“A Thuggish Abuse Of Power”: Republicans’ Devious Plan To Slow Down Obamacare Enrollment
Republican lawmakers who had criticized the Internal Revenue Service (IRS) for improperly targeting conservative nonprofits for additional scrutiny kicked off an investigation last week into community-based groups who received Navigator grants to help uninsured people enroll in the exchanges established by the Affordable Care Act, demanding that the organizations answer detailed questions and produce thousands of reams of documents.
Fifteen Republican members of the House Committee on Energy and Commerce, including Chairman Fred Upton (R-MI), are requesting detailed responses and thousands of pages of documents from approximately 60 percent of Navigator-recipients across the country by Sep. 13.
The tactic is reminiscent of the kind of practices Republicans had condemned over the summer, after news broke that the IRS subjected certain groups applying for 501 C4 nonprofit tax status to long, intrusive, questionnaires about their filings. Upton personally called such tactics a “thuggish abuse of power” and “simply un-American.”
But according to the GOP-backed letter, groups scrambling to begin enrolling individuals in coverage on Oct. 1, will have just two weeks to provide detailed written descriptions of their employees and activities, interactions with the Department of Health and Human Services, and “all documentation and communication related to your grant.”
Last month, the Obama administration distributed $67 million in federal grants to more than 100 hospitals, universities, Indian tribes, patient advocacy groups and local food banks “to help people sign up for coverage in new online health insurance marketplaces.”
The effort is just the latest attempt by Republicans to undermine enrollment in the Affordable Care Act. Republicans on the Energy and Commerce Committee have previously sent letters seeking information to entities tasked with educating the public about the law, opened investigations into public relations companies that had been contracted to promote the law on popular television shows, and warned the National Football League (NFL) and National Basketball Association (NBA) against encouraging enrollment in the law.
An HHS spokesperson strongly condemned the committee’s request to Politico, noting, “This is a blatant and shameful attempt to intimidate groups who will be working to inform Americans about their new health insurance options and help them enroll in coverage, just like Medicare counselors have been doing for years.”
By: Igor Volsky, Think Progress, September 3, 2013
“A Whole New Concept”: On Syria, Congressional Republicans Are Put Into The Position Of Actually Having To Govern
By seeking congressional approval for military action against the Syrian government, President Obama has accomplished something that the nation hasn’t seen in some time: He’s compelled Republicans to divert their attention from their concocted crises to an issue of actual substance.
As the August recess unfolded, Republicans — including a number of prospective presidential candidates — contemplated whether to shut down the government as a protest of Obamacare and whether to refuse to honor the nation’s debt as a cri de coeur against Obamacare or the deficit or Obama himself or perhaps modernity in general. These issues were debated at length, if never quite in depth, on right-wing talk radio and Web sites. That nobody but the hard-core Republican right seemed stirred by shuttering the government and defaulting on the debt mattered not at all.
If the American right increasingly seems to occupy an alternative planet, that’s largely because its media outlets — we can throw Fox News into the mix — dwell on stories so exquisitely calibrated to excite the right that they may not be stories at all. The New Black Panther Party? The Epidemic of Voter Fraud? The calculated perfidy of Benghazi? The impeachable crime of Obamacare (a socialist scam actually modeled on a proposal from a conservative think tank 20 years ago)? It’s not the editorials and opinionating of right-wing broadcasters and journalists that are driving the right into fantasyland. It’s the tales they spin into stories and the time and space they devote to events that never actually happened or that they surreally misconstrue.
By throwing the Syrian conundrum to Congress, Obama has at least confronted Republicans with a real-world choice. Since Saturday, the drumbeat for closing down the government has been muted in its usual haunts.
That’s why the coming collision of libertarian fantasies with reality will be instructive. Can a congressman vote to defund the government and approve a military action in the same month? Or vote to authorize cruise missile attacks while insisting the government default on its debts? All these issues will soon come before Congress in rapid succession.
The U.S. government has obligations to the American people even more fundamental than seeking to stop the use of chemical weapons that are killing innocents in a foreign land. It provides pensions to the elderly, health coverage to the old and the poor, and, in a few months, it will help Americans without health insurance buy private coverage. It has obligations that conservative opposition has kept it from meeting — among them, repairing and modernizing the nation’s infrastructure and creating the jobs (say, by repairing the infrastructure) that the nation’s private-sector employers are unable or unwilling to create.
Conservatives routinely disparage such basic government functions. But even right-wing media have to acknowledge the legitimacy of government when employing the armed forces is at issue. Whether it is wise or prudent to employ those forces is always the most legitimate of questions. Whether the nation should halt such actions, or the payment of its pensions and health-care obligations, because the government should stop functioning altogether until Obamacare or Obama or modernity just go away is not.
In theory, House Speaker John Boehner, who has spent decades in government, does not support its abolition. In practice, he has been cowed by his party’s libertarian right and by the increasing dissolution of other strains of Republicanism, which is why he has occasionally threatened both closure and default. As the share of Americans who support and identify with Republicans shrinks in the polls, the faithful who remain have taken on the aspects of a cult — secure in the knowledge of “facts” that aren’t facts, passionate about causes whose very existence bewilders their compatriots, determined to punish any believers who stray from the fold.
Now Syria has popped the balloon of their insular summer. Right-wing Republicans may decide not to authorize a strike because they want to embarrass the president, but even they must know that there’s more at stake than their war on Obama: life and death; the future of a crumbling country and a volatile region; our own security as well as U.S. credibility. There may even be more things in heaven and earth than are dreamt of in what passes for their philosophy.
By: Harold Meyerson, Opinion Writer, The Washington Post, September 3, 2013
“A Tragic Waste Of Time”: In The Budget Fight, The GOP Doesn’t Act In The National Interest
Are we really going to do this? Are we going to wade into a struggle we don’t really want to fight? Are we going to mire ourselves in a senseless, grinding conflict whose possible outcomes range from bad to worse?
I’m talking about the upcoming budget battles in Washington, of course. (What, you thought I meant something else?)
Incredibly, Congress seems determined to spend much of the fall demonstrating its boundless talent for dysfunction. House Republicans say they will threaten once again to send the nation into default — and the economy over a cliff — by refusing to raise the federal debt ceiling, now set at $16.7 trillion. This means that by mid-October, the government would exhaust its borrowing authority and be left without enough money to pay its bills.
“The president doesn’t think this is fair, thinks I’m being difficult to deal with,” House Speaker John Boehner (R-Ohio) said last week at an Idaho fundraiser. “But I’ll say this: It may be unfair, but what I’m trying to do here is to leverage the political process to produce more change than what it would produce if left to its own devices. We’re going to have a whale of a fight.”
In other words, Boehner is looking forward to the opportunity to threaten the nation with grievous harm. Nice little economic recovery you’re working on. Wouldn’t want anything to happen to it.
President Obama, who has seen this movie before, says there will be no fight because he categorically refuses to negotiate over the debt ceiling. He demands that Congress do its job — which amounts to a routine bit of bookkeeping — without all the needless drama.
Investors around the world still consider U.S. Treasury bills, notes and bonds to be the ultimate safe haven, especially in times of economic uncertainty. It is unthinkable that our elected officials, supposedly working in the nation’s best interests, would threaten this exalted and immensely beneficial status by intentionally triggering a default.
So who’s going to blink?
Obama certainly has the stronger political position. His approval numbers may be stuck in the 40s, but ratings for Congress are down in the teens — and sinking.
Boehner has almost no room to maneuver. House Republicans are still fuming at having been forced to swallow a modest tax increase for the wealthy as part of the “fiscal cliff” deal earlier this year. The responsible thing would be for Boehner to bring a simple bill raising the debt ceiling to the floor, where it would pass with the votes of Democrats and non-crazy Republicans. But that would probably cost Boehner his job.
You’re depressed already? I’m just getting started.
Before we even get to the debt-ceiling fight, the government will run out of authority to spend money on Sept. 30 — which means no ability to function — unless Congress approves a continuing resolution. Doing so should be another no-brainer, but some Republicans are itching for a government shutdown. Because, you know, that worked so well for Newt Gingrich in the ’90s.
Boehner wants none of that. But in an attempt to get House Republicans to avert a shutdown by passing a short-term funding bill, he promises them a “whale of a fight” later over the debt ceiling. (He treats his caucus as if it were a cage full of rabid wolverines.)
Oh, and there’s another whole dimension to the pointless political snarling and bickering we will have to endure over the next few months: Obamacare.
Some Republicans believe, or say they believe, that they can use the continuing-resolution fight or the debt-ceiling fight, or maybe both, to force Obama to sign legislation nullifying all or part of his health-care reforms. One idea is to take away Obamacare’s funding. Another is to delay the individual health insurance mandate, due to take effect next year.
Do they really believe the president is willing to forsake his most important legislative accomplishment? Before it even comes fully into effect?
This is a tragic waste of time and effort, and the House Republicans are to blame. Remember when Democrats captured the House in 2006? They worked with George W. Bush even though they disagreed with his policies. Most Democrats adamantly opposed the Iraq War, but then-Speaker Nancy Pelosi made sure that Bush got the funding he required for the troops.
Boehner and his crew need to act like grown ups. If they don’t, voters need to send them home.
By: Eugene Robinson, Opinion Writer, The Washington Post, September 2, 2013
“Rand Paul’s Dangerous Lasik Obsession”: But When It Comes To The Uninsured, Nobody Has A Right To Health Care
Senator Rand Paul has spent much of the August recess engaged in typical political activities—attending a roundtable on school reform, participating in a fundraiser for a fellow Republican, and speaking at a local ham breakfast. But Paul also set aside some time for one more unusual activity: Helping some people to see. Paul, an ophthalmologist, performed several eye surgeries. All of them were for patients who don’t have insurance. And he donated his services for free.
I know what you’re thinking: Paul and his advisers decided to publicize his day of charity care, in order to create the impression that he’s a do-gooder. You’re probably right. I first learned about it from an article by Katrina Trinko of National Review, who was on the scene to write about it. So were some other reporters, including a television crew. They didn’t get there by accident. But who cares? Maybe Paul was looking for good headlines or maybe he was trying to keep up his skills. (Senate rules prohibit him from maintaining a private practice while in office.) Regardless, Paul appears to have a genuine history of charity work: According to his official biography, he helped establish the Southern Kentucky Lions Eye Clinic and has won awards for his humanitarian work. Now, thanks to this latest surgical effort, a handful of people have better sight. Good for them and good for Rand Paul.
Of course, as Trinko’s story makes clear, Paul would have you believe that his good deeds—and his experience as a physician—justify his positions on health care policy. That’s another matter entirely. Paul is a well-known critic of government-run and government-regulated health care programs, starting with the Affordable Care Act. The opposition is in many ways philosophical: Nobody has a “right” to health care, he says, because that would mean people have a right to commandeer the labor of those who provide care. Trinko, in her article, quotes Paul explaining this position during a speaking event:
“As humans, yeah, we do have an obligation to give people water, to give people food, to give people health care,” Paul muses. “But it’s not a right because once you conscript people and say, ‘Oh, it’s a right,’ then really you’re in charge, it’s servitude, you’re in charge of me and I’m supposed to do whatever you tell me to do. . . . It really shouldn’t be seen that way.”
It’s a strange, almost nonsensical argument, for reasons that Paul Waldman notes at the American Prospect:
saying that health care is a right doesn’t mean that doctors have to treat people without being paid, any more than saying that education is a right means that public school teachers have to work for free. Because we all agree that education is a right, we set up a system where every child can be educated, whether their families could afford to pay for it themselves or not. It doesn’t mean that any kid can walk up to a teacher in the street and say, “I command you to teach me trigonometry for free. Be at my house at 9 tomorrow. You must do this, because I have a right to education and that means I am in charge of you and you’re supposed to do whatever I tell you to do.”
Of course, Paul is also making a practical argument. With less government interference and regulation, and more people paying for services directly rather than through insurance, the market would bring down prices on its own—and medical care would become more affordable for everybody. As proof, he points to a procedure ophthalmologists know well: Lasik, the laser eye surgery that eliminates the need for glasses or contact lenses. Via Trinko, again:
“Insurance doesn’t cover Lasik surgery, the surgery to get rid of glasses,” Paul remarks. “So it started at about $2,000 an eye, maybe even $2,500 an eye, and it’s down in some communities to under $500 an eye because competition works and people call on average four doctors to get the price and see how much it’s going to cost.”
Libertarians and conservatives love to cite Lasik. But Lasik tells you almost nothing about the rest of the health care system, for reasons Jeff Levin-Scherz, a physician at the Harvard School of Public Health, has pointed out:
1. Lasik surgery is entirely elective. No one NEEDS it!
2. Lasik surgery is never an emergency. Hence, it’s much more “shoppable” than most health care
3. Lasik surgery is highly automated—the computers actually do a substantial amount of the work. Therefore quality is more uniform than most health care
4. There is very high fixed cost for the Lasik laser—and the low variable cost makes it more likely that providers will price this at “marginal” cost—leading to large discounts. That’s not true of cognitive services.
Ten extra visits with a neurologists cost almost ten times as much as a single visit given the large variable cost of the neurologist’s labor. Ten extra Lasik surgeries cost only a small amount more than a single surgery—since the cost of the ophthalmologist and technician is a relatively smaller portion of the total cost.
And that’s not to mention the fact that the Lasik market has been prone to more problems than promoters like Paul let on. Paul Ginsburg, the economist and president of the Center for the Study of Health Systems Change, testified about this some years ago:
LASIK has the greatest potential for effective price shopping because it is elective, non-urgent, and consumers can get somewhat useful price information over the telephone. Prices have indeed fallen over time. But consumer protection problems have tarnished this market, with both the Federal Trade Commission and some state attorneys general intervening to curb deceptive advertising and poorly communicated bundling practices. Many of us have seen LASIK advertisements for prices of $299 per eye, but in fact only a tiny proportion of consumers seeking the LASIK procedure meet the clinical qualifications for those prices. Indeed, only 3 percent of LASIK procedures cost less than $1,000 per eye, and the average price is about $2,000.
Mostly, though, the problem with Paul’s position on health care reform is the number of people it leaves out. Like every other Republican who has demanded repeal of Obamacare, he’s never proposed anything that would come close to covering as many people, or providing the same level of protection. On the contrary, he’s proposed radical changes to Medicaid that would almost certainly even higher rates of uninsurance than exist today.
According to Trinko’s article, one of the patients Paul treats is a 55-year-old woman. She says she has no insurance because it would cost her $700 a month—money that she doesn’t have. Under Obamacare, people in her position would be eligible for subsidies worth hundreds or even thousands of dollars a month—or they’d have a chance to enroll in Medicaid, as long as their state officials weren’t refusing to participate Obamacare’s expansion of the program.
Paul helped that woman to see. But if he has his way, millions of Americans in similar situations won’t be as lucky. They won’t have the same access to care or they’ll face financial ruin. Ultimately, what Paul does at a surgical center matters a lot less than what he does at the Capitol—or, potentially, the White House.
By: Jonathan Cohn, Senior Editor, The New Republic, August 27, 2013
“Last Phase Of The Kabuki Dance”: John Boehner’s Phony New Ransom Demand That He’s Been Saving
Boxed in by his caucus’ demand to defund Obamacare on one side, and a steeled White House on the other, House Speaker John Boehner seems ready to throw in the towel and enter the last phase of the Kabuki dance he’s staged for the benefit of his insolent Republican base.
Of course, he won’t say this, and his recent comments at a fundraiser in Idaho appear on their face to be a doubling down, but, when read correctly, they actually suggest the opposite. “I’ve made it clear that we’re not going to increase the debt limit without cuts and reforms [to mandatory entitlement spending] that are greater than the increase in the debt limit,” he said yesterday.
This entitlement demand is mostly new. While we got hints that Boehner might put Social Security and Medicare on the table back in early July, we’ve hardly heard a peep about it since. Instead, Republicans have been focused defunding Obamacare.
As Josh Barro writes, insisting on entitlement cuts is often Boehner’s last move before capitulation, because he knows it’s a ransom demand that will never be paid. He did it in December, when spokesperson Michael Steel used almost the exact same words: “Any debt limit increase would require cuts and reforms of a greater amount.” (The next month, the House voted overwhelmingly to bypass the debt ceiling and got none of those cuts.) And Boehner did it 2011. That time, he won the overall battle, but he still didn’t get any entitlement cuts.
Cutting the safety net is anathema to Democrats, and in the unlikely scenario that they’d do it, they certainly aren’t going to rush it through in the perhaps 15 legislative work days Congress has before it hits the October debt ceiling deadline. Boehner knows this.
And he’s done nothing to suggest he’s serious about entitlement cuts. There was a brief, peculiar moment this spring when the White House not only was willing to talk social safety net reform, but actually put cuts to Social Security in their budget. And Democratic congressional leaders suggested they’d deliver enough votes to pass something. What did Boehner do? He rejected the proposal out of hand, sight unseen, and called it ”no way to lead and move the country forward.” (That was basically the White House’s expectation all along, they claimed when liberals threatened mutiny.)
If Boehner’s entitlement demand was an empty threat in 2011 and 2012, and he didn’t take up his best chance at it in 2013, then it has to be even more of a bluff today as the landscape has titled decidedly against Republicans, MSNBC’s Suzy Khim notes. The deficit is falling fast and a clear majority of Americans opposed to defunding Obamacare, according to a new Kaiser poll out today, so the White House holds most of the cards. Both they and Boehner know that a government shutdown or default will be worse for Republicans than for Democrats, so this time the president is refusing to negotiate with the hostage takers.
So now, all that’s left is for Boehner to somehow bring his base along. He doesn’t necessarily need their votes, but he needs to drop the pitchforks for moment. Brian Beutler previews how it may go down:
Boehner introduces legislation that both increases (or extends) the debt limit and includes some goodies for conservatives that make the bill a non-starter with Senate Democrats and the President (maybe a year-long delay of the individual mandate — let your imaginations run wild); that bill fails on the House floor; everyone panics; faced with no better option, Boehner breaks the Hastert rule, puts a tidy, Senate-passed debt limit bill on the floor, and we all dress up as Speaker Pelosi for Halloween.
Of course, Beutler notes, plenty of things could go wrong. For instance, Boehner could decide that he’ll refuse to break the Hastert rule (meaning he won’t put anything on the floor that isn’t supported by a majority of Republicans) under any circumstance.
He’s done that when it comes to immigration reform, where he could pass a bill tomorrow if he were willing to use Democratic votes. He knows that every time he breaks Hastert, he enrages the Republican base a little bit more, so it’s possible that he’s been saving it up for this moment, which he must have known would come.
By: Alex Seitz-Wald, The Plum Line, The Washington Post, August 28, 2013
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