“An Ideological Hurdle They Can’t Clear”: Why There’s No Republican Health Care Plan
Where’s the Republican alternative to the Affordable Care Act? The question is generally best suited for milk cartons – it’s pretty clear GOP officials would love to “repeal” the federal health care law, but we’ve been waiting for years to know what they’d “replace” it with.
This observation is an ongoing point of annoyance for the right, which is quick to argue that a variety of Republicans have presented reform plans of their own. Americans for Tax Reform’s Grover Norquist and Patrick Gleason push the argument in a new Politico piece, and Sen. Pat Toomey (R-Pa.) made a related case in the Republicans’ official weekly address over the weekend.
“There are common-sense, bipartisan solutions to our health care problems that don’t require ObamaCare’s wholesale government take-over of the system,” Toomey said. “Now, in a nutshell, we can make insurance more accessible, more affordable, and more responsive to individuals and families. And put patients and their doctors in charge of health care decisions, instead of politicians and government bureaucrats.” […]
Toomey did not mention a specific proposal, but he voiced support for allowing people to transfer insurance from job to job and purchase it across state lines.
And just like that, we’re reminded all over again why Republicans love to attack what exists, but struggle to craft a credible alternative of their own. Toomey still doesn’t quite understand that the Affordable Care Act is not a “wholesale government take-over” of the health care system, and more importantly, can’t get past the “nutshell” phase of the GOP’s rival policy.
In fairness, it’s worth emphasizing that Republicans did present something resembling a health care plan in 2009. Following up on our previous coverage, GOP officials missed a series of self-imposed deadlines in 2009, but eventually threw together a half-hearted joke – the GOP “policy” largely ignored the uninsured, did nothing for those with pre-existing conditions, and offered nothing for those worried about losing coverage when it’s needed most.
As Matt Yglesias noted at the time, the Republican approach to reform sought to create a system that “works better for people who don’t need health care services, and much worse for people who actually are sick or who become sick in the future. It’s basically a health un-insurance policy.” And as ThinkProgress added, the CBO crunched the numbers and found that the Republican alternative would leave “about 52 million” Americans without access to basic medical care.
Pressed for some kind of alternative to Obamacare, this was the best congressional Republicans could do.
Since then, GOP lawmakers have periodically stepped up with alternatives, all of which looked pretty similar. Indeed, a few months ago, when the Republican Study Committee said they’d finally put together an “Obamacare” rival, Ed Kilgore predicted before its unveiling that the policy would feature high-risk pools, interstate sales, tax credits, tort reform, and entitlement reform. A couple of hours later, the RSC unveiled its proposal and it was … exactly what Kilgore predicted it would be.
Months later, Toomey used his party’s weekly address to reiterate support for the same cliches.
The result is a stunted debate. We don’t have two competing approaches to solving a problem that has plagued the nation for decades; we have one party with a solution and another party that hates the solution but has no serious alternative. And this isn’t likely to change anytime soon – NBC’s First Read reported two weeks ago, “House Republicans wouldn’t commit Tuesday to offering their own formal alternative to the Affordable Care Act, instead vaguely describing their preference for a ‘patient-driven health care system.’”
As for why Republicans have no rival plan, as we discussed in September, there’s no great mystery. Every credible, effective solution requires some combination of regulating the private insurance market and investing in broader coverage for consumers. There’s just no way around that, and as a result, GOP officials are left with an ideological hurdle they simply cannot clear.
And so Republicans spin their wheels, condemning a policy that they used to like – remember, the basic ACA blueprint was a conservative approach to health care reform – while pretending to have an alternative they can’t identify in earnest.
By: Steve Benen, The Maddow Blog, December 16, 2013
“A Sobering Reminder”: The Number Of Uninsured Americans Increased By 7.9 Million Under George W. Bush
The week President Obama took office, initial jobless claims, the statistic that immediately gauges layoffs, hit a 26-year high with 637,000 applying for unemployment insurance in one week. It was clear that the president was inheriting a record deficit, a cratering economy and two floundering wars. But buried in all those crises was an unspoken slow-motion disaster that people rarely mentioned: the steady crumbling of our health care system.
“When [former president Bill] Clinton left office, the number of uninsured Americans stood at 38.4 million,” Ron Brownstein wrote in 2009. “By the time [former president George W.] Bush left office that number had grown to just over 46.3 million, an increase of nearly 8 million or 20.6 percent.”
The numbers were just as bad when you looked at the share of the uninsured.
When Clinton left office, 13.7 percent of the population was uninsured. Bush left with 15.4 percent lacking coverage. And the only health reform the last Republican to occupy the White House enacted in his eight years was to add an unfunded prescription drug benefit that guaranteed cuts would need to be made at some point.
So the 15.4 percent of Americans Bush left uninsured in 2008 continued to rise in 2009 to 16.1 percent, then peaked at 16.3 percent in 2010. In 2011, it dipped to 15.7 percent, the biggest drop since 1999. The last census report showed that 48.6 million Americans were uninsured – that’s 15.4 percent. Exactly where it was in 2008.
It would be easy to credit the recovering economy for the rise of insured Americans — initial jobless claims last week were half of what they were when Obama took office. But the percentage of the uninsured is now lower than it was in 2006, before the Great Recession hit.
The New York Times‘ Paul Krugman calls the Affordable Care Act’s role in bringing health-cost growth to its lowest rate on record the law’s “secret success.” But the other secret success is how Obamacare is helping to reverse the growth of the uninsured population. This began in 2011 with children and young adults being able to stay on their parents’ plans until age 26, covering more than three million. And it continues this year with millions of Americans being added to the Medicaid rolls and millions likely to sign up for private plans, if the law’s health care exchanges begin working well enough.
Still Republicans are playing up the estimated 5 million cancellations of plans due to Obamacare the same way they played up the deficit and faltering economy President Obama inherited as if it had been his fault.
We won’t know how many of these people end up in new plans until next year, but we do know that nearly all of them will pay the same or less with a new plan that cannot deny them coverage or charge them more if they get sick.
“To sum up, lots of people losing coverage are losing policies they never liked much, that they would have dropped soon anyway, and that would have left them facing potential financial ruin if they got sick,” The New Republic‘s Jonathan Cohn wrote. “Even those with truly good policies had no guarantees that in one year, let alone two or three, they’d still be able to pay for them.”
Now, millions of Americans are being offered affordable health insurance possibly for the first time in their lives, promising to cut the ranks of the uninsured by millions in just a few years.
While Republicans are mourning cancellations of the exact kinds of plans that left massive holes in our health care system, the question is: Where were those crocodile tears when almost 8 million Americans became uninsured under George W. Bush… and Republicans did nothing to stop it?
By: Jason Sattler, The National Memo, November 29, 2013
“A Series Of Near-Death Experiences”: Republicans Threatening National Harm Every Few Months
Against the backdrop of a government-shutdown deadline, Karen Tumulty noted yesterday the “cumulative effect of almost three years of governing by near-death experience.” It’s phrasing that rings true for a reason — since Republicans retook the House majority in January 2011, no major legislation has become law, but we have endured quite a few crises.
In April 2011, congressional Republicans threatened a government shutdown. In July 2011, congressional Republicans created the first debt-ceiling crisis in American history. In September 2011, congressional Republicans threatened a government shutdown. In April 2012, congressional Republicans threatened a government shutdown. In December 2012, congressional Republicans pushed the nation towards the so-called “fiscal cliff.” In January 2013, congressional Republicans briefly flirted with the possibility of another debt-ceiling crisis. In March 2013, congressional Republicans threatened a government shutdown. And right now, in September 2013, the odds of a government shutdown are quite good once again.
That’s eight self-imposed, entirely unnecessary, easily avoidable crises since John Boehner got his hands on the Speaker’s gavel — a 33-month period in which Congress racked up zero major legislative accomplishments.
Josh Marshall had a good item on the trend over the weekend.
Years ago, Daniel Patrick Moynihan coined the phrase ‘defining deviancy down.’ James Q. Wilson popularized the conceptually related “broken windows” theory of crime and crime prevention. Whether or not these theories and catch phrases work as sociology is separate question; subsequent research has not been kind. But they capture the toxic consequences of the normalization and expanded acceptance of destructive behavior — something that not only applies to individuals and communities but to states and their internal workings. Stepping back from the latest Washington debacle, you quickly see how far down this road we’ve gone without really even realizing it.
It has started to feel normal that two or three times a year we have a major state/fiscal crisis and maybe once every 18 months or two years, there is a true breakdown with fairly grave consequences….. [T]his is really unprecedented stuff — deep attacks on the state itself inasmuch as the state requires for it to function a penumbra of norms surrounding the formal mechanisms of government.
Quite right. In fact, I think it creates unsettling conditions and raises uncomfortable questions about the future of the American experiment.
Put simply, great nations can’t function this way. The United States can either be a 21st-century superpower or it can tolerate Republicans abandoning the governing process and subjecting Americans to a series of self-imposed extortion crises. It cannot do both.
We can be the indispensable nation — we can even be a shining city on a hill — but not with a radicalized major party that throws seasonal tantrums that threaten the nation’s wellbeing. The cost is simply too great.
In the abstract, I imagine Americans who don’t pay attention to day-to-day developments have come to expect routine gridlock and partisan bickering. Democrats and Republicans arguing is arguably the ultimate in dog-bites-man stories.
But those same Americans should search their memories: have they ever seen a governing party threaten five government shutdowns in less than three years, while sprinkling two debt-ceiling crises on top?
The American tradition has no experience with our own elected officials imposing deliberate crises on the nation — as if one of our major political parties is mad at us and feels the need to punish us for offending them.
I realize Republicans consider the Affordable Care Act an example of such profound outrage that they have no choice but to threaten Americans on purpose. I can’t begin to fathom why they hate a moderate law based on Republican principles with such wild-eyed contempt, but it’s currently the world we live in.
My suggestion to them, however, is that they introduce legislation that would deliver their preferred goals. If it passes, they’ll get what they want. If it fails, they can try winning more elections. Either way, watching Republican officials — ostensibly elected to advance our interests — threaten national harm every few months has quite tiresome.
By: Steve benen, The Maddow Blog, September 30, 2013
“Priority Deficit Disorder”: When Congressional Republicans’ Homework And Playtime Are At Odds
Back in March, just two months into the new Congress, Rep. Mike Kelly (R-Pa.) conceded that he had a small problem. He’d been assigned the task of working on loan guarantees for clean-energy companies, and was supposed to write legislation. But that never happened — Kelly got distracted.
His spokesperson said at the time, “It was a priority, and it remains an issue of interest. But Mike’s efforts shifted when he chose to focus more on holding the administration accountable with regards to Fast and Furious. And then when the Benghazi tragedy occurred, that took the cake.”
In other words, there was real work to do, but the Pennsylvania Republican couldn’t get to it because he decided made-up political “scandals” were a better use of his time.
Six months later, those attitudes continue to dominate the House GOP’s thinking.
Republicans on Capitol Hill are acknowledging that the fall’s looming fiscal fights could peel attention away from their investigation into the IRS’s singling out of conservative groups. […]
But Republicans have also made the IRS investigation a key part of their recent political message, at a time when the agency is trying to implement the Democratic healthcare law that conservatives are itching to defund. The controversy has also helped revive a Tea Party movement that had been flagging in recent months.
With all that in mind, GOP aides stress that the congressional investigation into the IRS will be moving full speed ahead, even as a potential debt default takes up much of the oxygen in the halls of Congress.
This will, by the way, include even more hearings into the discredited controversy.
John Feehery, a GOP strategist, told The Hill that Republicans “have to make the connection” between the non-existent IRS story and the Affordable Care Act “because it’s so hot right now.”
Oh for crying out loud.
Look, the House of Representatives is in session only nine days this month. Nine. Congress just took a four-week break, but the Republican-led lower chamber apparently wants to ease back into their work schedule.
On the to-do list? A budget crisis, a debt-ceiling crisis, a farm bill, immigration reform, appropriations bills, and fixing the Voting Rights Act. It’s simply unrealistic to think the dysfunctional House will complete all of these tasks, or even most of them, anytime soon, though a couple of these are non-optional.
But despite all of this work that remains undone, much of which should have been completed before the August recess, House GOP leaders are still eager to invest time and energy in a “scandal” that no longer makes any sense. Why? Apparently because it’s “so hot right now.”
It reminds me a lot of a child who prioritizes playtime over homework. Sure, the homework is important, but it’s not nearly as fun or satisfying as playing — so the child decides some of the homework just won’t get done.
Republicans remain a post-policy party. They have real work to do, which they will neglect because their shiny plaything has a firm grip on their limited attention span.
By: Steve Benen, The Maddow Blog, September 3, 2013
“Holding The Credit Rating Hostage, Again”: The GOP’s Big New Plan To Take Down ObamaCare
With crucial pieces of the Affordable Care Act set to kick in later this year, some conservative lawmakers have been trying to rally support within the party to shut down the government to block the law, or to force President Obama to scrap it.
That threat — a refusal to pass a budget (or in D.C. jargon, a “continuing resolution”) to fund the government until ObamaCare is defeated — hasn’t gained traction with the party at large. Yet now, multiple reports say the thinking inside the GOP is to shift the ObamaCare battle from the budget fight to another looming fall showdown: The debt ceiling. (For a refresher, read the Guardian‘s helpful history of the debt ceiling here.)
From the Washington Examiner’s Conn Carroll:
House leadership firmly believes that attaching anything “new” to a continuing resolution is politically untenable, while passing a higher debt limit, without attaching anything new, is also politically impossible. Hence the House leadership’s desire to fight ObamaCare through the debt limit, but not the CR.
The plan is to pass a 60-day CR extension that keeps discretionary spending at the existing sequestration levels. Then House leadership wants to combine Democratic desires to roll-back sequestration with conservative desires to delay/defund ObamaCare into the debt limit fight. [Washington Examiner]
A government shutdown, besides failing to actually defund ObamaCare, has the potential to be politically disastrous for the GOP. Republicans bore the brunt of public rage over the government shutdown in 1995 when they refused to bargain with President Clinton, and they would likely suffer the same fate should they go that route again now. No wonder conservative commentators like Charles Krauthammer have labeled the strategy “really dumb.”
Though the impact of a debt ceiling standoff is tougher to predict, the fallout would be more economic than political, potentially sparing the GOP on that front. Still, if the debt ceiling isn’t raised — meaning the U.S. couldn’t borrow more money to pay its existing debts, thus threatening the nation’s credit rating — the fiscal consequences for the country could be catastrophic. That’s why this gambit would represent a “massive escalation” in the ObamaCare funding showdown, argues New York‘s Jonathan Chait.
Closing the federal government for a limited period would have mostly political consequences (probably for the Republicans). The substantive effects build up cumulatively and start to really harm the economy after weeks on end, but the two sides could negotiate through a shutdown.
The debt ceiling is another story. The effects of missing the deadline would be immediate and, while unpredictable, potentially very large and irreversible. That’s why Obama now insists, after disastrously allowing himself to be extorted in 2011, he won’t negotiate the debt ceiling, but has never made an analogous pledge about a continuing resolution. [New York Magazine]
Unlike the very vocal threat to shut down the government over ObamaCare, the latest rumored standoff is, for now, merely rumblings from behind closed doors. And there’s at least some reason to believe it will amount to no more than an empty threat in the end.
The Republican leadership has been increasingly under pressure to appease the right wing of the party. Publicly insisting that ObamaCare funding will be fought further down the road would soothe the demand for that fight in the first place, while kicking the can down the road, perhaps indefinitely.
As the Washington Post’s Greg Sargent points out, this is exactly what happened with the last debt ceiling fight. In January, Boehner said the upcoming sequester debate, not debt ceiling fight, gave the GOP its best position to push for major budget cuts. Yet the sequester came and went without the GOP winning those deep concessions.
There’s some reason to think the same dynamic is at play here, too. The health care exchanges mandated under the ACA go into effect October 1. If Republicans really try to defund ObamaCare during the debt ceiling talks, they will, in effect, be arguing a settled debate.
Here’s Sargent:
So now, under this emerging plan, Republicans would be moving to demand a delay in ObamaCare’s implementation — after the exchanges kick in — in exchange for not allowing the country to go into default, even though Boehner himself has already admitted the debt limit must be raised to avoid putting the full faith and credit of the U.S. at risk?
What all of this comes down to is that GOP leaders need to decide if they are going to level with their base, and acknowledge that blocking ObamaCare by using this fall’s confrontations as leverage is just a nonstarter, period, full stop — whether we’re talking about a government shutdown, the debt limit, or whatever. [Washington Post]
By: Jon Terbush, The Week, August 15, 2013
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