“What’s Really Obstructing Obamacare?”: An Orchestrated GOP Resistance With Only One Very Ugly Precedent
So we’re a month into the Obamacare era. What does your average American know about it? That the website is a mess, and some number of Americans have suddenly lost their coverage after Barack Obama assured them that wouldn’t happen. These things are true, and a person would be quite wrong to deny this is deeply problematic.
But I wonder how many Americans know the other side of the coin. There are already numerous success stories out there. And then there’s the side of the story that has certainly received coverage but not nearly as much as it deserves to, which is the way—did I say way? Ways—the Republican Party is trying to make sure it fails. Todd Purdum wrote a piece for Politico yesterday on the GOP’s “sabotage” of the law. It was a terrific article, but he didn’t say the half of it.
All across the country, Republican governors and insurance commissioners have actively and directly blocked efforts to make the law work. In August, the Obama administration announced that it had awarded contracts to 105 “navigators” to help guide people through their new predicaments and options. There were local health-care providers, community groups, Planned Parenthood outposts, and even business groups. Again—people and groups given the job, under an existing federal law, to help people understand that law.
What has happened, predictably, is that in at least 17 states where Republicans are in charge, a variety of roadblocks have been thrown in front of these folks. In Indiana, they were required to pay fees of $175. In Florida, which under Governor Rick Scott (who knows a thing or two about how to game the health-care system, you may recall) has been probably the most aggressive state of all here, the health department ruled that local public-health offices can’t have navigators on their premises (interesting, because local public health offices tend to be where uninsured people hang out). In West Virginia, Utah, Pennsylvania, and other states, grantees have said no thanks and returned the dough after statewide GOP elected officials started getting in their faces and asking lots of questions about how they operate and what they planned to do. Tennessee issued “emergency rules” requiring their employees to be fingerprinted and undergo background checks.
America, 2013: No background checks to buy assault weapons. But you damn well better not try to enroll someone in health care.
If you Google “Obamacare navigators,” you will be hit smack in the face with the usual agitprop. “Reports” raise “questions” about their qualifications, you see. This is the old trick of finding one bad apple and extrapolating away to beat the band. But in this case the alleged bad apple wasn’t even bad. One enrollment assister in Lawrence, Kansas—one!—had an outstanding warrant. She hadn’t even been aware of the warrant. The group she worked for said, apparently credibly, that the warrant was “no longer active.” (Interestingly under the circumstances, it was about… an unpaid medical bill!) But my favorite story linked—inevitably—the navigator program to ACORN. You will recall that no one ever proved that anybody from ACORN ever did anything wrong, but of course in right-wing land this means nothing.
A second front: Now, with people trying to sign up, some Republican legislators are openly saying that they won’t permit their staffs to answer constituents’ questions about Obamacare. This is really the main job of a member of Congress, especially a House member: People call up all the time with questions about how to slice their way through the federal government’s briar patches, and you have caseworkers on duty—typically a couple in Washington and several more back home in the district regional offices—whose job is exactly that.
Purdum quoted Kansas Rep. Tim Huelskamp as saying he instructs his staff to refer callers to Kathleen Sebelius. But Huelskamp is not alone. Tennessee’s Diane Black says she doesn’t feel comfortable referring people to navigators. Utah’s Jason Chaffetz is referring people back to the administration, saying: “We know how to forward a phone call.”
Someone I know asked the other day: Has there ever been a law in the history of the country as aggressively resisted by the political opposition as this? Republicans didn’t do this with Social Security. Most of them voted for Social Security. They didn’t do it with Medicare. They, and the Southern racists who were then Democrats, didn’t do it with civil rights. There was a fair amount of on-the-ground opposition to that, but it wasn’t orchestrated at the national level like this was. And when the Voting Rights Act was passed the year after civil rights, Southern states in fact fell in line quickly. Check the black voter-registration figures from Southern states in 1964 versus 1966. It’s pretty amazing.
No, to find obstinacy like this, you have to go back, yes, to the pre-Civil War era. The tariff of 1828, the Kansas-Nebraska Act, which led to the civil war in “Bloody Kansas” and ultimately to the Civil War itself. Not a comforting thought. But it’s where we are.
The administration’s cockups are a legitimate story. I’ve never said otherwise. My first column about the website was quite tough on the administration and on Obama personally, when I wrote that I found it shocking that he apparently wasn’t riding herd on staff to make damn sure the thing worked. I said on television, to some host’s surprise, that yes, I did hold him accountable for the mistakes.
So I get why that’s a story. But the sabotage is a story, too. A huge one. It’s almost without precedent in American history, and the precedent it does have includes some of the ugliest chapters in this nation’s history. It gets coverage, yes. But not nearly the coverage it deserves. As is so often the case—as with Benghazi, as with Fast and Furious, as with the IRS—the bigger scandal is on the Republican side.
By: Michael Tomasky, The Daily Beast, November 1, 2013
“Health Care Sabotage 101”: The GOP, Not A Botched Website, Is The Real Obstacle To Implementing Obamacare
It’s the latest chapter of Barack vs. the Health Care Killers, The Continuing Saga of Posturing, Bad Faith, Spite and Ineptitude.
Republicans, who have used every trick in their playbook to gum up the works of the Affordable Care Act, are now holding hearings to investigate how the works got so gummed up.
They could save themselves the trouble by looking in the mirror, just as O.J. Simpson could have done to find his wife’s killer. But that would rob them of the chance to grandstand.
In fairness, they do have one point. The Obama administration botched the debut of its insurance marketplace website so badly that it fairly begged for an investigation. And since Republicans had little or nothing to do with the website, the blame for its failures falls squarely on the president and his deputies.
The screw-up was a gift. GOP lawmakers were calling the law a failure before most of it went into effect, but lacking any evidence they had to rely on mere accusation. Now, finally, they can say that their worst predictions had some validity.
Nevertheless, Republican “outrage” over the glitches is hard to take seriously. If they’re really looking to find what went wrong — and there was plenty — one suspects it’s only so they can clone the virus. Then anyplace where the law is working, such as Kentucky, Washington and Oregon, they can infect the system, watch it crash, shake their heads and snicker.
Come on, folks. Republicans want to “fix” what’s broken here as much as they want to “protect” women by targeting their reproductive rights and “defend” the vote by obstructing it. But because Healthcare.gov went live on the same day that the party crazies shut down the government over the law’s funding, they were too deep in their own morass to capitalize on it. Worse, they had to fold on the shutdown without getting anything in exchange. No wonder they’re pouncing on the chance to grill the people whose job it was to enable what they’ve called the worst law in the history of man.
Yes, the administration deserves to be on the hot seat. There was more than enough time to make sure the website worked properly and there is no excuse for its failure to do so.
Mr. Obama had to know that the first weeks would set the tone for public perception. If he had wanted to raise doubts about the program or shoo people away, he couldn’t have done a better job of it.
Once again, we have to wonder what goes on in his mind. This legislation is only the most important accomplishment of his presidency. He put everything on the line for it. Millions of people are counting on it for coverage they cannot otherwise afford. If he can’t get the introduction right, well, let’s just say it’s a good thing he won’t be running again.
But then there’s that pesky caveat called perspective. A botched website, which can and will be repaired, is nowhere near the biggest obstacle to the success of health care reform. That distinction goes to the program’s sworn enemies, who have been conducting a misinformation campaign of false claims and scare tactics since the law was passed. To hear them tell it, “Obamacare” will turn people into devil worshipping socialist homosexual vegetarians who want the terrorists to win. So of course they will do everything they can to stop it.
Exhibit One: The quickest and easiest way for states to enact the law’s reforms is to expand Medicaid, which would trigger a huge infux of federal dollars for the first several years. Yet Republican governors in 26 states have refused to do so. The primary excuse is that they won’t be able to afford it once the federal money stops. The subtext is that they’d rather sabotage the president than help their own citizens get the treatment they need. Thanks to them, according to a New York Times analysis, the new law will leave out two-thirds of the nation’s black citizens and single mothers, and half of the low-wage workers who currently lack insurance.
In addition, GOP governors (including our own Tom Corbett and, regrettably, a few Democrats) have refused to create insurance exchanges that would facilitate reaching the uninsured. Instead, those people will have to go to the federal exchange.
They’re also refusing to assist applicants and blocking the use of so-called “navigators,” whose job is to help people understand the law and sign up for its benefits. When a constituent calls with questions, they are making sure they’ll get no answers.
Then there was the government shutdown, during which Republicans offered more than 40 measures to cripple the law. They failed in every sense, but it still cost the country $24 billion.
It doesn’t take a genius to see where the real obstruction lies. For all its screw-ups, the Obama administration is trying to make health care reform work. And for all their public posturing, Republicans are trying to ruin it. But the law was duly passed, it’s here, and it’s not going away. They should save the fake righteousness for a cause that isn’t already lost.
By: Sally Kalson, Pittsburg- Post Gazette, October 26, 2013
“Hurting Real People Who Have Real Needs”: Republicans Are Suppressing Obamacare Enrollment
Republicans have done everything they could think of to repeal, defund, undermine and otherwise disrupt Obamacare. But they’ve failed, and that’s why they’ve turned to a last-ditch strategy to stop the law and take away the rights of millions of Americans to get the health care they need.
Governors and state legislators are adopting state laws and regulations to sabotage the work of “navigators,” the community organizations that will help consumers sign up for care. We are witnessing navigator suppression, and the Republicans’ objective is simple: the harder they make it for navigators to do their jobs, the harder it will be for people to benefit from Obamacare.
Republican governors in 21 states are already denying more than 5 million people health care by refusing to expand Medicaid. Navigator suppression is another way for the Obamacare haters to pile on and limit the reach of the law.
In a new report, Health Care for America Now conducted a detailed review of the most egregious laws and regulations found in 13 selected states: Arkansas, Florida, Georgia, Iowa, Illinois, Indiana, Maine, Missouri, Montana, Ohio, Tennessee, Texas and Wisconsin. These states are home to 17 million people without health insurance who are eligible for coverage under the health care reform law–fully 41 percent of the nation’s uninsured.
The excessive requirements we found include such things as residency rules, extra fees, additional and unnecessary training requirements, superfluous certification exams, and prohibitions against navigators talking with consumers about the benefits offered by different plans. These measures constitute direct interference in the enrollment process.
For example, in Missouri, state and local officials are barred from providing any assistance to an exchange. In Florida, the Department of Health released a directive prohibiting navigators from conducting outreach at any of the county’s 67 health departments. Fortunately, two big counties, Broward and Pinellas, are ignoring the order.
And just this month, Texas Gov. Rick Perry ordered the Insurance Commissioner to write new navigator regulations that require, among other things, that navigators complete 40 hours of training in addition to the 20 hours required by the ACA and then pass a “rigorous” state exam. Perry is even trying to limit the hours of navigator operations to 8 a.m. to 5 p.m. None of these rules is going to help get people covered in Texas, which has the nation’s highest percentage of uninsured residents.
These roadblocks and restrictions have caused groups to withdraw from the program and return their navigator grants. This is why President Obama in Maryland today criticized the Republicans for creating these sorts of “roadblocks” for the “churches and charities” working as navigators to educate the public about enrollment.
The Republicans claim these laws are about protecting consumers. But Georgia’s commissioner of insurance cleared that up when he boasted on video that he was doing everything he could to be “an obstructionist” to Obamacare.
Some of the Obamacare opponents may think they’re attacking the President or the law, but mostly they’re hurting real people with real health care needs. They’re making it harder for people to buy health care. This isn’t just an abstract political debate. For people without health insurance, this is about whether or not they can get medical care and get it without going bankrupt.
In a growing number of states, navigators are turning back their grants to help consumers because of navigator suppression policies.
Cincinnati Children’s Hospital Medical Center, for example, which was planning to enroll people at three hospitals, turned back $124,000 in federal grant money because of state restrictions that went into effect this past July.
Cardon Outreach was going to educate people in Florida, Oklahoma, Pennsylvania, and Utah. It returned its $833,000 grant.
In West Virginia, the Attorney General, Patrick Morrisey, a vocal opponent of the ACA, launched a harassment campaign against one of his state’s navigators, West Virginia Parent Training and Information. Morrisey posed dozens of questions to the group about its navigator program and gave them only 14 business days to respond. Instead, the organization decided to send back its $366,000 enrollment grant.
The Lower Rio Grande Valley Development Council along the Texas border with Mexico just returned $288,000 in navigator grant funds this week in response to Perry’s attack, and four other Texas navigator groups reportedly may follow suit.
These state officials have taken their cues from members of Congress. Republicans on the House Energy and Commerce Committee sent letters to 51 groups in 11 states, including food banks, legal aid societies, and United Way organizations. The committee demanded that these groups produce reams of paperwork about their operations and schedule a briefing of the committee by Sept. 13. The only purpose of the inquiry was to interfere with the ability of these groups to prepare for enrollment. That’s sabotage, and it’s a politically motivated abuse of power.
Many of the states now going after navigators are also passing laws to suppress voter registration and make it harder for minority, low-income and elderly residents to participate in elections. Just like voter suppression, enrollment suppression is an attack on people’s right to be healthy and free from financial hardship and bankruptcy.
That’s why navigator suppression shocks the conscience: it perpetuates the systematic denial of affordable health care to huge numbers of the most vulnerable individuals in our society, especially those in minority and lower-income populations.
Thanks to Obamacare, Americans no longer have to worry about getting the health care they need. They only have to worry about the Republicans taking it away.
By: Ethan Rome, Executive Director, Health Care for America Now; Health Care for America Now Blog, September 26, 2013
“Caught Between Arithmetic And Ideology”: Can Republicans Afford To Buck The Tea Party?
Since the Tea Party emerged following President Barack Obama’s victory in 2008, Republican governors have frequently been the faces of some of the most extreme policies in recent political memory. Even before her infamous “finger point” at the president, Arizona’s Jan Brewer was signing and defending her state’s racial-profiling bill, SB 1070. In Ohio, John Kasich championed a law—later repealed by voters—to strip public employees of bargaining rights. In Florida, Rick Scott has pushed a plethora of hard-right policies, from drug screening of welfare recipients and government employees to reductions in early voting. Michigan’s Rick Snyder, who has a moderate streak, went to the extreme last December when he approved “right to work” legislation in a state built largely by union labor.
Yet Brewer, Kasich, Snyder, and Scott are among the nine GOP governors who have staked considerable political capital on Medicaid expansion, a key piece of the Affordable Care Act. They haven’t been quiet about it, either. Brewer made good on a threat to veto every piece of legislation that came before her until lawmakers sent her a bill to expand Medicaid. Snyder rankled his party when he told recalcitrant Republican state senators to “take a vote, not a vacation.” Scott was among the first Republicans to announce his support for expansion. Kasich, struggling to win support from his party’s lawmakers, has vowed to find a way to expand Medicaid even if they won’t.
All this, while in Congress, the Tea Party Republicans have worked tirelessly to shut down the government rather than see the Affordable Care Act continue, marking it as the emblem of Obama’s big-government liberalism.
By championing Medicaid expansion, these governors are defying the Tea Party, which was instrumental in their elections. Such defiance has been exceedingly rare from Republican officeholders on any level since the Tea Party revolution of 2010. That election transformed state legislatures and governors’ mansions—in many cases overnight—into ideological strongholds. Increasingly, the policy priorities of national right-wing groups like ALEC and Americans United for Life began to take precedence over state-specific agendas, and bipartisanship disappeared from state capitols almost as thoroughly as it has Congress. “The broader pathologies of our politics have clearly moved to the state level,” says Norman Ornstein, resident scholar at the American Enterprise Institute and co-author with Thomas Mann of It’s Even Worse Than It Looks, which made the case that Republican extremism and hyper-partisanship has crippled Congress.
But Kasich, Snyder, and Scott govern states that Obama has won twice. They have all struggled with low approval ratings and polarized the electorate with their far-right policies. They all face tough battles for re-election in 2014. By backing Medicaid, they were guaranteed to inspire Tea Party wrath. By opposing it, they would deny health coverage to huge numbers of low-income residents, shut the door on billions in federal funding, and risk further alienating voters.
“Republican governors are caught in a tug-of-war between arithmetic and ideology,” says William Galston, a senior fellow at the Brookings Institution. “For some of them, ideology wins, and for others, who are looking to their self-interest and the interests of their state at least in the short to medium term, they have done a very simple calculation and that is that the Medicaid expansion is a good deal for their states.”
There’s little denying that Medicaid expansion to cover many more adults, is a good deal for every state. For the first three years, the federal government will pick up 100 percent of the cost for new recipients. After that, states will never pay more than 10 percent of the costs of expanded coverage; the rest of the bill goes to Washington. In Ohio alone, more than 500,000 people would gain access to coverage. With more people covered, of course, the costs to states of uncompensated care will drop. In June, a report from the Rand Corporation found that the first 14 states that opted out of expanding Medicaid will have 3.6 million more uninsured residents, lose $8.4 billion a year in federal payments, and pay an additional $1 billion in uncompensated care in 2016.
The arithmetic hasn’t been enough to convince most Republican governors to back Medicaid. Sixteen of the 30 oppose expansion, including the chief executive of another state Obama won twice, Wisconsin’s Scott Walker. Three other GOP governors had yet to venture a position.
Then there’s Pennsylvania’s Tom Corbett, a governor emblematic of the dilemma facing unpopular Republicans in swing states. Obama won Pennsylvania by 11 points in 2008 and by 5 points in 2012. But Corbett, who won in the 2010 wave, has stuck to the Tea Party agenda on everything from voter ID to welfare cuts. He was quick to announce that his state would reject federal funds for Medicaid expansion.
Under enormous pressure, however, he changed his mind, and last week announced he would support Medicaid expansion if the federal government agreed to a slew of concessions. Unlike Walker, a strong favorite in 2014 thanks to weak and divided opposition following a failed recall attempt, Corbett is among the most vulnerable incumbents in the country. Corbett is now trying desperately find some political path to moderation—though it’s likely to be too little too late and it stands in contrast to those like Snyder and Kasich, who actually took the lead on the issue.
That a minority of Republican governors has backed Medicaid expansion does not add up to a major shift in the political dynamic. But it could be significant, depending on the outcome of the 2014 elections. If a governor like Scott or Kasich can manage to win re-election even after infuriating his right-wing base on a key issue, it will send a couple of important messages to other Republicans, at least those in purple states: Yes, the Tea Party can be bucked. And no, making policy based on the needs of your state does not amount to certain political death. It might even save you from it.
By: Abby Rapoport, The American Prospect, September 23, 2013
“An Important Milestone”: In Michigan, A Defeat For The Tea Party And Victory For Common Sense
Obamacare took a big step forward on Tuesday night, when the Michigan Senate approved an expansion of the state’s Medicaid program. The state House is likely to back the same measure, as early as next week. And while the program requires a special federal waiver, the Obama Administration is likely to grant it. Assuming all of that happens, Michigan will become the twenty-fifth state to expand Medicaid as part of the Affordable Care Act. As a result, a few hundred thousand residents are likely to get insurance—and the state will get a much-appreciated infusion of federal funds, while putting up a much smaller share of state money.
For the advocates of making health insurance available to all Americans, it’s a huge victory. But the victory did not come easy—or without some last-minute drama.
Tuesday’s vote was the product of a long, sustained campaign by Democrats, moderate Republicans, progressive organizers and business leaders. For months, they have made the case for expansion—citing the likely financial and health benefits for Michigan’s uninsured citizens, and the expected boost to Michigan’s economy. The federal government is picking up most of the expansion’s costs, they have argued, and hospitals need the revenue to make up for money they lost on charity care and declining reimbursement from other sources.
Among those assessing the statistical impact were Marianne Udow-Phillips, director at the Center for Healthcare Research and Transformation and a lecturer at the University of Michigan School of Public Health. As she told me on Wednesday,
if you look at all the facts—the fact that the majority of physicians in the state are ready to serve this population; the positive impact on the state budget, on the state’s economy at large, on hospitals, on businesses, on all those who are currently insured (by reducing cost shifting) – not to mention the half a million people who will directly benefit by getting health insurance coverage in a program that has the highest satisfaction of any insurance coverage type in the state – you have to draw the conclusion that the Medicaid expansion is the right thing to do for the state.
Governor Rick Snyder and the state Chamber of Commerce have been among the strongest proponents of expansion. The state’s health care industry, naturally, has lobbied furiously. But Tea Party Republicans and their allies have been dead set againt it, arguing that Medicaid is a wasteful, expensive program that subsidizes the indolent—and that the size of the federal subsidies masked the true impact on the state, which would actually be negative.
Writing this week in the Detroit Free Press, Joseph G. Lehman and Clifford W. Taylor from the Mackinac Center for Public Policy warned that
The state’s main incentive to expand Medicaid is a federal promise to transfer to Michigan $2 billion (increasing to $3 billion) annually for three years if we add 320,000 Michiganders earning up to 138 percent of the poverty level to Medicaid rolls.
After three years our federal subsidy would shrink by $300 million per year, meaning either Michigan taxes increase by that much or lawmakers kick 320,000 people off Medicaid, which seems unlikely.
Expansion supporters have responded that, even after the reduction, the federal government would still be picking up 90 percent of the new cost. They have also tried to accommodate concerns about Medicaid efficiency, by, among other things, proposing that some Medicaid recipients pay a portion of their own costs. The compromises changed a few votes, and in June the state House approved its version of the expansion. But the Senate in June surprised everybody, including the governor, by rejecting the measure. One likely reason: Tea Party groups, and their financial backers, were threatening to support primary challenges to Republicans who voted yes.
The expansion’s supporters spent the remainder of the summer making their case, rallying the public, and lobbying individual members. As of Tuesday morning, they were confident they had 19 senators willing to vote yes. That would produce a tie in the 38-member chamber, with the lieutenant governor prepared to vote yes and break the tie. But when the Senate first voted in early afternoon, only 18 said yes. The chamber quickly voted to reconsider and, after a feverish few hours of lobbying and meeting, tried one more time. This time, the bill passed 20 to 18.
Progressives aren’t thrilled about some of the compromises, particularly those asking Medicaid recipients to pay a larger share of their costs. (Sarah Kliff has more of the details if you want them.) And it’s not out of the question that the federal government will raise objections, because the federal Medicaid law limits the ability of states to change the program. But given political resistance to any expansion, supporters are mostly elated at Tuesday’s outcome. “It’s not perfect, but it’s going to help nearly half a million Michiganders,” Amy Lynn Smith wrote at Electablog, a progressive website based in Michigan.
Michigan’s decision is an important milestone in the effort to make Medicaid available to all low-income Americans—an endeavor that has proven far more difficult than most experts anticipated. Last summer, when the Supreme Court made it easier for states to reject Obamacare’s planned expansion of Medicaid, many of us assumed the vast majority of states would participate anyway. The need for coverage was too great, and the allure of federal money too tempting, for even most Republicans to reject. Quite obviously we were wrong. Conservatives serving either as governor or state legislators have successfully blocked expansion across a wide swath of the country, including the huge states of Florida and Texas, where a few million people would be eligible.
But the Medicaid expansion has gotten support from several other Republican governors, including Jan Brewer in Arizona (where the expansion is already going forward) as well as Rick Scott in Florida and John Kasich in Ohio. Florida looks hopeless, at least for the time being, given the grip extreme conservatives have over the legislature. Ohio is another story: The politics there look a lot like the politics in Michigan. The same goes for Pennsylvania, although that state’s Republican governor, Tom Corbett, doesn’t yet support expansion.
Obamacare’s Medicaid component, in other words, is moving ahead. But progress is taking place in fits and starts, with frequent setbacks, thanks mostly to political opposition that’s strongest in the most conservative parts of the country.
Yeah, you should get used to that pattern.
By: Jonathan Cohn, Sebior Editor, The New Republic,
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