“More People Have Health Insurance”: Another Day, Another Sign That Obamacare Is Working
It’s impossible to say how big an impact the Affordable Care Act is having on the uninsured. But it’s getting impossible to deny that it’s having an impact at all.
The latest evidence comes from the Gallup organization, which surveys respondents about insurance status. According to Gallup, the percentage of adults without health insurance has been falling since the middle of last year. Now, Gallup says, it’s down to 15.6 percent. That’s the lowest rate that Gallup has recorded since late 2008.
These tracking surveys on the uninsured are far from precise. Among other things, people answering these surveys aren’t always sure of their own insurance status. Nobody should treat them as gospel.
But Gallup also found the most dramatic change in insurance status among low-income and minority populations, which would be consistent with implementation of a law that has its most dramatic impact on people with the least money. It’s also consistent with three other pieces of information
- Health Reform Monitoring Survey. In this survey, conducted by the Urban Institute and supported by the Robert Wood Johnson Foundation, the rate of uninsurance among non-elderly adults fell from 17.6 percent in the first quarter of 2013 to 15.2 percent in the first quarter of 2014.
- The Rand Corporation. According to reporting by Noam Levey of the Los Angeles Times, unpublished research from Rand suggests that the percentage of uninsured Americans fell from 20.9 in late 2013 to 16.6 percent in early 2014.
- Department of Health and Human Services. Late last week, HHS announced that enrollment in Medicaid and CHIP was 3 million higher than it had been in late 2013.
The Congressional Budget Office has projected that 13 million Americans will get health insurance because of Obamacare. Gallup’s numbers would correspond to a significantly smaller decline, although the numbers depend on what you choose as a starting point. Then again, Gallup’s numbers don’t account for the end of open enrollment—when, by all accounts, large numbers of people rushed to sign up for coverage. They also don’t account for a full year of enrollment in Medicaid and the Children’s Health Insurance Program, since people can sign up for those programs all year long.
In short, it seems pretty clear that, because of Obamacare, more people have health insurance. And, yes, that accounts for people who lost existing coverage because insurers cancelled old policies. The question is how big a difference the law is making. And it’s going to be a while before anybody knows.
By: Jonathan Cohn, The New Republic, April, 7, 2014
“A Wishy-Washy Wonk”: Paul Ryan, Still A Total Jerk
Remind me not to get in a foxhole with Paul Ryan. At the first sign of trouble, he’ll pack up his gunny sack and head for base camp, running into the latrine to hide.
Or so I conclude from the budget he released this week. Remember how last year Ryan was reinventing himself as the true friend of “the poors,” as we ironically say in liberal blogland? Aside from being stunned that all those skewed polls turned out to be exactly on the money and he and Mitt Romney lost, he was also, we were told, chagrined and maddened that he came away from the 2012 campaign with a reputation as a pitiless Randian with a hole where his heart used to be.
So he set out last year to prove us all wrong. He hired a disaffected ex-Democratic wonk as his top social-policy guy. He was getting the great press you’d expect out of Politico, which loves Republicans Who Confound Liberals (“The new Paul Ryan,” last December 10; “Is Paul Ryan the GOP’s Next Jack Kemp?”, December 12; someone was asleep at the wheel on December 11 I guess). America would soon see the revealed truth: Government keeps poor people poor, bleeds them of the pluck and spunk needed to liberate oneself from the dependent-American community. St. Paul would save them.
Then came the CPAC conference a month ago, and he tells one little story, about the kid who didn’t want a free lunch, just a normal brown bag like the other kids, and he gets it wrong, and the real and true version of the story doesn’t remotely prove the point he wants it to prove in his retelling, and he gets hammered over it for days, and boom, he throws in the poverty towel. To blazes with those poors. Kicking them was pretty fun after all.
I jest, of course, with my chronology. But the budget he put out this week is nothing to laugh at. Or maybe on reflection it is something to laugh at. Why in the world does it exist, and what good do he and his fellow House Republicans think it’s going to do them?
In case you haven’t heard the basic skinny, it’s a budget that’s very pre-new Paul Ryan, characterized by the two features that have chiefly characterized all Ryan budgets: meanness and dishonesty. Meanness starts with the $5.1 trillion in cuts to domestic discretionary spending programs over 10 years, with steep cuts to Medicaid and food stamps, and—
No, wait. Let’s stop here and mull this food stamp cut. As you probably know, in last year’s farm bill negotiations, House Republicans proposed a $40 billion cut to food stamps. By the time the House and Senate agreed to a farm bill last month, that was whittled down to $8.7 billion over 10 years. That’s a small cut in percentage terms (about 1 percent). But even it takes $90 a month away from 850,000 poor families. Ryan’s proposed food stamps cut? $125 billion. More than 14 times the size of the already controversial current cut. As St. Paul sayeth, we rejoice in our sufferings.
Beyond that it’s the usual Dickensian gruel. Federal programs block-granted, which always means far less money and almost always means that governors can spend the money on some more rewarding and more agreeably ZIP-coded constituency if they want to. Huge education cuts. Big cuts to Pell Grants. Oh, and here’s a nice touch—college students would start being charged interest on their loans while still in college, so that now, on top of everything else, the Republican Party is getting into the usury business.
Now don’t think I’ve forgotten the dishonesty part. Obamacare, as you might recall from the aforementioned campaign, cuts $716 billion in payments to hospitals and such. You remember—Romney and Ryan pounded on Obama about that $716 billion. You’re killing the oldsters, and so on.
Well, Ryan’s budget would repeal Obamacare. And yet, it pockets that same roughly $700 billion in Medicare cuts as savings, and, as Sahil Kapur noted for TPM, it “uses the savings to meet its fiscal targets.” How dandy is that? Hate Obamacare hate Obamacare hate Obamacare hate Obamacare…Oh, but I’ll pocket that $700 billion, Barack, thanks, great idea!
I haven’t even mentioned the plan’s biggest political weakness, which is Ryan’s return, yes, to Medicare, to quasi-privatizing it for people under 55. Democrats, until this week wholly on the defensive, have now been handed a huge sledgehammer. The 7.1 million Obamacare enrollees takes the heat off health care for the time being and allows for a topic change. And so here comes Ryan, the very day after Obamacare enrollment closed, offering that topic.
Why? Why is he re-introducing the idea of tampering with Medicare in an election year? In fact, why even release a document such as this? And why, having released it, force all your members to vote on it within the next week or so, which Ryan and Eric Cantor vow will happen? As Greg Sargent pointed out Wednesday, eight House Republicans in six different states are going to have to vote for this Medicare- and Medicaid-killing budget (old people understand that “Medicaid” means “nursing home care”).
And, depending on how you rate these things, there are around 25 House Republicans who could conceivably lose to Democrats this November. Why force them to vote for this? Or maybe if you’re John Boehner you don’t force them to. You let them vote no. But then you lose! Then what a laughing stock you are! But you’ll probably get 218 votes one way or another. So fine—you’ve forced some people in vulnerable positions to vote aye, but hey, you’ve won the vote. Then what? Then nothing. Harry Reid’s Senate will not even take it up. So it’s all symbolism.
And this is the symbol the GOP wants to present? The party that destroys federal education programs, Medicaid, food stamps, and (in the future) Medicare? I suppose they think it’ll rev up their base. Will it really? This is the fifth Ryan budget by my count. They’ve all said in essence the same thing, and they’ve all gone the same place: nowhere.
I’d like to know, sort of, what’s actually in Paul Ryan’s head and heart. But at the end of the day it doesn’t matter. What matters with him, as with any politician, is what he puts on paper. And here we have it. If this is trying to help the poor, then what Putin is doing in Russia is pro-gay. At least we won’t have to read any more “Paul Ryan loves poor people” stories. So long, St. Paul.
By: Michael Tomasky, The Daily Beast, April 3, 2014
“BobbyCare”: Jindal’s Generic Obamacare Alternative
If congressional Republicans need a fresh excuse to delay settling on an Obamacare “replacement” plan, Bobby Jindal’s given them one by throwing another plan into the mix. But on further examination, the Genius’ proposal is sort of the ultimate Generic Conservative Plan, complete with a Generic Conservative label, the Freedom and Empowerment Plan. It was released by Jindal’s pocket “think tank,” America Next.
Is there any hoary conservative health policy pet rock this plan omits? I don’t see any on a quick examination. You got your interstate insurance sales. You got “tort reform.” You got new incentives for setting up Health Savings Accounts. You got state-run high-risk pools for those with pre-existing conditions. You got a shift in the tax code from deductions for employer-sponsored health insurance to individually purchased health insurance. There’s a Medicaid block grant, and for extra measure, borrowed from the Ryan Budget, there’s Medicare converted to a premium support system for private insurance instead of single-payer government-supplied insurance.
There are a couple of wrinkles that stand out. Unlike, say, John McCain’s 2008 health care proposal, which BobbyCare resembles, Jindal would deploy not tax credits for insurance purposes but a new standard deduction. Wouldn’t that be regressive in its impact? No problem, says Jindal: po’ folks with little use for a tax deduction could share the state-run high-risk pools designed for those with preexisting conditions, providing an appropriately fenced-off health insurance ghetto for the poor and the sick (I’m sure that would fare really well in the federal and state appropriations processes).
Jindal’s plan is also a little vague about the transition to voucherized Medicare, though he suggests traditional Medicare should include a cap on “catastrophic” health expenses, presumably to reduce reliance on Medigap policies.
One provision isn’t vague at all:
[R]epeal of Obamacare will remove the law’s anti-conscience mandates, and the funding of plans that cover abortions. But true health reform should go further, instituting conscience protections for businesses and medical providers, as well as a permanent ban on federal funding of abortions, consistent with the Hyde Amendment protections passed by Congress every year since 1976.
BobbyCare is the work of a genius only if hunting and collecting past proposals is a brilliant endeavor (indeed, he seems concerned to take credit for Medicare as Premium Support away from Ryan by noting the 1999 commission he chaired proposed something similar). It will probably undercut support for more novel and politically feasible Republican proposals like the Coburn-Burr-Hatch plan. But no matter: the Legend of Bobby Jindal, Boy Genius, will get another layer of thin varnish.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, April 2, 2014
“Those Lazy Inner-City White Folks”: The Terrible Tyranny Of Federal Assistance
Unlike Rick Perry, Paul Ryan is a master of subtlety in his double-talk on the future of the New Deal/Great Society legacy under Republican governance. Conservative activists may understand that his budget proposals for turning Medicare into a defined-contribution premium support program, or for block-granting Medicaid, represent way stations to a return to the glorious days before 1933. But the out-front rhetoric is always about “saving” Medicare and “reforming” Medicaid. Similarly, Ryan has invested heavily in concern-trolling poor people by suggesting that their “moral fiber” and prospects for upward mobility are being threatened by the tyranny of federally subsidized food, health care, and income support. That all these crocodile tears happen to coincide with the policy predilections of conservatives who view poor people as looters and constitution-destroyers (following the explicit views of Ryan’s muse Ayn Rand) is just a coincidence, it seems.
But even Ryan screws up now and then, and he’s furiously back-peddling from comments made in the friendly confines of Bill Bennett’s radio show about the non-existent work ethic of “inner-city” men. Gee, wonder who he could be talking about? Lauren Victoria Burke asked him about that, and he was just stunned anyone could think it was a racial dog-whistle:
When I asked Ryan if he’d like to “revise and extend his remarks on black men” as he left he House floor after last votes on Wednesday he said, “it was taken out of context — it was, that was — out of left field — out of context.”
“This has nothing to do whatsoever with race,” Ryan added as we spoke in an elevator. He also indicated that it was Bennett that raised the initial issue over the course of a lengthy discussion.
“It was a long talk and he asked about the culture and I just went off of that,” Ryan said. “This has nothing to do whatsoever with race. It never even occurred to me. This has nothing to do with race whatsoever,” he repeated.
This sort of assertion, backed up when necessary by the claim that the questioner is “playing the race card,” is common enough on the Right that Ryan will probably get away with it unscathed. And that’s a shame: it would be instructive and entertaining to force him to produce some examples of inner-city white folks suffering from the terrible tyranny of federal assistance.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, March 13, 2014
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