“The Grandfather Of Obamacare”: How Mitt Romney Paid For Romneycare With Federal Help
Republican presidential candidate Mitt Romney told Univison in an interview Wednesday that he did not mind when President Obama called him the “grandfather” of Obamacare when referring to the program Romney instituted when he was governor of Massachusetts. Quite the opposite. Romney thought other states might take a page from the Massachusetts playbook.
We didn’t have to cut Medicare by $716 billion. We didn’t raise taxes on health companies by $500 billion, as the president did. We crafted a program that worked for our state. I believe the right course for health care reform is to say for each state we’re going to give you the Medicaid dollars you’ve had in the past, plus grow them by 1 percent. And you, as the states, are now going to be given targets to move people to insurance, and you craft programs that are right for your state. Some will copy what we did; others will find better ideas.
Romney is right: The state of Massachusetts did not cut Medicare to finance health care (nor could it have, as states don’t have a say in the federally financed entitlement budget). Whereas the Affordable Care Act levies a tax on insurance companies and makers of medical devices, the Massachusetts law has no similar provision.
But could a state with a capped Medicaid budget, as Romney has proposed, copy what Romney did in Massachusetts and end up with universal coverage? Romney’s own experience suggests probably not: His state a special pot of federal money, alongside a preexisting assessment on hospitals and insurers, to expand insurance coverage to 98 percent of its population.
Way back in 1985, under then-Gov. Michael Dukakis, Massachusetts set up a program called the Uncompensated Care Pool. Much like the name suggests, the pool is used to finance health care for those without insurance. Massachusetts financed the plan largely through assessments on hospitals and insurers. Under Romney’s administration In 2004, each industry paid in about $157 million to keep the pool running. That plan still operates today — under the name Health Safety Net – and covers health care needs that Massachusetts residents cannot afford.
Since the late 1990s, Massachusetts has also received additional Medicaid funds to enroll populations that other states traditionally do not cover. In 2005, when Romney was governor, the federal aid amounted to $550 million. As former Romney adviser John McDonough explains in his book “Inside Health Policy,” the funds were crucial to laying the foundation for universal health coverage. He takes us back to 2005, when the George W. Bush administration was getting ready to end that special funding arrangement:
“In Masachusetts, $350 million is a lot of money, and the news set off alarm bells. Governor Romney reached out and formed a partnership with Senator Kennedy to scheme how to keep the extra federal dollars coming. At that moment, the state’s mundane desire to retain federal dollars merged with the policy goal of universal coverage to create a new policy imperative. Romney and Kennedy proposed that Massachusetts keep receiving the extra payments and in return the state would shift the use of those dollars [to] subsidies to help lower-income individuals purchase health insurance coverage.”
Ryan Lizza recounts a similar version of events in his New Yorker article on Romneycare. That state ultimately secured three years of additional Medicaid funding, $1.05 billion, which largely financed the Massachusetts expansion. Both accounts suggest that it was a special commitment from the federal government, rather than a capped budget, that spurred Massachusetts’ success.
Since then, employers and individuals have chipped in to keep the universal coverage program afloat. The Blue Cross Blue Shield Foundation of Massachusetts saw spending by both of those groups increase in the year after Romneycare became law, which they attribute to rising medical costs and the insurance expansion.
Five years later, it’s largely federal funding that keeps Massachusetts’ universal coverage afloat. Since 2005, the state has twice renewed that federal waiver — the one Lizza and McDonough wrote about — to provide additional Medicaid dollars to the state.
The most recent renewal was last December 2011, when the state secured $26.75 billion in federal funds over the course of three years. It will, among other programs, continue to finance the universal coverage program.
“The milestone agreement also ensures the ongoing success of Massachusetts’ historic health care reform initiative, through which more than 98 percent of the Commonwealth’s residents, and 99.8 percent of children, have health insurance,” Massachusetts Health and Human Services Secretary JudyAnn Bixby wrote at the time. “The waiver fully funds our ongoing health care reform implementation.”
So Massachusetts used not just federal Medicaid money but federal dollars above and beyond that Medicaid money to finance their health reforms. It is difficult to see how Romney’s proposal to cut Medicaid spending and hand that reduced share over to the states would allow other states to follow Massachusetts’ example. It might not even permit Massachusetts to continue following Massachusetts’ example.
By: Sarah Kliff, The Washington Post, September 21, 2012
“By The People, For The People”: Proof Obamacare Puts Control Of Healthcare In The Hands Of The Consumer
One of the key talking points consistently mouthed by opponents of the Affordable Care Act is their declaration that the law wrests control of healthcare out from the hands of the consumer and places it squarely under the control of the federal government.
And yet, the meme—like so many others employed by dedicated Obamacare bashers— is simply not true.
Now, we can prove it.
You have likely never heard about the section of the ACA that provides federal loans to help launch consumer owned and controlled health insurance plans. The money is available for insurance plans showing a reasonable chance for success, are owned by the membership (people like you and I) and operated by a board of directors where members comprise the majority -not passive investors looking to make a buck.
It is health insurance by the people and for the people.
Tufts Medical Center in Massachusetts—along with their physician group and a company which owns and operates two hospitals in the region—has acted on this provision of the law and received $88.5 million in federal funds to create the state’s first member owned and controlled health insurance plan. While the program is being put together by a panel of experts, once the insurance plan is qualified to do business by the state’s insurance regulators, they will begin signing up individuals and small businesses who will not only become the owners of the plan, they will ultimately end up running the company.
How’s that for putting control of our healthcare back into the hands of the consumer?
The not-for-profit plan entitled the Minuteman Health Initiative—which expects to offer health insurance coverage in Eastern and Central Massachusetts beginning in 2014—is looking to bring down the cost of premiums to its members by streamlining the billing process and allowing providers to work directly with employers.
According to Dr. Jeff Lasker, chief executive of the Tufts physician group, New England Quality Care Alliance, “Imagine working closely with an employer who can help us gather data and, with employees’ permission, to be able to share that data with their primary care providers. “
Imagine, indeed.
Physicians, hospitals and consumers working alongside one another to design coverage options that better meet the needs of all the participants in the healthcare equation in the effort to bring about a better result for everyone—and done in an environment where the consumer is in control of the board of directors rather than profit driven executives whose bonuses are determined by how much money is left in the till at the end of the quarter.
Can there be anyone who does not see the great potential in this concept?
We are a nation where our health care is, for most of our citizens, controlled by private insurance companies—not the United States government. If you don’t believe that, just ask your physician what he or she must go through to get an insurance company to approve a treatment or procedure you need and how you end up paying for all this time your doctor invests in fighting for your care.
Will the Minuteman Health Initiative work? Will it accomplish the goal of lowering costs and providing appropriate benefits to consumers while allowing for a workable compensation structure to health care providers—all under the direction of the very people who depend on the plan for their health care needs?
We’ll see.
But if you don’t try something, you never find better solutions. And should the Minuteman plan work out, we can expect to see similar programs launched in every state in the union—insurance plans designed to work for both provider and beneficiary and all under the control of the people who actually pay the premiums and depend upon the benefits for the security of their families.
I don’t care how much you think you detest Obamacare. If you aren’t rooting for success in the case of the Minuteman Health Initiative—and the law that made it possible—you simply are not paying attention.
By: Rick Ungar, Contributor, Forbes, September 1, 2012
“Truth And Lies About Medicare”: Voters Can’t Believe Anything Republicans Say
Republican attacks on President Obama’s plans for Medicare are growing more heated and inaccurate by the day. Both Mitt Romney and Paul Ryan made statements last week implying that the Affordable Care Act would eviscerate Medicare when in fact the law should shore up the program’s finances.
Both men have also twisted themselves into knots to distance themselves from previous positions, so that voters can no longer believe anything they say. Last week, both insisted that they would save Medicare by pumping a huge amount of money into the program, a bizarre turnaround for supposed fiscal conservatives out to rein in federal spending.
The likelihood that they would stand by that irresponsible pledge after the election is close to zero. And the likelihood that they would be better able than Democrats to preserve Medicare for the future (through a risky voucher system that may not work well for many beneficiaries) is not much better. THE ALLEGED “RAID ON MEDICARE” A Republican attack ad says that the reform law has “cut” $716 billion from Medicare, with the money used to expand coverage to low-
income people who are currently uninsured. “So now the money you paid for your guaranteed health care is going to a massive new government program that’s not for you,” the ad warns.
What the Republicans fail to say is that the budget resolutions crafted by Paul Ryan and approved by the Republican-controlled House retained virtually the same cut in Medicare.
In reality, the $716 billion is not a “cut” in benefits but rather the savings in costs that the Congressional Budget Office projects over the next decade from wholly reasonable provisions in the reform law.
One big chunk of money will be saved by reducing unjustifiably high subsidies to private Medicare Advantage plans that enroll many beneficiaries at a higher average cost than traditional Medicare. Another will come from reducing the annual increases in federal reimbursements to health care providers — like hospitals, nursing homes and home health agencies — to force the notoriously inefficient system to find ways to improve productivity.
And a further chunk will come from fees or taxes imposed on drug makers, device makers and insurers — fees that they can surely afford since expanded coverage for the uninsured will increase their markets and their revenues.
NO HARM TO SENIORS The Republicans imply that the $716 billion in cuts will harm older Americans, but almost none of the savings come from reducing the benefits available for people already on Medicare. But if Mr. Romney and Mr. Ryan were able to repeal the reform law, as they have pledged to do, that would drive up costs for many seniors — namely those with high prescription drug costs, who are already receiving subsidies under the reform law, and those who are receiving preventive services, like colonoscopies, mammograms and immunizations, with no cost sharing.
Mr. Romney argued on Friday that the $716 billion in cuts will harm beneficiaries because those who get discounts or extra benefits in the heavily subsidized Medicare Advantage plans will lose them and because reduced payments to hospitals and other providers could cause some providers to stop accepting Medicare patients.
If he thinks that will be a major problem, Mr. Romney should leave the reform law in place: it has many provisions designed to make the delivery of health care more efficient and cheaper, so that hospitals and others will be better able to survive on smaller payments.
NO BANKRUPTCY LOOMING The Republicans also argue that the reform law will weaken Medicare and that by preventing the cuts and ultimately turning to vouchers they will enhance the program’s solvency. But Medicare is not in danger of going “bankrupt”; the issue is whether the trust fund that pays hospital bills will run out of money in 2024, as now projected, and require the program to live on the annual payroll tax revenues it receives.
The Affordable Care Act helped push back the insolvency date by eight years, so repealing the act would actually bring the trust fund closer to insolvency, perhaps in 2016.
DEFICIT REDUCTION Mr. Romney and Mr. Ryan said last week that they would restore the entire $716 billion in cuts by repealing the law. The Congressional Budget Office concluded that repealing the law would raise the deficit by $109 billion over 10 years.
The Republicans gave no clue about how they would pay for restoring the Medicare cuts without increasing the deficit. It is hard to believe that, if faced with the necessity of fashioning a realistic budget, keeping Medicare spending high would be a top priority with a Romney-Ryan administration that also wants to spend very large sums on the military and on tax cuts for wealthy Americans.
Regardless of who wins the election, Medicare spending has to be reined in lest it squeeze out other priorities, like education. It is utterly irresponsible for the Republicans to promise not to trim Medicare spending in their desperate bid for votes.
THE DANGER IN MEDICARE VOUCHERS The reform law would help working-age people on modest incomes buy private policies with government subsidies on new insurance exchanges, starting in 2014. Federal oversight will ensure a reasonably comprehensive benefit package, and competition among the insurers could help keep costs down.
But it is one thing to provide these “premium support” subsidies for uninsured people who cannot get affordable coverage in the costly, dysfunctional markets that serve individuals and their families. It is quite another thing to use a similar strategy for older Americans who have generous coverage through Medicare and who might well end up worse off if their vouchers failed to keep pace with the cost of decent coverage.
Mr. Romney and Mr. Ryan would allow beneficiaries to use vouchers to buy a version of traditional Medicare instead of a private plan, but it seems likely that the Medicare plan would attract the sickest patients, driving up Medicare premiums so that they would be unaffordable for many who wanted traditional coverage. Before disrupting the current Medicare program, it would be wise to see how well premium support worked in the new exchanges.
THE CHOICE This will be an election about big problems, and it will provide a clear choice between contrasting approaches to solve them. In the Medicare arena, the choice is between a Democratic approach that wants to retain Medicare as a guaranteed set of benefits with the government paying its share of the costs even if costs rise, and a Republican approach that wants to limit the government’s spending to a defined level, relying on untested market forces to drive down insurance costs.
The reform law is starting pilot programs to test ways to reduce Medicare costs without cutting benefits. Many health care experts have identified additional ways to shave hundreds of billions of dollars from projected spending over the next decade without harming beneficiaries.
It is much less likely that the Republicans, who have long wanted to privatize Medicare, can achieve these goals.
By: Editorial, The New York Times, August 18, 2012
“Ignore The Republican Hysteria”: Understanding The Health Care Law Is A Public Responsibility
In a sane climate, Mitt Romney would be running for president on his one big success as a politician: achieving something close to universal private health insurance coverage as governor of Massachusetts. Romneycare cut costs, improved health care outcomes and is quite popular there.
Alas, President Obama’s election has driven many Republicans so crazy that the putative nominee makes an unconvincing show of despising his own brainchild.
Has there ever been a more unconvincing faker in American politics? Romney acts as if he thinks voters are morons. But then, right-wing hysteria over the Supreme Court’s upholding “Obamacare” shows he could be correct.
Mandating health insurance wasn’t Romney’s own idea. The conservative Heritage Foundation saw it as a way to realize the practical and moral benefits of a socialized, government-run health care system like Canada’s through private, for-profit insurance companies — the best of both worlds.
Romney even wrote a 2009 USA Today column advising President Obama about the mandate’s advantages: “Using tax penalties, as we did [in Massachusetts], or tax credits, as others have proposed,” he wrote, “encourages ‘free riders’ to take responsibility for themselves rather than pass their medical costs on to others.”
The president put it this way in reacting to the Supreme Court’s validating Obamacare: “People who can afford to buy health insurance should take the responsibility to do so.”
So is it a tax, or is it a penalty?
The correct answer is “who cares?” Provide your family with the security of a decent health insurance policy and you don’t need to pay it.
Tyranny? Oh, grow up. The government can already make you sign up for Social Security, educate your children, vaccinate your dog, send you to fight a war in Afghanistan, limit how many fish you can catch, and put you in prison and seize your property for growing pot.
Furthermore, Justice Roberts is right. The U.S. government encourages all kinds of virtuous behavior through the tax code. You can get married, or pay higher taxes. Buy a house, have children, invest in a retirement account, even raise cattle (my personal favorite) or pay higher taxes.
And buying health insurance is an intolerable offense against liberty?
Ask Rush Limbaugh who pays for his Viagra. Answer: his employer-provided health insurance company. Only impoverished people, deadbeats and fools go without it.
And guess what? You’re already paying for their medical expenses when time and chance happens to them. As it happens to everybody, even right-wing Supreme Court justices who think it’s clever to compare an inessential food like broccoli to a universal human need like health care.
You can eat your vegetables or not; it’s entirely up to you.
But you can’t not get sick or hurt. And moral considerations aside, the rest of us can’t risk letting you lie down and die on the road. After all, it might be communicable. So there’s no non-participation in the health care system. Even if they drag you in feet-first, there you are.
And somebody’s got to pay for it.
It follows that the minority’s distinction between “activity” and “inactivity” with regard to health insurance is not merely specious legalistic jargon. Frankly, it’s downright adolescent.
Justice Scalia may increasingly resemble a small, volcanic Caribbean nation — eat your vegetables, Tony — but even he is not an island. We’re all in this together.
Previous to Obamacare, the United States has had the most inefficient health care finance in the advanced world, spending by far the highest percentage of its GDP on health care while getting worse results. Most western countries spend a fraction of what we do on health care and their citizens are demonstrably healthier.
Ending the perennial war between hospital bureaucrats and number crunchers at insurance companies and government agencies over who’s going to pay for indigent care should begin to change that.
Meanwhile, now that Obamacare has passed constitutional muster, it’s time for the wise and judicious American public to get off their lazy keisters, ignore the hysteria and learn what’s in the law and what’s not.
I recently took a brief online quiz sponsored by the Kaiser Foundation. I hope you won’t think I’m bragging by saying I got a perfect score. It’s my job to know the basics. Apparently, most Americans don’t. The percentage of citizens ignorant of even the new law’s most basic provisions was shocking.
Granted, the White House has done a terrible marketing job. But no, there’s no new government-run insurance company. If you’ve already got a policy you like, keep it. No, small businesses with fewer than 50 employees need not provide insurance; but, yes, they get tax credits if they do. No, undocumented immigrants aren’t eligible for help.
Many of you have mistakenly trusted carnival barkers like Limbaugh and Sarah Palin. Now that Obamacare’s the law, ignorance is no longer an excuse.
By: Gene Lyons, The National Memo, July 4, 2012
“Mythical Republican Reform”: Will Romney Pretend to Have a Health Plan?
The health-care ruling has exposed a delicate dance within the Republican Party. Romney does not want to run on the health-care issue. To the extent that he wants to invoke the issue, it’s to flay Obama for having focused on it as a distraction from the economy, not as an ideological crusade against Big Government. But conservative activists want to be sure that, if Romney wins, he will commit his political capital to repealing the Affordable Care Act. Thus their current focus on demanding that Romney pledge to repeal the law (see Avik Roy, Keith Hennessey, Rich Lowry, and David Brooks, among many others).
The interesting thing about these conservatives’ arguments is that they are all committed, to varying degrees, to upholding the pretense that the Republican Party really wants to impose a more technocratically sound version of health-care reform. To be sure, they insist they are advocating a vastly different philosophical vision centered around self-empowerment and free markets and other wonderful things. But all of them say, or imply, that they share the basic goals of the Affordable Care Act, which is to make coverage available to all Americans and to control cost inflation. So, for instance, Lowry argues, “The two central selling points of the law — insuring millions more people and keeping people with pre-existing conditions from getting locked out of insurance — can be addressed with policies that are cheaper and less disruptive (a tax credit for purchase of insurance and high-risk pools, respectively).”
I see two problems with this hopeful scenario, both fatal.
The first is that the mythical Republican reform plan is really hard to pass. Conservatives may think they have a cheaper way to fix the system, but it still costs money. And Republicans have never appropriated any money to cover the uninsured. Indeed, all their plans divert money that already exists to cover people who need health care for other purposes. Conservatives hopefully propose turning the health-care tax deduction into a more progressive tax credit. Great idea! Except the plans put forward by Romney and Paul Ryan plow the savings from eliminating that tax deduction back into lower tax rates. And it leaves no budgetary provision for high-risk pools or any other mechanism to subsidize coverage for the poor and sick.
Now, you could suppose that maybe this is all one giant oversight. Republicans failed to craft an alternative plan during the health-care debate, then voted to just straight repeal Obamacare with no replacement, then voted for a budget that just straight repeals Obamacare with no replacement, but when they have power, then they’ll really come up with a plan.
But where is the evidence that they have any desire to do so? Sunday, the two most powerful Republicans in Congress appeared on interview shows and were asked what they plan to do for the uninsured. Mitch McConnell hilariously danced and weaved, admitting that covering the uninsured is “not the issue”: http://youtu.be/QvZvNSKrOZ4
Paul Ryan, as he is apt to do, offered a much smoother take, couching his position in philosophical abstractions:
What — what Mrs. Kennedy and others were saying is this is new government-granted right. We disagree with the notion that our rights come from government, that the government can now grant us and define our rights.
Those are ours. Those come from nature and God, according to the Declaration of Independence, a huge difference in philosophy.
What this blather actually means is that he does not accept that the government has an obligation to ensure that all Americans have access to health care.
If Republicans really wanted to replace Obamacare with some more “market-friendly” alternative, then there’s a simple way they could go about it. They could promise to repeal the law only if they packaged the repeal with a replacement that did not increase the number of uninsured. But they’ll never do that, because the magic, cheaper free-market alternative does not exist, and the GOP has no interest in diverting resources to cover the poor and sick.
Hennessey, who lays out the most specific vision for repealing Obamacare, asserts, “Repeal and replacement should be separate legislative efforts.” This means, of course, that the actual plan is first to get rid of Obamacare, then pretend to work on a replacement before eventually discovering that it’s expensive and unpopular. Oh well. The only interesting question here on any level is why so many conservatives feel bound to pretend that the Republicans really are going to formulate some other plan to care for the poor and sick.
By: Jonathan Chait, Daily Intel, July 4, 2012
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