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“At The GOP Debate, America Was The Loser”: Republicans Aren’t Remotely Serious About Governing

Last night’s debate in Houston was not only the first time Marco Rubio and Ted Cruz really attacked Trump. It was also the first time anyone went after Trump for the appalling superficiality of his statements and ideas about policy, and it did reveal that Trump is someone who neither knows nor particularly cares how government works or about what you need to do to address complex problems.

That’s good. But the debate revealed something else, too: That Trump is right at home in the GOP, because even the supposedly more serious candidates on that stage had barely anything more to say about policy than he did.

Let’s look, for instance, at an exchange Rubio and Trump had on health care. When Trump started to talk about it, it became obvious he doesn’t understand the first thing about health care policy. “We’re going to have something much better, but pre-existing conditions, when I’m referring to that, and I was referring to that very strongly on the show with Anderson Cooper, I want to keep pre- existing conditions,” he said. What he means there is that he wants to keep the ban on insurance companies denying people coverage because of pre-existing conditions, which is one of the central (and most popular) components of the ACA.

But soon after, they had this enlightening exchange:

RUBIO: Here’s what you didn’t hear in that answer, and this is important guys, this is an important thing. What is your plan? I understand the lines around the state, whatever that means. This is not a game where you draw maps…

TRUMP: … And, you don’t know what it means…

RUBIO: … What is your plan, Mr. Trump?

(APPLAUSE)

RUBIO: What is your plan on healthcare?

TRUMP: You don’t know.

BASH: (inaudible)

TRUMP: … The biggest problem…

(CROSSTALK)

RUBIO: … What’s your plan…

TRUMP: … The biggest problem, I’ll have you know…

RUBIO: … What’s your plan…

TRUMP: … You know, I watched him meltdown two weeks ago with Chris Christie. I got to tell you, the biggest problem he’s got is he really doesn’t know about the lines. The biggest thing we’ve got, and the reason we’ve got no competition, is because we have lines around the state, and you have essentially….

RUBIO: … We already mentioned that (inaudible) plan, I know what that is, but what else is part of your plan…

TRUMP: … You don’t know much…

RUBIO: … So, you’re only thing is to get rid of the lines around the states. What else is part of your healthcare plan…

TRUMP: … The lines around the states…

RUBIO: … That’s your only plan…

TRUMP: … and, it was almost done — not now…

RUBIO: … Alright, (inaudible)…

TRUMP: … Excuse me. Excuse me.

RUBIO: … His plan. That was the plan…

TRUMP: … You get rid of the lines, it brings in competition. So, instead of having one insurance company taking care of New York, or Texas, you’ll have many. They’ll compete, and it’ll be a beautiful thing.

It keeps going for quite a while like that. “Lines around the states” refers to the question of allowing insurance companies to sell policies across state lines, instead of only within one state. This is one of a very small number of ideas that Republicans have settled on so that they have something to say when asked what they’d do about health care.

And Marco Rubio supports that, too. The lengthiest explication Rubio has offered on his plans for health care came in this op-ed from August, which basically presents that Republican grab-bag: let insurance companies sell policies across state lines, give people tax credits instead of subsidies, block-grant (i.e. cut) Medicaid, turn Medicare into a voucher program, expand health savings accounts. And oh, you’re one of the tens of millions of people with pre-existing conditions? Um…well, you can go in a high-risk pool, which is just about the worst and most expensive way to cover those people. Throw in some meaningless drivel about “patient-centered reforms” and “empowerment” and you’ve got your standard-issue Republican health care “plan.”

What’s the difference between that and when Trump says he’ll repeal the ACA and replace it with “something terrific”? Almost nothing. If there’s anything the last seven years have taught us, it’s that health care policy is extraordinarily complex, and any reform you make has to grapple with that complexity. Republicans can’t seem to bring themselves to grapple with it: they talk about repealing the ACA as if that would be no big deal, when in truth repealing the law would represent a massive disruption to the American health care system in history, much more so than the passage of the law itself.

And it isn’t just health care. We see it over and over again in other areas: Trump offers some ridiculously simplistic notion about what he’d do in a critical policy area, and anyone with a brain says, “My god, he has no clue what he’s talking about,” but then when you look at the other candidates, you see that their ideas are barely more coherent or realistic. Trump says he’ll kick the crap out of the Islamic State. That’s no plan. But what do the other candidates say? Call it “radical Islamic terrorism,” and, uh, form a coalition! And also some crap-kicking!

Trump says he’ll go to China and tell them to give us back our jobs, then we’ll have a spectacular economy. And the other candidates? They say that if we cut taxes and curtail regulations, then we’ll have a spectacular economy. Their plan is to bring back George W. Bush’s economic policies, which will somehow produce Bill Clinton’s economic growth. Such a clever strategy.

Trump says he can eliminate the deficit by finding “waste, fraud, and abuse,” a line from the 1980’s that he doesn’t seem to realize is now considered a joke. “We are going to cut many of the agencies, we will balance our budget, and we will be dynamic again,” he says. It’s obviously inane. And the other candidates? They want to hugely increase the deficit with their tax cuts and increases to military spending. But they’ll do things like “prevent massive, irresponsible spending bills” (that’s from Rubio’s deficit reduction “plan”) or eliminate the IRS and “evaluate areas of waste and fraud” (that’s Cruz). And people wonder why the deficit always goes up under Republican presidents.

So yes, Trump is an ignoramus. He has no idea what is actually involved in running the government. But what’s really depressing is that even the other guys, who have been in government and do have at least some grasp of how it works, haven’t bothered to present anything that’s more than a notch or two more sophisticated to the voters. Either they don’t care enough to be remotely serious about governing, or they think the public won’t care that they aren’t remotely serious about governing. Or maybe both.

 

By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Plum Line Blog, The Washington Post, February 26, 2016

February 27, 2016 Posted by | Donald Trump, GOP Primary Debates, Governing | , , , , , , , , | 4 Comments

“Life Changing And Life Saving”: Remembering What Matters About The Affordable Care Act

On the Affordable Care Act front today, there’s very good practical news, and not-so-good political news. That gives us an excellent opportunity to remind ourselves to keep in mind what’s really important when we talk about health care.

Let’s start with the good news. First, as Marketplace reported this morning, a new report from PriceWaterhouseCoopers shows that the average health insurance premium on the exchanges is actually lower than the average premium in employer-sponsored plans. And it isn’t because the coverage is inadequate; according to a spokesperson, “even when you factor in all the out-of-pocket costs, the average top tier gold and platinum plans are similar to employer ones.” It’s hard to overstate what a success this is. If you’ve ever bought health insurance on the individual market before now, you know that if you could get covered at all, you were likely to get a plan that was expensive but had lots of gaps and lots of cost-sharing. The whole point of the exchanges was to give people buying insurance on their own the same advantage of pooling large numbers of customers that you get when you’re covered through your employer. If it’s working, then that’s something to celebrate.

Second, as Jonathan Cohn tells us, Wellpoint, one of the nation’s largest insurers, is reporting that exchange sign-ups are meeting their expectations; they have 400,000 new customers, and expect the number to rise to a million by the end of open enrollment. Even more critically, although their new customers are slightly older than the population as a whole, they expected this because people with a more pressing need for insurance would be the first to sign up, and they already incorporated that into their rates for this year. That means they’re unlikely to lose money, there is unlikely to be a huge rate spike next year, and the dreaded “death spiral” looks less and less likely.

This supports the contention I’ve had for some time, that in its first few years the Affordable Care Act is going to basically be fine—it may not create a health care paradise, but nor will it be the disaster conservatives are so fervently hoping for.

Before we get to sorting through what matters from what doesn’t, let’s look at the not-so-good political news. The Kaiser Family Foundation is out with their latest health care tracking poll, and there isn’t a lot to be glad about. More people have an unfavorable than a favorable view of the ACA. Most Americans are unaware that almost all the provisions of the law are now in force. And maybe most troubling, nearly half of Americans are still unaware of the law’s most popular provision, that insurance companies are no longer allowed to discriminate against people with pre-existing conditions:

Before you say, “Obama should have told people about it!” I must remind you that during the last four years you spent away from Earth, the administration and its allies did in fact repeat over and over and over again that the ACA prohibits insurance companies from denying you coverage if you have a pre-existing condition. There are many reasons why so many people haven’t yet understood, but you can’t say they didn’t try (you can read more about the myth of the bad sales job here).

In any case, here’s what we have to remember: On the scales of history, a person with a pre-existing condition who gets health coverage weighs much more than a person who doesn’t know that because of the ACA, people with pre-existing conditions can get health coverage. We spend so much time talking about politics that it’s easy to forget that politics are not an end in themselves, they’re a means to an end. Liberals advocated for comprehensive health insurance reform for so many decades not because it was politically advantageous (at some times it was, and at other times the voters didn’t seem to care), but because it was right. The fact that so many millions of Americans had no health security up until now was a moral obscenity. The ACA is beginning to fix things—slower and less completely than we might like, but it is a beginning. And if it never becomes the political boon you were hoping for, it was still the right thing to do.

That isn’t to say that political effects don’t matter, because they do. If the Republicans take over the Senate this fall, bad things would result, particularly if they also win the White House two years later, and if the ACA’s political troubles contributed to that turn of events, it would be unfortunate. But in the long run, what matters most is the effect on Americans’ lives. When you get distressed by a story about a Democratic member of Congress who’s in a tough race where her opponent is hitting her for supporting Obamacare, you can think of the families who never had health coverage before, but do now. For millions of people it will life-changing, and for many, literally life-saving. Try not to forget.

 

By: Paul Waldman, Contributing Editor, The American Prospect, January 30, 2014

January 31, 2014 Posted by | Affordable Care Act, Health Insurance | , , , , , , , | Leave a comment

“Let’s Not Forget Medicare Advantage”: Selective Outrage Over Federal Health Care Costs

Knowing I’ve been both a critic of insurance company practices and a supporter of efforts to reform the industry, a FOX news producer reached out last week to get my take on accusations by conservatives that Obamacare will actually result in a bailout of big insurance companies.

Under the headline, “Bailing Out Health Insurers and Helping Obamacare,” The Weekly Standard on Monday urged Republicans to insist that future debt ceiling increases contain a no-bailout provision. The magazine also cited Sen. Marco Rubio’s, R-Fla., bill to repeal a provision of the Affordable Care Act designed to limit potential initial losses of insurers selling policies on the new health insurance exchanges.

I reminded the FOX producer that Republicans have been supporting — and vigorously defending — a much more expensive transfer of taxpayer dollars to private insurers than the one Obamacare foes are now concerned about.

Here’s the issue:

Lawmakers who drafted the Affordable Care Act knew that insurers would be reluctant to participate in the new health insurance exchanges — also called marketplaces — if the government didn’t create a temporary program to protect them against what’s known in the insurance world as adverse selection.

Insurers were concerned, for good reason, that the first people to sign up for coverage through the exchanges would be folks previously shut out of the insurance market — people who were older and sicker than the population at large. Those people couldn’t afford to buy coverage previously because insurers were able to charge them far more than younger, healthier people.

In many cases, insurers refused to sell coverage at any price to prospective customers with preexisting conditions. That’s a big reason why the number of uninsured Americans had reached nearly 50 million when Congress passed the reform law.

So it wasn’t the least bit surprising that the first few million who have signed up for coverage since the exchanges opened on Oct. 1 skew older than many expected. People who have been denied coverage for years are far more motivated to get insurance — and fast — than anyone else. There is not the same pent up demand among the young and healthy.

In anticipation of this, drafters of the reform law established a $25 billion risk fund to insulate insurers from big losses during the first three years. Although the risk fund has always been in the law, conservative pundits apparently just became aware of it.

Yes, $25 billion is a lot of money, but it is pocket change compared to the enormous amount of taxpayer dollars that have been flowing to private insurance companies for nearly three decades to keep them in the Medicare Advantage program, which has had the unwavering support of Republicans.

Republicans have long supported efforts to privatize Medicare, and the Medicare Advantage program is one of the ways they’ve tried to do it. Medicare Advantage is billed as a private alternative to traditional Medicare. When Americans reach 65, they can enroll in traditional Medicare or in a private plan operated by an insurer. If they opt for a private plan, the federal government still picks up the tab and transfers money to the private insurer every month.

As the U.S. Government Accountability Office explains it, the Centers for Medicare and Medicaid Services (CMS) adjusts the monthly payments it sends to private insurers to account for each beneficiary’s health status. As part of this risk adjustment process, CMS assigns each Medicare Advantage beneficiary a risk score — “a relative measure of expected health care costs,” as the GAO puts it.

We’re talking a lot of money here. In 2012 alone, the GAO calculated that the federal government spent about $135 billion on the Medicare Advantage program. The problem for taxpayers is that, according to the GAO, the government has been more than generous over the years to private insurers, having paid them way more than it should have because of shortcomings in how the risk scores are developed.

Interestingly, but not surprisingly, there was no mention of that, or any reference at all to the Medicare Advantage program, the biggest champion of which are Republicans, in The Weekly Standard’s “bail-out” story last week. If they are sincere in their alarm that Obamacare might reward private insurers with an extra $25 billion between now and the end of 2016, they should be apoplectic about the ongoing bailout known as the Medicare Advantage program.

 

By: Wendell Potter, The Center for Public Integrity, January 20, 2014

January 21, 2014 Posted by | Affordable Care Act, Conservatives, Health Care Costs | , , , , , , | 6 Comments

“Millions And Millions”: How Many People Has Obamacare Helped?

As the deadline to sign up for an insurance policy that takes effect in 2014 passes on December 23, the next crucial step in the debate about the future of the Affordable Care Act begins.

On January 1, Republicans will make the case that because of the estimated five million cancelation notices that went out last year, more people are uninsured under the president’s signature legislative accomplishment than newly insured.

The White House is preparing to rebut that argument aggressively. Last week, an administration official asserted that only about 10 percent of those who received those notices had not found a replacement plan, as most were offered another option by their current insurer. The remaining 500,000 or so have been offered a special exemption from the individual mandate.

But it will be almost impossible to know right away if the number of net insured went up in January, The Washington Post‘s Sarah Kliff explained on Friday.

“It’s the exact opposite of weather forecasting,” Stan Dorn, a senior expert at the Urban Institute, told Kliff. “There, you can be pretty confident of what will happen tomorrow but no idea about the future. Here it’s the reverse: Over time there will be significant gains, but that will take years, not months.”

All we have now is estimates, as some states are reporting signups and some are announcing actual enrollment numbers. As of Friday, 3.3 million people had signed up for insurance through the Affordable Care Act, with at least 970,000 of them having enrolled in private insurance plans, according to ACAsignups.net.

But these numbers don’t tell the whole story, Campaign for America’s Future’s Dave Johnson points out:

—71 million Americans on private insurance have gained coverage for at least one free preventive health care service such as a mammogram, birth control, or an immunization in 2011 and 2012. In the first 11 months of 2013 alone, an additional 25 million people with traditional Medicare have received at least one preventive service at no out-of-pocket cost.

—Up to 129 million Americans with pre-existing conditions—including up to 17 million children —will no longer have to worry about being denied health coverage or charged higher premiums because of their health status.

—Approximately 60 million Americans have gained expanded mental health and substance use disorder benefits and/or federal parity protections.

—41 million uninsured Americans will have new health insurance options through Medicaid or private health plans in the Marketplace. Nearly 6 in 10 of these individuals could pay less than $100 per month for coverage.

—Consumers have saved $5 billion over the past two years due to a new requirement that insurance companies have to spend at least 80 percent of premium dollars on care for patients (at least 85 percent for large group insurers). If they don’t, they must send consumers a rebate. In 2013, 8.5 million enrollees will receive rebates averaging $100 per family.

—Insurance companies must submit premium increases of 10 percent or more for review by experts. In 2012, 6.8 million Americans saved an estimated $1.2 billion on health insurance premiums after their insurers cut back on planned increases as a result of this process.

—Since the health care law was enacted, more than 7 million seniors and people with disabilities have saved an average of $1,200 per person on prescription drugs as the health care law closes Medicare’s “donut hole.”

—Over three million young adults have gained health insurance because they can now stay on their parents’ health plans until age 26.

—Individuals no longer have to worry about having their health benefits cut off after they reach a lifetime limit on benefits. Starting in January, 105 million Americans will no longer have to worry about annual limits, either.

—Using funds available through the Affordable Care Act, health centers are expanding access to care by building new sites and renovating existing sites. Health centers served approximately 21 million patients in 2012.

The millions and millions of people who’ve been helped by the law won’t be counted as the press tries to game out if Obamacare will reach the seven million private insurance signups the Congressional Budget Office predicted for its first year. But they’re definitely out there, and they’d be among the millions who would be affected if the GOP is ever successful in repealing the law.

 

By: Jason Sattler, The National Memo, December 22, 2013

December 24, 2013 Posted by | Affordable Care Act, Obamacare | , , , , , , , | Leave a comment

“Told You So, Obamacare’s Back”: By Next Fall, HealthCare.gov Is Going To Be A Net Plus For President Obama And Democrats

If one looks just at the raw, bottom-line number the Department of Health and Human Services released Wednesday—365,000 citizens enrolled since October 1—one might be inclined to think it’s not so hot. And it isn’t. That’s 180,000 or so a month, and if you post that number against the stated goal of 7 million by next spring, the stated goal looks awfully chimerical, and the thing seems a disaster (180,000 times six months, the enrollment period, is just 1.08 million).

Dig a little deeper and things look considerably better. If we could graph it, the bar line of enrollment would make for a pretty impressive ski slope: After just 27,000 people signed up in the whole of October, The New York Times reported over the weekend, about 100,000 people signed up in November, and then, in the first week of December alone, 112,000 chose plans. The Los Angeles Times put out slightly different numbers Wednesday but agreed on the trend. From an obviously atrocious starting place, enrollment is essentially quadrupling. If that pace were to continue, the 7 million figure would be cleared in March.

I still wouldn’t quite bet on that. But I would definitely and unflinchingly bet on the central proposition I argued last week:  By next fall, HealthCare.gov is going to be a net plus for Obama and the Democrats.

Wishful thinking? You can call it that if you want to. But I warn you I’m not usually a wishful thinker. Like most partisans on either side, I tend to expect the worst. It’s usually a wise insurance policy; you’re rarely disappointed. I write such things only when I really think them, like the time in August 2012 when I wrote a column suggesting that Obama could very well win about 330 electoral votes. He won 332, which most anyone else would have said when I wrote that piece was crazy.

I had a hunch then, and I have one now. And my bet is based on a lot more than enrollment numbers. It’s based on the numbers of people who are benefiting and will benefit from aspects of the law. These aren’t in the thousands. They’re in the millions. About 70 million citizens will enjoy free—free—preventive care for a range of services that typically weren’t covered at all before or at best were covered and required a co-pay. About half of them are Medicare recipients (= old people = voters). Preventive care, as you may know, is something our system hasn’t been doing very well. Now it will.

More than 100 million Americans live with what the insurance companies would define as pre-existing conditions. Over these next few months, as their symptoms flare up or especially if they worsen, requiring lengthy hospital stays and intense treatment, they’re going to be seeing that they don’t have to fret about money or whether they’re going to continue to be covered anymore. Mental-health coverage is going to be improved dramatically for up to 60 million Americans. Nearly 7 million senior citizens are going to find in the coming months that they’re no longer screwed by the doughnut-hole prescription-drug problem that was created by the Bush Medicare Part D law of 2003 and corrected by Obamacare. It is saving these 7 million seniors an average of $1,000 a year, which for many of these folks is probably a reasonable chunk of their income.

I could go on. The thing is that all this isn’t going to make the papers and the cable channels much. There isn’t a lot of inherent news value in a free cervical-cancer screening or a prescription-drug refill. But these millions of people live real lives, not on TV, and they and their families and friends will know what has happened.

You see that I’m not making a Beltway/political argument. Washington, D.C., will, I can promise you, be the last city in the United States to change its mind about Obamacare. Once a notion becomes conventional wisdom in this town and rocks a president’s poll numbers the way the disastrous rollout so clearly has, it takes a typhoon to dislodge it. Or a hurricane—remember how Karl Rove was making the United States a conservative country until Katrina came along and sent Bush’s approval numbers down there in the range of curdled milk?

The rollout won’t be a hurricane. It will be a calm rain, a steady shower of reality across the country that may never achieve quite enough force to trump inside-the-Beltway perception but will be strong enough to change many people’s minds around the country.

Fixes still need to be made. But now, as opposed to a month ago, one can feel as if they will be made. And without excusing the bollixing up of the rollout, of which I’ve written very critically, one can also say now that in historical context, this is all happening pretty fast. Remember, the original Social Security legislation was passed in 1935. And when did the first check go out? Not until 1940. Can you imagine a five-year lag in today’s media world? Roosevelt, and more important the program itself, would have been torn to pieces. I think in two more years’ time, and indeed less than that, many millions of Americans will see that what they thought was decent health insurance before the Affordable Care Act was like gaslight before electricity. If that’s wishful thinking, it’s for their sake, not the president’s.

 

By: Michael Tomasky, The Daily Beast, December 12, 2013

December 13, 2013 Posted by | Affordable Care Act, Obamacare | , , , , , , , | Leave a comment

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