“Eyes Wide Shut”: GOP Representatives Now Realize Effects Of The Sequester They Voted For
Representative Renee Ellmers (R-NC) introduced a bill on Tuesday that returns sequester-cut funding to physicians to provide chemotherapy drugs to patients. The Cancer Patient Protection Act of 2013, H.R. 1416, restores sequester cuts made to Medicare Part B in order to provide cancer treatment and reimburse physicians for the costs of cuts already made.
Ellmers, who voted in favor of the Budget Control Act of 2011, called these cuts to cancer treatment “unintended consequences.” However, the cutback in funding wasn’t accidental, as Ellmers suggests—the Budget Control Act explicitly orders a sweeping two-percent cut to Medicare.
Despite her efforts to reverse its inevitable effects, Ellmers still defends the sequester. “I do believe it will start a very important process that will help our economy to start to grow,” she said. “The debt that we have at the federal level is our biggest threat for our country.”
Representative Blake Farenthold (R-TX) joins Rep. Ellmers in opposing elements of sequestration despite having voted for it. Farenthold, among others, was disturbed to hear of the closing of 149 air traffic control towers—especially those in Texas. The congressman sent a letter to FAA Deputy Administrator Michael Huerta, stating, “I am deeply troubled for your public statements and proposed actions regarding the effect of the sequester on smaller, local airports. These airports have long played a vital role in economies across the country.”
Congressman Rodney Frelinghuysen (R-NJ) was among the 269 representatives who voted in favor of the Budget Control Act, yet he too did not hesitate to criticize its effects. In Frelinghuysen’s district, children in Washington Township may be unable to enroll in Head Start programs due to lack of funding. Frelinghuysen said, “I view potential budget cuts to such an important program as another reason why sequestration is a bad idea.”
To date, sequestration has had significant effects on many Americans, and is expected to cause upward of $85 billion in cuts to communities across the country. The elderly have lost vital programs like Meals on Wheels; veterans may face difficulty accessing mental health, substance abuse, and job counseling services; and funding can be cut for medical research of illnesses like Alzheimer’s Disease.
The effects of sequestration are tangible; millions across the country have faced cuts across a range of industries. Rather than criticizing the effects of the sequester and introducing legislation to obtain certain exemptions from these imminent cuts, perhaps members of Congress like Ellmers, Farenthold and Frelinghuysen should have weighed the consequences before even voting for the measure.
By: Allison Brito, The National Memo, April 11, 2013
“Republicans Are Out Of Excuses”: President Obama’s Budget And The Put-Up-Or-Shut-Up Challenge
As promised, President Obama sent Congress his budget for the 2014 fiscal year this morning, and there’s just enough in it to make everyone unhappy from a variety of directions.
Republicans won’t like everything about this plan that makes it progressive: it expands Medicaid, undoes sequestration cuts while ignoring Paul Ryan’s demands to slash public investments, pursues a universal-preschool initiative though new tobacco taxes, expands the Earned Income Tax Credit, invests another $50 billion in job-creating infrastructure, gives a big boost to federal R&D, and takes away breaks for Big Oil.
Democrats won’t like everything about this plan that makes it conservative: it includes additional Medicare reforms, it adopts chained-CPI to lower Social Security benefits, and it focuses more on the spending side of the ledger than the revenue side. On a fundamental level, Obama’s budget starts in the middle, rather than the left, making negotiations that much more difficult.
But whichever side you fall on, there’s an underlying strategy here. Ezra Klein’s summary sounds right to me:
Today’s budget is the White House’s effort to reach the bedrock of the fiscal debate. Half of its purpose is showing what they’re willing to do. They want a budget compromise, and this budget proves it. There are now liberals protesting on the White House lawn. But the other half is revealing what the GOP is — or, more to the point, isn’t — willing to do. Republicans don’t want a budget compromise, and this budget is likely to prove that, too.
As the White House sees it, there are two possible outcomes to this budget. One is that it actually leads to a grand bargain, either now or in a couple of months. Another is that it proves to the press and the public that Republican intransigence is what’s standing in the way of a grand bargain.
So, which of these two outcomes is more likely?
I think the smart money is on the latter. The president has called every GOP bluff and put his cards on the table — Republicans said Obama wouldn’t have the guts to go after entitlements and isn’t tough enough to risk the ire of his base. And now we know these assumptions were wrong — the president has presented a White House budget that includes the very entitlement “reforms” GOP leaders asked for, and liberals are furious.
It is, in other words, “put up or shut up” time. Republicans, out of excuses, can either meet Obama half-way or they’ll be exposed as craven. And if the last several years are any indication, GOP lawmakers will chose the latter without a moment’s thought.
Indeed, as Greg Sargent noted, congressional Republican leaders have already spent the afternoon arguing that Obama should simply give the GOP what it wants, and abandon the Democratic priorities, reinforcing the perception that Republicans still do not yet understand the difference between an offer and a gift.
In fact, I should mention that I received an email the other day from a long-time reader asking why I don’t seem more worked up about chained-CPI. The reader asked whether I support it (I don’t) and whether I’ve been relatively quiet about it out of some ideological or partisan predisposition.
I’ll tell you what I told him: I’m not worked up about it because I don’t see the scenario in which Republicans get chained-CPI by giving Obama hundreds of billions of new revenue. It’s easy to remain detached about a bad idea that seems highly unlikely to go anywhere. As Kevin Drum added today, “I don’t doubt that Obama’s offer is sincere, but it doesn’t matter. Republicans aren’t going to take it. Obama will get his proof that Republicans simply aren’t willing to negotiate seriously, and who knows? Maybe it will do him some good. But that’s all he’ll get.”
For me, the more interesting question is how the political world will process these developments when they occur. The Beltway said Obama needed to reach out to Republicans, so he reached out to Republicans. The Beltway said Obama needed to schmooze Republicans in a more personal way, so he did that, too. The Beltway said Obama needed to be willing to alienate his own supporters, and the president’s base has been duly outraged. The Beltway said Obama needed to put Medicare and Social Security on the table, and they’re on the table.
Will pundits who continue to blame “both sides” for partisan gridlock look ridiculous in the coming months? I sure as hell hope so.
By: Steve Benen, The Maddow Blog, April 10, 2013
“Insurance And Freedom”: How Many Americans Will Be Denied Essential Health Care In The Name Of Freedom?
President Obama will soon release a new budget, and the commentary is already flowing fast and furious. Progressives are angry (with good reason) over proposed cuts to Social Security; conservatives are denouncing the call for more revenues. But it’s all Kabuki. Since House Republicans will block anything Mr. Obama proposes, his budget is best seen not as policy but as positioning, an attempt to gain praise from “centrist” pundits.
No, the real policy action at this point is in the states, where the question is, How many Americans will be denied essential health care in the name of freedom?
I’m referring, of course, to the question of how many Republican governors will reject the Medicaid expansion that is a key part of Obamacare. What does that have to do with freedom? In reality, nothing. But when it comes to politics, it’s a different story.
It goes without saying that Republicans oppose any expansion of programs that help the less fortunate — along with tax cuts for the wealthy, such opposition is pretty much what defines modern conservatism. But they seem to be having more trouble than in the past defending their opposition without simply coming across as big meanies.
Specifically, the time-honored practice of attacking beneficiaries of government programs as undeserving malingerers doesn’t play the way it used to. When Ronald Reagan spoke about welfare queens driving Cadillacs, it resonated with many voters. When Mitt Romney was caught on tape sneering at the 47 percent, not so much.
There is, however, an alternative. From the enthusiastic reception American conservatives gave Friedrich Hayek’s “Road to Serfdom,” to Reagan, to the governors now standing in the way of Medicaid expansion, the U.S. right has sought to portray its position not as a matter of comforting the comfortable while afflicting the afflicted, but as a courageous defense of freedom.
Conservatives love, for example, to quote from a stirring speech Reagan gave in 1961, in which he warned of a grim future unless patriots took a stand. (Liz Cheney used it in a Wall Street Journal op-ed article just a few days ago.) “If you and I don’t do this,” Reagan declared, “then you and I may well spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” What you might not guess from the lofty language is that “this” — the heroic act Reagan was calling on his listeners to perform — was a concerted effort to block the enactment of Medicare.
These days, conservatives make very similar arguments against Obamacare. For example, Senator Ron Johnson of Wisconsin has called it the “greatest assault on freedom in our lifetime.” And this kind of rhetoric matters, because when it comes to the main obstacle now remaining to more or less universal health coverage — the reluctance of Republican governors to allow the Medicaid expansion that is a key part of reform — it’s pretty much all the right has.
As I’ve already suggested, the old trick of blaming the needy for their need doesn’t seem to play the way it used to, and especially not on health care: perhaps because the experience of losing insurance is so common, Medicaid enjoys remarkably strong public support. And now that health reform is the law of the land, the economic and fiscal case for individual states to accept Medicaid expansion is overwhelming. That’s why business interests strongly support expansion just about everywhere — even in Texas. But such practical concerns can be set aside if you can successfully argue that insurance is slavery.
Of course, it isn’t. In fact, it’s hard to think of a proposition that has been more thoroughly refuted by history than the notion that social insurance undermines a free society. Almost 70 years have passed since Friedrich Hayek predicted (or at any rate was understood by his admirers to predict) that Britain’s welfare state would put the nation on the slippery slope to Stalinism; 46 years have passed since Medicare went into effect; as far as most of us can tell, freedom hasn’t died on either side of the Atlantic.
In fact, the real, lived experience of Obamacare is likely to be one of significantly increased individual freedom. For all our talk of being the land of liberty, those holding one of the dwindling number of jobs that carry decent health benefits often feel anything but free, knowing that if they leave or lose their job, for whatever reason, they may not be able to regain the coverage they need. Over time, as people come to realize that affordable coverage is now guaranteed, it will have a powerful liberating effect.
But what we still don’t know is how many Americans will be denied that kind of liberation — a denial all the crueler because it will be imposed in the name of freedom.
By: Paul Krugman, Op-Ed Columnist, The New York Times, April 7, 2013
“The GOP Trickle Down Effect”: Sequestration Takes A Toll On Cancer And Medicare Patients
A funny thing happened on Rush Limbaugh’s radio show yesterday. The Republican host was complaining about a Washington Post report on sequestration cuts hurting cancer patients in the Medicare program, and told his listeners to ignore the news. “All of this is manufactured and made up,” Limbaugh said. How does he know? Because the sequester didn’t include “any cuts in Medicare,” he added.
And then Limbaugh got a call from a conservative oncologist — in this case, a physician who apparently shares the host’s worldview and has no use for the Washington Post — who conceded that the report is, in fact, accurate, forcing Limbaugh to change the subject.
Sequestration cuts are affecting Medicare — though not as much as some other programs — and as Sarah Kliff explained, cancer clinics really are turning away thousands of patients as a result of the Republican spending cuts.
Oncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive chemotherapy drugs while staying afloat financially.
Patients at these clinics would need to seek treatment elsewhere, such as at hospitals that might not have the capacity to accommodate them.
Kliff talked to one Long Island oncologist who said he and his staff held an emergency meeting earlier this week and decided they would no longer see one-third of their 16,000 Medicare patients. “It’s a choice between seeing these patients and staying in business,” Jeff Vacirca, chief executive of North Shore Hematology Oncology Associates said.
But if Medicare was supposed to be shielded from the sequestration policy, how is this happening? It has to do with how medical offices are reimbursed for medications that need to be administered by a physician — such as those given to cancer patients.
The New York Daily News reported today:
The so-called sequester cuts will force three-quarters of the thousands of cancer clinics nationwide to start referring Medicare patients to hospitals, according to the American Society of Clinical Oncology and other cancer treatment groups, which have appealed to the White House and Congress for help.
Elderly cancer patients are being hit hard because their drugs are among the handful of pharmaceuticals that were affected by the sequester cuts.
Medicare reimbursed oncologists for the cost of chemo drugs, plus 6%. But under the sequester, the federal government is now providing only 4% on top of the drugs’ cost, which can run $900 to $15,000 for a full course, depending on the cancer.
That 2% difference may not sound like much, but given the costs involved, it’s an enormous pay cut for the cancer clinics, which some are now saying is a prohibitive new expense they can’t afford.
Ted Okon, director of the Community Oncology Alliance, told Kliff, “If you get cut on the service side, you can either absorb it or make do with fewer nurses. This is a drug that we’re purchasing. The costs don’t change and you can’t do without it. There isn’t really wiggle room.”
Note, this doesn’t mean the sequester is necessarily cutting off cancer patients, but rather, it means these patients are being told by their local oncology clinics that they’ll have to seek care at hospitals — where the care will be less efficient and more expensive.
In case anyone’s forgotten, it’s within Congress’ power to simply turn the sequester off. The whole thing could take five minutes. But for now, congressional Republicans have ruled out the possibility of turning it off, and have also ruled out the possibility of a compromise to replace these brutal spending cuts.
With each passing day, we learn of increasingly drastic consequences associated with the policy.
By: Steve Benen, The Maddow Blog, April 5, 2013
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