“Putting The Train Wreck On Hold”: Everything Anti-Obamacare Republicans Predicted Is Proving To Be The Opposite Of Reality
The Affordable Care Act, like every landmark piece of legislation in modern times, has faced its share of trials. Getting it through Congress was nearly impossible, and the law was very nearly killed by the Republican appointees on the U.S. Supreme Court.
But with the law now secure and President Obama re-elected, there’s one more major challenge for “Obamacare” to overcome: the implementation hurdle. As we discussed several weeks ago, this is at least as big a hurdle as the others, and more than a few observers have raised the prospect of a “train wreck.” Even those who generally defend the law are worried.
They are, however, a little less worried today. As Matt Yglesias explained, implementation of the law is “fundamentally” going quite well.
The latest evidence comes to us today from California, America’s largest state and one of the states that’s tried the hardest to actually implement Obamacare. As Sarah Kliff explains, their exchanges are getting set up, and it looks like premiums for “silver” and “bronze” plans are both going to be lower than was previously expected. Far from a “train wreck,” in other words, the biggest single set of clients for the program is getting something like a nice, smooth high-speed train ride.
There was also good news from Oregon recently, where insurers that had initially come in with high premium bids are now asking to resubmit with cheaper offerings in the face of competition. And the Affordable Care Act’s goal of slowing the growth in aggregate health expenditures is also coming true.
Yep, at least for now, everything anti-ACA Republicans predicted — on premiums, on competition, on exchanges, on escalating costs — is proving to be the opposite of reality.
Now, because of state-by-state differences, there will be quite a bit of variety in outcomes. If you live in California or another state dominated by Democratic officials, you’ll likely have a very positive impression of how the law is being implemented, and how it benefits you, your family, and your community.
If you live in, say, Texas, you’re likely to have a very different kind of experience.
As Jonathan Cohn explained this morning:
Unfortunately, millions of uninsured and under-insured Americans live in places like Florida and Texas, where there is far less sympathy — and a great deal more hostility — to the idea of Obamacare. It’s entirely possible that the insurance bids in those states will be a lot higher, precisely because state officials there are doing nothing to help and quite a bit to hurt implementation. But if that happens, blame won’t belong with the heath care law or the federal officials in charge of its management. It will belong with the state officials who can’t, or won’t, deliver to their constituents the benefits that California’s officials appear to be providing theirs.
It’s not necessarily an explicitly partisan matter — I’m not saying that Democrats are necessarily better at health care governance. Rather, the point is, Democrats don’t have an ideological axe to grind when it comes to trying to sabotage federal health care law. Rick Perry, however, does.
To be sure, these red-state residents won’t be left out entirely, and they’ll still benefit from all kinds of consumer protections and expanded access that they’ll really appreciate, even if they don’t yet realize the available benefits. But the full benefits of implementation will elude them for a while in ways blue-state residents won’t have to deal with.
Regardless, the news out of California is a bit of a breakthrough, and heartening news for anyone hoping to see the Affordable Care Act succeed. For more on this, also take a look at the reports this morning from Klein, Krugman, and Beutler.
By: Steve Benen, The Maddow Blog, May 24, 2013
“From Poor Regulation To Terrorism”: Texas’ Wild West Approach To Protecting Public Health And Safety
You might think the fertilizer plant explosion in West, Texas, that leveled the town and killed 14 people would have given pause to those conservative policymakers and boosters in the Lone Star State who proudly boast of a “Texas Way” in which job-creators aren’t hassled by pointy-headed bureaucrats and regulators or income taxes or any of those other new-fangled socialist devices. But no: under the leadership of Gov. Rick Perry, we learn from a New York Times story today, Texas government and business officials are going out of their way to reiterate that this is a place where the Bidnessman walks tall, and poor living standards and high workplace risks are just the price of keeping job creators fat and happy.
Texas has always prided itself on its free-market posture. It is the only state that does not require companies to contribute to workers’ compensation coverage. It boasts the largest city in the country, Houston, with no zoning laws. It does not have a state fire code, and it prohibits smaller counties from having such codes. Some Texas counties even cite the lack of local fire codes as a reason for companies to move there.
But Texas has also had the nation’s highest number of workplace fatalities — more than 400 annually — for much of the past decade. Fires and explosions at Texas’ more than 1,300 chemical and industrial plants have cost as much in property damage as those in all the other states combined for the five years ending in May 2012. Compared with Illinois, which has the nation’s second-largest number of high-risk sites, more than 950, but tighter fire and safety rules, Texas had more than three times the number of accidents, four times the number of injuries and deaths, and 300 times the property damage costs….
“The Wild West approach to protecting public health and safety is what you get when you give companies too much economic freedom and not enough responsibility and accountability,” said Thomas O. McGarity, a professor at the University of Texas at Austin School of Law and an expert on regulation.
So I’d bet today’s news that Texas law enforcement officials have launched a criminal investigation based on reports that federal agents found bomb-making materials in the possession of a paramedic who was on the scene in West is going to generate a lot of excitement in the state’s conservative circles. True, the suspect who was arrested by the ATF isn’t an Arab or even a Chechen, and no one knows at this point if he had anything to do with the explosion, and if so, what his motives might have been.
But Lord a-mercy, wouldn’t it be nice if it was a terrorist and not an industry or lawmakers or regulators we ought to be looking at in connection with this tragedy? The very possibility must be worth toasting in certain circles during today’s Texas happy hours.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, May 10, 2013
“Keeping The Outcry At Manageable Levels”: The Perverse Policy Math Of The GOP’s Sequester
So we’re 10 weeks in, and the GOP’s sequester strategy is coming into sharper focus. If a cut affects Americans residing at the higher end of the socioeconomic ladder, move heaven and earth to make it right. But if it affects folks who may have less means … crickets.
So while everyone knows about the heroic efforts of Republicans to rein in flight delays and restart White House tours, we hear a lot less about those who are losing the assistance they need to send their kids to school, eat a hot meal or just make it until they find their next job.
And one is left to wonder: How did a country like America ever get here? The answer is that it’s all part of the GOP’s long game against government.
It starts with a perverse kind of policy math that says if a government cut creates an inconvenience we should do something about it. But if a cut takes away something that’s critical to your survival today or the life trajectory of your kids, well, you’re out of luck.
And the way the sequester plays out – moving slowly across the land, knocking a handful of people out of Head Start here, reducing unemployment checks there – is the perfect way to effectuate a plan as brutal as the one Republicans conceive. Spreading out the impacts keeps the outcry at manageable levels, and ensures that there is no one critical mass of objectors – until it’s too late.
And in the mean time, the GOP gets what it’s long wanted: The slow withdrawal of government from the day-to-day lives of ordinary people. Government will continue to do many expensive things if the sequester plays out as intended: protect the country; administer justice; subsidize some industries and not others. But it will be out of the “help people go as far as their hard work and talent will take them” business. That just won’t be its role anymore.
We can certainly have a society that operates that way. There’s no rule against it. But what will America look like if the GOP gets it way?
On the one hand the amount of taxes some pay should go down. And those who are fortunate enough to be born into good life circumstances will have less competition to fear from those who are less well off – they simply will have less ways to get into a position to compete. Presumably that means wealth continues to collect at the upper ends of the socioeconomic structure, while more families fall to the bottom.
That’s not how the GOP would describe their approach, of course. But at some point we have to move past hysterical rhetoric about big government and get to the nuts and bolts of the policies they are attempting to effectuate under that banner. Now would be a good time to have that discussion.
It’s not only happening on the federal level. Texas Gov. Rick Perry has made headlines by calling on his state’s universities to find a way to provide a college education for $10,000. Now I suppose we could conclude that the governor really is concerned about people who can’t afford a more expensive education, though there’s little in his record to support that notion. More likely, this is his semester sequester. Rather than finding ways for less wealthy students to get the same quality education as their more well heeled counterparts, Perry’s putting the onus on the universities to dumb down their educational offerings for a less wealthy track.
All of this, of course, turns the way most of us think about government entirely on its head. When elected officials run for office, they do so by articulating a philosophy about how to address the problems we face – as a community, town, city or country. We vote for them when we conclude their prescriptions fit with the way we would like to see the problems we care about approached. Over the history of this country, that process – electing people who’s views align with our own – has resulted in the construction of a state that is more muscular in some areas, less so in others.
Another way of saying: Head Start didn’t just emerge like some kind of algae bloom on the national treasury. We, citizens, saw a problem, that disadvantaged kids weren’t getting a very good education. We asked our representatives to do something about it. Head Start was one of the solutions they came up with. If public polling is any indication, we like it. And if research is any guide, it works.
But the sequester means Republicans don’t have to debate the merits of Head Start. Instead, they keep the debate squarely in the frame that suits them best: that government is too big, it doesn’t work, we can slash away and no one will be the worse for it. But of course they will.
So where does this all end up? My guess is programs that people rely on sustain deep cuts, which becomes an argument to cut them even more: Look! Their performance is inexplicably worsening! And in some cases we get back to a place approximating where we were when the programs were first initiated. Over time, news reports and research bubbles up showing the deplorable circumstances under which some folks live, go to school, etc. Stirred by our conscience and the better angels of our nature we decide something has to be done. And we turn to government. Because that’s what its there for.
And at that moment, a cycle of absurd sequester stupidity will have finally run its course.
By: Anson Kaye, U. S. News and World Report, May 2, 2013
“Inside The Anti-Obamacare Resistance”: A Facinating Glimpse Into Warped Conservative Ideology And Tactics
The two largest states that have so far failed to join in the Medicaid expansion provided for in the Affordable Care Act are Florida and Texas, where Republicans control the legislature and the governor’s office. Looking more closely at the intra-Republican battle over how and whether rich new federal funds can be captured without “surrendering” to the hated Obama provides a fascinating glimpse into conservative ideology and tactics.
Florida offers the murkiest situation. Gov. Rick Scott, who was beginning to look rather toasty in his 2014 re-election prospects, roiled conservative circles in his own state and nationally by suddenly coming out for Medicaid expansion in exchange for permission from the Obama administration to move Medicaid beneficiaries into private managed care plans. But Scott’s been stopped cold by GOP legislators, who in turn seem split between outright rejectionists centered in the state House and those in the Senate who want an even better “deal” that would utilize the state’s CHiP program, which is a privatized premium support scheme, instead of Medicaid for the expansion.
A conservative Florida reporter presents the views of the rejectionist camp quite vividly:
Tom Lauder, a reporter for Media Trackers Florida, which is closely following the Florida Obamacaid debate, says House Republicans appear likely to stand firm….
“Grassroots conservatives are particularly upset with Gov. Scott using the language of the left in his efforts to build momentum for Obamacaid,” Lauder explained. “When Scott argues, ‘I cannot, in good conscience, deny the uninsured access to care,’ he asserts that the only time people have access to goods and services is when government gives it to them as an entitlement. Scott has enraged his conservative base by making this big-government argument. This isn’t a question of whether government should give Medicaid to the poor and disabled, because the poor and disabled already qualify for Medicaid.”
At issue, Lauder says, is the rejection of Scott’s argument that federal funding will come without cost to state taxpayers.
“Scott’s conservative base also resents Scott talking about federal funding as if it were free money,” Lauder added. “Even if the federal government kept its promise to fund most of the Florida Medicaid expansion, which many conservatives doubt will be the case, Floridians pay federal taxes in addition to state taxes. Federal dollars flowing into Florida are not free dollars, even for Floridians.
In other words: Florida’s “true conservatives” don’t much care what mechanism is being used to expand coverage; they’re just flatly against it.
In Texas, meanwhile, the rejectionist camp is led by Gov. Rick Perry, as Ron Brownstein explains in a National Journal column:
Republican state Rep. John Zerwas, a health care leader who represents a district outside Houston, says legislators are getting an earful at home from providers and local officials worried about the state rejecting the money.
Against that backdrop, Zerwas and some GOP state House colleagues are searching for ways to steer Texas into the expansion. They assume the state will not move more people into the existing Medicaid program. But they consider it misguided to simply reject the federal money and deny insurance coverage to so many people who could obtain it. “We are not going to make this better … without doing something that substantially reforms how we deliver Medicaid,” Zerwas says. However, “we have to have a solution for this group of people.”
Last week, Zerwas introduced legislation that would authorize state health officials to negotiate with the Obama administration to expand while delivering coverage for the newly eligible through new means. He likes the deal the administration is discussing with Arkansas, which could allow the state to use Medicaid expansion dollars to instead buy private insurance for its eligible adults, and he believes that approach could be “sellable to the governor.”
Many here, though, wonder if Perry would take any deal. The widespread belief is that he intends to seek the GOP presidential nomination again in 2016, and accepting more Medicaid money would smudge his image of Alamo-like resistance to Obama.
This is an interesting scenario given recent efforts from the Perry camp (outlined earlier this week in another National Journal piece by Michael Catalini) to depict the swaggering, gaffe-prone Texan as “ahead of his time” in understanding the need for Republican outreach to Latinos. Notes Brownstein:
[I]f state Republicans reject federal money that could insure 1 million or more Hispanics, they could provide Democrats with an unprecedented opportunity to energize those voters—the key to the party’s long-term revival. With rejection, says Democratic state Rep. Rafael Anchia of Dallas, Republicans “would dig themselves into an even deeper hole with the Hispanic community.”
It’s unclear how this will all play out in Florida and Texas. But nobody recently has lost any money betting on the hard-core conservative approach, particularly on an issue as incendiary to the Right as Obamacare. That rejecting any sort of coverage expansion beyond that absolutely required by the ACA would mean leaving vast sums of federal money on the table would in fact be considered a badge of honor by a lot of the people involved.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, March 22, 2013
“Wishing On A Star”: The Debates Won’t Save Mitt Romney
If you’re a Romney partisan, and you’ve seen Barack Obama move ahead in the polls over the last couple of weeks, you may be saying to yourself, “Maybe the debates can save him.” After all, the four debates (three presidential, one VP) are the the only planned events between now and election day. Though you never know what kind of unexpected events might occur, tens of millions of voters will be watching. And so many times in the past, the race has been transformed by a dramatic debate moment.
Except that’s actually not true. As John Sides lays out quite well, after all the sound and fury, debates almost never change the trajectory of the race. Of course, something never happens up until the moment that it happens, but there’s strong reason to believe that the debates will change nothing this year in particular. But before I get to that, here’s Sides:
Why are presidential debates so often inconsequential? After all, many voters do pay attention. Debates routinely attract the largest audience of any televised campaign event. And voters do learn new information, according to several academic studies. But this new information is not likely to change many minds. The debates occur late in the campaign, long after the vast majority of voters have arrived at a decision. Moreover, the debates tend to attract viewers who have an abiding interest in politics and are mostly party loyalists. Instead of the debates affecting who they will vote for, their party loyalty affects who they believe won the debates. For example, in a CNN poll after one of the 2008 debates, 85 percent of Democrats thought that Obama had won, but only 16 percent of Republicans agreed.
All those memorable gaffes—George H.W. looking at his watch, Michael Dukakis not pounding his lecturn at the suggestion of his wife’s rape and murder, Al Gore sighing—turn out not to have had any discernible impact on the race. What was almost certainly the most disastrous debate performance of all—Dan Quayle’s in 1988—did not, you may recall, prevent him from becoming Vice President.
And this year is even less likely to produce anything significant. As James Fallows explained, Mitt Romney is at his best when he can prepare carefully, and at his worst when he’s taken by surprise. Over the course of the 500 or so primary debates the Republicans held, he was clearly the most informed and serious-seeming of the GOP candidates. Of course, besting Rick Perry and Michele Bachmann in verbal combat doesn’t exactly make you the Ted Williams of debating, but there’s little doubt Romney will show himself to reasonably knowledgeable, for what it’s worth. His problem, though, is that it isn’t worth much. He doesn’t need to convince Americans he can recite a ten-point plan, he needs to convince them that within him beats the heart of an actual human, one who understands and cares about them. The chances of him doing that are pretty slim.
By: Paul Waldman, Contributing Editor, The American Prospect, September 20, 2012
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