“Petulant Little Children”: Why The Republican Obamacare “No Strategy At All” Strategy Fell Apart
After President Obama signed the Affordable Care Act, conservative writer David Frum, who had been a speechwriter for George W. Bush, chided his compatriots for the strategy they had employed in opposing it. Had they worked with Obama on a compromise, he argued, the result could have been a more conservative version of the law; by simply opposing it in its entirety, they wound up with nothing once the law passed. For raising this criticism, Frum was declared a traitor and banished from the conservative movement; these days his (still conservative) ideas get a better hearing on the left than the right.
And what has been the Republican strategy on health-care reform since the ACA’s passage? Well, first they tried to kill it through the courts. That didn’t work, though they won for Republican governors the right to refuse the Medicaid dollars that would enable them to offer insurance to their states’ poor (congrats on that), though many of them are coming around to accept the money. In the one house of Congress they control, they’ve held dozens of symbolic repeal votes, so many that it’s become a national joke. They’re now threatening to shut down the government (very bad) or default on America’s debts (even worse) unless Obama agrees to shut the law down, a plan even many within their own party realize is insane. So they’ve ended up looking like petulant children who don’t know when they’ve lost, not to mention viciously cruel ideologues who would literally rather see people go without health insurance than allow them to get it through a system tainted in any way by contact with a law with Barack Obama’s signature on it.
So once again, they’re not getting what they want substantively, and they’re losing politically as well. Even Newt Gingrich—Newt Gingrich!—is criticizing them for not bothering to come up with the “replace” part of “repeal and replace.” Why didn’t they? It’s partly because, as I’ve argued before, the whole topic of health-care reform is something they just don’t care about. But Ed Kilgore adds an important insight: their stance of opposition to every single component of what is a pretty conservative reform plan not only left them defending the status quo, but has pushed them step by step so far to the right that they’ve now reached a point where they’ve almost rejected the very idea of insurance. They’re attacking Obamacare on the grounds that healthy people will have to buy insurance, but might not use it as much as sick people, even going so far as to encourage young people to stay uninsured. But that’s how insurance works! Is it a “bad deal” for many healthy young people? Absolutely, just like car insurance is a bad deal for people who never get into an accident, and homeowner’s insurance is a bad deal for people whose houses never burn down. You don’t have to be a health-care wonk to hear them saying these things and say, “Geez, these people are nuts.”
The real problem is that, as usually happens in a complex political world, the Republican “strategy” to oppose Obamacare was no strategy at all. It was a bunch of ad-hoc decisions, based on a mixture of reason, ill-informed judgment and emotion, made by people not necessarily working together, over an extended period of time. And now it’s falling apart.
By: Paul Waldman, Contributing Editor, The American Prospect, August 20, 2013
“Practicing Without A License”: Iowa Governor Must Personally Decide Whether Each Poor Woman On Medicaid Deserves Abortion Coverage
Iowa Gov. Terry Branstad (R) has approved a measure to expand his state’s Medicaid program under Obamacare, which will extend health coverage to tens of thousands of his poor residents. But there’s a catch buried in the Medicaid expansion legislation that the governor signed last week. Now, when low-income women on Medicaid seek insurance coverage for medically-necessary abortions, they’ll have to get approval from Branstad himself.
State-level Medicaid programs often exclude abortion from the health services they will cover for low-income beneficiaries. Just like the Hyde Amendment prevents federal money from directly funding abortion care, over 35 states have decided they don’t want state dollars to pay for abortion, either. Just 17 states allow low-income women on Medicaid to receive insurance coverage for most abortion services — the others, like Iowa, will only permit those women to be reimbursed for the cost of their abortion in cases of rape, incest, and life endangerment.
But now Iowa is going a step further. If a woman who gets her health care through Medicaid has an abortion that falls under one of the exceptions in the state’s abortion coverage ban — if she has been a victim of rape or incest, if her fetus has fatal abnormalities that won’t allow it to survive outside the womb, or if her life will be put in danger unless she ends the pregnancy — she’ll need to have her case approved by the governor’s office. Presumably, Branstad will choose whether to approve or deny each woman’s request for insurance coverage for her abortion. It’s the first law of its kind in any state.
“This bill — now law — is outrageous on many different levels,” Ilyse Hogue, the president of NARAL Pro-Choice America, said in a recent statement. “Women in Iowa already face so many barriers in trying to get safe, legal abortion care. Now their governor will be deciding personally on a case-by-case basis, whether a woman’s doctor will be paid for providing a legal, medically appropriate, and constitutionally guaranteed procedure.”
Under Iowa’s current policy, a state agency already reviews claims for Medicaid funding of abortion services to make sure the billing is adhering to the law and doesn’t fall outside of the approved exceptions. As the Des Moines Register reports, that process will likely continue under the new law. But there’s a notable difference: “instead of the final call being rendered by the Medicaid medical director, the democratically elected and politically accountable governor will decide.”
Low-income women are unlikely to be able to afford bills for abortion care, which can exceed $1,000 dollars. If the governor decides that Medicaid won’t cover the cost of an abortion procedure, the medical providers will likely be forced to absorb the cost.
Ultimately, denying low-income women access to affordable abortion services simply exacerbates the economic divides that lead some desperate women to seek out illegal abortion providers. By passing a mounting number of state laws that prevent women from using their insurance coverage to pay for reproductive care — as well as by forcing abortion clinics out of business and driving up the cost of the abortion pill — lawmakers are essentially making abortion too expensive for low-income women to access at all.
By: Tara Culp-Ressler, Think Progress, June 25, 2013
“Obamacare Is For Republicans, Too”: If GOP Governors Think Stonewalling Health Exchanges Hurts Only Democrats, They’re Wrong
Three months from now, Americans will get their first look at whether Obamacare works. The answer will depend a lot on Republican governors and legislatures — and they should want the law’s exchanges to be successful as much as the president does.
The new state insurance exchanges are supposed to start selling health coverage Oct. 1. The idea behind these marketplaces is that allowing apple-to-apple comparisons between health plans will foster competition and lower prices. Most Republican governors and legislatures, however, have resisted running their own exchanges; 19 states have refused to play any role whatsoever.
Continued resistance could hamper an already fraught process. In a report this week, the U.S. Government Accountability Office warned that the federal government is behind schedule in building exchanges in states that have refused to do so. This makes it even more crucial that all states pitch in to help.
Why should Republican opponents of the exchanges change tack now? First, there are the crass politics: Many residents who stand to benefit are their constituents. Federal exchange subsidies are available for people earning between 138 percent and 400 percent of the poverty level, or $32,500 to $94,200 for a family of four. According to 2012 exit polls, 42 percent of people with family incomes between $30,000 and $50,000 voted for Mitt Romney; for those earning between $50,000 and $100,000, the share was 52 percent. If Republican governors think stonewalling exchanges hurts only Democrats, they’re wrong.
Then there are the economic reasons: States with weak exchanges could become less attractive to businesses. John Hickenlooper, the Democratic governor of Colorado, said this week that his state supports its insurance exchange in part to help small businesses, which want healthy and productive workers.
Finally, and most compellingly, there is the human reason – – rather, 25 million human reasons. Well-run exchanges will make getting health insurance easier and more affordable. Even philosophical opponents of the Patient Protection and Affordable Care Act must concede this practical point. Obamacare also happens to be the law of the land.
Some Republican governors have already accepted a role in their exchanges. Iowa and Michigan are partnering with the federal government, while Idaho, Nevada and New Mexico agreed to build their own. It’s too late for other states to follow those courses, but there are still meaningful steps they could take.
One thing they can do is smooth the path for “navigators” – – people or organizations that will help others shop for insurance on the exchanges. Florida requires navigators to register with the state, and Pennsylvania is considering a similar move. This should be fine as long as registration is quick and straightforward.
States should also build solid lines of communication between the exchanges and state-run programs, especially Medicaid. Exchanges can use the information that states keep about people’s income and insurance status to determine whether they’re eligible for subsidies. Easy access to Medicaid databases will mean fewer errors and faster service for people in both programs.
State insurance regulators, who have the authority to approve insurance plans sold on federally run exchanges, can do their part by monitoring the participating insurance plans aggressively enough to keep rates down.
Perhaps the single biggest thing Republican officials could do is simply be ready and willing to address the inevitable hiccups. If states look for ways to stall progress, they’ll find them. Conversely, if governors who oppose the law nonetheless direct their officials to cooperate, the exchanges are more likely to survive those hiccups.
Governors could set a positive tone by reminding their residents that the exchanges are coming. Instead of saying the exchanges “are not going to work,” as Texas Governor Rick Perry did in December, they should encourage their constituents to see whether they’re eligible for subsidies. It doesn’t need to cost the states anything.
By: The Editors, Bloomberg, June 20, 2013
“A Very Sweet Deal”: Prescription Drug Price-Gouging Enabled By Congress
Republicans and Democrats don’t agree on much. But one thing they would agree on if they knew the facts is that because of the cozy relationship big drug companies have with our lawmakers in Washington, Americans pay far more for their medications than people anywhere else on the planet.
As a consequence, our health insurance premiums are much higher than they should be. And our Medicare program is costing both taxpayers and beneficiaries billions of dollars more than necessary.
Americans who are uninsured are at an even greater disadvantage: many of them have no choice but to put their health at risk because they can’t afford the medications their doctors prescribe for them.
Drug makers have so much influence in Washington that they’ve been able to kill numerous proposals over the years that would enable the U.S. government to regulate drug prices like most other countries do. Between 1988 and 2012, the pharmaceutical industry spent more on lobbying than any other special interest, forking over a total of $2.6 billion on lobbying activities, according to OpenSecrets.org. That’s far more than even banks and oil and gas companies spent.
That money helped them get a very sweet deal when members of Congress were drafting legislation that would eventually be the Medicare Part D prescription drug program. Drug makers were able to get their friends in Congress to insert language in the Part D legislation that prohibits the federal government from seeking the best prices from pharmaceutical companies.
According to a recent analysis by Health Care for America Now (HCAN), an advocacy group, the 11 largest drug companies reported $711.4 billion in profits over the 10 years ending in 2012, much of it coming from the Medicare program. They reaped $76.3 billion in profits in 2006 alone, 34 percent more than in 2005, the year before the Part D program went into effect.
“Americans pay significantly more than any other country for the exact same drugs,” said HCAN Executive Director Ethan Rome.
How much more do we pay than residents of other countries? Here are a few examples of what we pay on average for six brand name drugs compared to what residents of other countries pay, according to the International Federation of Health Plans:
— Celebrex (for pain) – U.S.: $162; Canada: $53
— Cymbalta (for depression and anxiety) – U.S: $176; France: $47
— Lipitor (for high cholesterol) – U.S.: $124; New Zealand: $6
— Nasonex (for nasal allergies) – U.S: $108; U.K.: $12
— Vytorin (for high cholesterol) – U.S: $123; Argentina: $31
— Nexium (for acid reflux) – U.S.: $123; Spain: $18
The Congressional Budget Office says that if Medicare could get the same bulk purchasing discounts on prescription drugs as state Medicaid programs already get, the federal government would save at least $137 billion over 10 years.
In his proposed budget for 2014, President Obama is asking Congress to require drug companies to sell their medications to Medicare at the best price they offer private insurance companies, which is what they are required to do for Medicaid.
On April 16, several members of Congress, led by Sen. Jay Rockefeller (D-W.Va.) and Rep. Henry Waxman (D-Calif.), introduced legislation to require drug companies to provide rebates to the federal government on drugs used by people who are eligible for both Medicare and Medicaid. One of the cosponsors was Independent Sen. Angus King, the former governor of Maine. The lawmakers noted that with the exception of Medicare Part D, all large purchasers of prescription drugs negotiate better prices. Their bill, they say, would correct excessive payments to drug companies, while saving taxpayers and the federal government billions of dollars.
As you can imagine, the drug companies don’t like what President Obama and the lawmakers are proposing. You can expect them to mount a multi-million dollar PR and lobbying campaign over the coming months to protect both their sweet deal with Medicare and their Wall Street-pleasing profits.
By: Wendell Potter, Guest Contributor, Politix, April 23, 2013
“Bullet Backdrops”: Arkansas Republican “Most Likely Won’t Try To Kill” Lawmakers Who Support Medicaid Expansion
Arkansas may become the first red state to accept the Obamacare Medicaid expansion, which the Supreme Court made optional in its decision last year, if the Department of Health and Human Services accepts its privatized plan.
(Of course, the states turning down Medicaid expansion are generally the ones that need it most.)
The notion of expanding government to improve health care outcomes apparently drove Chris Nogy of the Benton County Republican Committee a little nutty. In a recent newsletter, he encouraged his fellow Republicans to seek “Second Amendment” solutions against those who had voted for the expansion, and expressed dismay that he can’t actually back up these threats:
We need to let those who will come in the future to represent us [know] that we are serious. The 2nd amendment means nothing unless those in power believe you would have no problem simply walking up and shooting them if they got too far out of line and stopped responding as representatives. It seems that we are unable to muster that belief in any of our representatives on a state or federal level, but we have to have something, something costly, something that they will fear that we will use if they step out of line. If we can’t shoot them, we have to at least be firm in our threat to take immediate action against them politically, socially, and civically if they screw up on something this big. Personally, I think a gun is quicker and more merciful, but hey, we can’t.
Nogy’s wife is the group’s secretary and she claims the article was placed in the newsletter without her husband’s approval.
Medicaid expansion will provide health insurance for up to 250,000 Arkansans, ultimately saving dozens if not hundreds of lives, while driving down the costs of the state’s insured — who already subsidize the uninsured through higher rates.
Most of Arkansas’ estimated uninsured 401,100 are working families who simply can’t afford coverage.
Several Arkansas Republicans made it clear that they were appalled by Nogy’s comments.
“I’m embarrassed for the Benton County Republican Committee for including this article in their newsletter,” said State Senator Jon Woods (R). “I would think the Benton County Committee would have better judgment and not allow this to be sent out.”
The Benton County Republican Committee offered a statement:
“The letter was not approved and Mr. Nogy had no authority to submit it through the newsletter. As a committee, we respect the right of our legislators to vote based on their knowledge and feedback from the voters they represent. We will discuss this issue further with our executive committee.”
Nogy later clarified his comments in a letter to KFSM News.
He explained why he is more angry at Republicans than Democrats:
I don’t feel the same way about the Democrats as bullet backstops as I do about the Republicans who joined them. The Democrats were doing what their party told them they had to do because they were elected to do that job.
He concluded by saying that his threats were only meant to attract attention and he “most likely” won’t kill those Republicans who supported the Obamacare provision. He simply thought it was important to put a face behind his threats so lawmakers will take him seriously:
And for the record, I didn’t advocate violence. I mentioned violence to get people’s attention, and it worked. I advocated a serious political and social stand, an assured and significant negative response to any politician who breaks a primary voter/elected official promise contract. We have only one mechanism to maintain the ‘government of the people, by the people, and for the people’, and that is to elect those who promise to do as we demand they do. If we cannot make these people understand that we will not tolerate this kind of breach of contract, then we lose our ability as the people to control the government. And in this age of death threats from nameless, faceless thugs, we need these folks to know that while we most likely won’t try to kill them or harm their families, they should be much more certain of our response than fearful of the actions of those who will not identify themselves.
The contentious battle over expansion has shown that Republicans are eager to take the federal funds without getting any Obama on them. Lawmakers are so afraid to be caught pandering to the president or “takers” that they’ve officially declared that Medicaid expansion is not an entitlement.
Mr. Nogy should be happy to know that another feature of Obamacare is mental health parity.
By: Jason Sattler, The National Memo, April 22, 2013
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