“More Stuff Made Up About Obamacare”: A Nasty Ideological And Racial Undertone To Bobby Jindal’s Latest Campaign
It’s been obvious from the beginning that a big part of the GOP strategy for demonizing Obamacare has been to convince existing beneficiaries of federal health programs that ACA coverage would come out of their hides. Thus the constant efforts to convince Medicare enrollees that ACA was financed by “Medicare cuts” (not at all true with the exception of the reductions in super-subsidies offered to the Bush-era conservative pet rock of Medicare Advantage policies offered through private insurers). There’s also a nasty ideological and even racial undertone to this campaign aimed at white middle-class retirees who view their Medicare benefits as earned (via both payroll tax contributions and a lifetime of work), as opposed to the “welfare” being offered to those people supported by Medicaid or Obamacare.
But leave it to Bobby Jindal to come up with a line of attack that pits existing Medicaid beneficiaries against those who would qualify for coverage if, over his dead body, the ACA’s Medicaid expansion were to be enacted in Louisiana. TPM’s Dylan Scott has the story:
Engaged in all-out war with the liberal group MoveOn.org over a pro-Obamacare billboard, Louisiana Gov. Bobby Jindal (R) has accused the organization — and liberals in general — of endorsing discrimination against the disabled through their support of the federal health care reform law and its Medicaid expansion.
“Liberal groups like MoveOn.org won’t say one word about caring for individuals with disabilities, or how Obamacare prioritizes coverage of childless adults ahead of the most vulnerable,” Jindal wrote in an op-ed in the Shreveport Times last Thursday. “They just want to intimidate states into accepting Obamacare’s massive new spending programs.”
What does Bobby mean by “prioritizing” coverage of childless adults? Simply that expanded coverage comes with a higher federal match rate than is available for traditional Medicaid (not high enough, of course, to convince ideologically motivated Republicans, especially in the South, to execute an expansion that in many cases would represent a fiscal windfall for state governments while significantly reducing the ranks of the uninsured).
How, exactly, does that hurt people with disabilities, or others currently qualifying for Medicaid? The short answer is that it doesn’t, as Scott explains with some help from experts:
[T]here are a few huge problems with Jindal’s rationale, which effectively undermine the whole line of attack. First, some disabled people could actually qualify for health coverage under the Medicaid expansion, according to MaryBeth Musumeci, associate director of the Kaiser Commission on Medicaid and the Uninsured.
“People with disabilities can be within the new expansion group,” she said. “The ACA provides the opportunity for some people with disabilities to qualify for Medicaid who never qualified before. Their incomes, while still low, could have been above the very, very low limits states had set or they may not have been eligible at all if they fell into the category of single, childless adults. So it creates an expanded opportunity for people with disabilities to gain coverage.”
Second, Obamacare should have no policy bearing on the traditional Medicaid program. Federal funding for the traditionally eligible population remains exactly the same, and the states retain the same flexibility to manage their programs as existed prior to the law. The ACA brings a new population into the program, but there is no policy reason that it would lead to “discrimination” — as Jindal calls it — or any other detrimental effects for disabled people enrolled in the traditional program.
“I think that’s right,” Musumeci said when asked by TPM if the Obamacare’s Medicaid expansion should have no effect on traditional Medicaid. “What the Medicaid expansion essentially does is it creates a new eligibility category. Like any other time Congress has expanded eligibility of the program, it is adding statutory authority to cover this new group of people.”
“But it’s built into the same underlying Medicaid program. States still have all of the flexibility that they previously had in terms of how they structure their care delivery system, their benefits packages, and all of those things.”
It would be interesting to know how well people with disabilities, and other current Medicaid beneficiaries, would fare in Louisiana if the national Republican “reform” of Medicaid, a block grant that reduced federal funding over time, were to be enacted. Let’s hope we don’t find out. But in the meantime, the “prioritization” argument against the Medicaid expansion is just another effort to frighten one group of safety net beneficiaries they have a stake in excluding others. It’s exactly what we’ve come to expect from self-styled conservative Christian warriors like Bobby Jindal.
By: Ed Kilgore, Contributing Writer, Washington Monthly Politica Animal, March 20, 2014
“Republicans Can’t Win By Attacking Health Care In 2014”: We will Turn The Corner If Progressives Do Not Sit On The Sidelines
For me, the fact that Republicans keep using the Affordable Care Act – Obamacare – as a political football is a tragedy. Sure, the law has problems, but it is already saving lives and improving the health of millions of Americans.
Thankfully, it seems that Republicans who are counting on attacking the health reform system to get them into the end zone will be stopped short of the goal line based on numbers coming out of a March special election for a Florida House seat
For me, the Affordable Care Act comes down to people’s lives and health. Consider the story of a young man I met who told me that this new avenue to becoming insured had saved his life.
He had some symptoms that made him worry about his health. But he, like many Americans without insurance, ignored them, as he couldn’t afford to see the doctor. After the Affordable Care Act became law, he got coverage through his parents’ health insurance plan, and on visiting a doctor, found out he had stage 4 — that’s advanced — cancer. Fortunately, he got to the doctor in time to save his life.
That young man is far from alone. As of the end of February, some 11 million Americans have health coverage under the new law. Repealing it, as Republicans continue to insist, would take away coverage from each and every one of them.
In the Florida election, Republican David Jolly said “I’m fighting to repeal Obamacare, right away.” His opponent, Democrat Alex Sink, countered, “We can’t go back to insurance companies doing whatever they want. Instead of repealing the health care law, we need to keep what’s right and fix what’s wrong.”
The key part of Sink’s message was to remind voters why people wanted health care reform in the first place. As one of Sink’s TV ads said, “Jolly would go back to letting insurance companies deny coverage.”
That’s an effective reminder of the huge problems Americans have had for decades, when insurance companies could deny care because of a pre-existing condition, charge people higher rates because they were sick, and even charge women higher rates than men. The ACA ended all that.
The candidates in Florida pushed especially hard for the votes of seniors, which is not surprising given both Florida’s high senior population and the fact that seniors vote more frequently than other age groups.
In its ads for Jolly, The Republican Congressional Campaign repeated the same misleading charge that Republicans used successfully in 2010 to scare seniors against the ACA, that it cut $716 billion from Medicare. But unlike 2010, when Democrats did not respond to attacks on the ACA, Sink pushed back.
She reminded seniors that the ACA actually provides important new Medicare benefits, including closing the infamous prescription drug “donut hole.” Sink’s ads accurately said, “His [Jolly’s] plan would even force seniors to pay thousands more for prescription drugs.”
By Election Day, voters had a clear contrast between the positions of the candidates on the ACA. It was a close election, with Jolly winning by a small margin (48.4 percent to 46.5 percent) in a district with an 11-point Republican advantage, one that has been represented by the GOP for nearly 60 years.
But polling found that independent voters in the district supported the “keep and fix” position over the “repeal” position by a margin of 57 percent to 31 percent. Sink actually gained ground over Jolly during the election on the question of which candidate had a better position on the ACA.
I am very much looking forward to the time when Congress can start having real debates on how, as Sink said, “we can keep what’s right and fix what’s wrong” with the Affordable Care Act. However, it looks like it will take at least one more election, in 2014, to get us to that point.
We will turn the corner if progressives do not sit on the sidelines, but instead welcome the debate that Republicans insist on having about repealing the ACA.
That debate is an opportunity for people to be reminded in concrete terms that the new health care program, for all its shortcomings, is about providing every American with the peace of mind that comes with having health coverage.
By: Richard Kirsch, Senior Fellow at The Roosevelt Institute; Published in The National Memo, March 20, 2014
“Forget The Conventional Wisdom”: What Florida Really Tells Us About Obamacare
Was it really Obamacare that sunk Sink? I mean of course Alex Sink, the Democratic Florida congressional candidate who lost to Republican David Jolly on Tuesday. After the results were announced, Washington’s conventional wisdom congealed immediately: This was all about Obamacare, and it’s going to doom the Democrats come November.
Not so fast, says Geoff Garin, the pollster who did Sink’s polling in the race. Garin argues in a memo he released the day of the voting that “the issue ultimately provided more of a lift than a drag to her campaign.” He followed up by telling me yesterday: “She would have done worse if she’d neglected to hit back and engage the issue.” There’s a lesson in there for Democrats as they march toward November.
Garin put two key questions to the district’s voters. The first paraphrased the criticisms of Sink on Obamacare: Sink supports this law that will take away $716 billion from Medicare, and that caused 300,000 Floridians to lose their coverage and 2,500 patients at a district cancer center to have to change doctors. The second paraphrased criticisms of Jolly’s health-care position: He wants to totally repeal the law instead of fix it, a position that would let insurers again discriminate against the already ill and charge women more than they charge men for coverage. Repeal would also cut expanded prescription-drug coverage for Medicare recipients.
Respondents were asked to say whether this information gave them “very major doubts” about the candidates, “fairly major” doubts, “just some” doubts, or “no real” doubts. Results: While 43 percent now entertained very major doubts about Sink, 50 percent said they had very major doubts about Jolly. And 35 percent had no real doubts about Sink while only 26 percent had no real doubts about Jolly.
If that polling is accurate, then “more lift than drag” is accurate and fair. Guy Molyneux, a partner of Garin’s who oversaw some Obamacare polling for a couple of unions in January, echoed the point that there are at least three things Democrats can say about the law and the Republicans’ repeal zeal that poll really well. People broadly understand, Molyneux told me, that the law protects against discrimination based on pre-existing conditions, and they approve of that strongly. They also know that insurers can no longer drop sick people on whim, and they like that. And they’re getting to know that the law prevents insurers from charging women more than men, and they like that, too; even men.
There’s one more thing that people don’t yet know very well, but the polling indicates that it could be a strong debating point, too: Under the law, insurers have to publicly justify any rate increases greater than 10 percent. This is called rate review, and it and the medical-loss ratio provisions of the law (explained here) are the two main planks that guard against willy-nilly rate hikes. A Heath and Human Services study from last September found that nearly 7 million citizens had saved more than $1 billion because of rate review, and moreover, that insurance companies were seeking increases of 10 percent far less frequently than before the law because of the added oversight.
Since everybody and his brother assumes that the Affordable Care Act is going to increase their rates, seems to me it’d be awfully useful for the Democrats to develop a sharp talking point or two explaining to people that the law actually helps prevent crazy premium increases.
This all makes the Obamacare story a lot more complicated than “disaster for Dems.” It just doesn’t have to be. Republicans know this, too. Why are they, or some of them, suddenly talking about replacing the law? Precisely to try to insulate themselves from the effective Democratic attack that they’d give carte blanche to insurance companies to go back to their old ways.
It’s worth dwelling on this for a paragraph—it’s important to understand. It was in the spring of 2010 that the GOP unveiled “repeal and replace.” They stuck with that through the election. Then, once they’d retaken the House, they dropped “replace” and went for “repeal” only. Now that a midterm election is coming again, though, they’re starting to put “replace” back in their rhetoric. But it’s as hollow this time as it was then. “Our challenge,” Molyneux told me, “is to show that there’s nothing behind the curtain there.”
Lord knows, the Democrats have more problems than health care staring them in the face for the fall. The turnout question is the biggest one, although they say they’re making efforts this time that have no precedent in a midterm election. And Obama’s bad approval numbers—worse still in many of the states with high-profile Senate contests—are a huge factor. “If Obama’s still at 41 percent in mid-October, we’re in a world of hurt,” Molyneux says. And finally, but far from least, the economy. An awful, awful number from this week’s NBC/Wall Street Journal poll: Fully 57 percent of those surveyed said they think we’re still in a recession.
So yeah, there’s a lot for Democrats to worry about. But in most of the contested states—not Louisiana, probably not Arkansas, but the others—they can make Obamacare a net wash if they can be clear about the implications of “repeal” and call out their GOP opponents on “replace.” And maybe as a bonus show they have some fight in them, and give those unmotivated young and Latino voters some good reasons to go to the polls.
By: Michael Tomasky, The Daily Beast, March 14, 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
“When The Red Meat Gets Really Bloody”: A Reflection Of Actual Republican Priorities And Governing Philosophy
When I wrote about Rick Perry’s very well-received speech at CPAC representing the underlying radicalism that has become commonplace at conservative gatherings, I did so in part because we’ve all gotten too accustomed to the duplicitous game played by Republican pols who talk out of both sides of their mouths about very popular federal domestic programs like Medicare and federally guaranteed student loans. If they aren’t hinting they’d like to repeal them altogether, they’re often promising to defend them to the last ditch, like Paul Ryan so conspicuously did with respect to Medicare in 2012.
But to my surprise, at least one major Republican writer was disturbed by Perry’s rhetoric at CPAC: Commentary‘s Peter Wehner:
It is one thing – and I think very much the right thing – to argue for a more limited role for the federal government and conservative reforms of everything from entitlement programs to education, from our tax code to our immigration system to much else. It’s quite another when we have the kind of loose talk from the governor of the second most populous state in America.
I realize that some people will argue that what Perry is offering up is simply “red meat” for a conservative audience. It’s a (lazy) default language those on the right sometimes resort to in order to express their unhappiness with the size of the federal government. But words matter, Governor Perry is actually putting forth (albeit in a simplified version) a governing philosophy, and most Americans who hear it will be alarmed by it.
As a political matter, running under the banner of “Get out of the health care business! Get out of the education business!” hardly strikes me as the best way to rally people who are not now voting for the GOP in presidential elections. I’m reminded of the words of the distinguished political scientist James Q. Wilson: “Telling people who want clean air, a safe environment, fewer drug dealers, a decent retirement, and protection against catastrophic medical bills that the government ought not to do these things is wishful or suicidal politics.”
Wehner, of course, is not your typical conservative writer. In February of last year, he and WaPo columnist Michael Gerson penned one of the more serious post-2012 articles on the need for some serious rethinking of the GOP message and policy agenda, earning them a spot in Ryan Cooper’s list of “Reformish Conservatives” in the May/June 2013 issue of the Washington Monthly.
But still, with Republicans getting themselves all revved up for a big 2014 victory so long as they keep their message simple and stupid, it’s refreshing to hear at least one voice suggest there is long-term danger–or really short-term danger, since 2016 isn’t that far away–in Perry’s kind of rap. At some point, Democrats are going to figure out how to effectively make the case that the “red meat” speeches reflect actual Republican priorities far more than the “incremental reform” or even defense-of-the-status quo rhetoric GOPers aim at swing voters.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, March 13, 2014
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