“There Won’t Be Any Highs Ahead”: Congress Deserves Public’s Contempt For Its Obsession With Destroying Obamacare
Congress is back—and the House has an ambitious plan for the year ahead. OK, an ambitious plan to cement its place in history as the Do-Nothingest Congress of all time.
The House has scheduled all of 97 days in session before the November elections, with many of them being half days or pro forma ones. And Majority Leader Eric Cantor’s memo to his troops outlining the plan for the year ahead made it clear that there is at most a bare-bones agenda, focused like a laser, yet again, on repealing or further sullying and delegitimizing Obamacare. The only possible good news coming out of that is that the obsessive focus on killing Obamacare may provide the excuse for House leaders to extend the debt ceiling without blackmail this time, by convincing their rank-and-file that it is the best way to avoid distractions and keep the focus on the health insurance law.
The obsession with Obamacare, and the near-universal belief among Republican lawmakers and conservative spinmeisters that the law will collapse spectacularly of its own weight, is fascinating.
Remember that when Sen. Ted Cruz incited the shutdown last year over the demand to defund Obamacare, his argument was that this was the last chance before the law was implemented in January—after which it would be impossible to stop it, because so many Americans would be delighted with its benefits. Cruz told Sean Hannity last July, “If we don’t do it [defund Obamacare] now, in all likelihood, Obamacare will never, ever be repealed. Why is that? Because on January 1, the exchanges kick in, the subsidies kick in; … their plan is to get the American people addicted to the sugar, addicted to the subsidies, and once that happens, in all likelihood, it never gets …”
At which point Hannity agreed, saying, “It’s over—it never gets repealed.”
The awful and bumpy rollout of the plan changed all that; now, for Cruz, Hannity, and everyone else in the right-wing echo chamber, there won’t be any highs ahead, or at least the highs and sugar addictions will be overwhelmed by bad drugs and overdoses.
Which view is right? We don’t know for sure, but there is some interesting evidence in the rollout of the Medicare Part D plan in 2005, via an excellent analysis by Georgetown University’s Center on Health Insurance Reform. The report makes clear that there are many parallels between Part D and Obamacare.
First, both plans passed with substantial partisan tension, which tarnished the initial public views of them. Second, both plans created much confusion in the public, with small proportions of Americans having even a basic understanding of what was in the plans and how they would work. Third, both plans had a lot of time after passage and before they actually took effect to prepare for a massive rollout. Fourth, neither had its website ready to roll when the deadline hit, and both had crashes and long delays to gain access. Fifth, even after the websites became more reliable, other problems persisted, including inadequate call centers and inexperienced navigators at the local level who were unprepared with full or sophisticated answers to questions posed by those trying to sign up. Sixth, supporters of the laws issued cautions when they were first unveiled, warning of glitches ahead and asking the public for understanding and help at ameliorating the problems.
Now for the differences. While Medicare Part D was the subject of serious partisan chicanery—the infamous three-hour vote in the House; the conference committee that barred key Senate Democrats from participating, including Senate Democratic Leader Tom Daschle; the “bait and switch” that in the end took out all the parts of the bill that had made Ted Kennedy an initial partner of the Bush administration—once it was law, most Democrats worked hard to make the plan accessible and workable for seniors, as did Democratic governors and state legislatures.
Of course, the opposite is true of Obamacare. Despite yeoman efforts to make the bill bipartisan—months and months of negotiation by Senate Finance Chairman Max Baucus with Chuck Grassley and other Senate Republicans, starting from a framework devised and endorsed by Grassley—it got not a single GOP vote. But after passage, it has received nothing but yeoman efforts to sabotage it, including from a slew of Republican governors denying insurance to the most needy of their constituents simply to stymie the law’s implementation. And whenever a Republican talks about how to make the law work better, instead of blowing it up (Jack Kingston of Georgia comes to mind), he or she is vilified by partisans and their media acolytes.
Second, the mainstream media reported on the glitches in the Medicare Part D plan but did not jump all over them with front-page or highlighted stories, or repeated and lengthy inquests on Sunday talk shows. The opposite has been true of Obamacare, with an added twist that reflects the new economic and political realities for media, as reported in a piece by Maggie Mahar at healthinsurance.org. Mahar investigated a ballyhooed article in the Fort Worth Star-Telegram titled “Obamacare Stirs Anxiety for Thousands.” The cases of those who were purportedly shafted by Obamacare proved to be false or exaggerated, and three of the four cases cited were tea-party adherents who strongly opposed the law, two of whom had never even checked for prices on the exchanges. After a lengthy stonewall by the paper’s editors, it became clear that no one had fact-checked the piece, which was written by a reporter with no expertise in health policy, under a tight time frame, assigned by an editor who only wanted bad news, not any stories of those who had been helped by the new law. This is more a case of underresourced news outlets eager to report bad news than bias, but it reflects the tougher climate for a law that affects far more people in far more ways than Part D did.
Eight years after its rocky rollout and deep public skepticism, the Medicare Part D plan is widely popular. I have no idea if that will be the case with Obamacare—and if achieving popularity takes any length of time, the political damage, in this November election and maybe even in 2016, will already have been done. What I do know is that there are going to be a whole lot of winners under the Affordable Care Act, and a smaller number, but still a significant one, of losers or those caught up in the inevitable upheaval to the health care system.
And I know if your only legislative or policy plan for 2014, in the face of a sluggish economy, a crisis of long-term unemployment, and a host of other short and long-term problems facing the country, is to bet on the spectacular failure of the health care plan, you deserve the public contempt your Congress is receiving.
By: Norm Ornstein, The National Journal, January 8, 2014
“Call It A Comeback”: More Than 9 Million Americans Have Health Insurance Through Obamacare
You don’t get much credit for fixing something that should have worked in the first place, but the Obama administration has avoided a major catastrophe by delivering on its promise to fix HealthCare.gov for most Americans.
After two months of barely functioning, the federal online health care exchanges delivered, racking up 975,000 enrollments in the month of December. That brings the total number of people who have picked a plan through an exchange since October 1 to about two million. The administration reached about two-thirds of its goal of enrolling 3.3 million by the end of 2013 after being fully operational one-third of the time. And it turns out most of the enrollments came during the one-week extension the White House gave itself after the initial problems with the site became apparent.
Four million people have qualified for Medicaid, according to ACASignups.net. Another 3.1 million young adults are covered by their parents’ health insurance, thanks to a provision in the Affordable Care Act (ACA).
This means over nine million people have gained coverage through the ACA since it first became law.
That number could easily shrink or grow as insurers report on how many people purchased ACA-compliant policies directly through them. It’s also unclear how many canceled policies were replaced by plans purchased through the exchanges.
Looking at the rate of enrollments for Medicare Part D, president of health research firm Avalere Health Dan Mendelson believes that the administration can hit its goal of seven million enrollments by the close of open enrollment on March 31.
“Where they are, with about two million enrolled, if they continue to enroll at the present rate, and there’s a little acceleration at the end, they could get to seven million,” Mendelson told the Washington Post‘s Sarah Kliff.
However, Republicans are still predicting doom for the president’s signature legislative accomplishment, suggesting that the disastrous rollout of the exchanges is just the beginning of the problems.
“Just about everyone on the right is still living in October, the annus horribilis of Obamacare (yes, I know it was just a month, and I don’t care), and is waiting to move in for the kill after the whole thing collapses,” The New York Times‘ Paul Krugman wrote.
Republicans are assuming that the estimated 3 percent of Americans who will be paying more under the law along with disruptions of relationships with doctors will overwhelm both the news of millions gaining coverage and Republican states denying Medicaid expansion to five million working people.
Predictions of Obamacare’s death made sense when it seemed a very real possibility that HealthCare.gov could not be fixed.
Now that those predictions have been proven wrong, the law will have a chance to be judged on its merits.
By: Jason Satler, The National Memo, December 30, 2013
“We Invent, Experiment, And Fix What Has To Be Fixed”: Why You Shouldn’t Succumb To Defeatism About The Affordable Care Act
Whatever happened to American can-do optimism? Even before the Affordable Care Act covers its first beneficiary, the nattering nabobs of negativism are out in full force.
“Tens of millions more Americans will lose their coverage and find that new ObamaCare plans have higher premiums, larger deductibles, and fewer doctors,” predicts Republican operative Karl Rove. “Enrollment numbers will be smaller than projected and budget outlays will be higher.”
Rove is joined by a chorus of conservative Cassandra’s, from Fox News to the editorial pages of the Wall Street Journal, all warning that the new law will be a disaster.
Robert Laszewski, president of Health Policy and Strategy Associates, anticipates a shortage of doctors. “There just aren’t going to be enough of them.”
Professor John Cochrane of the University of Chicago predicts the individual mandate will “unravel” when “we see how sick the people are who signed up on exchanges, and if our government really is going to penalize voters for not buying health insurance.”
The round-the-clock nay-saying is having an effect. Support for the law has plummeted to 35 percent of those questioned in a recent CNN poll, a 5-point drop in less than a month. Sixty-two percent now say they oppose the law, up four points from November.
Even liberal-leaning commentators are openly worrying. On ABC’s “This Week,” Cokie Roberts responded to my view that the law eventually would prove popular by warning of “a whole other wave of reaction against it” if employers start dropping their insurance.
Some congressional Democrats are getting cold feet. West Virginia Senator Joe Manchin recently fretted that “if it’s so much more expensive than what we anticipated and if the coverage is not as good as what we had, you’ve got a complete meltdown.”
Get a grip.
If the past is any guide, some fixes will probably be necessary – but so what? Our current healthcare system is the real disaster — the most expensive and least effective among all developed countries, according Bloomberg’s recent ranking. We’d be collectively insane if we didn’t try to overhaul it.
But we won’t get it perfect immediately. What needs fixing can be fixed. And over time we can learn how to do it better.
If enrollments are lower than anticipated, the proper response is to keep at it until larger numbers are enrolled. CHIP, the Children’s Health Insurance Program, got off to a slow start in 1998. The Congressional Research Service reported “general disappointment … with low enrollment rates early in the program.” CHIP didn’t reach its target level of enrollment for five years. Now it enrolls nearly ninety percent of all eligible children.
Richard Nixon’s Supplemental Security Income program of 1974 – designed to standardize welfare benefits to the poor — was widely scorned at the time, and many states were reluctant to sign up. Even two years after its launch, only about half of eligible recipients had enrolled. Today, more than 8 million Americans are covered.
If mistakes are made implementing the Affordable Care Act, the appropriate response is to fix them. When George W. Bush’s Medicare Part D drug benefit was launched, large numbers of low-income seniors had to be switched from Medicaid. Many needed their prescriptions filled before the switch had been completed, causing loud complaints. The website for the plan initially malfunctioned. Pharmacies got the wrong information. Other complications led even Republican Representative John Boehner to call it “horrendous.” But the transition was managed, and Medicare Part D is now a firm fixture in the Medicare firmament.
If young people don’t sign up for the Affordable Care Act in sufficient numbers and costs rise too fast, other ways can be found to encourage their enrollment and control costs. If there aren’t enough doctors initially, medical staffs can be utilized more efficiently. If employers begin to drop their own insurance, incentives can be altered so they don’t.
Why be defeatist before we begin? Even Social Security — the most popular of all government programs — had problems when it was launched in 1935. A full year later, Alf Landon, the Republican presidential candidate, called it “a fraud on the workingman.” Former President Herbert Hoover said it would imprison the elderly in the equivalent of “a national zoo.” Americans were slow to sign up. Not until the 1970s did Social Security cover most working-age Americans.
As Alexis de Tocqueville recognized as early as the 1830s, what distinguishes America is our pragmatism, resilience, and optimism. We invent, experiment, and fix what has to be fixed.
Of course there will be problems implementing the Affordable Care Act. But if we’re determined to create a system that’s cheaper and more effective at keeping Americans healthy than the one we have now – and, in truth, we have no choice – we have every chance of succeeding.
By: Robert Reich, The Robert Reich Blog, December 27, 2013
“Told You So, Obamacare’s Back”: By Next Fall, HealthCare.gov Is Going To Be A Net Plus For President Obama And Democrats
If one looks just at the raw, bottom-line number the Department of Health and Human Services released Wednesday—365,000 citizens enrolled since October 1—one might be inclined to think it’s not so hot. And it isn’t. That’s 180,000 or so a month, and if you post that number against the stated goal of 7 million by next spring, the stated goal looks awfully chimerical, and the thing seems a disaster (180,000 times six months, the enrollment period, is just 1.08 million).
Dig a little deeper and things look considerably better. If we could graph it, the bar line of enrollment would make for a pretty impressive ski slope: After just 27,000 people signed up in the whole of October, The New York Times reported over the weekend, about 100,000 people signed up in November, and then, in the first week of December alone, 112,000 chose plans. The Los Angeles Times put out slightly different numbers Wednesday but agreed on the trend. From an obviously atrocious starting place, enrollment is essentially quadrupling. If that pace were to continue, the 7 million figure would be cleared in March.
I still wouldn’t quite bet on that. But I would definitely and unflinchingly bet on the central proposition I argued last week: By next fall, HealthCare.gov is going to be a net plus for Obama and the Democrats.
Wishful thinking? You can call it that if you want to. But I warn you I’m not usually a wishful thinker. Like most partisans on either side, I tend to expect the worst. It’s usually a wise insurance policy; you’re rarely disappointed. I write such things only when I really think them, like the time in August 2012 when I wrote a column suggesting that Obama could very well win about 330 electoral votes. He won 332, which most anyone else would have said when I wrote that piece was crazy.
I had a hunch then, and I have one now. And my bet is based on a lot more than enrollment numbers. It’s based on the numbers of people who are benefiting and will benefit from aspects of the law. These aren’t in the thousands. They’re in the millions. About 70 million citizens will enjoy free—free—preventive care for a range of services that typically weren’t covered at all before or at best were covered and required a co-pay. About half of them are Medicare recipients (= old people = voters). Preventive care, as you may know, is something our system hasn’t been doing very well. Now it will.
More than 100 million Americans live with what the insurance companies would define as pre-existing conditions. Over these next few months, as their symptoms flare up or especially if they worsen, requiring lengthy hospital stays and intense treatment, they’re going to be seeing that they don’t have to fret about money or whether they’re going to continue to be covered anymore. Mental-health coverage is going to be improved dramatically for up to 60 million Americans. Nearly 7 million senior citizens are going to find in the coming months that they’re no longer screwed by the doughnut-hole prescription-drug problem that was created by the Bush Medicare Part D law of 2003 and corrected by Obamacare. It is saving these 7 million seniors an average of $1,000 a year, which for many of these folks is probably a reasonable chunk of their income.
I could go on. The thing is that all this isn’t going to make the papers and the cable channels much. There isn’t a lot of inherent news value in a free cervical-cancer screening or a prescription-drug refill. But these millions of people live real lives, not on TV, and they and their families and friends will know what has happened.
You see that I’m not making a Beltway/political argument. Washington, D.C., will, I can promise you, be the last city in the United States to change its mind about Obamacare. Once a notion becomes conventional wisdom in this town and rocks a president’s poll numbers the way the disastrous rollout so clearly has, it takes a typhoon to dislodge it. Or a hurricane—remember how Karl Rove was making the United States a conservative country until Katrina came along and sent Bush’s approval numbers down there in the range of curdled milk?
The rollout won’t be a hurricane. It will be a calm rain, a steady shower of reality across the country that may never achieve quite enough force to trump inside-the-Beltway perception but will be strong enough to change many people’s minds around the country.
Fixes still need to be made. But now, as opposed to a month ago, one can feel as if they will be made. And without excusing the bollixing up of the rollout, of which I’ve written very critically, one can also say now that in historical context, this is all happening pretty fast. Remember, the original Social Security legislation was passed in 1935. And when did the first check go out? Not until 1940. Can you imagine a five-year lag in today’s media world? Roosevelt, and more important the program itself, would have been torn to pieces. I think in two more years’ time, and indeed less than that, many millions of Americans will see that what they thought was decent health insurance before the Affordable Care Act was like gaslight before electricity. If that’s wishful thinking, it’s for their sake, not the president’s.
By: Michael Tomasky, The Daily Beast, December 12, 2013
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