“Reality Be Damned”: Do Republicans Need A Plan B On ObamaCare?
For years, Republicans have trotted out the same message: ObamaCare is a massive disaster, and the public knows it. And when Healthcare.gov crashed out of the starting gate, that message proved quite resonant.
Yet as ObamaCare begins to turn the corner, Democrats are going back on the offensive, touting the law’s benefits and successes in hopes of boosting support for it — and the party — ahead of the 2014 elections. Republicans, meanwhile, have so far stood by the same critiques, betting that the law will still be seen as a failure come Election Day.
Which raises a thorny question for the GOP: What if ObamaCare works?
Undoubtedly, ObamaCare is now functioning better than it was in October. Though problems remain for the exchange site — the back end is still a mess, often sending bogus or incomplete information to insurers — enrollments are reportedly surging through both the federal and state-run marketplaces.
Good news in hand, the White House and congressional Democrats this week launched a campaign of daily pro-ObamaCare messaging to promote the law ahead of the December 23 enrollment deadline for coverage that kicks in January 1, 2014. Their goal is to present a “raw two-sided picture,” according to Politico, with “Democrats delivering benefits on one side, and Republicans trying to deny them on the other.”
“My main message today is: We’re not going back,” Obama declared in a reboot speech Tuesday.
If ObamaCare keeps improving, the GOP’s “we told you ObamaCare was a mess” pitch could quickly wear thin. And if it does, Republicans will find themselves in need of a new argument or a legislative alternative.
So far, they don’t really have either.
On the messaging front, House Speaker John Boehner (R-Ohio) on Tuesday repeated boilerplate GOP criticisms that the law is “fundamentally flawed,” and that it “continues to wreak havoc on American families, small businesses, and our economy.” Other GOP leaders similarly contended that the law is still a problem-plagued failure.
That the message hasn’t changed despite ObamaCare’s turnaround proves that “Republican complaints of two months ago were purely opportunistic,” wrote Jamelle Bouie over at the Daily Beast.
“For them, it just doesn’t matter if Healthcare.gov is working, since ObamaCare is destined to fail, reality be damned!” he added. “At most, the broken website was useful fodder for attacks on the administration. Now that it’s made progress, the GOP will revert to its usual declarations that the Affordable Care Act is a hopeless disaster.”
The GOP has also yet to offer a credible legislative alternative to ObamaCare. Though there are several Republican bills that would reform the health-care system, they’re generally considered suspect, and none have consensus support within the GOP. Boehner on Tuesday tellingly dodged a question about whether he would even bring up such a bill up for a vote, saying only, “We’ll see.”
Polls have shown that while voters aren’t too keen on the health-care law, they’re willing to give it a chance. Indeed, the first few months of ObamaCare’s disastrous rollout could be a distant memory once coverage and benefits kick in next year.
Which points to another problem for Republicans: Their anti-ObamaCare crusade will be tough to sustain once people begin to see the law’s benefits in action. Mother Jones‘ Kevin Drum sussed out that point, writing, “Once the benefits of a new program start flowing, it’s very, very hard to turn them off.”
By the middle of 2014, ObamaCare is going to have a huge client base; it will be working pretty well; and it will be increasingly obvious that the disaster scenarios have been overblown….
Given all this, it’s hard to see ObamaCare being a huge campaign winner. For that, you need people with grievances, and the GOP is unlikely to find them in large enough numbers. The currently covered will stay covered. Doctors and hospitals will be treating more patients. ObamaCare’s taxes don’t touch anyone with an income less than $200,000. Aside from the Tea Partiers who object on the usual abstract grounds that ObamaCare is a liberty-crushing Stalinesque takeover of the medical industry, it’s going to be hard to gin up a huge amount of opposition. [Mother Jones]
Republicans have so far committed themselves to staunchly opposing ObamaCare no matter what, even producing a playbook for attacking the law from here to November 2014. But if ObamaCare continues to improve, the GOP might need to draw up a new play — or risk getting burned at the polls.
By: John Terbush, The Week, December 4, 2013
“Unsatisfying To The Media And Republicans”: Surprise, Obamacare Now Projected To Cost Hundreds Of Billions Less Than Expected
Amidst the dark skies of the Healthcare.gov launch, some daylight may finally be emerging with respect to one of the critical goals of the Affordable Care Act—bending the cost curve of America’s expensive healthcare system.
According to a New York Times report out Tuesday, the Congressional Budget Office has quietly removed hundreds of billions of dollars from the projected costs of Obamacare, primarily the result of an anticipated decrease in the federal government’s contribution to the Medicaid expansion program along with the projected cost of the subsidy payments to those buying private insurance policies on the healthcare exchanges.
Why the good news?
The more favorable projections are the direct result of the slowing trend in the growth of healthcare spending over the past five years leading to a slowdown in rising costs. While, ten years ago, per-capita spending on healthcare had been growing by an average annual rate of 5 percent, that number was dramatically cut to 1.8 percent during the 2007-2010 period and reduced even further to 1.3 percent in the years following 2010.
Do we have Obamacare to thank for this highly successful “bending” of the cost curve?
Naturally, the answer depends upon who you ask as there simply is no definitive way of knowing—yet.
While most economist believe that the lion’s share of the reduction is due to the sluggish economy—making Americans far more careful when it comes to making decisions regarding when or if to spend money on medical care—others believe that some of the plans built into the ACA designed to get people to spend less may actually be working.
Among Obamacare inventions that do appear to be paying off in lower healthcare costs is the government’s refusal to pay hospitals more when patients are re-admitted within 30 days of their initial discharge. Additionally, new plan designs engineered to reward providers for quality of care rather than for quantity of care may well be paying off in terms of lowering the overall cost of care.
According to the Kaiser Family Foundation—widely regarded as an honest, non-partisan broker when it comes to healthcare issues and analysis—the declining increases in the cost of healthcare is 75 percent the result of economic factors and 25 percent a benefit of the cost cutting measures in the ACA that do, in fact, appear to be working.
Of course, the big question is whether or not these cost lowering provisions of Obamacare will continue to do the job once the economy regains its more typical trajectory.
There are reasons to be hopeful that healthcare spending can be held down once the economy kicks into higher gear.
For starters, while many Americans shopping for new health insurance policies may be decrying the higher deductibles they are discovering in the new offerings, higher deductibles should have a meaningful impact on the decisions people make when determining whether or not a visit to the doctor or agreeing to a given procedure is really necessary. While a $250 deductible will likely not cause a patient to ask how much a suggested CT Scan is going to cost, a $3,000-$5,000 deductible is far more likely to cause the patient to ask a few more questions and make more focused decisions when payment for the test is coming out-of-pocket.
Not surprisingly, there are no shortage of economists and pundits who believe that the ACA will prove inadequate to the task of controlling costs once the economy is in better shape.
Others are more hopeful, believing that the slowdown in costs are very much a result of hospitals and insurance companies understanding that something had to change given the unsustainable trends in rising costs. As a result of a desire to derail out-of-control costs before the costs derailed them, insurers and hospitals became involved in substantial systemic revisions designed to lower healthcare spending even before the government required them to do so.
Discussing whether the current decreases can last when previous periods of cost-curve bending did not, Annie Lowrey writes in her New York Times piece—
“This time may be more durable. Insurance and hospital executives in Massachusetts, Illinois and California, among other places where reforms have gone the furthest, report a consensus that spending growth had become unsustainable, and that expectations that Washington would force changes to the system spurred them to make changes themselves.”
If this is true—and I believe the evidence reveals that it is—these self-imposed changes, in tandem with the changes brought about by elements of Obamacare that don’t receive nearly as much attention as the more hot button issues, may prove to provide lasting changes to the system; changes that will point our cost trajectory in the right direction.
Like most elements of the Affordable Care Act, these issues and results only go to prove that far more time is required before we can even begin to measure the real benefits or detriments of Obamacare.
While this reality may prove unsatisfying to the media, politicians and those in the public who are so emotionally committed to the failure and ultimate death of Obamacare—whether for political purposes or only so that the opponents can experience the satisfaction of having been right—anyone interested in realistic measurement of this dramatic change in our system better settle in for the long run.
It’s going to be awhile until we know how this story ends.
By: Rick Ungar, Op-Ed Contributor, Forbes, December 4, 2013
“Brazen Dishonesty”: California GOP ‘Reaches For The Bottom’
Health care policy can get confusing, even for policy experts who study the details for a living. It’s one of the reasons dishonesty in the political debate surrounding health care is so damaging – even the most well-intentioned people often don’t know how best to separate fact from fiction.
It’s why efforts from political officials – who know better – to deliberately confuse people are so disappointing. Michael Hiltzik reports:
Opponents of the Affordable Care Act never stop producing new tricks to undermine the reform’s effectiveness. But leave it to California Republicans to reach for the bottom. Their goal appears to be to discredit the act by highlighting its costs and penalties rather than its potential benefits.
The device chosen by the Assembly’s GOP caucus is a website at the address coveringcaliforniahealthcareca.com. If that sounds suspiciously like coveredca.com, which is the real website for the California insurance exchange, it may not be a coincidence.
In theory, this is a site created by California Republicans to serve as a “resource” for those looking for additional information. In practice, the site “is worse than useless” – it didn’t direct users to the in-state exchange marketplace, and includes demonstrable falsehoods intended to deceive the public.
Like what? The site includes the ridiculous notion that the Affordable Care Act increases the federal budget deficit, which is the exact opposite of reality. It also claims the IRS will use the law to target conservatives; it says the law will discourage private-sector hiring; and it even hints in the direction of the death-panel smear by raising the specter of “rationing” for the elderly.
All of these claims are wrong. All of them are presented, however, on a website that presents itself as objective and non-partisan.
Stepping back, dishonesty on this scale is certainly brazen, but it raises anew a lingering question: if the Affordable Care Act is so awful, and will be as horrific as critics claim, why do Republicans continue to feel the need to make stuff up? Shouldn’t reality be damaging enough?
By: Steve Benen, the Maddow Blog, December 4, 2013
“The Blurred Line Between Caricature And Reality”: Republicans Are Nothing If Not Predictable
It’s become a running joke: when Republican get bored with the latest manufactured outrage of the day, they turn to the Benghazi and IRS “scandals” as a standby. Indeed, it’s been widely assumed over the last several weeks that as the Affordable Care Act improves, GOP lawmakers would have no choice but to return to their favorite faux political controversies.
They are nothing if not predictable. Here’s Senate Minority Whip John Cornyn (R-Texas) yesterday:
“Since the terrible tragedy that took four American lives in Benghazi, we’ve had difficulty, to put it mildly, trying to get to the bottom of this,” the second-ranking Senate Republican said during a Google Hangout session he held while the Senate is on recess. ”Now the goal is to talk to the Benghazi survivors – people who were actually there who could tell the truth and expose what happened and hold the people responsible accountable. This has been a cover up from the very beginning.”
And here’s House Oversight Committee Chairman Darrell Issa (R-Calif.) soon after:
The House’s chief investigator says the FBI is stonewalling his inquiry into whether the agency and the Internal Revenue Service targeted conservative group True the Vote for special scrutiny, and Rep. Darrell E. Issa is now threatening subpoenas to pry loose the information from FBI Director James B. Comey Jr.
Mr. Issa, California Republican, and Rep. Jim Jordan, Ohio Republican, are leading the House Oversight and Government Reform Committee’s IRS inquiry. They also said the FBI is refusing to turn over any documents related to its own investigation into the IRS, which began in the days after an auditor’s report revealed the tax agency had improperly targeted tea party groups for special scrutiny.
The White House should probably consider this a good sign. Remember, as recently as last week, congressional Republicans were reluctant to talk about literally any issue other than the Affordable Care Act, afraid that any distraction from the dysfunctional website might let Democrats off the hook. Even the reaction to the “nuclear option” was muted because Republicans wanted all of the political world’s focus solely on health care – and nothing else.
And it now appears that phase is ending and far-right lawmakers are back to Benghazi and the IRS. If that isn’t affirmation of the White House’s health care initiative getting back on track, nothing is.
By: Steve Benen, The Maddow Blog, December 3, 2013
“Will The GOP Ever Be Happy?”: No Matter The Facts, They Just Don’t Care If Healthcare.Gov Works Or Not
Healthcare.gov is well on its way to full stability, but Republicans refuse to acknowledge it. No matter the facts, the GOP is committed to the message that Obamacare has failed.
It wasn’t that long ago when Republicans were deeply concerned over the quality of the president’s healthcare website.
In a letter to Kathleen Sebelius, head of the Department of Health and Human Services, Rep. Darrell Issa and Sen. Lamar Alexander demanded answers for the massive glitches that attended the rollout of Healthcare.gov. “We are concerned by recent comments to the media that the system suffers from architectural problems that need design changes,” wrote the two GOP lawmakers, “We seek information about these problems as well as whether you still expect individuals to suffer a tax penalty if they do no purchase government-approved health insurance.”
Likewise, in a statement, Republican National Committee chairman Reince Priebus said that “Obamacare is collapsing under its own weight.” This was echoed by the Senate Republican Policy Committee, which called the website an “inexcusable train wreck” and wondered “how President Obama can tax uninsured Americans for not having something that they can’t purchase.”
The administration responded to all of this criticism—and more—with a promise that Healthcare.gov would work for the majority of users by December 1st. And it does. According to the administration, a five week “tech surge” has doubled the capacity of the online interface to the health care exchanges that form the core of the Affordable Care Act. As of this month, the website can handle 50,000 simultaneous users, for a total limit of 800,000 users per day. The site is functional more than ninety percent of the time, up from fifty-five percent of the time in October.
There is still a whole host of work to finish, especially on the back-end, where critical communications are made to insurers with regards to subsidies and eligibility. Overall, however, the White House has achieved more than 400 of the 600 fixes on its “punchcard” of repairs. Healthcare.gov is on the fast track to full stability, which will be a significant boost to the law and its prospects.
Given the extent to which Republicans were so concerned with the status of the website, you’d think they would greet this as good news, even as they continue to oppose the law. The message doesn’t have to be extensive. Something as simple as, “We still oppose the law, but we’re glad Americans haven’t been left in the cold,” would suffice.
Even that, however, is too generous for Republicans, who can’t concede any goodwill to the president’s health care law. “[The] website is least of Obamacare’s problems,” tweeted Sen. John Cornyn of Texas. “This isn’t just about a broken website, it’s about a fundamentally-flawed law,” wrote Michael Steel, a spokesperson for Speaker of the House John Boehner. And on ABC’s This Week, Oklahoma Senator Tom Cole said that “You never get a second chance to make a first impression, and the first impression here was terrible.”
The Republican complaints of two months ago were purely opportunistic. For them, it just doesn’t matter if Healthcare.gov is working, since Obamacare is destined to fail, reality be damned! At most, the broken website was useful fodder for attacks on the administration. Now that it’s made progress, the GOP will revert to its usual declarations that the Affordable Care Act is a hopeless disaster. Meanwhile, hundreds of thousands of Americans have gained access to health insurance thanks to the Medicaid expansion or the exchanges, and many more will join their ranks as the deadline for coverage approaches.
Republicans haven’t offered a response to this because, as of this moment, the party doesn’t have a response. Yes, there are conservative intellectuals with ideas for reform, but as an institution, the GOP has little to say about the constellation of problems in American health care. Even in their drive for repeal, Republicans failed to offer an alternative. At most, lawmakers like Bob Corker of Tennessee have tentatively called for “market-driven” reforms, like changes to the tax code, and allowing insurers to sell across state lines. Ironically, the Affordable Care Act allows for these changes, but that doesn’t seem to matter to the GOP.
It’s almost cliché to say that the Democratic Party is gambling its success on the Affordable Care Act. If it works, the party can point to a broad program that delivers needed benefits to millions of Americans. If it doesn’t, it’s hard to imagine how Democrats will re-earn the trust of a skeptical public, to say nothing of the fate of the uninsured and the broader consequences for liberalism.
In the same way, the Republican Party is gambling its fate on the failure of the law, with no attempt to grapple with the possibility of its success. What happens if Obamacare works as advertised? How do GOP leaders salvage a failed crusade? And more importantly, how do GOP voters react when the prospect of repeal is completely, unambiguously off the table?
By: Jamelle Bouie, The Daily Beast, December 2, 2013
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