“Boehner Struggles With His Failed ACA Predictions”: He Should At Least Try To Discuss The Substance Of The Issue Honestly
House Speaker John Boehner sat down with NBC’s Chuck Todd on “Meet the Press” yesterday, and the host asked a good question about the Republican leader’s failed predictions about the Affordable Care Act. Regrettably, the Speaker couldn’t respond with an equally good answer.
TODD: You made some dire predictions about health care. 2014 you said fewer people would have health insurance. According to plenty of surveys, more people have health insurance today than they did before it went down from – the uninsured rate went down 17 percent to just under 12 percent. You said it would destroy jobs. The first year it was implemented, the country added 3 million jobs. Why…
BOEHNER: Obamacare made it harder for employers to hire people. The economy expands and as a result, you are going to have more employees because businesses have to. But if you can ask any employer in America, and ask them whether Obamacare has made it harder for them to hire employees, they’ll tell you yes. Because it’s a fact.
When you look at – you know why there are more people insured? Because a lot more people are on Medicaid. And giving – you know, we expanded Medicaid in a big way. And giving people Medicaid insurance is almost like giving them nothing. Because there aren’t – you can’t find a doctor that will see Medicaid patients.
The Speaker soon added that, as far as he’s concerned, the Affordable Care Act is “not working.”
Boehner might have a credible argument, if we abandoned the agreed upon meaning of “working.”
Look, I realize that health care policy has never been the Ohio Republican’s strong suit, and the Speaker isn’t a wonk deeply engaged in policy details. I can also appreciate why he’s a little embarrassed about making all kinds of ACA predictions, each of which turned out to be wrong. It’s just not realistic to think Boehner will fess up on national television to getting the entire fight over health care backwards.
There’s just no avoiding the fact, however, that Boehner’s comments on “Meet the Press” were woefully incorrect.
According to the Speaker, “it’s a fact” that the Affordable Care Act has “made it harder for employers to hire people.” There’s simply no evidence to support this. None. The U.S. economy saw a jobs boom coincide with the implementation of the ACA. Indeed, the reform law has actually created plenty of jobs within the health care industry by spurring “unprecedented” levels of “entrepreneurial activity.”
At the same time, Boehner believes the drop in the uninsured rate is the result of Medicaid expansion, but that’s wrong, too – millions of consumers have gained private coverage by way of exchange marketplaces. This is even true of the Speaker’s home state of Ohio, which is prepared to create its own exchange if the Supreme Court makes it necessary.
As for the benefits of Medicaid, coverage through the program is not the practical equivalent of “nothing.” Many Americans who’ve gained health security through Medicaid have benefited greatly from affordable care.
Boehner’s conclusion – that “Obamacare” is “not working” – is only true if one closes their eyes, sticks their fingers in their ears, and refuses to consider the evidence. The law is pushing the uninsured rate to new lows; it’s succeeding in satisfying consumers; the law’s price tag is lower than expected; it’s producing impressive results on premiums and enrollment totals; we’re seeing the lowest increase in health care spending in 50 years; the number of insurers who want to participate in exchange marketplaces keeps growing; there’s reduced financial stress on families, the efficacy of Medicaid expansion is obvious, as is the efficacy of the medical-loss ratio and efforts to reduce medical errors system-wide.
The maligned law is even becoming more popular.
Boehner doesn’t have to like the law. He doesn’t even have to admit he was wrong. But he should at least try to discuss the substance of the issue honestly.
By: Steve Benen, The Maddow Blog, May 4, 2015
“Kansas Has Gone Full Tea Party”: Kansas’ Experiment In Concentrated Conservatism Keeps Getting Grimmer
Kansas is in the midst of a grim experiment putting crackpot supply-side economic theories into practice. While these economic anti-reforms will have devastating results for poor people in the state, in other respects Republican Gov. Sam Brownback and his legislative allies have made the government more intrusive into the private lives of the state’s citizens. April has provided some particularly egregious examples of this disastrous turn.
Kansas has been a Republican state for a long time. Since 1936, the only time the state has given its electoral votes to a Democratic candidate was to Lyndon Johnson in the massive landslide of 1964. Despite this, Kansas has historically not been a far-right state. Prominent Kansas Republicans have generally been moderates, like Bob Dole and Nancy Kassebaum. Kathleen Sebelius, President Obama’s former secretary of health and human services, was the state’s Democratic governor as recently as 2009.
But since the election of Brownback, Kansas has gone full Tea Party. Kansas Republicans have enacted massive upper-class tax cuts, with the idea that they would produce such an explosion of economic growth that the state would actually gain revenues. This makes no sense in theory and has been a catastrophe in practice. Revenues have cratered, while economic growth lags behind neighboring states. Spending on the poor has decreased, while the tax burden on the poor has increased. Needless to say, Kansas has rejected the Medicaid expansion offered by the Affordable Care Act, denying access to health care for many poor Kansans.
Kansas Republicans certainly have no intention of taking responsibility for this disaster, which means a search for scapegoats. The targets should not be surprising: poor people, women, and gay people.
Earlier this month, Brownback signed a bill that, among other things, prevents welfare recipients from spending government-provided funds on things poor people do not spend their money on, such as cruise ships. As Emily Badger of The Washington Post observes, this reflects a trend in Republican-governed states of placing burdens and restrictions on poor people that do not apply to any other recipients of government benefits — and for no good reason.
The demeaning of the poor doesn’t end there. Recipients of funds from the Temporary Assistance to Needy Families program will have their daily withdrawals, using the provided ATM cards, limited to $25 a day, not only creating needless inconvenience, but effectively transferring money from the poorest citizens in the state to banks in the forms of additional fees.
Brownback rose to prominence as more of a social conservative than a fiscal conservative. So it’s not surprising that Kansas is placing irrational legal burdens on women as well. Kansas passed a bill banning dilation and evacuation abortions (under the junk science name “dismemberment abortions.”) The procedure is safe — so there is no health-related justification for banning it — and is the most common one used for second-trimester abortions, which women have a constitutional right to obtain.
Even worse, the ban does not contain exceptions for rape, incest, or most threats to a woman’s health. The law puts women’s health at risk by interfering with the judgment of doctors in order to punish women for exercising their constitutional rights in a way Kansas legislators disapprove of.
Brownback’s attacks on basic justice and equality don’t end there. In 2007, Sebelius issued an order banning discrimination against LGBT state employees. Earlier this year, Brownback rescinded the order, creating a new standard under which state employees could be fired simply because of their sexual orientation. Brownback defended the order using the traditionally disingenuous “special rights” language so often employed by those who favor legal protection for bigotry: “This Executive Order ensures that state employees enjoy the same civil rights as all Kansans without creating additional ‘protected classes’ as the previous order did.”
This argument would make sense — if you think that gay and straight people are equally likely to be discriminated against because of their sexual orientation. In the actually existing world, Brownback’s measure does not guarantee civil rights to all Kansans, opening the door for discrimination against gays and lesbians based on their sexual orientation.
Under Brownback, Kansas has offered a concentrated form of what most national Republicans claim to want. Tax cuts for the wealthy, tax increases and reduced benefits for the poor, arbitrary interference with the reproductive freedom of women, and increased discrimination against gays and lesbians. Voters next November should ask themselves whether they want this ghastly agenda to be repeated on a national scale.
Editor’s note: A previous version of this article mistakenly asserted that Kansas recently banned dilation and extraction abortions, but these were already illegal.
By: Scott Lemieux, The Week, April 24, 2015
“Obamacare Opponents Still Await The Apocalypse”: Opponents Are As Wrong About Obamacare As Reagan Was About Medicare
A while back, progressive activists and politicians pushed for legislation to provide health insurance for a cohort of Americans who could not easily pay for their doctors’ visits and medications. Predictably, that effort was met with fierce resistance from conservatives, who didn’t seem concerned about those less-fortunate citizens who couldn’t afford medical care.
Conservatives denounced the plan as “socialized medicine” or a “communist takeover” of the American health care system. One notable conservative was especially alarmist, declaring that if the proposal passed Congress, “… 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.”
No, that hysterical tirade didn’t come in response to the Affordable Care Act. Those words were spoken in 1961 by Ronald Reagan, who was crisscrossing the country to campaign against the adoption of Medicare. Yes, Medicare, which Congress passed in 1965 and is widely considered a resounding success.
Fast-forward a few decades. The same alarms were sounded more recently, as progressive activists and politicians pushed for legislation to provide inexpensive health insurance for those who couldn’t afford it. Actually, the denunciations of the Patient Protection and Affordable Care Act, usually called “Obamacare,” may have been even more hysterical.
As the law neared passage, I watched angry crowds gather near the White House — many holding vicious, racially charged signs lambasting the president — to chant about “socialism” and “communism.” Strangely, the most vehement criticisms came from Americans 65 and older, the very cohort that benefits from Medicare.
President Obama signed the Affordable Care Act in March 2010, so it has been the law of the land for five years. Given that, it’s possible to make a reasoned assessment of its strengths and weaknesses.
First off, let’s note that there has been no “socialist takeover” of American medicine. Obamacare uses private health insurance providers; the law merely sets requirements for health insurance plans and issues subsidies to patients who cannot afford to purchase policies.
As you might expect, the number of Americans with health insurance — and, therefore, with access to preventive medical care — has increased in the last five years. Before the law went into effect, there were 48 million uninsured Americans. Now, with 16 million people having signed up for Obamacare, that number has been cut by a third.
Furthermore, health insurance companies are no longer allowed to deny coverage to patients who are already sick or to set a “lifetime cap” on the amount of money a company will pay for medical care. Adult children, who might be in college or working at low-paying jobs without benefits, can stay on their parents’ policies until they are 26.
The Affordable Care Act may also have decreased the rate at which health care costs were escalating. Five years ago, medical care costs were skyrocketing, well beyond the rate of general inflation. Now, those costs are still going up — but at the lowest rate in 50 years. While economists aren’t certain that Obamacare’s cost-containment measures are responsible, many of them give the law credit.
To be sure, the Affordable Care Act has been no panacea. There are still 32 million Americans without health insurance. And, despite the president’s early pledge that people already insured could retain their policies, a tiny but vocal group lost their insurance because Obamacare deemed those policies inadequate. Many in that group ended up paying more for insurance, hardly a happy outcome.
But the worst failings of the Affordable Care Act are beyond its supporters’ control. Because of persistent, irrational Republican opposition, more than 20 states have refused to expand Medicaid — even though the feds would pay the lion’s share of costs. That means that millions of working-class Americans are not getting the health care they need. Furthermore, Obamacare’s unrelenting antagonists have mounted yet another challenge to the law before the U.S. Supreme Court.
It’s hard to fathom. The Affordable Care Act has failed to produce the apocalypse (remember “death panels”?) its fiercest critics predicted; instead, it has given millions of people access to decent health care. Its opponents are as wrong about Obamacare as Ronald Reagan was about Medicare.
By: Cynthia Tucker, Pulitzer Prize for Commentary in 2007; The National Memo, March 28, 2015
“Can’t Stop, Won’t Stop”: GOP Will Never Stop Coming For Obamacare
Obamacare turned 5 on Monday, a birthday achieved despite sustained and repeated efforts to smother the law in its cradle.
The law has taken some hits, including a 2012 Supreme Court decision that buckled the knees of the bill’s backers but seemed to make the Affordable Care Act the settled law of the land.
Now the Supreme Court has again taken up another challenge to the law.
King v. Burwell hinges on whether or not four words buried deep in the text of the law contain the seeds of Obamacare’s destruction by eliminating tax subsidies for people living in states that declined to set up their own insurance exchanges.
But even if they lose again at the court, conservatives say that they will continue to try to undo the law through the courts.
Michael Cannon, a health-policy expert at the Cato Institute, said the most promising challenge to the ACA comes from the state of Maine, which, after the Roberts court ruled in 2012 that the federal government was limited in how much it could compel states to expand Medicaid, sued to roll back its existing Medicaid coverage.
Last year, a federal appeals court ruled against the state, but Gov. Paul LePage has appealed to the Supreme Court, even as Maine’s attorney general has refused to represent the state in its challenge of the law.
Other remaining challenges include Sissel v. U.S. Department of Health and Human Services, which argues the ACA is unconstitutional because it violated the Constitution’s origination clause that states spending bills must originate in the House, not the Senate.
“They are both kind of long shots,” acknowledged Cannon, noting that “the Supreme Court has never struck anything down on origination grounds” and that the House likely lacks standing in its lawsuit against the administration.
If the administration loses King v. Burwell, most health-policy experts predict that it will create a “death spiral” as low-income beneficiaries lose their subsidies in states that did not set up their own exchanges, and insurers are forced to raise rates. But conservatives say they will not delay in kneeing the law into the grave by filing lawsuits in states that set up their own exchanges.
Because many states rushed to do so, conservatives say they expect that governors and their health departments may have violated their state constitutions, and so even residents of those states that believed they were immune from the Burwell decision could face a loss of subsidies as well.
If the Supreme Court decides in favor of the government in King, conservative legal scholars said that what they decide to do in the future to tear down the law depends upon precisely the way in which the judgment is rendered. Halbig v. Burwell mirrors the King case in many respects, but other cases could still go forward, in particular one in Indiana in which several dozen school districts have argued that the employer mandate to provide health insurance puts too much of a burden on state and local governments.
Smaller challenges to the law, meanwhile, continue to mount. Little Sisters of the Poor sued to exempt themselves from the contraceptive mandate. If successful, the suit would allow more organizations to opt out than the Hobby Lobby decision did.
Another challenge, brought by the Goldwater Institute of Arizona, takes aim at the Independent Payment Advisory Board, which was designed to permit the Executive Branch to limit Medicare payments. Even some of the law’s liberal supporters, like former Vermont Gov. Howard Dean, have said that the board should be eliminated or rethought.
Meanwhile, conservative legal scholars say they continue to pore over the text of the law in the hopes that they will find some other legal weaknesses that were not readily apparent. The King case, after all, hinges on four words in the text that were discovered by a legal scholar months after the law was passed.
“This law is so complicated that even those who have read it don’t understand the depths of it,” said John R. Graham, a senior fellow at the conservative National Center for Policy Analysis. “Every time we look at it, we find something else to take to a judge.”
And such lawsuits, he added, help galvanize opposition to the bill years after it has passed.
“They keep the energy up, keep Obamacare on the front pages, keep hope alive.”
Which is necessary, because many conservatives still hope that the law will collapse under its own weight.
“They have really reached the limit of sign-ups. Enrollment is flattening as people see more and more how expensive the coverage is, how high the deductibles are, all the hoops they have to jump through, and they realize it is just not very attractive insurance,” said Grace-Marie Turner of the Galen Institute. She said that many states would be able to opt out of some of the law’s provisions in 2017, and find their own alternatives.
“There is going to be huge momentum going forward to make changes to this law,” Turner said. “I could go on forever about how damaging this law has been to people’s lives. It has to be changed.”
By: David Freedlander, The Daily Beast, March 25, 2015
“Completely Erroneous Impressions”: The Race Between Slander And Reality On Obamacare
Speaking of million pixel images, Sarah Kliff has an important piece at Vox today about perceptions of Obamacare five years in, and the big takeaway is how little has changed, in no small part because people with no direct experience of the new system have internalized the (mostly negative) propaganda they’ve heard. That is particularly true with respect to completely erroneous impressions of the net cost of Obamacare:
Forty-two percent of Americans think Obamacare has gotten more expensive over the past five years. Only 5 percent of poll respondents hit on the right answer: budget estimates for the Affordable Care Act have consistently fallen since it became a law.
Make no mistake: Obamacare spends a lot of money on its tax credits and Medicaid expansion. It recoups some, but not all, of that new spending with hundreds of billions of dollars in Medicare cuts, which reduce federal health spending. The bulk of the remainder is made up with tax increases. But back when the law was passing, Republicans argued up, down, and sideways that the Congressional Budget Office was sharply underestimating the amount of money Obamacare spends.
In fact, the CBO overestimated the cost of Obamacare — and by quite a lot. In April 2014, it marked down its Obamacare projection by more than $100 billion. Much of the revision comes down to the fact that health-care costs have grown very slowly during 2009, meaning it’s less expensive for the government to help millions of Americans purchase coverage. Just this month, CBO released new projections showing that Obamacare’s subsidies would cost 20 percent less over the next decade than initially expected.
The government is now spending less on health care than CBO had projected back in January 2010 — a projection that didn’t include any Affordable Care Act spending at all.
Another problem is that people attribute to the Affordable Care Act phenomena that would have occurred anyway, especially rising (though more slowly rising) premiums and disruption of individual insurance policies–and even the long, long trend away from fee-for-service medicine delivered by doctors of one’s own choice.
Assuming it is not crippled by the U.S. Supreme Court or repealed by a Republican Congress and president, Obamacare will slowly or surely chip away at the misconceptions. It is, sad to say, a sign of progress that (according to the Vox survey) that only 26% of self-identified Republicans believe in the “death panel” meme. The bigger question is how long it might take for Republican politicians to end their propaganda and treat Obamacare as part of the national landscape–as something to change, not kill–and whether that will precede their next turn in real power.
By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, March 23, 2015
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