Today, Scott Walker and Marco Rubio have published plans — really, not so much plans as skeletal descriptions of planlike concepts — to replace Obamacare. Their fundamental dilemma is that Obamacare provides a popular benefit to millions of voters. Appealing to the conservative base demands they eliminate the program that provides this benefit. Appealing to the general election requires them to promise something to compensate the victims of repeal. How will they fund that something? This is the basic problem that for decades has prevented Republicans from offering a health-care plan. Rubio and Walker show that they still have no answer.
The usual pattern in politics is for politicians to turn complex problems into simple ones. But covering the uninsured is a simple problem they want to make complex. The main reason people lacked insurance before Obamacare is that they did not have enough money to afford it. Some of those uninsured people had unusually high health costs. Some of them had unusually low incomes. Boiled down, Obamacare transferred resources from people who are rich and healthy to people who are poor and sick, so the poor and sick people can afford insurance.
It cuts funds, but not benefits, from Medicare. And it transfers resources to sick people through regulations. The individual insurance market is reorganized so that insurers can’t deny essential health services or jack up prices to people with preexisting conditions. This means people with expensive medical needs pay less, and people with cheap medical needs have to pay more. Repealing Obamacare means eliminating all these forms of redistribution from the rich and healthy to the poor and sick. And replacing them with … what?
Walker and Rubio are fairly clear about their plans for regulating the insurance market. They want to go back to the pre-Obamacare, deregulated system. They’d eliminate the requirements that insurance plans cover essential benefits, and let them charge higher prices to sicker customers. That’s good for people who have very limited medical needs (as long as they never obtain a serious medical condition, or have a family with somebody with a serious medical condition). It’s bad for people who have, or ever will have, higher medical needs.
Both Walker and Rubio promise to take care of people with preexisting conditions by creating separate “high-risk pools.” That is a special kind of insurance market for people with expensive medical conditions. As you may have guessed, insurance for people with expensive medical needs is, well, expensive. Making that insurance affordable therefore requires lots of subsidies from the government. Where would Walker and Rubio get the money for that? They don’t say.
Both the Rubio and Walker planlike concepts share a basic structure and an extreme lack of detail. Walker’s document is a few pages padded out with ample white space. Rubio’s op-ed, which repeats the talking points of another op-ed from a few months ago, contains even less information. And the lack of detail is not a matter of filling in the fine print. Both Walker and Rubio have signed the Grover Norquist pledge to never raise a single penny of tax revenue ever, under any circumstances.
Both Walker and Rubio propose to cut funding for Medicaid, but this doesn’t create much room to subsidize coverage, since Medicaid is already much cheaper than Medicare or private insurance. Indeed, the main conservative complaint about Medicaid is that it is so cheap that many doctors refuse to see its patients. Republicans are willing to cut Medicaid because they’re generally willing to cut programs that focus on the very poor, but there’s not much blood to be drawn from this stone.
It is tempting to treat the lack of specifics in the Republican health-care plans as a problem of details to be filled in. But it is not a side problem. It is the entire problem. They will not finance real insurance for the people who have gotten it under Obamacare, nor will they face up to the actual costs they’re willing to impose on people. The party is doctrinally opposed to every available method to make insurance available to people who can’t afford it. They have spent six years promising to come up with an alternative plan, and they haven’t done it, because they can’t.
By: Jonathan Chait, Daily Intelligencer, New York Magazine, August 18, 2015
August 21, 2015
Posted by raemd95 |
Affordable Care Act, Health Care, Marco Rubio, Scott Walker | Deregulation, Grover Norquist Pledge, Health Insurance Companies, Medicaid, ObamaCare, Poor and Low Income, Repeal and Replace, uninsured |
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Another year, another controversy over Planned Parenthood. Selectively edited videos filmed by an anti-abortion activist have given partisans another excuse to attack women’s reproductive services, starting with those provided by a well-established non-profit dedicated to women’s health care. Never mind that abortions represent a tiny percentage of Planned Parenthood’s work.
Some Republicans have gone so far as to threaten to shut down the government unless all federal funding for Planned Parenthood is eliminated. (By law, none of that money supports abortion services.) Even as prominent Republicans such as Senate Majority Leader Mitch McConnell try to tamp down that impulse, others — firebrand Sen. Ted Cruz (R-TX) among them — continue to insist that the entire government should be brought to its knees when Congress returns to work after Labor Day.
This is really just another opportunity to try to limit women’s reproductive choices, another chance to grandstand and exaggerate. If this outrage reflected genuine concern about lives ended while still in the womb, wouldn’t more conservatives be worried about what happens to poor babies once they are born?
For decades now, I’ve listened to anti-abortion activists rail against a “culture of death,” a callous disregard for the unborn, the “murder” of babies still in the womb. I’ve witnessed protests outside abortion clinics, listened to “pro-life” state legislators mischaracterize rape, and covered misleading campaigns that suggest abortions lead to breast cancer and mental illness. I’ve watched as hostility toward Roe v. Wade has become a litmus test inside the Republican Party.
But here’s the disconnect: Over those years, I’ve also seen anti-abortion crusaders become increasingly hostile to programs and policies that would aid poor kids once they’ve come into the world. Conservative lawmakers have disparaged welfare, criticized federal housing subsidies and even campaigned against food assistance. How does that affect those children for whom they claim so much concern?
In Alabama, where anti-abortion sentiment is as commonplace as summer heat waves, the state legislature is contemplating cutting millions from Medicaid, the program that provides health care for the poorest citizens, including children. Meanwhile, the state’s two U.S. senators, Republicans Jeff Sessions and Richard Shelby, are among those demanding that Planned Parenthood receive no more federal funds because of the controversy over the sale of fetal tissue.
To be fair, there are those among abortion critics who show a principled concern for poor children, whose opposition to abortion is paired with a passion for social justice. Take Ohio Gov. John Kasich, who is among the rare GOP governors to support the Medicaid expansion offered by the Affordable Care Act. “Now, when you die and get to the meeting with Saint Peter, he’s probably not going to ask you much about what you did about keeping government small. But he is going to ask you what you did for the poor. You’d better have a good answer,” he said in June.
Then there are the Catholic Health Association and the Leadership Conference of Women Religious, led by nuns. They’ve also adopted assistance to the poor as a core mission.
Their compassion stands in contrast to the U.S. Conference of Bishops, which is largely known for its conservative stances on abortion and same-sex marriage. (That may change with Pope Francis, who has made social justice his hallmark.) Last year, I attended a Catholic high school commencement where the headmaster, a priest, bragged about the number of his students who had attended anti-abortion protests. He said nothing about protests over cuts in assistance to the poor.
It’s easy enough to inflame with the Planned Parenthood videos; without context (again, selective editing), leaders of the organization are heard discussing money for the donation of fetal tissue. That’s not a conversation that’s easy to hear.
But Planned Parenthood is doing nothing illegal, and fetal tissue research has been vital to improving the quality of life for an aging America. Many of those who are angered by the videos would be surprised to know that they may have benefited from fetal tissue research.
Still, I’d take their criticism more seriously if they’d spend as much time trying to help poor children once they are born. Since they don’t, they’re just engaging in a war on women — especially women who don’t have any money.
By: Cynthia Tucker, Pulitzer Prize Winner for Commentary in 2007; Featured Post, The National Memo, August 15, 2015.
August 18, 2015
Posted by raemd95 |
Planned Parenthood, Reproductive Choice, Women's Health | Conservatives, Fetal Tissue Research, Government Shutdown, Jeff Sessions, Mitch McConnell, Poor and Low Income, Richard Shelby, U. S. Conferance of Bishops |
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With one careless comment, Jeb Bush revealed a fundamentally indifferent attitude toward half the U.S. electorate.
“I’m not sure we need half a billion dollars for women’s health issues,” he said in a speech at the Southern Baptist Convention in Nashville, Tennessee.
It was a throwaway aside in a longer blather about defunding Planned Parenthood, and one imagines that no sooner were the words out of his mouth than his cringing consultants were drafting a clarification.
The inevitable statement soon followed, admitting he “misspoke” and adding that “there are countless community health centers, rural clinics and other women’s health organizations that need to be fully funded.”
Too late. The game was on. Hillary Clinton blasted back, “When you attack women’s health, you attack America’s health.”
I don’t believe Bush misspoke. There’s something about abortion he wishes to ignore: Abortion is a women’s health issue. You cannot separate abortion from this context.
Oppose it or not — and I do — abortion is a medical procedure that ends an unwanted or health-threatening pregnancy. If we want to encourage the trend toward decreasing numbers of abortions in this country — and no one in their right mind wants to see more of them — we need to bolster women’s reproductive health services. That means ensuring wide access to sex education and contraceptives. (It also means honestly admitting that an overwhelming majority of Americans accept that abortion should be permitted when a pregnancy is the result of incest or rape, or when the health of the mother is threatened.)
If you oppose abortion and you’re not ready to promote the most effective ways of preventing unwanted pregnancies, you’re not serious. If you call for “defunding” Planned Parenthood — as virtually the entire Republican Party does — you are attacking a leading purveyor of contraceptives and information about how to use them for women of limited economic resources. You’re also threatening to shut down 700 clinics that provide crucial preventative health measures like pap smears and refer women for mammograms.
About 85 to 90 percent of Planned Parenthood’s work is providing these basic health services, often to low-income women without access to health insurance. That’s according to analysis of the organization done by PolitiFact. Abortions add up to about 3 percent of the organization’s services, and they are not funded with federal money.
A recent vote in the U.S. Senate to defund Planned Parenthood, which failed, called for redirecting the monies to other women’s health facilities that did not provide abortions. The problem is that there are far too few such clinics to meet the need. Moreover, the effort misunderstands how Planned Parenthood receives $528 million annually: mostly through Medicaid reimbursements and competitive Title X family planning grants.
The plain truth is that the Republicans who wish to destroy Planned Parenthood — and Bush is far from the most vociferous — really don’t care that the bulk of its work has nothing to do with abortion. Nor do they care about standards of accuracy in the accusations they make against the organization.
They have worked hand in glove with the Center for Medical Progress, an anti-abortion group inspired by the ethically dubious video techniques of conservative activist James O’Keefe. This group set up a phony front company and then lured Planned Parenthood officials into secretly videotaped conversations about providing fetal tissue for research. The group then released videos selectively edited to suggest that Planned Parenthood was in the illegal business of selling fetal tissue.
The bogusness of this charge is patently obvious when one views the unedited tapes, but that matters little to GOP opportunists, who promise all sorts of congressional inquisitions.
Fine. Hold hearings. See what you find. My guess is that it will be zilch (See: Benghazi).
Meanwhile, the American public needs to know that these new anti-abortion activists are picking up the cudgels of the folks that brought us the so-called Summer of Mercy protests that required federal marshals to restore order in Wichita, Kansas, in the 1990s. Tactics used to include clinic bombings and harassing any woman who set foot near a clinic, regardless of what services she might be seeking.
That phase of the movement failed, although it never went away. In 2009, Kansas abortion doctor George Tiller was shot dead at his church.
Pro-life activists have figured out that it’s better to co-opt the Republican Party than to engage in terrorism. That’s progress. Unfortunately, disingenuous attacks on women’s health care purely to court votes do no favors to either women or unborn babies.
By: Mary Sanchez, Opinion Page Columnist, The Kansas City Star; The National Memo, August 12, 2015
August 13, 2015
Posted by raemd95 |
Hillary Clinton, Jeb Bush, Planned Parenthood, Women's Health | Contraception, Fetal Tissue Research, George Tiller, James O'Keefe, Poor and Low Income, Rape and Incest, Reproductive Choice, Reproductive Rights |
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So here we are again: Republicans want to make a policy change, but since doing so will be difficult through the ordinary legislative process, they are threatening to shut down the government to get what they want.
This time it’s about Planned Parenthood, long a target of conservative loathing. Galvanized by selectively edited videos made by conservative activists trying to make it seem as though the organization is profiting from the sale of fetal tissue, Republicans in Congress are now trying (as they have before) to “defund” Planned Parenthood. The White House says it will veto any budget bill that does that.
In response, at least some conservatives have reverted to a time-worn tactic: Shutdown! Ted Cruz says if that is what it takes to eliminate funding for Planned Parenthood, so be it. Some of his allies in the House seem to agree. Conservative pundit Erick Erickson demands, “If Republicans are not willing to make this their hill to die on…the Republican Party needs to be shut down.”
For the record, most of the money Planned Parenthood receives from the federal government comes from reimbursement for health care services through Medicaid. Precisely zero goes to abortion services; by law, no federal funds can go to abortions. So when Republicans say they want to “defund” Planned Parenthood, what they’re talking about is taking away medical services — breast cancer screenings and the like — from poor women.
I’m not going to go too deeply into the videos, other than to say that nothing in them shows that the organization did anything illegal. The worst anyone has been able to say is that the “tone” used by Planned Parenthood officials was callous. You can object to fetal tissue research if you like, even though it’s done with the consent of patients and can yield valuable medical insights, but there’s no evidence that Planned Parenthood isn’t complying with the laws that cover how that tissue can be used.
Until Barack Obama became president, most government shutdowns happened for one reason: because Congress and the president couldn’t agree on a budget. Sometimes the issues were broad, like cuts to domestic spending, and sometimes they were more specific. But they were usually connected in some rational way to the perceived necessity for a shutdown, in that there was disagreement on how to spend the money that will keep the government operating.
But Republicans in the Obama era have been nothing if not creative thinkers when it comes to policy procedures and norms. And in this area, their innovation was to say, “We have a policy disagreement with the other side, but we can’t get our way through the normal channels. So how about if we shut down the government until we get what we want?”
There’s one important fact about this threat that you’d think Republicans would have learned by now: It always fails. The public doesn’t rally around the shutdowners’ cause, because it violates a basic sense of how policy-making ought to operate. Congress can bicker and fight, but the way it makes decisions is that legislators vote on things, and the side with more votes wins (except for proposals that are filibustered, but that’s a different story), subject to the presidential veto. If you lose through that process, you’ve lost, period. Even if you were right on the merits, the system’s rules are longstanding and familiar enough that they seem fair, since everyone understands the rules and agrees to live under them.
But relying on a shutdown is like a baseball team that’s trailing at the start of the ninth inning, so they hide all the balls and say they won’t return them until they’re declared the victor. It just doesn’t seem right.
And it isn’t just that Republicans can’t get enough public support for the shutdowns — more importantly, they don’t actually get what they want. In 2013, they shut down the government in an attempt to repeal the Affordable Care Act. The Affordable Care Act, you may have noticed, is still around. In 2014, they nearly shut down the government in an attempt to stop Obama’s executive actions on immigration. That failed there, too (though some of those actions have been held up in the courts).
It should be noted that the congressional GOP leadership is smart enough to say they’re not interested in another shutdown psychodrama. But if they’re in a tough spot, besieged by their more conservative members — not to mention outside groups and pundits — there’s no denying the part they’ve played in making this a regular demand of conservatives. It was the congressional leaders who devised the strategy of opposing Barack Obama on everything and filibustering every bill of any consequence. They’ve happily gone along with the hysteria on the right that says that Obama isn’t just a president they disagree with, but an enemy of America who seeks to destroy everything we hold dear. They’ve encouraged the belief that compromise is always, and by definition, an act of betrayal.
Given all that, is it any surprise that whenever a new issue comes up, at least some on the right think it’s a hill worth dying on? Shutting down the government might be doomed to fail, but I suppose it feels like fighting.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Week, August 3, 2015
August 4, 2015
Posted by raemd95 |
GOP, Government Shut Down, Planned Parenthood | Affordable Care Act, Congress, Conservatives, Fetal Tissue Research, Immigration, Poor and Low Income, Republicans, Ted Cruz, Women's Health |
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As noted earlier today, it’s the 50th anniversary of the enactment of Medicare and Medicaid.
I strongly suspect the former will get more attention, because it’s a non-means tested program with an extremely powerful bipartisan constituency (despite constant GOP efforts to screw over future beneficiaries via a phased-in voucherization or some other way to shift costs to old folks). Everybody’s either on it or going to go on it if they live long enough.
Medicaid’s another matter, of course. It’s means-tested with the states having significant control over eligibility and benefits, which means it involves different sets of people (particularly now that half the states have accepted the ACA’s Medicaid expansion while half haven’t) and significantly different benefits and service delivery models in different states. With the exception of a little-understood long-term care component that pays for nursing home care for people who have disposed of most of their assets, Medicaid is a poor folks program–you know, for those people–which because it is state (and to some extent locally) operated means these poor folks are not necessarily dealing with the friendliest policy-makers, administrators or providers, particularly given Medicaid’s relatively low reimbursement rates.
But to the Republicans who have all pretty much agreed upon a policy of “block-granting” Medicaid, which means dumping the Medicaid population on the states with a fixed (and ultimately declining) sum of money and letting them do whatever they want to do with them, the question about Medicaid isn’t whether its structure and financing are giving the poor the kind of health care the rest of us would want, but instead whether it’s worth anything at all. That’s largely the function of prejudice plus a 2013 study in Oregon of people receiving and not receiving Medicaid benefits which provided some startling-sounding data on how little real benefit Medicaid created. It’s hard to read any conservative discussion of Medicaid and not hear the Oregon study “proved” Medicaid’s worthless.
So that’s why with Medicaid’s fate perhaps hanging in the balance after the upcoming election, three excellent policy writers, Harold Pollack, Bill Gardner and Timothy Just, have written an explanation of the Oregon study that rebuts its invidious use.
[P]erhaps the most important limitation of the study stems from an assumption that many readers would be unlikely to notice. [The Oregon researchers] placed a very low value—$25,000—on a year of additional life for Medicaid beneficiaries. The typical threshold used in health services research is much larger, in recent studies far above $100,000 per additional year of (healthy) life. Yet because the median income of the Oregon study participants was about one-fourth of the median income in the United States, the researchers chose to value an additional life-year at about one-fourth of the usual threshold. This assumption powerfully frames everything that follows in this analysis. After all, if you start out by assuming that Medicaid beneficiaries’ lives are worth very little, you will find that it is not worth spending much money to prolong them.
So the idea of Medicaid being “worthless” is closely correlated with the idea of the life of poor folks being relatively “worthless” (there are defensible reasons for this valuation in the study itself, but not for the way it’s being used by anti-Medicaid ax-grinders) as well. If you don’t share that premise, you shouldn’t share the related conclusion, either.
In any event, progressives should gird up their loins for a fight to save Medicaid in the near future. I’ve thought of myself as a warrior for the continuation of Medicaid ever since I was drawn into the 1981 Reagan Budget fight, wherein the administration suffered a rare defeat in its efforts to “cap” federal Medicaid spending, thus gradually making it a state-financed program. The fight just ahead could be even tougher.
By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, July 30, 2015
August 2, 2015
Posted by raemd95 |
Medicaid, Medicaid Expansion, Medicare | Bil Gardner, Conservatives, Harold Pollack, Medicaid Block Grants, Medicard Vouchers, Oregon Study, Poor and Low Income, Republicans, Timothy Just |
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mykeystrokes.com 