“When A Politician Tells The Truth”: GOP Candidates Are Seeing Obamacare In A Different Light
In an interview with a reporter last month, Senator Thad Cochran (R-MS) “accidentally” made complimentary remarks about the Affordable Care Act, routinely known as Obamacare. (His campaign aides claim he misunderstood the question.) Some analysts say those remarks were among the missteps that have left the senator in danger of defeat as he faces a primary runoff against a Tea Party upstart, Chris McDaniel.
It’s possible that Cochran was confused when he told The Washington Post that the ACA “is an example of an important effort by the federal government to help make health care available, accessible and affordable.” It’s also possible that he committed the standard political gaffe as commentator Michael Kinsley defined it years ago: “… when a politician tells the truth — some obvious truth he isn’t supposed to say.”
Either way, Cochran’s comments are a reminder of a pronounced shift among Republican politicians discussing Obamacare on the campaign trail. Few of them are delivering feisty denunciations and declarations of repeal, as they did just a few months ago. Even in deeply conservative states, Republicans are muting their rhetoric, acknowledging positive tenets of the ACA and engaging in equivocation — or, in some cases, fabrication — to cover their tracks.
That’s because the political terrain has shifted beneath their feet. In practice, as its proponents have long predicted, the ACA has helped millions of people to obtain health care they would not have been able to afford otherwise. Surely it’s no surprise that few voters want to give up benefits they have just begun to enjoy.
That has meant some less-than-artful dodging by such indefatigable partisan warriors as Senate Minority Leader Mitch McConnell. In keeping with the GOP script, McConnell has been adamant about repealing the ACA.
But in his home state of Kentucky, Kynect, the state-run exchange that connects residents to Obamacare, is wildly popular, having signed up more than 400,000 people for health insurance. So McConnell takes advantage of voters’ confusion — many don’t understand that Kynect is Obamacare — to suggest he supports the exchange but not that foul law that made it possible. Indeed, he has gone so far as to declare that they are unconnected — a laughable lie, even in the warped reality of a political campaign.
Several other prominent Republicans have found themselves in a similar bind, as many facets of the law prove politically popular. Voters still don’t like “Obamacare,” but they like many of its provisions, including those that outlaw bans on patients who have pre-existing conditions.
Voters also support the provision that prevents lifetime caps on insurance payments — something that benefits those with serious, chronic illnesses — and the one that allows parents to keep their children insured until they are 26 years old. Indeed, the only provision that remains broadly unpopular is the mandate that requires every adult to buy health insurance (a necessary feature of the law, and one that many Republicans, including Mitt Romney, once believed in).
Perhaps the most dramatic shift among GOP pols has concerned Obamacare’s Medicaid expansion. The Supreme Court’s ruling affirming the ACA made the Medicaid expansion optional for states, and most Republican governors resisted it. That was foolish and shortsighted, since the federal government pays the overwhelming portion of the additional cost. Those governors — and their GOP colleagues in Congress — were willing to trade better health for some of their poorest residents for the chance to poke Obama in the eye.
But now some of them are seeing the error of that calculation. For one thing, it’s hard to own up to a willingness to shaft the working poor. For another, some rural hospitals can’t afford to stay open unless they receive additional Medicaid funds. Those hard facts have forced GOP Senate candidates such as Michigan’s Terri Lynn Land to back away from their diehard opposition to Obamacare.
And, as more Americans benefit, the resistance will grow weaker still. That was the historical cycle with Medicare — which the GOP establishment fought long and hard — and Obamacare will likely follow that path to broad acceptance.
By: Cynthia Tucker, Visiting Professor at The University of Georgia; The National Memo, June 7, 2014
“Memo To GOP”: The War Over Big Government Health Care Is Over, And You Lost
The federal government has released new data on Medicaid enrollment showing that with the implementation of the Affordable Care Act, six million Americans were added to the program’s rolls. That’s six million low-income people who now have health coverage, who can see a doctor when they need to and who don’t have to worry about whether an accident or an illness will send them spiraling into utter financial ruin.
The numbers reveal something else, too, something that should horrify conservatives: we’re well on our way to health-care socialism.
Okay, that’s an exaggeration. But only a slight one. And at a time when the press is realizing that Republicans are losing their taste for anti-Obamacare bloviating (more on that in a moment), it shows that Bill Kristol’s nightmare has nearly come true.
Back in 1993, Kristol wrote Republicans an enormously influential memo advising that the best approach to Bill Clinton’s health reform plan was not to do everything they could to kill it outright. If any plan managed to pass, he warned, “it will re-legitimize middle-class dependence for ‘security’ on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.”
Now let’s look at where we are today. Prior to ACA implementation, there were just under 59 million people enrolled in Medicaid and CHIP, the program that covers poor children. States that accepted the ACA’s expansion of Medicaid signed up a total of 5.2 million new people. The states that rejected the expansion signed up an additional 800,000; these are “woodwork” enrollees, people who were already eligible under their state’s (often absurdly restrictive) rules, but came out of the woodwork to sign up because of all the attention to health care. Add them in, and there are now 64 million Americans on Medicaid and CHIP.
On top of that, there are now over 52 million seniors on Medicare. There are another 9 million veterans enrolled in the Veterans Health Service.
That’s a total of 125 million Americans getting their insurance from the federal government (or, in the case of Medicaid, a federal-state program). The current U.S. population is 318 million. That means that 39 percent of us, or just under two out of every five Americans, are recipients of government health insurance.
As a liberal, of course, I believe that’s a good thing, though just how good varies from program to program (I’ve spent enough time fighting with private insurance companies to wish I could be insured by the government). Conservatives, on the other hand, view this as a disaster. What they’ve only partly come to terms with is the fact that it’s going to be almost impossible for them to do anything about it.
It’s true that Republicans appear to have realized that while the ACA remains unpopular, the idea of repealing it is even less popular. Which is why, as the November election approaches, they’ve almost stopped trying to elevate the issue. As Sam Baker points out, Republicans passed on the opportunity to use the confirmation of Sylvia Burwell to be HHS secretary as a forum to relitigate the law, and the bills circulating around the Hill on health care are now more likely to be small-bore fixes. Notes Baker: “Anyone who’s been around Capitol Hill and health care for the past four years can see it — the anti-Obamacare fire just isn’t burning as hot as it used to.”
Beyond that, as this blog has documented, multiple Republican Senate candidates are now mouthing support for Obamacare’s general goals and have essentially been reduced to gibberish when trying to explain their “repeal and replace” stance.
But the story is bigger than all of this. Republicans may have to accept that while we may not have the single-payer system liberals want, government still dominates American health care, and that isn’t going to change.
It isn’t just that Republicans could stage another fifty ACA repeal votes in the House and accomplish just as little as the last 50 repeal votes did. Rather, it’s that even if Republicans took back the White House and both houses of Congress, moving people off their government insurance would be next to impossible.
One of the most important lessons of the last 20 years of health reform is this: people fear change. That’s what the Clinton administration found out when their attempt at reform crashed and burned, in large part because the Clinton plan would have meant a change in coverage for most Americans. The Obama administration took that lesson to heart in creating its plan, which was designed to give coverage to people who lacked it but offer only new protections to those who already had insurance. That was also the reason for the false but endlessly repeated “if you like your insurance, you can keep it” assurances — they knew that if most Americans, particularly those with somewhat-secure employer plans, thought they’d have to endure some kind of change, then they’d once again be gripped by fear.
Any Republican plan to unwind the ACA is going to run headlong into people’s fear of change and be stopped in its tracks. Are you going to push 64 million Medicaid and CHIP recipients off their current insurance and onto private plans? Are you going to move away from employer-provided coverage? Are you going to privatize Medicare?
Perhaps, given the right circumstances, Republicans could overcome that fear. But I wouldn’t bet on them finding a way to do it.
By: Paul Waldman, The Plum Line; The Washington Post, June 5, 2014
“Why So Many Are Clueless”: Shameful Coverage Of Obamacare’s Real Impacts
If you read my column last week about a Senate hearing that showed how Obamacare has affected Americans, you might have wondered if I was in the same room with reporters who presumably covered the event.
The disparity goes a long way toward explaining why so many of us are clueless about the actual impact the law is having on our lives.
The title of the May 21 Senate Commerce Committee hearing: “Delivering Better Health Care Value to Consumers: The First Three Years of the Medical Loss Ratio.” I was one of four witnesses talking about the part of the law that requires health insurers to issue rebates to policyholders if they spend more than 20 percent of premiums on non-medical expenses, including profits — the so-called Medical Loss Ratio.
Prior to the passage of the law, insurance company executives — who consider what they spend on medical care to be a loss — were in many cases devoting up to half of premiums they collected to pay for advertising and other administrative functions and to reward executives and shareholders.
As I wrote last week, consumers have saved at least $3 billion since the provision of the law that mandates insurers must spend at least 80 percent of our premiums on medical care went into effect in 2011.
The hearing wasn’t just about numbers, however. Katherine Fernandez, a small business owner from Houston, testified about how the MLR provision and other aspects of the law have enabled her family to pay less for far more comprehensive coverage than was possible in the past.
She told the committee that because both her husband and son had pre-existing conditions, the only policies available to them pre-Obamacare would not cover any medical care pertaining to those maladies. And even then the policies had both high premiums and high deductibles. She said that during the 14 years prior to the law’s passage, her family paid more than $100,000 in premiums for what she described as bare-bones coverage. And the premiums went up sharply every year — 165 percent between 2000 and 2003 alone.
She said she was elated when the Affordable Care Act passed. “No more pre-existing condition clauses … and insurance companies had to refund some of what we paid if they didn’t spend enough. What reasonable ideas.”
If you read the accounts of the hearing in The Washington Post, USA Today, Politico or CBS News — the only news outlets I could find that provided any coverage — you would not have read anything about the $3 billion consumers have saved as a result of the MLR provision or how the law has benefited the Fernandez family.
The focus of all those stories was a brief exchange toward the end of the hearing between Committee Chair Jay Rockefeller, a West Virginia Democrat, and GOP Sen. Ron Johnson of Wisconsin about whether the color of President Obama’s skin might explain why some people are opposed to the law.
Rockefeller suggested race might be a factor, which provoked a spirited denial from Johnson. Politico’s only hint about the hearing’s actual subject was this: “His (Rockefeller’s) critiques of the GOP again came in a sparsely attended committee hearing, this time during an analysis of health-care spending.”
The only one of these pieces that even mentioned “medical loss ratio” was the CBS story, and it, too, was primarily about the exchange between Rockefeller and Johnson. In the USA Today article, which apparently was based on a National Journal transcript, the only hint of a hearing was in the very last sentence: “Rockefeller then veered into another topic before adjourning the hearing.”
That other topic, of course, was the medical loss ratio.
The Washington Post likewise found medical loss ratio of no interest. Its story, too, was about the back-and-forth between Rockefeller and Johnson during what the reporter dismissed as “an otherwise sleepy committee hearing.”
Granted, it is challenging to substantively cover the Affordable Care Act. The U.S. health care system is dizzyingly complex, and so is the law. It’s far easier to write about constant political sparring than to take the time to educate readers about what’s actually in the law and how it affects people. It’s not a heavy lift to review a transcript and write the kind of “he said, she said” — in this case the “he said, he said” — coverage that passes for journalism.
There are a lot of reasons why Americans don’t know how the law affects them or why they believe things about Obamcare that aren’t true. The Democrats have done a lousy job of explaining it. And more than $400 million has been spent by opponents attacking it — 15 times as much as has been spent by supporters. But one of the biggest reasons is the failure of many in the media to provide anything other than the most superficial coverage. As a former reporter who used to cover hearings on the Hill, I consider that shameful.
By: Wendell Potter, The Center For Public Integrity, June 2, 2014
“McConnell’s Obamacare Policy”: Repeal It, Then Immediately Reinstate The Whole Damn Thing
I think there’s one way, and only one way, to interpret Mitch McConnell’s position on the Medicaid expansion in Kentucky, and last night the Washington Post’s fact checker confirmed it. McConnell wants to repeal the Medicaid expansion (along with the rest of Obamacare) and then let the people who run the state of Kentucky (i.e. people other than him) decide whether to reinstate it, and pay for it out of state coffers.
That’s a difficult position to support, which explains why his campaign obscures it behind a bunch of rambling designed to convince people (including very politically savvy people) that McConnell has come around to supporting the Medicaid expansion.
But it’s actually identical to his position on Kynect—the state’s health insurance exchange—and perhaps he’ll apply it to other integral parts of Obamacare as well. As a general matter it amounts to arguing that Obamacare should be repealed, and then reinstated in full at the state level. But that’s a total fantasy.
When Obamacare is repealed, the funding Kynect relies upon, as well as the health plans and rules that make it a popular and widely used portal, will disappear as well. No biggie, says McConnell. Once they’re gone, the state can decide whether it wants to reinstitute those things on its own.
But of course, as with Medicaid expansion, it’s almost impossible to imagine states riding to the rescue of those harmed by Obamacare’s repeal. Running the exchange is fairly expensive on its own, but its costs would dwarfed by the resources required to recreate the actual market Obamacare has created in Kentucky. Remember, Kentucky flirted with creating Obamacare’s coverage guarantee without creating any incentives for everyone to purchase insurance. No mandate, no subsidies. And the system predictably collapsed. But it’s unlikely that Kentucky could afford to reinstate ACA-style subsidies on its own. And without them, the plans will be too expensive to justify a mandate. And so under McConnell’s policy, Kentucky’s newly insured would be left with nothing.
The idea that ACA politics are gruesome for Democrats is so deeply ingrained in the national media’s belief system that it won’t be shaken loose by McConnell’s dissembling alone. But if it were true, why would Republicans across the country be hiding their true views about Obamacare behind the word “fix”? Why would any Republicans, let alone the Senate GOP leader, be saying they want to get rid of everything Obamacare does except the things it does in their own states?
By: Brian Beutler, The New Republic, May 30, 2014
“The Comforting Feeling Of Rolling Heads”: It May Make You Feel Better, But Will The Issue Be Solved?
Since the firing of Health and Human Services Director Katherine Sebelius you no longer hear as much about repealing the Affordable Care Act (although certain candidates, most recently Scott Brown, continue to bring it up). But when her head rolled a lot of people seemed to feel better. Now the call is for the head of Veterans Affairs Secretary Eric Shinseki, after dozens of stories cited deaths allegedly related to delayed care for veterans at many of the nation’s 1700 veterans hospitals and treatment centers. If he is let go people may feel better. But will the issue be solved?
The so-called secret lists of veterans waiting for care is troubling, but if it is true then the system as a whole needs an overhaul. This has been apparent for some time and was previously highlighted by the conditions at Walter Reed Hospital and the delay in computerizing records. But these things most likely won’t follow merely by firing the secretary. And although Congress is calling for another investigation, at the same time recent budget proposals by the GOP reduce money for veterans, including cutting health benefits for veterans.
VA hospitals and clinics served 8.76 million veterans last year. In 2008, 37 percent of veterans sought treatment for PTSD and depression. But it is thought that at least half of all veterans suffer from these. Those who report PTSD usually also suffer from many other conditions, some of which do not manifest themselves until more than 5 years after service.
The VA is a huge bureaucracy which serves as the largest single health care system in the country. Along with men and women who served in Iraq and Afghanistan, it still serves veterans of World War II, Korea and Vietnam. Today’s veterans survive injuries that would have quickly killed veterans of earlier wars, including burns, amputations and traumatic brain injuries. And in the past ten years the numbers of vets seeking care has increased exponentially due to our most recent wars, with almost half of those veterans seeking disability compensation for their injuries.
For some perspective: In 2010 the Office of Inspector General for the Department of Health and Human Services reported that bad care contributed to 180,000 deaths of patients in Medicare alone. As many as 440,000 people nationwide suffer from some sort of preventable harm which could have contributed to their death. And that is in our civilian hospitals. Medical error is the third leading cause of death in the US.
Average wait time in hospital emergency rooms has risen. It can take two to four weeks to get an appointment with a specialist (In 2009 people waited an average of 20 days. In 2010 fifty percent of our population felt they could have avoided a trip to the ER if they had been able to get an appointment with their regular doctor People without insurance have received little or no care until recent changes with the implantation of the ACA. Before the passage of the ACA, as many as 45,000 uninsured died each year.
In many small towns, including Savannah, Georgia, waiting times to see a mental health specialist can be at least a month for a psychologist and three to six months for a psychiatrist. At the local VA clinic in Savannah, veterans wait no more than three weeks, and often less, for mental health care and walk-ins who are in crisis are treated immediately.
According to the Associated Press yesterday, a recent report indicated that the department’s internal watchdog found no evidence that delays have caused patient deaths. President Obama has appointed deputy White House chief of staff to review VA policies and procedures.
Further inquiries will be held and outrage will continue to mount until something concrete is done. This is not a new issue. But firing Shinseki is like providing palliative care for end-of-life patients: the patient will be more comfortable but he will still die. Any investigation into the VA has to result in major changes to the system as a whole which will not be possible if the problem is “solved” by yet another head rolling.
By: Lisa Solod, Washington Monthly Political Animal, May 17, 2014
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