“37 Pages Of Talking Points”: The Republican Healthcare Plan Isn’t Actually A Healthcare Plan
Rep. Billy Long (R-Mo.) boasted on Twitter yesterday, “You’ve asked for it and tomorrow, House Republicans will release our plan to replace Obamacare.” Whether or not this actually constitutes a “plan,” however, is open to some debate.
After six years of vague talk about a conservative alternative to the Affordable Care Act, House Republicans on Tuesday finally laid out the replacement for a repealed health law – a package of proposals that they said would slow the growth of health spending and relax federal rules for health insurance. […]
In finally presenting one, Speaker Paul D. Ryan of Wisconsin and his Republican team did not provide a cost estimate or legislative language. But they did issue a 20,000-word plan that provides the most extensive description of their health care alternative to date.
Perhaps, but let’s not grade on a curve. It was seven years ago this month that House Republican leaders began promising to unveil a GOP health-care-reform plan, and for seven years, the party has done nothing except offer vague soundbites and vote several dozen times to repeal the Affordable Care Act, replacing it with nothing.
Or put another way, we’ve seen seven years of posturing on health care policy, but no actual governing.
The New York Times is correct that we now have an “extensive description” of the House Republican vision on the issue, but an “extensive description” does not a plan make. There’s still no legislation; there are still no numbers; there’s still no substance to score and scrutinize.
The Huffington Post summarized the problem nicely: “Speaker Paul Ryan wants to replace 20 million people’s health insurance with 37 pages of talking points.”
The plan, which isn’t legislation and is more like a mission statement, lacks the level of detail that would enable a full analysis, but one thing is clear: If put in place, it would almost surely mean fewer people with health insurance, fewer people getting financial assistance for their premiums or out-of-pocket costs, and fewer consumer protections than the ACA provides.
It’s difficult to be certain, because the proposal, which House Speaker Paul Ryan (R-Wis.) will talk up at the American Enterprise Institute in Washington on Wednesday, lacks crucial information, like estimates of its costs and effects on how many people will have health coverage.
The document weighs in at 37 pages, which includes the cover, three full pages about how terrible Obamacare is, and two blank sheets.
As for the outline itself, the “plan” includes exactly what we’d expect it to include: tax credits, health savings accounts, high-risk pools that Republicans don’t want to finance, transitioning Medicare into a voucher/coupon system, and the ability to buy insurance across state lines without necessary consumer safeguards and protections.
After seven years of study, GOP lawmakers are stuck with the same collection of ineffective ideas they’ve been pushing to no avail all along.
When House Speaker Paul Ryan (R-Wis.) announced plans to unveil a six-part “Better Way” governing agenda, he vowed, “We’re not talking about principles here. This is substance.” That may have been the goal, but as of this morning, we’re still left with “a starting point” and “a broad outline” on health care that will ostensibly help Republicans to work out the details later.
There’s no great mystery here. Republicans haven’t been able to come up with a credible reform package for some pretty obvious reasons: (1) they’re a post-policy party with no real interest in governing; (2) health care reform has never really been a priority for the party, which would prefer to leave this in the hands of the private sector and free-market forces; and (3) trying to improve the system requires a lot of government spending and regulations, which contemporary GOP policymakers find ideologically abhorrent.
On this last point, New York’s Jon Chait explained a while back, “The reason the dog keeps eating the Republicans’ health-care homework is very simple: It is impossible to design a health-care plan that is both consistent with conservative ideology and acceptable to the broader public. People who can’t afford health insurance are either unusually sick (meaning their health-care costs are high), unusually poor (their incomes are low), or both. Covering them means finding the money to pay for the cost of their medical treatment. You can cover poor people by giving them money. And you can cover sick people by requiring insurers to sell plans to people regardless of age or preexisting conditions. Obamacare uses both of these methods. But Republicans oppose spending more money on the poor, and they oppose regulation, which means they don’t want to do either of them.”
A Republican Hill staffer famously put it this way in 2014: “As far as repeal and replace goes, the problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act…. To make something like that work, you have to move in the direction of the ACA.”
Which, of course, Republicans can’t bring themselves to do. The result is a shell of a plan, like the one Paul Ryan is rolling out today.
By: Steve Benen, The Maddow Blog, June 22, 2016
“We’ll Never Stop Arguing About It”: Obamacare Is Helping A Lot Of People. Not Everyone Thinks That’s Good News
In politics there are some issues where liberals and conservatives share the same goal, but disagree about how to achieve it — we all want to have as little crime as possible, for instance, but there are different ideas about how to accomplish that. Then there are issues where the two groups have different goals — liberals want to preserve women’s reproductive rights, and conservatives don’t. And sometimes, there are issues we think fall in the first category, but actually belong in the second.
Health care may just be that kind of issue, where we talk as though we all have the same fundamental goals, but we actually don’t. There’s an interesting article in the New York Times today on a major success of the Affordable Care Act that demonstrates why we’ll never stop arguing about it. Here’s how it begins:
The first full year of the Affordable Care Act brought historic increases in coverage for low-wage workers and others who have long been left out of the health care system, a New York Times analysis has found. Immigrants of all backgrounds — including more than a million legal residents who are not citizens — had the sharpest rise in coverage rates.
Hispanics, a coveted group of voters this election year, accounted for nearly a third of the increase in adults with insurance. That was the single largest share of any racial or ethnic group, far greater than their 17 percent share of the population. Low-wage workers, who did not have enough clout in the labor market to demand insurance, saw sharp increases. Coverage rates jumped for cooks, dishwashers, waiters, as well as for hairdressers and cashiers. Minorities, who disproportionately worked in low-wage jobs, had large gains.
Before we go farther, we should remember that the ACA is a complex piece of legislation that affects every area of American health care, but for now we’re going to talk just about insurance coverage. When liberals see a report like this one, they say, that’s terrific — some of the most vulnerable people in America, and those who had the hardest time getting covered before, now have health insurance. They offer this as practical evidence of the law’s success.
But conservatives (not all conservatives, but many of them) don’t see that as a success at all. If the government is helping an immigrant who washes dishes for a living get health coverage, then to them that means that government is redistributing tax money from deserving people to undeserving people. The two groups look at the same practical effect, and interpret it in opposite ways.
That isn’t to say that the ACA didn’t give benefits to everyone, because it did. Millions of middle-class and even upper-class people were hurt by the fact that insurance companies used to be able to deny you coverage if you had a pre-existing condition, but the ACA outlawed that. And if the payment reforms in the law bring down overall health spending, we all benefit. But the most visible and dramatic parts of the law relate to the tens of millions of Americans who used to be without health coverage but now have it.
This is why Republicans continue to call the ACA a “disaster” and a “catastrophe” despite the good it has done. Liberals hoped that once the law was implemented and its practical effects became clear, the law would become hugely popular. Instead, views of the law divide closely on ideology and partisanship, and that hasn’t changed and won’t change.
That’s because there’s a fundamental clash of values at work, which means that liberals and conservatives will always judge it according to different standards. Because the law did a large amount to bring coverage to those who couldn’t afford it (through both the expansion of Medicaid and subsidies), and because it included a raft of new regulations meant to solve a variety of problems within the health care system, conservatives will always oppose it, whether it succeeds on its own terms or not. To doctrinaire conservatives, a government regulation that accomplishes what it sets out to isn’t a success at all; it’s a moral failure by definition. That’s why liberals will never convince them to support the ACA by pointing to its practical successes.
That isn’t to say that conservatives don’t make practical arguments against the ACA, because they do. But they’re mostly window dressing placed atop their moral objections to government involvement in health care. So yes, they predicted that Obamacare would destroy the economy, and cost millions of jobs, and lead to fewer people with health coverage, and balloon health care spending, and make premiums skyrocket. When they turned out to be wrong about all these things, conservatives didn’t say, “Well gee, I guess this law was a pretty good idea after all.” Because the fundamental moral objection remains, whatever the practical impact.
You can see it in the decision to accept or reject the law’s expansion of Medicaid. The federal government offered states a huge pot of free money to provide coverage to their poor citizens, and though some conservative governors tried to argue that it would be too expensive, those arguments were laughably weak. As one independent analysis after another has shown — from groups like the Rand Corporation, not exactly a bunch of lefties — taking the expansion leads to healthier state finances and better economic growth, on top of helping your state’s constituents. But for many governors, insuring poor people isn’t a moral good at all; just the opposite, in fact. So they were even willing to incur economic damage in order to avoid it (and to give Barack Obama the finger, of course).
Where this all leaves us is that the ACA will never become something we agree on, no matter what it does or doesn’t do in the real world. But even that’s not the whole story, because there are political factors at work. Smart Republicans understand that with each passing year, the law becomes more and more entrenched and harder to unwind, no matter how much they hate it. It’s one thing to keep people from getting insurance, but it’s something quite different, and far more politically dangerous, to take away insurance people already have — and if they really repealed the law, that’s what they would be doing, not just to a few people but to 20 million or so.
That’s why Republicans have so much trouble coming up with their “repeal and replace” plan. It’s not because there aren’t conservative health care wonks who could give them an outline. It’s because any real repeal would be so spectacularly disruptive to the system that it would a political nightmare. Just today there’s an article in The Hill on the efforts of the Republican task force charged with producing the new repeal-and-replace legislation, under the title, “GOP group promises ObamaCare replacement plan — soon.” If you’ve been following this issue, you know that title is a joke. As the piece says:
Coming up with a plan to replace ObamaCare has been an aim for the Republican Party for so long that it’s become a laugh line even in conservative circles. Despite voting more than 50 times in the House to repeal the law, the GOP has not once voted on legislation to take its place.
But every couple of months, they say that they’ll be releasing their plan any day now.
If Republicans actually took the White House and held Congress, my guess is that they’d pass something they called “repeal and replace” but which would leave the ACA largely intact. Just as they propose to privatize Medicare but rush to tell seniors who love it that their own coverage wouldn’t be affected, it would be some kind of time-delayed change that would avoid kicking people who now have insurance off their coverage. And if Hillary Clinton gets elected in the fall, it’ll be another four or eight years before they could even try this. No matter what happens between now and then, conservatives won’t ever decide that the ACA has worked out well, whether it actually did what it was designed to do or not. As far as they’re concerned, the design itself was the problem. But they may decide, as they did with Medicare, that doing away with it isn’t worth the bother — at least not worth bothering to to try all that hard.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Plum Line Blog, The Washington Post, April 18, 2016
“Seven Years And Counting”: House Republican On Health Care Plan: ‘Give Us A Little Time’
One of the best running jokes in American politics is the one about Republicans releasing their own alternative to the Affordable Care Act. Any day now, GOP leaders have been saying for many years, they’re going to have a plan that rivals “Obamacare,” and it’s going to be awesome.
Yesterday, The Hill reported on the latest installment in this ongoing fiasco.
A group of senior House Republicans is promising to deliver proof that the party is making headway in its six-year struggle to replace ObamaCare.
“Give us a little time, another month or so,” House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) told reporters this week. “I think we’ll be pretty close to a Republican alternative.”
Upton is not just some random figure in the broader effort: The Michigan Republican is a key committee chairman and a member of House Speaker Paul Ryan’s “task force,” responsible for coming up with the GOP’s reform alternative.
Upton said the Republican group is currently in “listening mode” – which it’s apparently been in since its creation 14 months ago.
And yet, we’re apparently supposed to believe that in “another month or so,” House Republican lawmakers will be “pretty close” to having their own reform plan.
Who knows, maybe the GOP is making enormous strides towards its goal. Maybe “listening mode” is going so well that the Republican alternative to the Affordable Care Act is nearly complete. Maybe, with “a little time,” they’re ready to deliver.
It’s certainly possible, but the odds are heavily against it.
As we discussed when the Republican “task force” was created early last year, the political world may not fully appreciate just how overdue this GOP health care plan really is. It was on June 17, 2009 that then-Rep. Roy Blunt (R-Mo.) made a bold promise. The Missouri Republican, a member of the House Republican leadership at the time, had taken the lead in crafting a GOP alternative to the Affordable Care Act, and he was proud to publicly declare, ”I guarantee you we will provide you with a bill.”
The same week, then-Minority Whip Eric Cantor (R-Va.) told reporters that the official Republican version of “Obamacare” was just “weeks away.” We’d all see the striking proof that far-right lawmakers could deliver real solutions better than those rascally Democrats.
This was nearly seven years ago. The Huffington Post’s Jeffrey Young has gotten quite a bit of mileage out of a joke, documenting all of the many, many times in recent years GOP officials have said they’re finally ready to unveil their big health care solution, only to quietly fail every time.
In early April 2014, then-House Majority Whip Kevin McCarthy (R-Calif.) said his party’s health plan was nearly done, but it was being delayed “at least a month.” That was 24 months ago. In 2015, assurances that the Republican plan was on the way were also wrong.
In 2016, however, a GOP leader has been reduced to arguing, “Give us a little time,” seemingly unaware of how hilarious this is.
As we talked about last week, the problem probably isn’t dishonesty. In all likelihood, Republicans would love to have a health care plan of their own – no one likes to appear ridiculous while breaking promises – but haven’t because they don’t know how to craft one.
As New York’s Jon Chait explained, “The reason the dog keeps eating the Republicans’ health-care homework is very simple: It is impossible to design a health-care plan that is both consistent with conservative ideology and acceptable to the broader public. People who can’t afford health insurance are either unusually sick (meaning their health-care costs are high), unusually poor (their incomes are low), or both. Covering them means finding the money to pay for the cost of their medical treatment. You can cover poor people by giving them money. And you can cover sick people by requiring insurers to sell plans to people regardless of age or preexisting conditions. Obamacare uses both of these methods. But Republicans oppose spending more money on the poor, and they oppose regulation, which means they don’t want to do either of them.”
Or as a Republican Hill staffer famously put it in 2014, “As far as repeal and replace goes, the problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act…. To make something like that work, you have to move in the direction of the ACA.”
Which, of course, Republicans can’t bring themselves to do.
But hope springs eternal, and I can’t wait to hear more about the GOP’s progress in “another month or so.”
By: Steve Benen, The Maddow Blog, April 19, 2016
“Sound And Fury Signifying Nothing”: Republicans; “Do What I Say, Not What I Don’t Do”
Think for a minute about the agenda that is being articulated by Republicans these days. And then, given the fact that they now control both houses of Congress, think about what they aren’t doing about it. For example:
* They say that we need to fight ISIS more aggressively (whatever that means). But President Obama has been asking Congress to pass an Authorization for the Use of Military Force against ISIS for months now. Nada.
* They say that we need to secure our borders. Most of them think we should build an impenetrable wall on our border with Mexico. Some of them even say that we should deport all 10 million undocumented immigrants. Have we seen a bill on any of that in Congress? No.
* They say that they want to repeal Obamacare. OK, they actually passed a bill to do that. But they’ve also said that they want to replace it. Anyone seen that plan floating around anywhere? Not so much.
* They say that the problem with gun violence is that we don’t do enough to provide mental health treatment. Congress could do something about that. Have they? No.
* We’ve heard a lot about criminal justice reform. And some bills even passed out of committees. But so far – nothing has actually come up for a vote.
* I don’t know about you, but I haven’t even heard any rumblings from Congress on anything we can do about jobs or wages.
* Of course, most Republicans deny that climate change even exists, so they’re not interested in doing anything about that.
That is the backdrop on which President Obama has stepped forward to take executive actions where he can. Here’s how Ed Kilgore described it:
If you look back at Obama’s record on big executive actions — on guns, climate change, and immigration — you see the same situation. It’s not that he’s fought for “liberal” as opposed to “conservative” policies in these areas. It’s that congressional Republicans, pressured by conservative opinion-leaders and interest groups, have refused to do anything at all…So there’s literally no one to hold bipartisan negotiations with on these issues, and no way to reach common ground.
Even if we simply look at the issues Republicans themselves have identified, none of them are stagnant. There is no such thing as a neutral position. Choosing to do nothing has consequences.
Republicans can shout all they want about how President Obama is by-passing Congress with his executive actions. But until they quit shouting and actually demonstrate that they can do something, it’s all sound and fury signifying nothing.
By: Nancy LeTourneau, Political Animal Blog, The Washington Monthly, January 21, 2016
“A Political Disaster Of Unimaginable Proportions”: Why Republicans Wouldn’t Actually Repeal Obamacare
Last week, in a bold example of their governing prowess, congressional Republicans took their 62nd vote to repeal the Affordable Care Act, and this time they actually passed it through both houses and sent it to President Obama to be vetoed. Naturally, they were exultant at their triumph. Speaker Paul Ryan admitted that there is as yet no replacement for the ACA, but they’ll be getting around to putting one together before you know it. The fact that they’ve been promising that replacement for more than five years now might make you a bit skeptical.
What we know for sure is this: If a Republican wins the White House this November, he’ll make repeal of the ACA one of his first priorities, whether there’s a replacement ready or not. To listen to them talk, the only division between the candidates is whether they’ll do it on their first day in the Oval Office, in their first hour, or in the limo on the way back from the inauguration.
But I’ve got news for you: They aren’t going to do it, at least not in the way they’re promising. Because it would be an absolute catastrophe.
Let’s take a brief tour around the consequences of repealing the ACA. First, everyone who benefited from the expansion of Medicaid would immediately lose their health coverage. According to Charles Gaba of acasignups.net, who has been tracking these data as assiduously as anyone, that amounts to about nine million people. Granted, the working poor are not a group whose fate keeps too many Republicans up at night, but tossing nine million of them off their health coverage is at least bound to generate some uncomfortable headlines.
Then there’s all the people who now get their health coverage through the exchanges that the ACA set up. Remember how fake-outraged Republicans were back in the fall of 2013 because some people with crappy health plans got letters from their insurers telling them that they’d have to sign up for a plan that was compatible with the ACA’s new standards? The truth was that some of them would wind up paying more for coverage while others would pay less, but it was the subject of a thousand credulous news stories portraying them all as victims, to Republicans’ unending joy.
Now imagine that ten million people, the number signed up for private coverage through the exchanges, all had their coverage simultaneously thrown into doubt. Think that might cause some bad press for the party and the president who did it?
There’s more. The ACA also allowed young people to stay on their parents’ insurance until age 26; three million took advantage of the provision. They’d likely lose their insurance too. Oh, and if you’re a senior on Medicare? Get ready for the return of the “doughnut hole” in prescription drug coverage, which the ACA closed.
Let’s add in one more element (though there are lots of the ACA’s provisions we don’t have time to discuss). One of the central and most popular provisions of the ACA banned insurance companies from even asking about pre-existing conditions when they offer you a plan. About half of Americans have some kind of condition that in the old days would mean they either could get insurance but it wouldn’t cover that condition, or they couldn’t get covered at all. If you bought insurance in the old days, you remember what a hassle it was to document for the insurer every time you saw a doctor for years prior. You don’t have to do that now, but if Republicans succeed, we’ll be back to those bad old days. So they can look forward to lots of news stories about cancer survivors who now can’t get insurance anymore, thanks to the GOP.
But wait, they’ll say, our phantom replacement plan has a solution: high-risk pools! This is a common element of the various inchoate health-care plans Republicans have come up with. Anyone who knows anything about insurance knows why these are no solution at all. They take all the sickest people and put them together in one pool, which of course means that the premiums to insure them become incredibly high. As I’ve written elsewhere, high-risk pools are the health insurance equivalent of going to a loan shark: You might do it if you’re desperate and have no other option, but you’re going to pay through the nose. So good luck with that.
Even if Republicans could come together around a single replacement plan, that plan would still be a political disaster. The theory behind their health-care ideas is that once we inject some more market magic into health care, everything will be great. But there are a couple of important things to understand about this idea. First of all, their plans don’t even try to achieve anything like universal coverage. It just isn’t one of their goals, and as a consequence, implementing their plans is going to mean a lot more uninsured than we have now, a reversal of the progress the ACA is made, with millions or even tens of millions of people likely to lose coverage. Second, even if the market mechanisms they use were to work out how they predict—and it’s almost certain they won’t, but let’s give them the benefit of the doubt for a moment—it would take a substantial amount of time.
In this, the ACA is direct. You can’t afford coverage? Here’s a subsidy, now you can afford coverage. But under Republican plans, more people shopping around for their health care is, over time, supposed to bring costs down, which will eventually translate to lower premiums. But in the meantime, while we wait for the invisible hand to perform its alchemy, millions upon millions of Americans will get screwed. Think there’s going to be a political backlash?
I suspect that many conservatives understand that, but still think that in the long term, their small-government ideas will leave us with a superior system. But that still leaves them with a political dilemma. On one hand, repealing the ACA would be spectacularly disruptive—in fact, unwinding the law will probably be more disruptive than putting it in place was, now that the entire health-care and health-insurance industries have adapted to it—and there will be millions of people victimized by repeal. It will be a political disaster of unimaginable proportions.
On the other hand, they’ve invested so much emotional, political, and rhetorical energy over the last six years into their opposition to this law that they would seemingly have no choice but to repeal it, no matter the consequences. Liberals may argue that the ACA would have been a lot better if it hadn’t worked so hard to accommodate the market-based character of the American health-care system, but Republicans have been telling their constituents that it’s the most horrific case of government oppression since the Cultural Revolution (or as Ben Carson says, “the worst thing that’s happened to this nation since slavery”). They can’t exactly turn around to the people who elected them and say, “Look, I know we said we’d repeal this thing, but that’s going to be a real mess. How about if we just make some changes to it so it works more like we’d like?”
Or maybe they could. Just look what happened to Matt Bevin, the new governor of Kentucky. He ran on a platform of purging the state of every molecule of that despicable Obamacare, but now that he’s in office, things are looking a little more complicated. That’s because Kentucky is one of the great ACA success stories, where the expansion of Medicaid brought health insurance to a half a million low-income people who didn’t have it, and the state’s health-care exchange, Kynect, was a model of success. So Bevin is now backtracking on his promise, saying that instead of just eliminating the Medicaid expansion he’s going to reform it. And Kynect may get the axe (which would mean just turning it over to the federal government), but that won’t happen for quite some time, if at all.
And that’s what I think we’d see if we actually got a Republican president and a Republican Congress forced to deal with the consequences of what they’ve been promising for so long. Once they have the ability to bring down such a health-care calamity on the public, it’s not going to seem like such a great idea. They’ll say they’re as committed to it as ever, while behind the scenes they’ll be frantically trying to figure out how to do something they can call “repeal” but that won’t actually get rid of all the things people like about the law. I wouldn’t be surprised if we saw a “repeal” bill that, in the name of an effective transition, left much of the law in place, then slowly instituted their market-driven ideas over time. Because there are limits to even what kind of damage an all-Republican government would inflict—if not on the country, then at least on their political fortunes.
By: Paul Waldman, Senior Writer, The American Prospect, January 10, 2016
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