“King v. Burwell And Jindal’s Real Leverage”: Interfering With The Signals Other Republicans Are Trying To Send To The Supreme Court
Well, fate may have given Bobby Jindal his heart’s desire: a way to exert real leverage on the GOP via his aborning presidential campaign.
He sure needed some help. His efforts to be a holier-than-anyone ally of the Christian Right were probably doomed to failure against competition with the credentials of Mike Huckabee, Ted Cruz, Ben Carson and Rick Perry. And his record in Louisiana–increasingly criticized by Republicans as well as Democrats–is becoming a real millstone.
But thanks to a proposal on health care he first tossed into the mix last spring, Jindal is well-positioned to argue against any Obamacare “replacement” that relies on the basic structure of the Affordable Care Act, or that incorporates its budgetary assumptions, or that can be said to “compete” with the satanic instrument of socialized medicine by treating people well.
The Washington Examiner‘s Philip Klein thinks this is potentially a very big, and not necessarily (for Republicans) very good deal:
Louisiana Gov. Bobby Jindal has laid down a marker on conservative alternatives to President Obama’s healthcare law that could shape the 2016 Republican presidential race — even if he doesn’t win.
On Tuesday, Jindal wrote a letter to Congress, putting members on notice: “(C)onservatives need to focus on truly conservative health reforms — and not merely a slightly-less-liberal plan.”
He followed this up with a speech in Washington, D.C., where he took a swipe at Senate Majority Leader Mitch McConnell, R-Ky., and House Speaker John Boehner, R-Ohio.
“If the whole point of this election was simply to give John Boehner and Mitch McConnell nicer offices, let’s give them back,” Jindal said, as reported by my Washington Examiner colleague Jason Russell. “What is the point of having a Republican Party if it’s only going to become a second liberal party?….”
One Republican alternative plan, first unveiled last year but re-introduced for this Congress on Thursday by Sens. Orrin Hatch, R-Utah, Richard Burr, R-N.C., and Rep. Fred Upton, R-Mich., does lean on the current Obamacare baseline. And it includes a tax increase on employer-based health insurance that helps finance generous subsidies for low-income Americans to purchase coverage.
But Republicans have another option. They could wipe out Obamacare completely, return tax and spending levels to where they would have been if the law had never passed, and build a free market alternative from scratch. This is the approach that Jindal favors and that he took when he released his own healthcare plan last year.
Going this route would mean that Republicans couldn’t spend much on subsidizing health coverage, opening them up to attacks that they’re stripping away Obamacare without offering a sufficient life raft for its beneficiaries. Jindal argues that Republicans shouldn’t fall into the trap of competing with Democrats on coverage totals and that they should instead focus on reducing costs.
Whatever the policy debate, politically speaking, it’s clear to see how Jindal’s position could influence other candidates in the Republican presidential primary. Though Jindal hasn’t been among the leaders in early presidential polls, he’s still viewed as an important policy voice among conservatives, especially on healthcare.
But there’s an even more immediate way Bobby’s attacks on any Obamacare replacement plan that seeks to “compete” with Democratic beneficence could cause problems: by interfering with the signals other Republicans are trying to send to the Supreme Court that they can avoid chaos if the Court knocks out the ACA’s subsidies in states using a federally created exchange. As reformicon Ramesh Ponnuru notes in a column criticizing Jindal’s proposal, it doesn’t just fail to avoid disruption of insurance markets and coverage–it promises a whole lot of it. And if other presidential wannabes pick up on his line of attack, the fiction that Republicans can be expected to behave responsibly in the aftermath of a shocking Supreme Court decision would vanish once and for all.
Yeah, in some respects it would be nice if Bobby just went back to his Muslim-bashing.
By: Ed Kilgore, Contributing Writer, Political Animal, The Washington Monthly, February 6, 2015
“Deadly Consequences”: Public Health Experts Have Estimated How Many Americans Will Die If The Supreme Court Repeals Obamacare
When conservative American Enterprise Institute scholar Michael Strain published an article last week titled, “End Obamacare, and people could die. That’s okay.” he made two critical errors: He embedded a genuinely extreme view into a banal one, and then demanded absolution for both without defending the former.
Strain’s larger point is so uncontroversial, it barely needs reprising: Obamacare was not the final word in U.S. health policy, and if Republicans want to replace the Affordable Care Act with a different, less redistributive set of reforms, they should be able to try, without necessarily catching hell for preferring a system that tolerates marginally more avoidable deaths than Obamacare does (especially if they ply fiscal savings into different programs that alleviate poverty, or improve general welfare).
This is an unobjectionable point. Had Strain argued that the Republican presidential nominee should make an Obamacare alternative the centerpiece of his 2016 platform, nobody would have called it immoral. But the premise of his article is that conservatives (including himself, presumably) will be pleased if the Supreme Court intervenes to gut Obamacare, because it would provide Republicans the missing leverage they’ll need to impose a replacement through the political branches.
First comes god from the machine, and only then comes an Obamacare replacement.
If such a dramatic predicate carried no consequences, Strain’s cost-benefit argument would stand on its own. But when you account for the damage the Supreme Court would incur in order to provide Republicans their missing leverage, it collapses completely.
In a brief to the Supreme Court, dozens of public health scholars, along with the American Public Health Association, detail the harm the Court would create by ruling for the challengers in King vs. Burwell. Most of their analysis is rooted in the basic point that stripping insurance away from eight million people would dramatically impede their access to the health system. But they also flesh out the corollary argument that an adverse ruling would have deadly consequences, and ballpark the number of avoidable deaths such a ruling would cause.
“Researchers found that, in the first four years of the [health care reform] law in Massachusetts, for every 830 adults gaining insurance coverage there was one fewer death per year,” the brief reads. “Using the national estimate that 8.2 million people can be expected to lose health insurance in the absence of subsidies on the federal marketplace, this ratio equates to over 9,800 additional Americans dying each year. Although the specific policy context and population impacts of any policy cannot be directly extrapolated from one setting to another, the general magnitude and power of these findings from the Massachusetts study demonstrate that even when approached cautiously, these earlier findings carry enormous public health implications for withdrawing subsidies and coverage from millions of Americans.”
The Massachusetts story wouldn’t unfold precisely in reverse everywhere the subsidies disappeared, but the experience there suggests the Supreme Court ruling would have measurable mortality implications. These costs (read: deaths) couldn’t be paired against the benefits of increased spending on anti-poverty programs. These are the costs conservatives are eager to inflict on others simply to gain the leverage they need to advance an alternative that the status quo forecloses.
Responding to critics in a followup article, Strain brushes this all aside by stipulating that Republicans would never allow all this suffering. “I think it’s very likely that the congressional GOP would enact some sort of replacement if the Supreme Court strikes down Obamacare,” he writes. “They would very likely take measures to address the needs of those who lost their subsidies as a result of the Court’s action.”
To back up his suspicions, he cites a suspiciously limited set of news reports, quoting Republicans who claim to be working on such a plan—or, at least “talking about how to build consensus on a replacement.”
He does not quote from this Wall Street Journal article titled, “Republicans to Block Legislative Fix to Health-Care Law,” or this article by TPM’s Sahil Kapur titled, “Republicans Are At A Loss On What To Do If SCOTUS Nixes Obamacare Subsidies.”
For those who haven’t been keeping score all along, Republicans have spent the past several years cyclically promising and then failing to deliver an Obamacare alternative. They didn’t have an alternative prepared in 2012 when conservatives asked the Court to declare Obamacare unconstitutional. They didn’t have an alternative prepared later in the year, when Mitt Romney was their presidential candidate. They didn’t have an alternative prepared when they shut down the government as part of an ill-fated effort to defund Obamacare. They didn’t run on an Obamacare alternative in 2014. And they don’t have an Obamacare alternative prepared this week, though they’re scheduled to pass another repeal bill on Tuesday.
The story’s a little different today in that the subsidies really could disappear by fiat, harming millions of people, under GOP control of Congress. Republicans genuinely haven’t encountered a motivating force this strong in the five years since Obamacare became law. If in defiance of such a remarkable pattern, Republicans manage between now and June to come up with a workable plan or a stopgap—one that President Obama will sign—they will have filled the hole in Strain’s argument. Five months might seem like a long time in politics, but remember: It took Democrats more than twice that to pass Obamacare, and almost 10 times as long thereafter to implement it.
By: Brian Beutler, The New Republic, February 2, 2015
“Deja Vu, All Over Again”: Every Day Is Groundhog Day For The GOP’s Obamacare Replacement
In a moment of irony not lost on observers, the GOP-led House Rules Committee will spend Groundhog Day considering the 114th Congress’s first destined-to-be-vetoed attempt to repeal Obamacare. Adding to the déjà vu is the fact that, despite promises to replace the health care law, Republicans still don’t have a firm plan.
The latest repeal bill, sponsored by Rep. Bradley Byrne, an Alabama Republican, doesn’t propose a replacement, but mandates that relevant committees “report to the House of Representatives legislation proposing changes to existing law.” Those proposals, in the language of the bill, should meet 12 provisions, all of which either rehash generic Republican priorities (“foster economic growth and private sector job creation by eliminating job-killing policies and regulations”) or repeat old conservative health care proposals, like medical liability reform.
Further to Byrne’s bill, Reps. Paul Ryan, Fred Upton, and John Kline are expected to lead a task force to create an alternative. “House Republicans’ most serious attempt thus far to develop their health care reform package,” Politico reported Friday.
Early last year, Republicans devoted considerable time to hyping up possible replacements. There was the proposal from Senators Tom Coburn and Orrin Hatch last January; then a March measure from the House Republicans, which The Washington Post described as a “conservative approach to fixing the nation’s health-care system”; and, a few weeks later, Louisiana Gov. Bobby Jindal’s Bobbycare.
And then in April 2014, Rep. Ryan released a budget for 2015 that repealed the law without endorsing any kind of replacement. When asked about his party’s plans, Ryan told The Washington Examiner that “we have lots of ideas of how to offer patient-centered health care… So you’ll see a lot of different comprehensive Republican alternative plans.”
Those alternatives never really solidified. The problem in 2014 was that Republicans couldn’t agree on one, or even on whether it was politically worthwhile to push an alternative that might distract from the Democrats’ Obamacare woes. The problem now is that the Supreme Court might completely gut the health care law in June by ruling that the three dozen states issuing Obamacare subsidies through federal exchanges are acting unlawfully.
Republicans have said that they want to be ready when the court decides—but they don’t seem to have a plan for that scenario. Then again, the Obama administration might not have a plan themselves.
By: Arit John, Bloomberg Politics, January 31, 2015
“Heading Towards A GOP Train Wreck”: You’re Going To See The Republican Party With All Their Clothes Off
Does anyone else see a train wreck coming for this Republican Congress?
House Ways and Means Chair Paul Ryan (R-WI) will lead along with two other top committee chairs a Republican task force to come up with a plan in case the Supreme Court strikes a blow to Obamacare later this year…
They will be tasked with working up an alternative plan if the Supreme Court invalidates tax credits in the 30-plus states that use HealthCare.gov, as well as a more general Obamacare alternative if the law were to be repealed…
Coming in the opposite direction is this train:
There is internal dissent on whether Republicans ought to come up with an alternative. One congressional GOP health aide, who was granted anonymity to speak candidly, said his party is as determined as ever to fight Obamacare, and will remain so as long as it exhibits failure. He said devising an alternative is fraught with the difficulty of crafting a new benefits structure that doesn’t look like the Affordable Care Act.
“If you want to say the further and further this gets down the road, the harder and harder it gets to repeal, that’s absolutely true,” the aide said. “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. You have to have a participating mechanism, you have to have a mechanism to fund it, you have to have a mechanism to fix parts of the market.”
Pushing on the accelerator of both trains is this:
Leaders in the GOP-controlled House and Senate see the court challenge as their best hope for tearing apart a law they have long opposed. If the court strikes down the subsidies, Democrats are expected to clamor for lawmakers to pass a measure correcting the language in the law to revive them. Congressional Republicans say there is no possibility they would allow that.
“No, no, no, no;” said Sen. Dan Coats (R., Indiana).
Rep. McDermott came up with a different analogy.
GOP congressional leaders haven’t coalesced around a specific replacement for the law should the court strike down the subsidies. Democrats say that makes them vulnerable, and plan to paint the GOP as responsible for taking away benefits that millions already receive.
“What you’re going to see is the Republican party with all their clothes off,” said Rep. Jim McDermott (D., Wash.) “They are standing out there naked as a jaybird and they are going to have to stand up and explain, ’Well, now we got rid of it – now what do we do?’”
It would all be humorous if it weren’t so terribly tragic.
By: Nancy LeTourneau, Political Animal Blog, The Washington Monthly, January 31, 2015
“The GOP’s 20-Year War On Health Care”: Republicans Are Going To Extraordinary Lengths To See That More Americans Die
Stop the presses: John Boehner admitted Thursday that the Republican Party’s long-awaited alternative to Obamacare needs a little more time in the oven. “You know, the discussions about Obamacare and what the replacement bill would look like continue. We’re trying to build consensus around one plan,” the Speaker told Hill reporters. “Not there yet.”
As if you even needed me to tell you, rest assured: It could be six months from now, a year from now, five years from now, or the day Bibi Netanyahu and Khaled Mashal share a Nobel Peace Prize—they aren’t going to have a plan. Oh, they might have a “plan.” They had a “plan” last year, or at least Oklahoma Sen. Tom Coburn and two others did. For about two days, they were really tooting its horn. Then it dawned on people that paying for it would involve a hefty middle-class tax increase, on higher-end insurance plans. You may have noticed since then that the Coburn “plan” has not exactly become a leading Republican talking point.
As conservatives continue to hail the Halbig decision, some historical context is called for. In my last column, I wrote that conservatives and Republicans are going to extraordinary lengths to see that more Americans die. Not every reader was won over by that opinion, as you might imagine. But I think it’s beyond dispute, as a little discussion of political history should show.
The problem of millions of uninsured has existed in this country since—well, since forever. But as a running news story that the media paid attention to, for the last 25 or 30 years. I remember when the then-horrifying number was 15 million uninsured. Then 20 million, then 30 million, on up to the 46 million figure we often saw bandied about before the Affordable Health Care was enacted (10 million new Americans are insured as a result of it—a very respectable dent, for just one year). So, 30 years, a full generation, tens of millions of people adversely affected. And what, in all that time, has the Grand Old Party proposed to do about it all?
Not. One. Thing. Republican presidents had (if we go back to 1984) 16 years to pass some kind of health-insurance law. But none of the three ever even proposed one. George W. Bush did pass his Medicare law, but that was about adding prescription-drug coverage for seniors; it didn’t insure any previously uninsured citizens. What the GOP did instead, of course, was to fight tooth-and-nail to stop the two Democratic attempts to insure more people, succeeding the first time, failing the second.
And “tooth-and-nail” hardly begins to describe the demented and nearly sociopathic reality of Republican and conservative opposition to trying to make health insurance affordable for working-class people. Opposition to doing so has been one of the four grand accomplishments of the Republican Party of our time, which I would rank as follows, one scratched on each side of the obelisk: one, start disastrous wars and commit torture; two, make people despise the government; three, nearly cause a new Depression; and four, deny health insurance to as many people as possible, as aggressively and nastily as possible. It’s a grim record generally, and with regard to health care specifically, inarguably one that has promoted insalubriousness and suffering and, indeed, deaths that might have been avoided or delayed if people had had insurance.
It is true that some conservative intellectuals have offered up some ideas—as we know, the same individual mandate that the right now calumniates was a conservative idea at first. And John McCain actually had a decent-ish health-care platform plank in 2008. But if McCain had been elected, it’s very unlikely that the constellation of interests and power centers in the GOP would have permitted him ever even thinking about pursuing it. It was just something he felt he had to say to have credibility with middle-of-the-road voters. And in any case he wasn’t elected, and those conservative intellectuals’ ideas were never seriously proposed by elected Republicans, so the historical record is what it is.
The 20-year war on health care—since their 1993 defeat of the Clinton plan—has been about Republicans’ hatred of government; their view of people who don’t have insurance as lazy or flawed and not worth lifting a finger for; and their fear that if a law is passed and succeeds in bringing health care to millions, they and their whole vision of society will be discredited in the eyes of millions. Of course, these days, all that is shot through with one more element: a heavy dose of Obama hatred.
I was on Hardball Wednesday evening with David Corn, and Chris Matthews showed poll numbers during our segment that surprised even me. The topic was “rooting for failure.” Back in 2006, he said, Democrats were asked in a Fox News poll whether they wanted President Bush’s policies to succeed or fail. Answers: 40 succeed, 51 fail. Not particularly generous. But earlier this year, he said, CNN asked Republicans the same question about President Obama. Answers: 14 succeed, 73 fail.
Think about that. Three-quarters of regular Republicans want Obama to fail. And just one in seven wants him to succeed. We pundits spend most of our time blaming politicians for inaction, but maybe it’s time to start blaming the people. If regular Republicans feel like this, there’s no way the elected officials who represent them are going to do anything that looks remotely like compromise or cooperation.
And no, they’re not going to offer a real health-care plan either. They first promised that in 2010, during the campaign season, so they could say “repeal and replace” instead of just “repeal” and sound like they had a positive side. Then they dropped “and replace,” and now that it’s election time again, it’s back. But it’s not in their DNA to do anything constructive about health care. Or—the VA crisis, the border crisis, the Middle East crisis, the wage-and-inequality crisis, et cetera—about much of anything.
By: Michael Tomasky, The Daily Beast, July 25, 2014
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