“It’s All Or Nothing”: The Obama Administration Plays Hardball On Medicaid
When the Supreme Court upheld the Affordable Care Act, it also gave Republican states a gift by saying they could opt out of what may be the ACA’s most important part, the dramatic expansion of Medicaid that will give insurance to millions of people who don’t now have it. While right now each state decides on eligibility rules—meaning that if you live in a state governed by Republicans, if you make enough to have a roof over your head and give your kids one or two meals a day, you’re probably considered too rich for Medicaid and are ineligible—starting in 2014 anyone at up to 133 percent of the federal poverty level will be eligible. That means an individual earning up to $14,856 or a family of four earning up to $30,657 could get Medicaid.
Republican governors and legislatures don’t like the Medicaid expansion, which is why nine states—South Dakota, plus the Southern states running from South Carolina through Texas—have said they’ll refuse to expand Medicaid (many other states have not yet said whether they’ll do it). But some states asked the Obama administration whether they could expand Medicaid a bit—maybe not cover everyone up to 133 percent like the law says, but add a few people to the rolls. And yesterday, the administration said no. It’s all or nothing: either you expand Medicaid up to 133 percent, or you get none of the new money. Was that the right thing to do? Well first, let’s talk about that money.
These Republican states offer worries about cost as their reason for rejecting the Medicaid expansion. But in truth, it’s an incredibly sweet deal for them. Right now, the federal government generally pays half of the cost of Medicaid, with the state picking up the other half. But the federal government will pay 100 percent of the cost of new Medicaid recipients signed up because of the expansion between 2014 and 2016. After that the federal contribution will step down to 90 percent by 2020, where it will stay forever more. So the state gets to insure a whole bunch of its citizens for nothing at first, and eventually for only 10 cents on the dollar. And in return they get reduced costs for uncompensated care, and a healthier, more productive citizenry with more money to spend. Some studies have projected that states will more than make up for their 10 percent contribution with health care savings they’ll get from an insured population; that’s likely to be particularly true among those states whose Medicaid eligibility standards are currently the stingiest, who not coincidentally have the highest rates of uninsured citizens (and, also not coincidentally, are precisely those states where the Republican leadership is refusing to accept the expansion).
And yet, the most conservative among them won’t take the deal. The federal government is saying to the states, Here is a bunch of free money for you to give health insurance to your uninsured poor citizens. And these states are saying, No way! Their justification of budget worries is so unpersuasive that it’s impossible to avoid the conclusion that they would rather see people have no insurance, and thus be poorer, sicker, and die sooner, than get Medicaid via Obamacare. It’s truly a moral abomination.
By playing a little bit of hardball and not letting states get away with a partial expansion, the administration is betting that before long the states will find all this free money to insure their citizens irresistible. And they may be right. That’s what happened when Medicaid was established in 1965; few states signed up at first, but before long they all did. Right now these governments are being pressured by some powerful interests to take the expansion, particularly the hospitals who have to deal with patients with no way to pay their bills. If they expanded Medicaid a little but not fully, that pressure wouldn’t be as intense and they could claim they expanded coverage. This way they won’t be able to hide behind a partial expansion and claim they did the right thing. Let’s hope the administration is right, because millions of Americans’ futures depend on it.
By: Paul Waldman, Contributing Editor, The American Prospect, December 11, 2012
“Saving Medicare From The GOP, Again”: Raising Medicare Age Won’t Save Money But Will Cost Lives
Raising taxes on the rich alone won’t close the deficit or erase the national debt, as Republicans superciliously inform us over and over again. But in their negotiations with the White House to avert the so-called fiscal cliff, Congressional Republicans seem obsessed with a change in Medicare eligibility whose budgetary impact (when compared with ending the Bush tax cuts for the wealthy) is truly negligible — but whose human toll would be immense.
That Republican imperative is to raise the Medicare eligibility age from 65 to 67.
Why do Speaker John Boehner and the Republican majority in the House so badly want to put Medicare out of reach of elders younger than 67? It will be costly to their most loyal voting constituency among older whites. And it won’t save much money, according to the nonpartisan Kaiser Family Foundation’s latest study – which shows that the estimated $148 billion in savings over ten years is largely offset by increased insurance costs, lost premiums, and higher subsidies that will be paid as a consequence. The Center on Budget and Policy Priorities offers an even more stringent analysis, which shows that raising the eligibility age in fact will result in total costs higher than the putative federal savings — which amount to around $50 billion over ten years. Contrast that with the savings achieved by ending the Bush tax cuts for the wealthy, which amounts to well over $1 trillion during the same period — and it becomes clear which party wants to reduce deficits.
Assuming that the savings are mostly mythical, the only sensible assumption is that Republican politicians and financiers simply hate Medicare, a highly successful and popular federal program that the right has been trying to destroy, with one tactic or another, ever since its establishment in 1965. They don’t really care whether their alleged solutions save money or improve efficiency. They want a privately-funded medical system that preserves profits rather than a system that improves and expands health care, as Medicare has done for almost half a century.
What the Republicans evidently desire most in their “reform” crusade is to exacerbate inequality among the elderly – because that is the only assured outcome of their plans.
The impact of raising the Medicare eligibility age by two years will fall most heavily upon older African-American and other minorities, as they are still known. The projected damage is summarized clearly in a chart posted on Monday by Sarah Kliff at the Washington Post’s Wonkblog. The number of uninsured among the elderly will be increased for all groups, but the greatest increase will be among minorities, who will also become more likely to postpone medical care because they lack coverage. The net effect of those changes, to project from what we already know about people who lack of insurance and postpone care, will be earlier deaths and much suffering.
Even more broadly, delaying eligibility is a direct assault on the standard of living of working-class Americans, especially those who have earned their way through physical labor. By age 65, people who have spent decades engaged in hard physical work – as firefighters, nurses, or other first responders, to consider the most obvious examples – are ready to stop working. Medicare is a critical element of their ability to retire, but Washington elites, especially on the right, are obtusely unsympathetic to their conditions.
It is up to the Democrats in Washington, especially President Obama, to protect Americans from such policy proposals, which are economically idiotic and socially inhumane. For there is one objective that the Republicans would certainly achieve if they induce the President to accept, or worse, propose, any such plan: They will discredit his second term before it has begun.
By: Joe Conason, The National Memo, December 11, 2012
“Republicans Need To Wise Up”: It’s Not Their Uninspiring Candidates Or Unsound Tactics, It’s Their Unpopular Ideas
The biggest problem the Republican Party faces is not uninspiring candidates or unsound tactics. It is unpopular ideas.
This reality was brought home in last month’s election. It’s playing out in the struggle over how to avoid the “fiscal cliff.” And we’ll see it again in coming fights over immigration, entitlements, inequality and a host of other issues. Here’s the sad thing: Republicans get this stuff so wrong that Democrats aren’t even forced to go to the trouble of getting it right.
There will be those who doubt the sincerity of my advice to the GOP, since my standing as a conservative is — justifiably — less than zero. But I’ve always believed in competition, if only to prevent liberals from becoming lazy and unimaginative. One could argue that this is already happening.
Take the question of what to do about undocumented immigrants. The Republican Party takes an uncompromising line against anything that could be construed as amnesty — any solution that provides “illegal” immigrants with a path to citizenship. Much has been made of the impact the immigration issue had in the election, as Latinos voted for President Obama over Mitt Romney by nearly 3-1.
It is obvious to sentient Republicans why the party cannot afford to so thoroughly alienate the nation’s largest minority group. What the GOP seems not to grasp is that the party’s “send ’em all home” stance is way out of line with much of the rest of the electorate as well.
A Politico-George Washington University poll released Monday asked voters whether they favored “an immigration reform proposal that allows illegal or undocumented immigrants to earn citizenship over a period of several years.” That would be amnesty, pure and simple — and a whopping 62 percent said they were in favor, compared to 35 percent who said they were opposed.
You might expect Democrats, then, to be pushing hard for a straightforward amnesty bill. But they don’t have to. Because Republicans are so far out in right field on the issue, Democrats haven’t actually had to do anything to reap substantial political benefits. They’ve just had to sound more reasonable, and less hostile, than Republicans, which has not required breaking a sweat.
On the central fiscal-cliff question, the GOP is similarly out of step. The Politico poll found that 60 percent of respondents favor raising income taxes on households that earn more than $250,000 a year. The Republican Party says no — and thus allows itself to be portrayed as willing to sink the economic recovery, if necessary, to ensure that tycoons can keep their pantries stocked with caviar.
Where is the incentive for Democrats to get serious about fiscal matters? As long as the GOP remains adamant on what many Americans see as a no-brainer question of basic fairness, those who believe in progressive solutions get a pass.
The truth is that raising top marginal rates for the wealthy is probably as far as we should go on the tax front right now, given the fragility of the recovery. The best thing we could do for the country’s long-term fiscal health is spur the economy into faster growth, which will shrink deficits and the debt as a percentage of gross domestic product.
That said, it’s hard to imagine long-term solutions that don’t eventually require more tax revenue from the middle class as well as the rich. But why should Democrats mention this inconvenient fact when Republicans, out of ideological stubbornness, are keeping the focus on the upper crust?
The same basic dynamic plays out in the question of reforming entitlements. Republicans proposed turning Medicare into a voucher program; polls show that voters disagree. The GOP seems to be falling back to the position that the eligibility age for the program should be raised. Trust me, voters aren’t going to like that, either.
Nor, for that matter, do voters like the GOP’s solution for the millions of Americans who lack health insurance, which Romney summarized as, essentially, go to the emergency room. A smart Republican Party would stop focusing exclusively on how government can pay less for health care and, instead, begin to seriously explore ways to reduce health-care costs. A smart GOP would acknowledge the fact that Americans simply don’t want to privatize everything, which means we need new ideas about how to pay for what we want.
Faced with an opposition that verges on self-parody, progressive thinkers are mostly just phoning it in. This won’t change until somebody defibrillates the GOP, and we detect a pulse.
By: Eugene Robinson, Opinion Writer, The Washington Post, December 10, 2012
“Never Ever, Ever, Ever…”: Grover Norquist’s Pledge Used To Be Politically Expedient, Now It’s Not
A few words to ponder as we sail toward the fiscal cliff. Those words would be: “That was then, this is now.”
Strip away the false piety and legalistic hair-splitting offered by Republican lawmakers rationalizing their decision to abandon a pledge that they will never ever, ever, ever vote to raise taxes, and that’s pretty much what the explanation boils down to.
Rep. Peter King says he understood the pledge, propounded by the almighty Grover Norquist and his group Americans for Tax Reform, to obligate him for only one term. Apparently, he thought it had to be renewed, like a driver’s license.
Sen. Lindsey Graham says that if Democrats agree to entitlement reform, “I will violate the pledge … for the good of the country” — a stirring statement of patriotism and sacrifice that warms your heart like a midnight snack of jalapeño chili fries.
In other words: bull twinkies. If you want the truth of why a trickle of GOP lawmakers is suddenly willing to blaspheme the holy scripture of their faith, it’s simple. The pledge used to be politically expedient. Now it is not.
This is not, by the way, a column in defense of the Norquist pledge. The only thing dumber than his offering such a pledge was scores of politicians signing it, an opinion that has nothing to do with the wisdom or lack thereof of raising taxes and everything to do with the fact that one ought not, as a matter of simple common sense, make hard, inflexible promises on changeable matters of national import. It is all well and good to stand on whatever one’s principles are, but as a politician — a job that, by definition, requires the ability to compromise — you don’t needlessly box yourself in. Never say never.
Much less never ever, ever, ever.
So this revolution against “he who must be obeyed,” however modest, is nonetheless welcome. It suggests reason seeping like sunlight into places too long cloistered in the damp and dark of ideological rigidity.
But it leaves an observer in the oddly weightless position of applauding a thing and being, simultaneously, disgusted by it. Has politics ever seemed more ignoble than in these clumsy, self-serving attempts to justify a deviation from orthodoxy? They have to do this, of course, because the truth — “I signed the pledge because I knew it would help me get elected, but with economic ruin looming and Obama re-elected on a promise to raise taxes on the rich and most voters supporting him on that, it’s not doing me as much good as it once did” — is unpretty and unflattering.
In this awkward about-face, these lawmakers leave us wondering once again whether the vast majority of them — right and left, red and blue, Republican and Democrat — really believe in anything, beyond being re-elected.
There is a reason Congress’ approval ratings flirted with single digits this year. There is a reason a new Gallup poll finds only 10 percent of Americans ranking Congress “high or very high” in honesty and ethics.
Lawyers rank higher. Advertisers rank higher. Even journalists rank higher.
This is the sad pass to which years of congressional grandstanding, fact spinning, cookie-jar pilfering and assorted harumphing and pontificating have brought us. And while a certain cynicism toward its leaders functions as a healthy antigen in the body politic, it cannot be good for either the nation or its leaders that so many of them are held in plain contempt.
The moral malleability exemplified by the likes of King and Graham will not help. Perhaps we should ask them to sign a new pledge: “I will always tell you what I think and what I plan to do in plain English, regardless of whether you like it or it benefits me politically.”
But no lawmaker would make that pledge. And who would believe them if they did?
By: Leonard Pitts, Jr., The National Memo, December 10, 2012
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