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How The Budget Deal Affects The Affordable Care Act

So how does this mammoth budget-cutting deal, with its congressional “supercommittee” affect health reform?

Good question, because lots of people in Washington are asking it too.

More specific answers will become clearer in the next few weeks, but here’s a first version of the road map to both the policy and the politics.

First, understand there are two different processes – and each, separately, aims at cutting more than $1 trillion over the next decade.

The one that you’ve probably heard most about is the “supercommittee” of 12 members of Congress. They are supposed to identify savings by Thanksgiving. Entitlements – Medicare, Medicaid, Social Security and aspects of the Affordable Care Act – are part of their turf. So are taxes and revenue – at least in theory. It’s not so clear that the Republicans see it that way given the public statements of Congressional leaders.

If they agree on some kind of grand deal by Thanksgiving, Congress has to take it or leave it by the end of December, eliminating the usual congressional dilly-dallying. (It looks like dilly-dallying to the casual observer or much of the public, but remember that all that arcane, tedious process IS policy in Congress. If you slow something down, make it go through hoops, amend it, hold it up, etc., it doesn’t become law. That may be good or, depending on your point of view, bad politics.)

If Congress takes any recommendations that the supercommittee agrees on, that’s the law. If the committee fails, or Congress rejects it, then the “trigger” gets pulled. The official name is “sequestration.” That’s a fancy name for automatic cuts – 2 percent across-the-board cuts in Medicare, for instance, affecting all health care providers, doctors, hospitals, etc. It won’t affect beneficiaries – at least not directly.

Medicaid is not subject to the trigger. Neither, according to the preliminary interpretations I’ve received from analysts and congressional staff, are the big, key subsidies in the health care reform law – the Medicaid expansion and the subsidies that will help low-income and middle-income people afford health care in the new state exchanges.

Other parts of the health reform law are, however, subject to automatic cuts. Among them: Cost-sharing subsidies for low-income people. This isn’t the help paying the premium; this is the help with the co-pays when people do get care. But the payments are made to health plans, not directly to beneficiaries so it won’t have the direct impact of discouraging care. It may affect how health plans make decisions about what markets to participate in. Gary Claxton and Larry Levitt at Kaiser Family Foundation explain here.

Also, the supercommittee could have a partial deal – meaning there’s still a trigger, but a smaller one. Maybe they won’t reach agreement on $1.2 trillion to $1.5 trillion in savings, which would avoid the trigger. But maybe they could agree on, say, $500 billion. That means a trigger wouldn’t have to go as deep because some of the savings would already be identified.

To recap – before we go on to the second stage of this process: The “super-committee” can do whatever it wants to health care, Medicare, Medicaid, Social Security, etc. – if it can agree, if it can get the rest of Congress to agree and if the president doesn’t veto it.

Will the Democratic Senate and the Obama White House agree to cuts that eviscerate health reform? Not likely. In fact, the Democrats “won” on very few aspects of the budget/debt deal. Walling off Medicaid and key parts of the health coverage expansion were two of the “wins.” That’s a bright line worth paying attention to as this moves forward.

Does that mean other health-reform related spending will be untouched? Given how many moving parts there are to any spending deal, and the fact that defense and tax policy are also part of the mix, chances are it will be affected. But expect to see that bright line remain visible – maybe not quite as bright, but visible. (The CLASS Act, the voluntary long-term care program created under health reform, is a different story; it’s quite vulnerable.)

The second part is the annual appropriations process. The budget deal provides for cuts – real cuts in spending, not just slowing the rate of growth. Health programs (aspects of the health reform legislation touching on exchange creation, prevention, community clinics, etc., and just about everything else at the Department of Health and Human Services – the FDA, NIH, CDC, etc. – will be subject to these cuts. But this isn’t an across the board process, it’s a line-by-line, or at least category/agency-by-category/agency, process. And there is some horse trading.

It’s safe to say that the Republicans will try to cut discretionary portions of the new health law. That’s not a new political dynamic, it doesn’t arise out of the debt ceiling or the Wall Street woes. It’s what we’ve seen since last fall’s elections and the repeal/defund fights of the past few months. And House Budget Chairman Paul Ryan has publicly tried to insert health care into any potential deal. So expect to see more Republican push to cut, and continued Democratic push back. Will health spending emerge unscathed? It’s too soon to know but, given the amount of savings Congress needs to find –both in this budget deal and in the perennial quest to fund the “doc fix” payments – some cuts are clearly possible. Some of it may affect aspects of exchange establishment, regulation, prevention, public health, etc. But it’s hard to see the Democrats allowing cuts so deep that they basically constitute a side door to repeal.

One further twist – some Republicans are calling for a delay in health reform implementation to save money.”Delay” may sound better to an ambivalent public worried about spending than “repeal.” What’s delayed (if anything), how it’s delayed, how long it’s delayed, and what stopgaps are created in the meantime could have an impact on how many people get covered in 2014.

Assorted committees and government agencies are still examining the new budget law and how it will affect … everything. So the perspective I’ve outlined here – and I’m writing amid all the market turbulence – may change as the economic and political climates change. But the lines in the sand around the trigger – health reform, Medicaid and Social Security – tell us something about where the White House will come down.

By: Joanne Kenen, Association of Health Care Journalists, August 10, 2011

August 11, 2011 Posted by | Affordable Care Act, Budget, Congress, Conservatives, Debt Ceiling, Debt Crisis, Deficits, Democrats, Economy, GOP, Government, Health Care, Health Reform, Ideologues, Ideology, Individual Mandate, Insurance Companies, Journalists, Lawmakers, Medicaid, Medicare, Politics, Public Health, Republicans, Right Wing, Social Security, Tax Increases, Tax Loopholes, Taxes, Teaparty | , , , , , , , , , , , , , , , , , , | 1 Comment

The FAA Shutdown And The New Rules Of Washington

Congressman John Mica, the Florida Republican blamed for single-handedlyshutting down the Federal Aviation Administration, sounded like a beaten man when he called me Thursday evening.

The usually biting chairman of the House transportation committee spoke with remorse about the standoff, which put 74,000 people on furlough or out of work, delayed airport-safety projects and cost hundreds of millions of taxpayer dollars.

“I’ve had a brutal week, getting beat up by everybody,” Mica told me, minutes after Senate Majority Leader Harry Reid announced a deal that would end the shutdown and avoid the cuts to regional air service that Mica wanted.

“I didn’t know it would cause this much consternation,” Mica said. “Now I’ve just got to get the broom and the shovel and clean up the mess.” Switching metaphors, he said he wanted “to unclog the toilet, but it backed up. So I don’t know what to do, what to say.”

One thing he’s going to do is make amends. He said he would introduce legislation Friday to pay FAA workers for their furlough days. “We just want to cheer all those workers who have been left out on a limb by this,” he explained.

Mica’s experience shows the high-risk nature of business in the new Washington, where even routine issues like FAA funding can become conflagrations. With no goodwill between the two parties, or the two chambers, ordinary disagreements mushroom into governing crises, with unpredictable results.

In the debt-limit standoff, Democrats capitulated to most Republican demands to avoid a default. In the FAA confrontation, Republicans pursued similar brinkmanship — but this time Democrats resisted, let the shutdown happen and, at least in Mica’s view, won the fight.

Mica started out with a sensible aim: He wanted to clean up years of messy funding for the FAA. Lawmakers hadn’t been able to agree on issues such as rural-airport subsidies and landing slots at Reagan National, so they kept the agency going with 20 stop-gap funding bills since 2007.

But Mica overreached. Letting his anti-labor ideology take over, he tried to use the FAA bill to overturn a decision by the National Mediation Board to rescind an old rule that had made it unusually difficult for airline workers to organize. Delta Air Lines furiously lobbied Congress to intervene.

Mica knew Senate Democrats would resist, so he tried to create a bargaining chit: He drafted plans to cut funds for small airports in the home states of Reid (Nev.) and Jay Rockefeller (W.Va.), chairman of the Senate transportation panel.

The Floridian publicly admitted his ruse. “It’s just a tool to try to motivate some action” on the labor rule, he told a group of airport executives last month, according to Aviation Daily. “I didn’t plan it to be this national issue,” he told me.

Senate Democrats, seizing on Mica’s admission that the bill was a “tool,” refused to deal. They let the shutdown happen and railed against Mica after lawmakers left for recess.

Reid accused him of taking “hostages.” House Minority Whip Steny Hoyer pointed out that the shutdown cost taxpayers more than the program Mica tried to cut. Privately, Mica’s GOP colleagues harshly criticized him.

The Orlando Sentinel, near Mica’s district, took the congressman to task and said it was “pathetic” that “members of Congress now are enjoying their summer vacations, while some essential FAA inspectors are working without pay.”

On Thursday, Democrats announced a plan to reopen the FAA and said they would use waivers from Transportation Secretary Ray LaHood to avoid Mica’s rural airport cuts. Mica, pronouncing himself thwarted, said he was stunned that Democrats took Republicans “by the short hairs,” as he put it. “Quite honestly we did not expect that.”

They should have. The 10-term lawmaker was operating under archaic rules. “In our business, you use your legislative tools . . . and put a little leverage on it,” he said. “How else do I do it? Am I going to send them a bouquet?”

But Mica, as much as anybody, created a culture of distrust, where staking out bargaining positions leads not to compromise but to warfare. And now he’s surprised?

“People don’t have to get so personal,” he said with a sigh. “A lot of people hate me now and think I’m the worst thing in the world for what I did.” It’s “this sort of gotcha,” he said, “that’s changed the dynamics of people working more effectively together.”

Hopefully he’ll remember that the next time he sticks it to the other side.

By: Dana Milbank, Opinion Writer, The Washington Post, August 4, 2011

August 6, 2011 Posted by | Congress, Conservatives, Democrats, GOP, Government, Government Shut Down, Ideologues, Ideology, Jobs, Labor, Lawmakers, Lobbyists, Politics, Public, Public Employees, Republicans, Right Wing, Union Busting, Unions | , , , , , , , , , , , , , , | 1 Comment

GOP Passes Up Generational Conservative Victory In Order To Protect The Wealthy

Oh, the irony.

After generations of conservative dogma based solidly in the belief that fundamental changes to America’s entitlement programs are essential to the economic survival and betterment of the nation, that goal is now, finally, within the reach of the true believers.

Yet, remarkably, this dramatic change in national direction is being permitted to slip right through conservative fingers by the very people whom those ensconced on the right should be counting upon to bring home this great philosophical victory.

The fulfillment of the conservative dream is not vanishing from sight because Nancy Pelosi and the forces of progressivism are prepared to defend entitlements to the death. Nor is it happening because the President of the United States has counted up the votes and decided that messing with entitlements will cost him re-election.

It is not even the result of “bleeding hearts” like me rising nobly in defense of the needy and downtrodden.

Significant entitlement reform, long the goal of the fathers of modern day conservatism, is being flushed down the drain by the very Republican Party that has long battled to bring that goal to reality.

Somewhere in Connecticut, William F. Buckley Jr. is turning over in his grave.

On Saturday, Speaker of the House John Boehner announced that the ‘grand bargain’ – rumored to bring $4 trillion in debt reduction over the next ten years through a mixture of entitlement reform, defense cuts and a measure of revenue increases resulting from cleaning up the tax code to get rid of some of the corporate entitlement programs that result in lower taxes and higher subsidies – is now off the table.

Apparently, Boehner could not sell the GOP Congressional Caucus on a deal that involved anything in the way of revenue increases- not even in exchange for accomplishing reforms for which his party has fought since the days of FDR and his “New Deal”.

True conservatives should not blame Boehner for this heresy as it appears that he is no happier with the position he is being forced to take than the President is with his proposal being rejected by House Republicans who don’t grasp the whole compromise thing.

What Boehner likely understands – better than those who he is supposed to be leading – is that the GOP is permitting the fundamental change, long at the heart of the conservative cause, to vanish into thin air and that it is happening in the name of protecting corporate subsidies that are the very antitheses of a free market economy – another of the inviolate tenets of conservative policy.

Subsidies that provide government incentives to industry are as anti-free market as government subsidies and controls that conservatives argue have skewed the costs of health care in America and led to our current crisis.

According to American conservative scripture, a truly free market requires that players compete on level ground – not with the edge that comes from government handouts and special tax breaks, whether they be for the benefit of a corporation or an individual.

Thus, the GOP is rejecting the opportunity to accomplish a landmark, philosophical milestone by protecting a policy that is, in and of itself, a violation of that same conservative philosophy.

Is the irony of this enough to make even the most ardent conservative believer question what in the world is going on here?

It certainly should be.

Could the explanation for this odd behavior be that the Congressional Republican Caucus has decided to turn its back on what is supposed to be their most fundamental beliefs because their constituents are demanding that they do so?

Apparently not.

According to the Christian Science Monitor, the GOP Caucus does not appear to have any interest whatsoever in listening to its base.

“Two-thirds (67 percent) approve of making more of high earners’ income subject to Social Security tax, and nearly as many approve of raising taxes on incomes of over $250,000 (66 percent), reducing military commitments overseas (65 percent) and limiting tax deductions for large corporations (62 percent),” the Pew Research Center reported last month.

“Notably,” Pew found, “Republicans are as likely as Democrats to approve of limiting corporate tax deductions.”

Still, any kind of tax increases – whether it be a greater tax bite on the wealthy or on corporations seen as “job creators” – is off the table as far as large numbers of Republican House members are concerned. Via The Christian Science Monitor

So, the GOP rejection of the debt deal is neither based in the free market philosophy nor the fundamental belief in entitlement reform. It is also not based on meeting their obligations to their constituents.

So, what is driving their rather remarkable position?

It must be jobs and the economy.

Surely, the Republicans in Congress are convinced that removing tax subsidies to the oil industry and cleaning up the tax code to get rid of corporate welfare that is no longer of any discernable value to the nation will make what is already a very bad jobs situation even worse.

Except that it turns out that you have to search long and wide to find an economist who supports this notion.

The other argument that advocates of tax cuts for the rich make is that many small-business owners would be see their taxes go up and thus would be discouraged from hiring workers. The facts do not support this. “Only 3 percent of small-business owners are in the top bracket,” notes Roberton Williams, a senior fellow with the Tax Policy Center, which is sponsored by the Brookings Institution and the Urban Institute. And, he adds, “They are not all what we think of as job-creating small businesses. A lot of them are hedge-fund managers and law-firm partners.” So other than perhaps a few restaurateurs on Manhattan’s Upper East Side, the workforce is unlikely to be affected. Via Newsweek

So, while Eric Cantor continues to try and sell his base on this argument, it’s pretty hard to find anyone who knows anything about economics who actually is buying the pitch.

If it’s not philosophical dogma or fulfilling their obligation to those who elected them and it’s not the economy and/or jobs, what exactly is their problem?

I don’t know about you, but I can only think of one other explanation – fealty to the wealthy corporations and wealthy individuals who keep your Republican leadership rolling in the campaign cash so they can remain in their powerful jobs.

Now, if you believe this is a good enough reason to risk the financial stability of the nation – and possibly the world – then it’s all good.

Personally, I’m a little concerned.

I fear we are witnessing one of the most perverse and dangerous games our leaders have ever embarked upon. I’m stunned by the sheer audacity of these elected officials so ready to play chicken with the financial lives of so many simply to benefit a very few.

But what really amazes are the millions of middle class Americans who continue to believe that these officials are somehow acting in their best interest.

As curious as I am to see what will ultimately come of this game, my curiosity is far more piqued by the possibility that these middle class Americans might finally understand that the Republicans they sent to Congress work for the big corporations and care little for their needs and problems.

Should that light bulb (incandescent or otherwise) finally turn on, these folks should be assured that nobody is expecting them to run into the waiting arms of the Democratic Party. They can still quietly send their Congressional representatives a message indicating that they would prefer not to be abandoned so that Exxon might keep the government checks flowing in while maintaining their standing as upright, committed conservatives.

If these folks could – just this once – grasp what is being done in their name and communicate their rejection of the behavior of their leaders, the rest of us would genuinely appreciate it.

A true conservative should be as disgusted with what the Congressional Republican Caucus is doing as the rest of us and probably a great deal more so.

By: Rick Ungar, The Policy Page, Forbes, July 10, 2011

July 11, 2011 Posted by | Budget, Businesses, Class Warfare, Congress, Conservatives, Corporations, Debt Ceiling, Deficits, Democrats, Economic Recovery, Economy, Elections, GOP, Government, Government Shut Down, Ideologues, Ideology, Jobs, Middle Class, Politics, President Obama, Republicans, Right Wing, Taxes, Unemployed, Wealthy | , , , , , , , , , , , , , | Leave a comment

Tea-pocrisy Is Not Particularly Complicated

Michele Bachmann, at her announcement speech today, offering an extended paean to the Tea Party:

I am here in Waterloo, Iowa to announce today: We can win in 2012, and we will. Our voice has been growing louder and stronger. And it is made up of Americans from all walks of life like a three-legged stool. It’s the peace through strength Republicans, and I’m one of them. It’s fiscal conservatives, and I’m one of them, and it’s social conservatives, and I’m one of them. It’s the Tea Party movement, and I’m one of them.

The liberals, and to be clear I’m NOT one of them, want you to think the Tea Party is the Right Wing of the Republican Party. But it’s not. It’s made up of disaffected Democrats, independents, people who’ve never been political a day in their life, libertarians, Republicans. We’re people who simply want America back on the right track again.

The Los Angeles Times yesterday, revealing some very un-Tea-Party-like behavior from the Bachmann family:

Rep. Michele Bachmann has been propelled into the 2012 presidential contest in part by her insistent calls to reduce federal spending, a pitch in tune with the big-government antipathy gripping many conservatives.

But the Minnesota Republican and her family have benefited personally from government aid, an examination of her record and finances shows. A counseling clinic run by her husband has received nearly $30,000 from the state of Minnesota in the last five years, money that in part came from the federal government. A family farm in Wisconsin, in which the congresswoman is a partner, received nearly $260,000 in federal farm subsidies.

And she has sought to keep federal money flowing to her constituents. After publicly criticizing the Obama administration’s stimulus program, Bachmann requested stimulus funds to support projects in her district.

Bachmann yesterday defended herself by describing the clinic funding and “one time training money” for employees that didn’t financially benefit Bachmann’s husband. But presumably the clinic itself benefitted from having government money train its workers. Otherwise it’s hard to see why Bachmann’s husband’s clinic wanted the funding. And of course, there’s all that stimulus money Bachmann wants for her district.

I don’t really know if these revelations will damage Bachmann’s status as the Tea Party’s leading warrior queen (yes, you have been dethroned, Sarah Palin). That’s because this sort of hypocrisy is widespread among Tea Partyers themselves — let’s call it “Tea-pocrisy.”

As Steve Benen has been documenting — see here and here — there’s no shortage of officials and political activists who embrace the Tea Party even as they benefit directly or indirectly from government generosity themselves. Some House GOP freshmen have even been the direct recipient of farm subsidies.  And now the relevations about Tea Party chieftain Bachmann herself.

The point, as always, is that Tea Partyers are frequently for government spending as long as it’s benefitting the right people. Tea-pocrisy is not particularly complicated.

 

By: Greg Sargent, The Washington Post Plum Line, June 27, 2011

 

 

 

June 27, 2011 Posted by | Conservatives, Elections, GOP, Government, Ideologues, Ideology, Iowa Caucuses, Politics, Republicans, Right Wing, Taxes, Teaparty | , , , , , , , , | Leave a comment

Senate Democrats Weigh Making Big Mistake On Health-Care Reform

I’m getting some worried e-mails from Hill staffers who think Senate Democrats might rubberstamp a policy House Republicans passed to undermine the Affordable Care Act. It’s the sort of policy decision that won’t get much attention but could have some very big, and very bad, effects, so let’s take a moment and go through it.

If you’ve been paying attention to the debate over the Affordable Care Act, you’ve probably heard about the 1099 provision. Essentially, small businesses manage to avoid paying taxes on a lot of small transactions. The 1099 provision would’ve forced them to report those transactions, raising about $20 billion over 10 years. But it would’ve require a lot of paperwork. So much paperwork, in fact, that Democrats agreed to repeal it.

When the Senate repealed the provision, they paid for it by canceling other spending that Congress had authorized, but that hadn’t yet been put to a particular purpose. House Republicans took a different approach. They’re trying to sharply increase the amount of subsidies that families will have to pay back if their income increases during the course of a year. The Center on Budget and Policy Priorities has a longer explanation of how this would work, but here’s the short version:

Under their proposed policy, a family with income at 225 percent of the poverty line who needed subsidies for the first half of the year but canceled them mid-year when the husband got a better job could get a bill for more than $4,500 at the end of the year.

A more worrying example goes the other way: Imagine a family where the breadwinner makes much more than 400 percent of poverty, but loses his job late in the year. He tries to apply for subsidies so the family can keep getting health insurance but is told that he shouldn’t bother — because his total income that year will still be above 400 percent of poverty, he’ll get a bill at the end of the year forcing him to pay back the money.

The Affordable Care Act, unfortunately, already includes a “payback” policy along these lines — the House Republicans are just proposing to make it much, much worse. This will do two things: make people hate the Affordable Care Act for bait-and-switching them, and keep people from entering the exchanges because they’ve heard horror stories of huge bills. It’s clear why the GOP wouldn’t mind that outcome, but there’s no reason for Democrats to accept it. The Senate should stick with the 1099 repeal that the Senate has passed.

By: Ezra Klein, Columnist-The Washington Post, March 8, 2011

March 8, 2011 Posted by | Affordable Care Act, Health Reform | , , , , , , , , , | Leave a comment

   

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