“Glib Ideological Purity”: Mitt Romney Would Pass The Buck On Disasters
Back when he was being “severely conservative,” Mitt Romney suggested that responsibility for disaster relief should be taken from the big, bad federal government and given to the states, or perhaps even privatized. Hurricane Sandy would like to know if he’d care to reconsider.
The absurd, and dangerous, policy prescription came in a GOP primary debate in June. Moderator John King said he had recently visited communities affected by severe weather and noted that the Federal Emergency Management Agency “is about to run out of money.”
“There are some people . . . who say, you know, maybe we’re learning a lesson here that the states should take on more of this role,” King said. “How do you deal with something like that?”
Romney replied: “Absolutely. Every time you have an occasion to take something from the federal government and send it back to the states, that’s the right direction. And if you can go further and send it back to the private sector, that’s even better.”
Romney went on to express the general principle that, given the crushing national debt, “we should take all of what we’re doing at the federal level and say, ‘What are the things we’re doing that we don’t have to do?’ ”
King gave him a chance to back off: “Including disaster relief, though?”
Romney didn’t blink. “We cannot afford to do those things without jeopardizing the future for our kids,” he said, adding that “it is simply immoral . . . to rack up larger and larger debts and pass them on to our kids.”
Now, with an unprecedented and monstrous storm bashing the East Coast, this glib exercise in ideological purity is newly relevant. Was Romney really saying that the federal government should abdicate the task of responding to natural disasters such as the one now taking place? Yes, he was. Did he really mean it? Well, with Romney, that’s always another question.
As the legendary Watergate source Deep Throat never actually said: “Follow the money.”
The dishonest “solution” proposed by Romney and running mate Paul Ryan for the federal government’s budget woes relies largely on a shell game: Transfer unfunded liabilities to the states.
Most disastrously, this is what Romney and Ryan propose for Medicaid, the health-care program for the poor. The GOP plan would give the states block grants that would not begin to cover Medicaid’s rising costs. Governors and legislatures would be forced to impose draconian cuts, with potentially catastrophic impact for millions of Americans.
Medicaid’s most expensive role — and thus, under Romney, the most imperiled — is to fund nursing-home care for seniors who classify as “poor” only because they have exhausted their life savings. Transferring the onus of Medicaid and other programs to the states would save money only by making it impossible to provide services at current levels.
For the hard-right ideologues who control the Republican Party, this would be a good thing. Our society has become too dependent on government, they believe, too “entitled” to benefits; we are unwilling to “take personal responsibility and care for” our lives, as Romney said in his secretly recorded “47 percent” speech.
Romney’s budget proposals would end all this coddling — except for the Pentagon and its contractors, who would get a big boost in federal largess, and of course, the wealthy, who would get a huge tax cut.
So-called “discretionary” federal spending would be sharply reduced. This would include spending for such agencies as FEMA. So yes, even if Romney was just pandering to the right-wing base at that June debate, one consequence of his policies would be to squeeze funding for federal emergency relief.
I guess having to survive a few hurricanes, tornados and earthquakes on our own would certainly foster personal responsibility.
And by the way, why is it that we’re having such a huge hurricane make landfall in such an unusual place at such a late date in the season? Is this another of those freakish once-in-a-century weather events that seem to be happening so often these days?
I know it’s impossible to definitively blame any one storm on human-induced atmospheric warming. But I’m sorry, these off-the-charts phenomena are becoming awfully commonplace. By the time scientists definitively establish what’s happening, it will be too late.
As has been noted, the words “climate change” were not spoken during the presidential debates. Hurricane Sandy wants to know why.
By: Eugene Robinson, Opinion Writer, The Washington Post, October 29, 2012
“Medicaid On The Ballot”: Unfortunately Mr. Romney, A Lack Of Insurance Does Kill People
There’s a lot we don’t know about what Mitt Romney would do if he won. He refuses to say which tax loopholes he would close to make up for $5 trillion in tax cuts; his economic “plan” is an empty shell.
But one thing is clear: If he wins, Medicaid — which now covers more than 50 million Americans, and which President Obama would expand further as part of his health reform — will face savage cuts. Estimates suggest that a Romney victory would deny health insurance to about 45 million people who would have coverage if he lost, with two-thirds of that difference due to the assault on Medicaid.
So this election is, to an important degree, really about Medicaid. And this, in turn, means that you need to know something more about the program.
For while Medicaid is generally viewed as health care for the nonelderly poor, that’s only part of the story. And focusing solely on who Medicaid covers can obscure an equally important fact: Medicaid has been more successful at controlling costs than any other major part of the nation’s health care system.
So, about coverage: most Medicaid beneficiaries are indeed relatively young (because older people are covered by Medicare) and relatively poor (because eligibility for Medicaid, unlike Medicare, is determined by need). But more than nine million Americans benefit from both Medicare and Medicaid, and elderly or disabled beneficiaries account for the majority of Medicaid’s costs. And contrary to what you may have heard, the great majority of Medicaid beneficiaries are in working families.
For those who get coverage through the program, Medicaid is a much-needed form of financial aid. It is also, quite literally, a lifesaver. Mr. Romney has said that a lack of health insurance doesn’t kill people in America; oh yes, it does, and states that expand Medicaid coverage show striking drops in mortality.
So Medicaid does a vast amount of good. But at what cost? There’s a widespread perception, gleefully fed by right-wing politicians and propagandists, that Medicaid has “runaway” costs. But the truth is just the opposite. While costs grew rapidly in 2009-10, as a depressed economy made more Americans eligible for the program, the longer-term reality is that Medicaid is significantly better at controlling costs than the rest of our health care system.
How much better? According to the best available estimates, the average cost of health care for adult Medicaid recipients is about 20 percent less than it would be if they had private insurance. The gap for children is even larger.
And the gap has been widening over time: Medicaid costs have consistently risen a bit less rapidly than Medicare costs, and much less rapidly than premiums on private insurance.
How does Medicaid achieve these lower costs? Partly by having much lower administrative costs than private insurers. It’s always worth remembering that when it comes to health care, it’s the private sector, not government programs, that suffers from stifling, costly bureaucracy.
Also, Medicaid is much more effective at bargaining with the medical-industrial complex.
Consider, for example, drug prices. Last year a government study compared the prices that Medicaid paid for brand-name drugs with those paid by Medicare Part D — also a government program, but one run through private insurance companies, and explicitly forbidden from using its power in the market to bargain for lower prices. The conclusion: Medicaid pays almost a third less on average. That’s a lot of money.
Is Medicaid perfect? Of course not. Most notably, the hard bargain it drives with health providers means that quite a few doctors are reluctant to see Medicaid patients. Yet given the problems facing American health care — sharply rising costs and declining private-sector coverage — Medicaid has to be regarded as a highly successful program. It provides good if not great coverage to tens of millions of people who would otherwise be left out in the cold, and as I said, it does much right to keep costs down.
By any reasonable standard, this is a program that should be expanded, not slashed — and a major expansion of Medicaid is part of the Affordable Care Act.
Why, then, are Republicans so determined to do the reverse, and kill this success story? You know the answers. Partly it’s their general hostility to anything that helps the 47 percent — those Americans whom they consider moochers who need to be taught self-reliance. Partly it’s the fact that Medicaid’s success is a reproach to their antigovernment ideology.
The question — and it’s a question the American people will answer very soon — is whether they’ll get to indulge these prejudices at the expense of tens of millions of their fellow citizens.
By: Paul Krugman, Op-Ed Columnist, The New York Times, October 28, 2012
“Romney’s Closing Argument”: For Those Who Prefer “Big And Bold Dishonesty”
For the candidate afflicted with “Romnesia,” you never know when you hear that he’s making his “closing argument” if that is indeed the case, or he’s got three or four more in his pocket. But that’s the label BuzzFeed’s Zeke Miller is giving to Mitt Romney’s speech in Ames, Iowa, today–a place, you may recall, that he strictly avoided when Iowa Republicans kicked off the presidential cycle with a straw poll in the summer of 2011.
But anyway: the guts of Mitt’s final pitch is that he and Paul Ryan are thinking big and bold while Barack Obama is petty and timid:
Four years ago, candidate Obama spoke to the scale of the times. Today, he shrinks from it, trying instead to distract our attention from the biggest issues to the smallest–from characters on Sesame Street and silly word games to misdirected personal attacks he knows are false.
This is pretty rich coming from the guy who has spent much of the last month relentlessly pandering to the coal industry. But at any rate, what’s interesting about the “big and bold change” stuff is that it’s true: but not in any way he’s admitting. To hear his “closing argument,” here’s a sample of what he and Paul Ryan are fighting for:
We will save and secure Medicare and Social Security, both for current and near retirees, and for the generation to come. We will restore the $716 billion President Obama has taken from Medicare to pay for his vaunted Obamacare.
We will reform healthcare to tame the growth in its cost, to provide for those with pre-existing conditions, and to assure that every American has access to healthcare. We will replace government choice with consumer choice, bringing the dynamics of the marketplace to a sector of our lives that has long been dominated by government.
I’m sure you know by now how Mitt ‘n’ Paul plan to “save” Medicare. The “save Social Security” bit presumably refers to “reform” plans they haven’t had the guts to reveal, though Ryan was an early backer of partial privatization and Romney has talked vaguely about means-testing benefits.
But it’s the “health care reform” claim that is really incredible. By repealing Obamacare, Romney and Ryan would eliminate health insurance coverage for 30 million people who would otherwise be covered beginning in 2014. The Medicaid block grant they propose would according to the most credible indeeliminate coverage for another 17-23 million people. That’s 47-53 million Americans who will have to find some other way to secure health care or simply do without. And what are the “reforms” proposed instead? The Romney campaign has already been forced to admit that its candidate’s deep concern for people with pre-existing conditions extends only so far as preserving current laws allowing people to pay both employer and employee shares of health premiums after they’ve lost their jobs, or try to buy terrible, expensive policies through state risk pools. But believe it or not, the big and bold Romney/Ryan agenda would make things worse by the “market-based” reform of interstate insurance sales, which would create a race to the bottom sure to eliminate most of the protections available to poorer and sicker people.
I won’t even get into the hypocrisy of talking about getting government out of health care while demanding that the single-payer Medicare program keep paying insurance companies and providers $716 billion in unnecessary reimbursements. But the gap between what Romney is saying on health care and other issues, and the reality of his agenda, already gigantic when this campaign began, has only grown. If you like your dishonesty big and bold, he’s your man.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, October 26, 2012
“Medicaid Is the Real Target”: Mitt Romney’s Priorities, Aid For The Rich, Paid For By The Poor
Since August, when Mitt Romney chose Paul Ryan as his running mate, the two campaigns have fought a fierce battle over who is the most stalwart protector of Medicare. In the first presidential debate, Romney assailed President Obama for his $716 billion in Medicare cuts, and Ryan did the same in last week’s vice presidential face-off. Likewise, the Obama campaign has hit Team Romney for the Ryan plan and its Medicare “premium support”—which, if implemented, would gradually replace traditional Medicare with subsidized, regulated private insurance.
The irony is that—in the short term, at least—Medicare will stay unchanged, regardless of who wins the election. Seniors are among the most mobilized voters in the electorate, and there’s too much political risk involved in making big, immediate changes to Medicare. For that reason, Medicare reform plans on both sides are backloaded and will take time to unfold.
The same isn’t true of Medicaid, the other major federal health-care program. The primary constituency for Medicaid—poor and working-class families—lacks the clout and influence of seniors. And while the Obama administration expanded the program in the Affordable Care Act, it has also made Medicaid a ripe target for conservative cuts to social insurance.
This means that, as Mother Jones’ Kevin Drum pointed out last week, Medicaid, not Medicare, is the actual flashpoint in this election. Romney has promised to “block grant” the program, giving states more flexibility in dealing with eligibility and benefits. Some states would use this as an opportunity to innovate. But as Drum notes, just as many would use it as an excuse to drop health coverage for poor people:
Lots of states, especially poor states in the South, don’t have much interest in experimenting. They just want to slash eligibility for Medicaid. Given the freedom to do it, they’d adopt what Ed Kilgore calls the “Mississippi model,” cutting off coverage for a family of three earning anything over $8,200. For all the talk of fresh thinking and new solutions, what they really want to do is simple: They want to stop providing medical care for poor people.
Admittedly, this is a little speculative. It’s possible—albeit, unlikely—that a future governor of South Carolina or Alabama might want to use the new flexibility to improve services for lower-income people. With that in mind, it’s also worth noting the extent to which Romney’s block-grant plan involves a massive cut to overall Medicaid spending. The Center on Budget and Policy Priorities finds that with a Paul Ryan-style block grant in place, overall Medicaid spending would decline by one-third over the next decade. When you put this in the context of Romney’s budget proposals—which include new defense spending and a promise to protect Medicare—and his promise to repeal the Affordable Care Act, the result is a $1.5 trillion reduction in Medicaid spending by 2022. These cuts would add an additional 14 to 19 million people to the ranks of the uninsured, on top of the 30 million people who would lose coverage as a result of full Obamacare repeal.
It’s his approach to Medicaid, more than anything else, that reveals Mitt Romney’s priorities—aid for the rich, paid for by taking relief from the poor.
By: Jamelle Bouie, The American Prospect, October 15, 2012
“Pilfering The Federal Treasury”: Mitt Romney’s Medicaid Shell Game
Mitt Romney is lambasting federal aid in his campaign for the presidency, including derisive comments against those who receive government assistance. But he pulled all the stops to pursue federal aid as governor of Massachusetts, even hiring “revenue maximization” contractors to scour federal programs for every possible penny — and using financial schemes to maximize and then divert the aid from his needy constituents.
In his first budget proposal, Romney promised balancing the budget without tapping reserves, and “without the use of fiscal gimmicks.” However, buried in the details, he suggested tapping reserves such as taking $4 million from the Catastrophic Illness in Children Relief Fund, and he included fiscal gimmicks to maximize and divert federal aid into his general state coffers.
His strategies are akin to tax schemes using offshore bank accounts — but instead of avoiding federal taxes, seeking to pilfer the federal treasury. The Wall Street Journal labeled such financing mechanisms “Medicaid Money Laundering” and a “swindle.”
Medicaid is a matching grant program. If a state with a 50 percent match rate like Massachusetts spends $50 on qualifying services, the federal government will provide an additional $50 so there is $100 total for Medicaid services. The federal match payment is much higher in some states, such as Mississippi where its almost 75 percent.
Unfortunately, some states concocted budget shell games, often with private consultants, providing an illusion of state spending to claim federal matching funds, when no state spending has occurred. As governor of New Hampshire, Judd Gregg developed such a practice labeled “Mediscam.” Gregg taxed hospitals serving the poor, routed the money into an “uncompensated care fund” which he sent right back to the hospitals, and used the round-trip of money to claim federal matching funds. Then, the swindle gets worse, because he routed the federal Medicaid funds into his general coffers rather than for Medicaid services.
Romney’s schemes were similar to Gregg’s. Buried in his 2004 budget, Romney proposed maximizing federal aid by taxing hospitals, shifting the resulting tax payments in and out of an uncompensated care fund, back to hospitals as adjustment payments, and diverting resulting federal Medicaid funds to state general revenue. He also proposed using taxes on nursing homes and pharmacies in his efforts to maximize and divert federal aid.
In such strategies, health care facilities serving the poor are used to claim federal funds to help the poor. But the health care facilities and the poor may get nothing, as the state diverts the federal aid to general coffers — and revenue maximization contractors reap millions in contingency fees. Romney used such private companies to help carryout his strategies.
After a US General Accounting Office report responding to concerns of Republican Senator Charles Grassley, the Romney administration vigorously defended using contingency-fee revenue maximization consultants and revenue practices – that the GAO labeled illusory. The GAO responded that “hospitals should benefit from increased federal reimbursements and Massachusetts’s arrangement appeared to result in lower payments to hospitals, despite increased claims for federal reimbursement.” The Romney administration even defended double (if not quadruple) billing practices “of allowing multiple agencies to bill Medicaid” for “services for the same beneficiary.” The GAO concluded that the Romney administration “did not provide convincing evidence that the [Medicaid] services provided by the four state agencies were unique,” and the Bush administration agreed with the GAO’s conclusions.
The Bush administration implemented regulations trying to reduce such practices, and the Obama administration continues efforts to improve fiscal integrity in the Medicaid program. However, Romney would virtually end federal oversight by block-granting federal Medicaid funds to states.
It’s not hard to imagine how a governor — one that employs complex shell games to find loopholes in federal rules in order to maximize and divert federal aid — would use the federal funds if handed to the state without any federal oversight. The answer to state misuse of federal aid is not to give those states even more discretion to do whatever they wish – but to simplify the claiming process, reduce loopholes allowing the revenue schemes, and improve oversight to ensure Medicaid funds are used as intended.
Romney has undergone dramatic and hard to follow shifts in his apparent views of government aid. Romney2004 proposed cutting healthcare while simultaneously proposing illusory schemes to maximize and divert federal Medicaid funds. Romney2006 changed course with the first nearly universal healthcare plan. Now Romney2012 is turning back to cuts, denouncing federal aid he once schemed to maximize and divert, condemning those who need government aid, and seeking repeal of national health care reform that is nearly identical to the plan he signed into law. And now he proposes giving all the federal money from the Medicaid program to states without federal control.
Romney2004 would have a field day with Romney2012’s plan.
By: Daniel L. Hatcher, Law Professor, University of Baltimore, Published in The Boston Globe, October 12, 2012
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