’t have. It won’t be the thirty-two million hoped for, and it’s becoming clear that the meaning of the plan’s legacy will be fought over not for a few months but for years. Still, state by state, a new norm is coming into being: if you’re a freelancer, or between jobs, or want to start your own business but have a family member with a serious health issue, or if you become injured or ill, you are entitled to basic protection.
Conservatives keep hoping that they can drive the system to collapse. That won’t happen. Enough people, states, and health-care interests are committed to making it work, just as the Massachusetts version has for the past seven years. And people now have a straightforward way to resist the forces of obstruction: sign up for coverage, if they don’t have it, and help others do so as well.
By: Atul Gawande, MD, The New Yorker, Published September 29, 2013
“Hurting Real People Who Have Real Needs”: Republicans Are Suppressing Obamacare Enrollment
Republicans have done everything they could think of to repeal, defund, undermine and otherwise disrupt Obamacare. But they’ve failed, and that’s why they’ve turned to a last-ditch strategy to stop the law and take away the rights of millions of Americans to get the health care they need.
Governors and state legislators are adopting state laws and regulations to sabotage the work of “navigators,” the community organizations that will help consumers sign up for care. We are witnessing navigator suppression, and the Republicans’ objective is simple: the harder they make it for navigators to do their jobs, the harder it will be for people to benefit from Obamacare.
Republican governors in 21 states are already denying more than 5 million people health care by refusing to expand Medicaid. Navigator suppression is another way for the Obamacare haters to pile on and limit the reach of the law.
In a new report, Health Care for America Now conducted a detailed review of the most egregious laws and regulations found in 13 selected states: Arkansas, Florida, Georgia, Iowa, Illinois, Indiana, Maine, Missouri, Montana, Ohio, Tennessee, Texas and Wisconsin. These states are home to 17 million people without health insurance who are eligible for coverage under the health care reform law–fully 41 percent of the nation’s uninsured.
The excessive requirements we found include such things as residency rules, extra fees, additional and unnecessary training requirements, superfluous certification exams, and prohibitions against navigators talking with consumers about the benefits offered by different plans. These measures constitute direct interference in the enrollment process.
For example, in Missouri, state and local officials are barred from providing any assistance to an exchange. In Florida, the Department of Health released a directive prohibiting navigators from conducting outreach at any of the county’s 67 health departments. Fortunately, two big counties, Broward and Pinellas, are ignoring the order.
And just this month, Texas Gov. Rick Perry ordered the Insurance Commissioner to write new navigator regulations that require, among other things, that navigators complete 40 hours of training in addition to the 20 hours required by the ACA and then pass a “rigorous” state exam. Perry is even trying to limit the hours of navigator operations to 8 a.m. to 5 p.m. None of these rules is going to help get people covered in Texas, which has the nation’s highest percentage of uninsured residents.
These roadblocks and restrictions have caused groups to withdraw from the program and return their navigator grants. This is why President Obama in Maryland today criticized the Republicans for creating these sorts of “roadblocks” for the “churches and charities” working as navigators to educate the public about enrollment.
The Republicans claim these laws are about protecting consumers. But Georgia’s commissioner of insurance cleared that up when he boasted on video that he was doing everything he could to be “an obstructionist” to Obamacare.
Some of the Obamacare opponents may think they’re attacking the President or the law, but mostly they’re hurting real people with real health care needs. They’re making it harder for people to buy health care. This isn’t just an abstract political debate. For people without health insurance, this is about whether or not they can get medical care and get it without going bankrupt.
In a growing number of states, navigators are turning back their grants to help consumers because of navigator suppression policies.
Cincinnati Children’s Hospital Medical Center, for example, which was planning to enroll people at three hospitals, turned back $124,000 in federal grant money because of state restrictions that went into effect this past July.
Cardon Outreach was going to educate people in Florida, Oklahoma, Pennsylvania, and Utah. It returned its $833,000 grant.
In West Virginia, the Attorney General, Patrick Morrisey, a vocal opponent of the ACA, launched a harassment campaign against one of his state’s navigators, West Virginia Parent Training and Information. Morrisey posed dozens of questions to the group about its navigator program and gave them only 14 business days to respond. Instead, the organization decided to send back its $366,000 enrollment grant.
The Lower Rio Grande Valley Development Council along the Texas border with Mexico just returned $288,000 in navigator grant funds this week in response to Perry’s attack, and four other Texas navigator groups reportedly may follow suit.
These state officials have taken their cues from members of Congress. Republicans on the House Energy and Commerce Committee sent letters to 51 groups in 11 states, including food banks, legal aid societies, and United Way organizations. The committee demanded that these groups produce reams of paperwork about their operations and schedule a briefing of the committee by Sept. 13. The only purpose of the inquiry was to interfere with the ability of these groups to prepare for enrollment. That’s sabotage, and it’s a politically motivated abuse of power.
Many of the states now going after navigators are also passing laws to suppress voter registration and make it harder for minority, low-income and elderly residents to participate in elections. Just like voter suppression, enrollment suppression is an attack on people’s right to be healthy and free from financial hardship and bankruptcy.
That’s why navigator suppression shocks the conscience: it perpetuates the systematic denial of affordable health care to huge numbers of the most vulnerable individuals in our society, especially those in minority and lower-income populations.
Thanks to Obamacare, Americans no longer have to worry about getting the health care they need. They only have to worry about the Republicans taking it away.
By: Ethan Rome, Executive Director, Health Care for America Now; Health Care for America Now Blog, September 26, 2013
“Caught Between Arithmetic And Ideology”: Can Republicans Afford To Buck The Tea Party?
Since the Tea Party emerged following President Barack Obama’s victory in 2008, Republican governors have frequently been the faces of some of the most extreme policies in recent political memory. Even before her infamous “finger point” at the president, Arizona’s Jan Brewer was signing and defending her state’s racial-profiling bill, SB 1070. In Ohio, John Kasich championed a law—later repealed by voters—to strip public employees of bargaining rights. In Florida, Rick Scott has pushed a plethora of hard-right policies, from drug screening of welfare recipients and government employees to reductions in early voting. Michigan’s Rick Snyder, who has a moderate streak, went to the extreme last December when he approved “right to work” legislation in a state built largely by union labor.
Yet Brewer, Kasich, Snyder, and Scott are among the nine GOP governors who have staked considerable political capital on Medicaid expansion, a key piece of the Affordable Care Act. They haven’t been quiet about it, either. Brewer made good on a threat to veto every piece of legislation that came before her until lawmakers sent her a bill to expand Medicaid. Snyder rankled his party when he told recalcitrant Republican state senators to “take a vote, not a vacation.” Scott was among the first Republicans to announce his support for expansion. Kasich, struggling to win support from his party’s lawmakers, has vowed to find a way to expand Medicaid even if they won’t.
All this, while in Congress, the Tea Party Republicans have worked tirelessly to shut down the government rather than see the Affordable Care Act continue, marking it as the emblem of Obama’s big-government liberalism.
By championing Medicaid expansion, these governors are defying the Tea Party, which was instrumental in their elections. Such defiance has been exceedingly rare from Republican officeholders on any level since the Tea Party revolution of 2010. That election transformed state legislatures and governors’ mansions—in many cases overnight—into ideological strongholds. Increasingly, the policy priorities of national right-wing groups like ALEC and Americans United for Life began to take precedence over state-specific agendas, and bipartisanship disappeared from state capitols almost as thoroughly as it has Congress. “The broader pathologies of our politics have clearly moved to the state level,” says Norman Ornstein, resident scholar at the American Enterprise Institute and co-author with Thomas Mann of It’s Even Worse Than It Looks, which made the case that Republican extremism and hyper-partisanship has crippled Congress.
But Kasich, Snyder, and Scott govern states that Obama has won twice. They have all struggled with low approval ratings and polarized the electorate with their far-right policies. They all face tough battles for re-election in 2014. By backing Medicaid, they were guaranteed to inspire Tea Party wrath. By opposing it, they would deny health coverage to huge numbers of low-income residents, shut the door on billions in federal funding, and risk further alienating voters.
“Republican governors are caught in a tug-of-war between arithmetic and ideology,” says William Galston, a senior fellow at the Brookings Institution. “For some of them, ideology wins, and for others, who are looking to their self-interest and the interests of their state at least in the short to medium term, they have done a very simple calculation and that is that the Medicaid expansion is a good deal for their states.”
There’s little denying that Medicaid expansion to cover many more adults, is a good deal for every state. For the first three years, the federal government will pick up 100 percent of the cost for new recipients. After that, states will never pay more than 10 percent of the costs of expanded coverage; the rest of the bill goes to Washington. In Ohio alone, more than 500,000 people would gain access to coverage. With more people covered, of course, the costs to states of uncompensated care will drop. In June, a report from the Rand Corporation found that the first 14 states that opted out of expanding Medicaid will have 3.6 million more uninsured residents, lose $8.4 billion a year in federal payments, and pay an additional $1 billion in uncompensated care in 2016.
The arithmetic hasn’t been enough to convince most Republican governors to back Medicaid. Sixteen of the 30 oppose expansion, including the chief executive of another state Obama won twice, Wisconsin’s Scott Walker. Three other GOP governors had yet to venture a position.
Then there’s Pennsylvania’s Tom Corbett, a governor emblematic of the dilemma facing unpopular Republicans in swing states. Obama won Pennsylvania by 11 points in 2008 and by 5 points in 2012. But Corbett, who won in the 2010 wave, has stuck to the Tea Party agenda on everything from voter ID to welfare cuts. He was quick to announce that his state would reject federal funds for Medicaid expansion.
Under enormous pressure, however, he changed his mind, and last week announced he would support Medicaid expansion if the federal government agreed to a slew of concessions. Unlike Walker, a strong favorite in 2014 thanks to weak and divided opposition following a failed recall attempt, Corbett is among the most vulnerable incumbents in the country. Corbett is now trying desperately find some political path to moderation—though it’s likely to be too little too late and it stands in contrast to those like Snyder and Kasich, who actually took the lead on the issue.
That a minority of Republican governors has backed Medicaid expansion does not add up to a major shift in the political dynamic. But it could be significant, depending on the outcome of the 2014 elections. If a governor like Scott or Kasich can manage to win re-election even after infuriating his right-wing base on a key issue, it will send a couple of important messages to other Republicans, at least those in purple states: Yes, the Tea Party can be bucked. And no, making policy based on the needs of your state does not amount to certain political death. It might even save you from it.
By: Abby Rapoport, The American Prospect, September 23, 2013
“Collapse Of Their Credibility”: GOP Desperate To Defund ObamaCare Now Because They Know Its Popularity Is About To Skyrocket
Why are the Tea Party Republicans so desperate to defund ObamaCare right now? Because they know that once it goes into effect its popularity will skyrocket.
They know that once it is fully implemented, it will be impossible to take away the many benefits of ObamaCare. It is one thing to prevent something good from being passed by Congress. It’s quite another to take something away from the voters.
The Republicans know that once it is in effect, it will be impossible to tell the millions of Americans who have a pre-existing condition that they have to return to the days when they either were denied insurance coverage or had to pay an arm and a leg to get it.
They know that once it is in effect, it will be impossible to end the affordable coverage that will soon be available to the millions who are not covered by their employers and will have access to health insurance through the health insurance exchanges – where prices have come in lower than projected.
They know that once it is in effect, it will be very difficult to end coverage for the millions who will for the first time have health insurance through expanded Medicaid.
They know that once it goes into effect, it will be very hard to convince Americans to turn the health care system back over to the big insurance companies.
Most importantly, they know that all of the many ObamaCare “horrors” they have predicted – from “death panels” to price increases to a “government takeover” – will not happen.
As a consequence, they believe that once ObamaCare is fully implemented their credibility on the subject will collapse, support for major new progressive initiatives will increase, the popularity of the President – and of Democrats in Congress – will go up, and their chances of hanging on to the House or taking the Senate in 2014 – and the White House in 2016 – will decline.
All of that is why the Tea Party Republicans are so desperate to stop ObamaCare. That’s why they will risk shutting down the government or defaulting on America’s obligations – on the chance that they can force President Obama and the Democrats to delay its implementation and allow them to live to fight another day.
They are desperate. And to achieve their narrow ideological goal, they are willing to use the same desperate measures that other marginal movements have adopted around the world: they have taken a hostage. Except their hostage is not one person – it’s 320 million people – it’s the American economy.
The success of their hostage taking strategy faces two virtually insurmountable obstacles:
First, the President has made clear that he is not willing to negotiate at all over the debt ceiling or ObamaCare.
Many of these hostage takers are the same people who would demand, categorically, that the American government should never negotiate with hostage takers, because to do so only encourages them to take more hostages and make more demands.
President Obama apparently agrees with them. He knows that if he negotiates with people who are willing to collapse the American economy just to get their way, that they will then use the same threat again and again. And he is unlikely to budge, since he is obviously unwilling to sacrifice his signature initiative — ObamaCare.
Second, many key GOP stake holders think that the Tea Party’s willingness to shut down the government or cause a default is sheer madness and would severely damage the GOP brand. Democratic pollsters Jim Carville and Stan Greenberg wrote in a memo last Wednesday:
The Republican Party has a serious brand problem, and it keeps getting worse. The GOP is viewed unbelievably negatively, and even Republicans themselves agree that it is deeply divided.
Polls show the Republican brand problem manifesting itself in the Virginia gubernatorial race, and in Senate races across the country. And if Republicans damage their brand even worse by shutting down the government, we think that they could trigger a revolt that might even imperil their House majority in 2014.
The GOP demand that President Obama and the Democrats surrender or face a government shutdown or default is like a combatant in a war demanding that the other side surrender or he’ll blow his own head off. From a purely political point of view -if it weren’t so bad for the country and economy – you’d have to say: “Go ahead, make my day.”
All the polls show that if either a shutdown or default takes place, the Republicans will take the blame by a factor of at least two to one.
And after they have taken the blame, in the end they will collapse. Even the Wall Street Journal editorial page said recently:
The evidence going back to the Newt Gingrich Congress is that no party can govern from the House, and the Republican Party can’t abide the outcry when flights are delayed, national parks close and direct deposits for military spouses stop. Sooner or later the GOP breaks.
So while the state of desperation in evidence among Tea Party Republicans at the prospect of ObamaCare going into effect — and becoming very popular — might be understandable, their desperate strategy of holding the economy hostage in order to kill it is downright suicidal.
Then again, while suicide bombers end up as victims of their own actions at the end of the day, there is no question they can inflict enormous amounts of pain and suffering on everyone else.
By: Robert Creamer, The Huffington Post Blog, September 20, 2013
“Camouflaging What They’re Up To”: GOP Bets Voters Aren’t Paying Attention To Their Obamacare Obstructionism
The House GOP leadership reportedly feels confident that they’ve defused the fanatical right’s push for a government shutdown fight over defunding Obamacare. The leaders apparently think that shutting down the government is, as a general matter, a bad idea because it tends to irritate voters who want those elected to govern to actually, you know, govern.
This prompts Greg Sargent to wonder why the GOP doesn’t get in more trouble for its general refusal to govern. The short answer, I think, is that Republicans think voters aren’t paying attention.
Sargent cites a new report from NRO’s Robert Costa outlining the House GOP leaders’ plans to avoid a shutdown and continue the battle to derail Obamacare. The latest idea: Demand an Obamacare delay in exchange for raising the debt ceiling (a legislative version of “delay Obamacare or the economy gets it”). Costa quotes veteran GOP pollster David Winston as saying that the GOP wants to avoid a shutdown because people expect them to govern.
Sargent writes:
The idea appear[s] to be that staging a shutdown to force the destruction of Obamacare — rather than offering an alternative — constitutes a failure to govern. But if that is so, why is not doing everything Republicans can to sabotage the law short of pushing for a shutdown, while offering no alternative, also a failure to govern?
I would think the answer is fairly obvious: A government shutdown is a high-profile and very unusual event and one that generally involves a fairly clear villain. If there’s a shutdown, it’s because one side is being obstinate – to wit, if House Republicans refuse to pass a bill to keep the government open without simultaneously defunding an existing law, they’ll be responsible for it regardless of how many times they claim that it’s Obama’s fault because he refuses to go along with their demands.
On the other hand, everything else the GOP is doing to make sure the law doesn’t work – from refusing to work on bills which would correct its faults to refusing to accept federal funding for a Medicaid expansion (Jonathan Chait has a great rundown of these tactics) – is not as eye-catching as a shutdown and falls into a different media narrative, one of generalized congressional gridlock. If Congress can’t pass a bill which would, to take an example from Chait, fix the law so it doesn’t force many church health insurance plans to disband, it’s easy to ascribe it to generalized gridlock (a pox on both their houses!) rather than GOP obstinacy in the larger context of a refusal to cooperate with the very routine legislative work of trying to fix a law’s problems.
Political junkies understand what the GOP is up to. But the party is gambling that medium- and low-information voters who couldn’t help but notice a shutdown won’t bother themselves with the ins and outs of daily governance (or lack thereof).
It seems a safe bet in the short term, but we’ll see whether voters figure it out as they actually start to tune in and get ready to vote next year.
By: Robert Schlesinger, U. S. News and World Report, August 13, 2013
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