“Between A Rock And A Stupid Place”: The Medicaid Scandal Of State Level Republicans
As the reality of states refusing the insanely generous terms of the Affordable Care Act’s Medicaid expansion (viz., the Texas legislature’s proactive legislation prohibiting the state from participating), begin to sink in, with it comes the realization that a completely perverse situation will now prevail in these states. The New York Times‘ Robert Pear explains for anyone who hasn’t heard:
More than half of all people without health insurance live in states that are not planning to expand Medicaid.
People in those states who have incomes from the poverty level up to four times that amount ($11,490 to $45,960 a year for an individual) can get federal tax credits to subsidize the purchase of private health insurance. But many people below the poverty line will be unable to get tax credits, Medicaid or other help with health insurance.
You will occasionally hear that people left exposed by states refusing to expand Medicaid are “covered” by Obamacare health insurances exchanges, and that’s true for what little it’s worth. The subsidies designed to make coverage affordable for the working poor (and a big chunk of the middle class), however, don’t kick in until a beneficiary’s income is above the federal poverty line. That’s because it did not occur to the Affordable Care Act’s sponsors that the Medicaid expansion provisions covering all Americans up to the poverty line would become voluntary for the states. And you know what? Had they known the Supreme Court was going to so rule, they probably would have thought no state would hate its own poor people enough to turn down the fiscal deal represented by the expansion (that was certainly the assumption a lot of otherwise smart observers made when the Court’s decision came down). Turns out as many as 25 states may in fact go in that stupid and malevolent direction, leaving up to 5.7 million Americans at the very heart of Obamacare’s intended coverage population without meaningful access to health insurance.
Now normally you’d think a Court-created “hole” in a legislative plan of this size would lead to a legislative “fix,” wouldn’t you? But that is for sure not happening until such time as Democrats regain control of the House and of 60 Senate seats–the temporary majorities that made enactment of the Affordable Care Act over the united opposition of the GOP possible in the first place.
The scandal of state-level Republicans leaving so much federal money on the table and so many poor people in the lurch may well become a campaign issue in 2014. But while this treachery is very likely to become a long-term political issue for Republicans in the affected states–particularly in the South, where its racial dimensions are impossible to ignore–the overall landscape going into the 2014 midterm election is hardly promising for Democrats there or nationally.
So putting things right and holding the happy architects of this wildly unfair situation may take a good long while. But payback’s hell.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, May 28, 2013
“Putting The Train Wreck On Hold”: Everything Anti-Obamacare Republicans Predicted Is Proving To Be The Opposite Of Reality
The Affordable Care Act, like every landmark piece of legislation in modern times, has faced its share of trials. Getting it through Congress was nearly impossible, and the law was very nearly killed by the Republican appointees on the U.S. Supreme Court.
But with the law now secure and President Obama re-elected, there’s one more major challenge for “Obamacare” to overcome: the implementation hurdle. As we discussed several weeks ago, this is at least as big a hurdle as the others, and more than a few observers have raised the prospect of a “train wreck.” Even those who generally defend the law are worried.
They are, however, a little less worried today. As Matt Yglesias explained, implementation of the law is “fundamentally” going quite well.
The latest evidence comes to us today from California, America’s largest state and one of the states that’s tried the hardest to actually implement Obamacare. As Sarah Kliff explains, their exchanges are getting set up, and it looks like premiums for “silver” and “bronze” plans are both going to be lower than was previously expected. Far from a “train wreck,” in other words, the biggest single set of clients for the program is getting something like a nice, smooth high-speed train ride.
There was also good news from Oregon recently, where insurers that had initially come in with high premium bids are now asking to resubmit with cheaper offerings in the face of competition. And the Affordable Care Act’s goal of slowing the growth in aggregate health expenditures is also coming true.
Yep, at least for now, everything anti-ACA Republicans predicted — on premiums, on competition, on exchanges, on escalating costs — is proving to be the opposite of reality.
Now, because of state-by-state differences, there will be quite a bit of variety in outcomes. If you live in California or another state dominated by Democratic officials, you’ll likely have a very positive impression of how the law is being implemented, and how it benefits you, your family, and your community.
If you live in, say, Texas, you’re likely to have a very different kind of experience.
As Jonathan Cohn explained this morning:
Unfortunately, millions of uninsured and under-insured Americans live in places like Florida and Texas, where there is far less sympathy — and a great deal more hostility — to the idea of Obamacare. It’s entirely possible that the insurance bids in those states will be a lot higher, precisely because state officials there are doing nothing to help and quite a bit to hurt implementation. But if that happens, blame won’t belong with the heath care law or the federal officials in charge of its management. It will belong with the state officials who can’t, or won’t, deliver to their constituents the benefits that California’s officials appear to be providing theirs.
It’s not necessarily an explicitly partisan matter — I’m not saying that Democrats are necessarily better at health care governance. Rather, the point is, Democrats don’t have an ideological axe to grind when it comes to trying to sabotage federal health care law. Rick Perry, however, does.
To be sure, these red-state residents won’t be left out entirely, and they’ll still benefit from all kinds of consumer protections and expanded access that they’ll really appreciate, even if they don’t yet realize the available benefits. But the full benefits of implementation will elude them for a while in ways blue-state residents won’t have to deal with.
Regardless, the news out of California is a bit of a breakthrough, and heartening news for anyone hoping to see the Affordable Care Act succeed. For more on this, also take a look at the reports this morning from Klein, Krugman, and Beutler.
By: Steve Benen, The Maddow Blog, May 24, 2013
“Full Speed Ahead”: Republican Overreach Is Coming Soon
A number of people have asked whether the Republicans will overreach in their reaction to the current collection of scandal-ish controversies (by the way, someone really needs to come up with a name that encompasses them all). The answer to that question is, of course they will. Try to remember who we’re talking about here. Overreaching is their thing. Congress will be going home this weekend, and I’ll bet the Republicans are going to come back from their recess reassured that their constituents really, really want them to pursue Barack Obama to the ends of the earth. I’ll explain why in a moment, but in the meantime the National Journal has details on their strategy:
Congressional Republicans head into next week’s Memorial Day recess armed with a strategy designed to keep the controversies that have consumed Washington in the news back home.
Both House and Senate Republicans will focus on the Internal Revenue Service targeting conservative groups for extra scrutiny as well as the still-open questions about Benghazi. And more and more, they’ll try to tie them together into a made-for-2014 narrative of an unaccountable and out-of-control government.
In interviews on local television and radio programs and with newspapers, Senate Republicans plan to talk about the Obama administration’s “credibility gap.” They’ll throw into the mix Health and Human Services Secretary Kathleen Sebelius’s request that health industry officials help fund “Obamacare,” a move Republicans call a “shakedown” of the companies she regulates, according to a Senate GOP leadership aide.
Lawmakers will argue that a “lack of details, stonewalling,” and what they call an “ever-changing White House narrative” on both Benghazi and the IRS have led to a trust deficit with the public, a sentiment reflected in recent polls, the aide said.
Part of the aim is to get voters to question how they can trust the administration, and the IRS more specifically, to enforce key provisions of Obama’s health care law after improperly targeting Americans.
This fits into Republicans’ emerging scandal-riding midterm election strategy—one that the GOP’s congressional campaign committees think can blend easily into their anti-Obamacare message to help the party take the Senate in 2014.
When they return from this recess, Republicans are going to be more sure than ever that they’re doing the right thing. Think about what a member of Congress does when he’s home. He’ll be doing those media interviews with friendly talk-radio hosts, for whom outrage is the bread and butter of their programming. He might do a couple of town meetings, and who comes to those? People who like him already (i.e. the Republican base, who will tell him to keep up the scandal-mongering) and people who are pissed off about something. But right now, the people who think the scandal thing is going too far aren’t really pissed off, they’re just kind of disappointed. So they won’t be so inclined to show up. And then the representative will just go around town talking to folks, and once again the ones he’s most likely to hear from are his supporters who want to tell him to stick it to that no-good socialist in the White House.
After a few days of that, he’ll come back to Washington thinking, “Wow, my constituents are really fired up about this stuff. Full speed ahead!”
By: Paul Waldman, Contributing Editor, The American Prospect, May 14, 2013
“Reverse Sticker Shock”: Reality-Based Evidence On Obamacare In California Amidst All The GOP Hysteria
For months now we’ve been told that the Affordable Care Act would produce a cataclysm of skyrocketing health insurance premiums, particularly in the individual insurance markets that the law most affects. Earlier this week alarms were raised particularly in California with the news that three major insurance companies had decided against participating in the health care exchanges that would offer Obamacare coverage.
So it’s a bit of a shock–sort of a reverse sticker shock–today to learn that preliminary assessments of the cost of the new, improved (because subject to new minimum coverage requirements) policies in California once the exchanges are up and running will in most cases be lower than what citizens of this high-cost state are accustomed to paying. TNR’s Jonathan Cohn summarizes the news:
Based on the premiums that insurers have submitted for final regulatory approval, the majority of Californians buying coverage on the state’s new insurance exchange will be paying less—in many cases, far less—than they would pay for equivalent coverage today. And while a minority will still end up writing bigger premium checks than they do now, even they won’t be paying outrageous amounts. Meanwhile, all of these consumers will have access to the kind of comprehensive benefits that are frequently unavailable today, at any price, because of the way insurers try to avoid the old and the sick.
Sarah Kliff of Wonkblog has more details:
Health insurers will charge 25-year-olds between $142 and $190 per month for a bare-bones health plan in Los Angeles.
A 40-year-old in San Francisco who wants a top-of-the-line plan would receive a bill between $451 and $525. Downgrade to a less robust option, and premiums fall as low as $221.
These premium rates, released Thursday, help answer one of the biggest questions about Obamacare: How much health insurance will cost. They do so in California, the state with 7.1 million uninsured residents, more than any other place in the country.
Multiple projections expected premiums to be relatively high.
The Congressional Budget Office predicted back in November 2009 that a medium-cost plan on the health exchange – known as a “silver plan” – would have an annual premium of $5,200. A separate report from actuarial firm Milliman projected that, in California, the average silver plan would have a $450 monthly premium.
Now we have California’s rates, and they appear to be significantly less expensive than what forecasters expected.
On average, the most affordable “silver plan” – which covers 70 percent of the average subscriber’s medical costs – comes with a $276 monthly premium.
Such numbers, it is important to note, do not reflect the actual cost to the estimated 2.6 million Californians who will qualify for Obamacare tax subsidies (available to those with incomes up to 400% of the federal poverty rate).
One of the “horror stories” we’ve been hearing from Obamacare opponents for years now is that the whole scheme will collapse once healthy, low-income young people realize they’ll face large news costs for the kind of minimum high-deductible catastrophic coverage they actually need. They’ll bail, it has been suggested, not only from Obamacare (screwing up the broad-based risk pools that make affordable coverage for older and sicker people possible), but from Obama’s political coalition as well. So this comment from Kliff about the California numbers is worth noting:
For a less robust “bronze” plan, which covers 60 percent of the average beneficiary’s costs, the tax credit could actually cover the entire premium for low-income twenty-somethings.
None of this should really be that surprising; the idea that a broader pool plus competition and guaranteed benefits would provide a better bargain (plus vastly greater security) for consumers in the individual market was central to the entire Affordable Care Act architecture. But it’s taken a while for facts to catch up with all the negative agitprop. It won’t keep House Republicans from voting to repeal the entire law a 38th or 39th or 40th time before the bulk of the Affordable Care Act becomes effective next year. Still, it’s nice to see some reality-based evidence amidst all the hysteria.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, May 24, 2013
“Resonance Resistant”: Republicans Racing Off The Cliff In Their Supercharged Outrage Machine
Whether one thinks the demiscandals being howled about in Washington should or should not resonate more widely, they don’t.
According to a Gallup report released Thursday, “The amount of attention Americans are paying to the I.R.S. and the Benghazi situations is well below the average for news stories Gallup has tracked over the years.” (The Associated Press phone records case wasn’t mentioned.) Why might this be? I have a few theories:
CREDIBILITY People know that the Internal Revenue Service is the conservatives’ bogeyman. It’s the agency that collects the taxes that Republicans hate so much. Some Americans see taxes as, at worst, a necessary nuisance; Republicans see them as an absolute evil. The I.R.S. is the agency that collects the wealth from “us” for the government to redistribute to “them.” As National Journal pointed out Friday, “The agency also implements much of the country’s social policy through the tax code.” We all know that anything with “social” in its name activates the conservative gag reflex.
And on the Associated Press front, it just doesn’t ring true to have Republicans standing up as defenders of the “lame-stream media.” It’s like the person with the club feigning common cause with the baby seal. People just don’t buy it.
Furthermore, Republicans have exhibited a near-pathological need to say anything, no matter how outlandish, that would invalidate the Obama presidency. This has left them with little credibility now that there may be legitimate problems. This is the story of the political party that cried “Kenyan.”
COMPLEXITY Where is Benghazi? Seriously, folks, quickly point it out on a map. Thought so. Now, to the controversy: the talking points — what they said, and the machination of how that was altered, and whether Al Qaeda should have been immediately blamed, and whether the word “terror” should have had an “-ist” or an “-ism.” Seeking to find the killers of four dead Americans is honorable; endless testimony about a fussed-over script used to explain the tragedy is mind-numbing.
UNPOPULARITY It is clear that the Justice Department overreached on the Associated Press scandal and that its strong-arm tactics are likely to have a chilling effect. But Americans are not big fans of mass media. A November Gallup poll found that only a fourth of Americans rate the honesty and ethical standards of journalists highly. Even bankers ranked higher.
As for Tea Party groups that received extra scrutiny from the I.R.S., an Associated Press-GfK poll released last month found that fewer than a fourth of Americans say they support the group. The Tea Party may well be passé.
The policy issue is a different story, as The Washington Post pointed out this week: “In 2010, the Supreme Court’s landmark ‘Citizens United’ decision cleared the way for corporations and labor unions to raise and spend unlimited sums of money, and register for tax-exempt status under section 501(c)(4).”
That decision was extremely unpopular. An ABC News/Washington Post poll released nearly a month after the decision was handed down found that 80 percent of Americans opposed it.
So an unpopular movement applied for tax-exempt status under conditions made possible by an unpopular court decision, in order to influence politics with unfathomable amounts money from unnamed donors? Good luck gaining sympathy for that.
ZEALOTRY The Congressional Tea Party Caucus founder, Michele Bachmann, who never misses a chance to say something asinine, suggested to the conservative site wnd.com that it was “reasonable” to worry that the I.R.S. might use Obamacare to kill conservatives.
The article reads, in part:
“Since the I.R.S. also is the chief enforcer of Obamacare requirements, she asked whether the I.R.S.’s admission means it ‘will deny or delay access to health care’ for conservatives. At this point, she said, that ‘is a reasonable question to ask.’ ”
“Reasonable” and “Bachmann” don’t even belong in the same conversation, let alone the same sentence, and yet she remains one of the most visible spokeswomen for the movement.
Even former House Speaker Newt Gingrich warned Republicans against overreaching. In an NPR interview that aired Friday, Gingrich, referring to the impeachment of President Clinton, said, “I think we overreached in ’98 — how’s that for a quote you can use?”
He continued, advising his party to be “calm and factual.” Ha! That’s too rich, and too late. Republicans are already invoking the I-word.
Republicans are their own worst enemies at times like these, unable to leave well-enough alone, and missing chances to honestly engage the public as they race off the cliff in the supercharged outrage machine.
By: Charles M. Blow, Op-Ed Columnist, The New York Times, May 17, 2013
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