“Obamacare, Beyond The Label”: The Politics Of Obamacare Are Upside-Down
The Affordable Care Act was supposed to be a slam-dunk issue for the Republicans in this fall’s elections. Karl Rove told us so in April, writing that “Obamacare is and will remain a political problem for Democrats.”
So how’s that Obamacare thing working out for the GOP?
The most significant bit of election news over the last week was the decision of Senator Mark Pryor, the embattled Arkansas Democrat, to run an ad touting his vote for the health care law as a positive for the people of his increasingly Republican state.
Pryor’s ad is so soft and personal that it’s almost apolitical. After his dad, the popular former senator David Pryor, tells of his son’s bout with cancer, he notes that “Mark’s insurance company didn’t want to pay for the treatment that ultimately saved his life.” The picture has widened to show Mark Pryor sitting next to his father. “No one should be fighting an insurance company while you’re fighting for your life,” he says. “That’s why I helped pass a law that prevents insurance companies from canceling your policy if you get sick, or deny coverage for pre-existing conditions.”
Who knew a law that critics claim is so dreadful could provide such powerful reassurance to Americans who are ill?
Democrats have never fully recovered from the Obama administration’s lousy sales job for (and botched rollout of) what is, legitimately, its proudest domestic achievement. That’s one reason Pryor doesn’t use the word “Obamacare” in describing what he voted for. Another is that in many of the states with contested Senate races this year, most definitely including Arkansas, President Obama himself is so unpopular that if you attached his name to Social Security, one of the most popular programs in American history would probably drop 20 points in the polls.
So, as the liberal bloggers Greg Sargent, Brian Beutler and Steve Benen have all noted, Republicans would much prefer to run against the law’s name and brand than the law itself. They also really want to avoid being pressed for specifics as to what “repealing Obamacare” would mean in practice.
As one Democratic pollster told me, his focus groups showed that when voters outside the Republican base are given details about what the law does and how it works, “people come around and say, ‘That’s not so bad, what’s everybody excited about?’”
This consultant says of Democrats who voted for the law: “You’re going to be stuck with all the bad about this but not benefit from any of the good unless you advertise” what the Affordable Care Act does. This is what Pryor has decided to do.
In fact, according to Gallup, Arkansas is the No. 1 state in the country when it comes to reducing the proportion of its uninsured since the main provisions of the ACA took effect. The drop was from 22.5 percent in 2013 to 12.4 percent in 2014. The No. 2 state is Kentucky, where the uninsured rate fell from 20.4 percent to 11.9 percent. What they have in common are Democratic governors, Mike Beebe in Arkansas and Steve Beshear in Kentucky, committed to using Obamacare — especially, albeit in different ways, its Medicaid expansion — to help their citizens who lack coverage. Beshear has been passionate in selling his state’s version of Obamacare, which is called kynect.
Kentucky also happens to be the site of another of this year’s key Senate races. Democrat Alison Lundergan Grimes is giving Republican leader Mitch McConnell what looks to be the toughest re-election challenge of his 30-year Senate career.
The Bluegrass State is particularly instructive on the importance of labeling and branding. A Public Policy Polling survey earlier this month found that the Affordable Care Act had a net negative approval rating, 34 percent to 51 percent. But kynect was rated positively, 34 percent to 27 percent. Grimes and the Democrats need to confront McConnell forcefully on the issue he has tried to fudge: A flat repeal of Obamacare would mean taking insurance away from the more than 521,000 Kentuckians who, as of last Friday, had secured coverage through kynect. How would that sit with the state’s voters?
Election results, like scripture, can be interpreted in a variety of ways. You can bet that foes of expanding health insurance coverage will try to interpret every Republican victory as a defeat for Obamacare. But as Mark Pryor knows, the president’s unpopularity in certain parts of the country doesn’t mean that voters want to throw his greatest accomplishment overboard — even if they’d be happy to rename it.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post; The National Memo, August 25, 2014
“Widening Disparities”: Maine Props Up ‘Two Americas’ With No Medicaid Expansion
The Affordable Care Act, as originally passed, holds tremendous promise to decrease health care costs and increase insurance coverage rates across rural states like Maine. But federal court opinions and repeated vetoes of Medicaid expansion are putting all that into jeopardy. Already, data is pointing to widening disparities between the states embracing health reform and those that have resisted — in the numbers of uninsured, in new health care jobs and in the finances of local hospitals.
Historically, the United States has maintained the highest health spending in the world, but it still had lower life expectancies and the highest rates of infant mortality in the developed world. Health costs have sucked up 18 percent of our gross domestic product, leaching out wage gains and damaging America’s global competitiveness.
These factors drove Congress and the president to enact health care reform. Since then, despite the fact that health care utilization typically increases as the economy recovers from recession, health care cost growth has been held in check and health economists increasingly agree that this is due to the structural reforms initiated by the ACA.
And, with federal subsidies and Medicaid expansion to help cover the working poor, the number of people who are uninsured in the country is going down. These are promising trends, but die-hard reform opponents continue to work to reverse them. Every recalcitrant governor, every contentious court decision impedes health reform from realizing its full potential, despite its proven success to date.
There are two Americas. One is prosperous, long-lived and healthy. The second comprises the working poor who are short-lived, disabled early and beset by chronic illnesses that could have been prevented — diabetes, heart failure, pulmonary disease. Those in this second America are people who have a job — maybe two — but do not earn enough to make ends meet.
We make special provisions for some of the most vulnerable in this group — children, the elderly and disabled — but millions of hard-working Americans fall through the gaps. And unfortunately, the ranks of America’s working poor are increasing, not shrinking.
An American born in one of our rural counties is likely to live a shorter life than a person in Algeria or Bangladesh. Meanwhile, Americans who live in prosperous urban regions have life expectancies that rival the healthiest places in the world. This disparity exists, and it takes money. It costs our economy, through lost worker productivity and the high price of treating people in emergency rooms when they cannot afford less expensive preventive care.
As designed, health reform aimed to erase health disparities. It pumped money into making affordable health care available to Americans in poorer, more rural states like Maine. It offered good jobs and billions in economic impact while improving the quality of care to all Americans wherever they live, whatever their income. It directed money to cost-effective primary care and dedicated scholarship funds to increase the number of doctors in rural and underserved areas, like much of Maine.
The New York Times recently reported that state-level refusal to expand Medicaid combined with the recent court ruling jeopardizing subsidies to residents of states on the federal exchange threaten to undo the national reform and create a state-by-state patchwork. This would effectively maintain the two Americas. The states that declined to expand Medicaid or design state exchanges are mostly the poorer, less healthy states. Right now, Maine is on this list.
Gov. Paul LePage has vetoed majority votes to expand Medicaid five times. If we continue in this direction, 12 percent of Mainers will continue to be uninsured while 96 percent of residents in nearby Massachusetts are insured.
Politics threaten to block health reform from fulfilling its promise: to bridge the yawning gap in health and economic potential between the two Americas. Partisan politics shouldn’t block Maine from reaping the benefits of health reform — both in better health outcomes and in expanded economic opportunity.
By: Christy Daggett, Policy Analyst, The Maine Center for Economic Policy; Published in The Bangor Daily News, August 19, 2014
“The Big Problem With Paul Ryan’s New Poverty Plan”: Accountability Is Only Required Of Poor People
Today, Rep. Paul Ryan is unveiling his latest idea to change the federal government’s poverty programs. For someone who is constantly saying how concerned he is about poverty, Ryan’s previous budgets have relied an awful lot on slashing benefits to poor people. But this time, he promises that his proposal doesn’t cut benefits, but merely reorganizes them. Some parts of the proposal might be worthwhile. But it’s hard to avoid the conclusion that it’s still driven by the longstanding conservative desire to limit the help we give to the poor.
The centerpiece of the proposal is a consolidation of multiple separate programs into a single block grant that would be given to states; they could decide how to dispense the money, and the federal government’s job would essentially be reduced to oversight. States would choose whether or not to participate.
This sounds reasonable until you start to think about how it would play out. In practice, it’s likely that the states most eager to sign on would be precisely those that aren’t too happy about the ways the federal government provides benefits now. The devil would be in the details; what if a state decided to take its entire block grant and devote it to giving lectures to poor people on why they should get married? There could be a lot of needs going unmet while states implement their ideologically-driven visions of how poverty ought to be addressed.
Ryan’s plan assumes that the same Republican states that rejected the federal government’s offer to insure poor citizens through the expansion of Medicaid — in other words, who would rather see poor people go uninsured than get coverage from the government — are now going to be spectacularly committed and creative in working to help those same poor citizens through their time of need. Color me skeptical.
Ryan insists his plan would hold funding for these programs constant, not cut them. But it’s more complicated than that. Conservatives have long advocated block-granting of poverty programs, always with the justification that states will better deliver assistance to poor Americans if they aren’t hamstrung by requirements from Washington. But there’s little evidence that block granting accomplishes anything other than making it easier for these programs to be cut in future years or simply whittled away by inflation. As Jared Bernstein points out, Temporary Assistance to Needy Families, which we used to call “welfare,” was block-granted in 1996 and has since then seen its value slashed by 30 percent in inflation-adjusted terms.
One of the real dangers of Ryan’s approach is that it would render the programs unable to deal with economic downturns unless Congress stepped in and supplied more money, which would be unlikely as long as Republicans control at least one house. So for instance, right now the food stamp program is an entitlement; if you meet eligibility standards you’re entitled to food stamps. The program can never run out of money in a given year. When the Great Recession hit, millions of Americans found themselves newly out of work and thus eligible for food stamps.
But under Ryan’s program, food stamps would be part of a block grant whose total amount is fixed. If and when another recession hit, states would be flooded with people who needed assistance, but they’d have the same limited sum of money they got at the beginning of the year. So they’d either have to turn people away or find a way to rob Peter to pay Paul, taking money out of other poverty programs to meet the increased need for food.
(There’s a brief discussion of inserting a provision into the plan to account for this kind of eventuality, but it seems neither particularly well thought-out nor nearly adequate to address what could be a major need.)
Ryan’s plan would also require “accountability” from those receiving assistance, in the form of time-limited benefits and work requirements (how you satisfy those requirements when people can’t find work is its own sad story). This too is a hallmark of the Republican approach to poverty programs, in which poor people have to jump through hoops to demonstrate their moral worth to get benefits. “Accountability” is something that is required of poor people, and only poor people. Farmers who get government subsidies don’t have to be “accountable.” Nor do government contractors who waste huge amounts of taxpayer money. Only the poor are forced to pee in a cup or account for their time or endure a hundred other petty humiliations, so we can be sure that if they get any government assistance they have proven themselves to be morally upstanding enough to deserve help.
That isn’t to say there’s nothing worthwhile in Ryan’s proposal. As he writes in a USA Today op-ed, “Right now, you have to go to a bunch of different offices to enroll in a bunch of different programs, often with different paperwork requirements and eligibility standards. Under the Opportunity Grant, you could go to one office and work with one person.” As anyone who has tried to apply for assistance knows, the paperwork requirements seem designed to hold down enrollment by making it as difficult as possible to apply. Streamlining that process would be terrific.
While this plan isn’t going to become law (at least not any time soon), it does serve a political purpose of showing that Republicans are thinking about poverty, and Ryan isn’t the only one in his party trying to revive “compassionate conservatism.” We can give him credit for addressing the issue. If only there was more reason to believe his ideas would do much to help Americans who are struggling.
By: Paul Waldman, Contributing Editor, The American Prospect; Published at The Plum Line, The Washington Post, July 24, 2014
“The GOP’s 20-Year War On Health Care”: Republicans Are Going To Extraordinary Lengths To See That More Americans Die
Stop the presses: John Boehner admitted Thursday that the Republican Party’s long-awaited alternative to Obamacare needs a little more time in the oven. “You know, the discussions about Obamacare and what the replacement bill would look like continue. We’re trying to build consensus around one plan,” the Speaker told Hill reporters. “Not there yet.”
As if you even needed me to tell you, rest assured: It could be six months from now, a year from now, five years from now, or the day Bibi Netanyahu and Khaled Mashal share a Nobel Peace Prize—they aren’t going to have a plan. Oh, they might have a “plan.” They had a “plan” last year, or at least Oklahoma Sen. Tom Coburn and two others did. For about two days, they were really tooting its horn. Then it dawned on people that paying for it would involve a hefty middle-class tax increase, on higher-end insurance plans. You may have noticed since then that the Coburn “plan” has not exactly become a leading Republican talking point.
As conservatives continue to hail the Halbig decision, some historical context is called for. In my last column, I wrote that conservatives and Republicans are going to extraordinary lengths to see that more Americans die. Not every reader was won over by that opinion, as you might imagine. But I think it’s beyond dispute, as a little discussion of political history should show.
The problem of millions of uninsured has existed in this country since—well, since forever. But as a running news story that the media paid attention to, for the last 25 or 30 years. I remember when the then-horrifying number was 15 million uninsured. Then 20 million, then 30 million, on up to the 46 million figure we often saw bandied about before the Affordable Health Care was enacted (10 million new Americans are insured as a result of it—a very respectable dent, for just one year). So, 30 years, a full generation, tens of millions of people adversely affected. And what, in all that time, has the Grand Old Party proposed to do about it all?
Not. One. Thing. Republican presidents had (if we go back to 1984) 16 years to pass some kind of health-insurance law. But none of the three ever even proposed one. George W. Bush did pass his Medicare law, but that was about adding prescription-drug coverage for seniors; it didn’t insure any previously uninsured citizens. What the GOP did instead, of course, was to fight tooth-and-nail to stop the two Democratic attempts to insure more people, succeeding the first time, failing the second.
And “tooth-and-nail” hardly begins to describe the demented and nearly sociopathic reality of Republican and conservative opposition to trying to make health insurance affordable for working-class people. Opposition to doing so has been one of the four grand accomplishments of the Republican Party of our time, which I would rank as follows, one scratched on each side of the obelisk: one, start disastrous wars and commit torture; two, make people despise the government; three, nearly cause a new Depression; and four, deny health insurance to as many people as possible, as aggressively and nastily as possible. It’s a grim record generally, and with regard to health care specifically, inarguably one that has promoted insalubriousness and suffering and, indeed, deaths that might have been avoided or delayed if people had had insurance.
It is true that some conservative intellectuals have offered up some ideas—as we know, the same individual mandate that the right now calumniates was a conservative idea at first. And John McCain actually had a decent-ish health-care platform plank in 2008. But if McCain had been elected, it’s very unlikely that the constellation of interests and power centers in the GOP would have permitted him ever even thinking about pursuing it. It was just something he felt he had to say to have credibility with middle-of-the-road voters. And in any case he wasn’t elected, and those conservative intellectuals’ ideas were never seriously proposed by elected Republicans, so the historical record is what it is.
The 20-year war on health care—since their 1993 defeat of the Clinton plan—has been about Republicans’ hatred of government; their view of people who don’t have insurance as lazy or flawed and not worth lifting a finger for; and their fear that if a law is passed and succeeds in bringing health care to millions, they and their whole vision of society will be discredited in the eyes of millions. Of course, these days, all that is shot through with one more element: a heavy dose of Obama hatred.
I was on Hardball Wednesday evening with David Corn, and Chris Matthews showed poll numbers during our segment that surprised even me. The topic was “rooting for failure.” Back in 2006, he said, Democrats were asked in a Fox News poll whether they wanted President Bush’s policies to succeed or fail. Answers: 40 succeed, 51 fail. Not particularly generous. But earlier this year, he said, CNN asked Republicans the same question about President Obama. Answers: 14 succeed, 73 fail.
Think about that. Three-quarters of regular Republicans want Obama to fail. And just one in seven wants him to succeed. We pundits spend most of our time blaming politicians for inaction, but maybe it’s time to start blaming the people. If regular Republicans feel like this, there’s no way the elected officials who represent them are going to do anything that looks remotely like compromise or cooperation.
And no, they’re not going to offer a real health-care plan either. They first promised that in 2010, during the campaign season, so they could say “repeal and replace” instead of just “repeal” and sound like they had a positive side. Then they dropped “and replace,” and now that it’s election time again, it’s back. But it’s not in their DNA to do anything constructive about health care. Or—the VA crisis, the border crisis, the Middle East crisis, the wage-and-inequality crisis, et cetera—about much of anything.
By: Michael Tomasky, The Daily Beast, July 25, 2014
“Creating Two Different Nations”: The Deepening Divide Between Red And Blue America
Halbig v. Burwell, the case in which opponents of the Affordable Care Act won a dramatic if temporary victory yesterday, has profound implications for millions of Americans’ health care. But it’s also a demonstration of a trend that is determining more and more of what our politics and our country are going to look like in future years.
We talk a lot about America being divided ideologically, with liberals and conservatives increasingly distrustful and dismissive of each other. But we’re also in the process of creating two different nations, where stepping across a state border means entering a society with profoundly different laws and policy goals. And Republicans may have just stumbled on a way to use the federal government to increase that division.
Both parties are driving this broad movement. In many Republican-controlled states, it’s now all but impossible for a woman to get an abortion; people are encouraged by the state government to bring their guns to church and into bars; and taxes are whittled away while social services are slashed. Democrats too have gotten more aggressive in places they control, on issues like raising the minimum wage, same-sex marriage, and legalizing marijuana.
But the challenges to the ACA have shown the Republicans a new path, a kind of federalized federalism, where they can not only make Red America a more conservative place through state laws, but exempt Red America from federal laws they don’t like.
This wasn’t part of a carefully laid-out plan. Initially Republicans were just using any and every means they could find to undermine the ACA, with the goal of destroying it completely. Though they failed to do that, they won their first significant (if partial) victory when the Supreme Court ruled that states could opt out of the law’s expansion of Medicaid, which meant that we have two different countries when it comes to health coverage for poor people. If you’re poor and you live in a blue state or one of the few red states that has accepted the expansion, you can get free health insurance. If not, you’re out of luck. See, for instance, this vivid New York Times article about the city of Texarkana, which lies half in Texas and half in Arkansas; whether you get health insurance is determined by which side of town you live in.
In the Halbig case, conservatives located a drafting error and pursued it for no reason other than that it looked like a promising vehicle for Republican-appointed judges to strike a blow at the law. Creating two different countries when it comes to the ACA wasn’t really the goal, but it could be the outcome.
Let’s imagine the Supreme Court upheld the D.C. Circuit panel’s decision. In the states that have already established state exchanges, nothing would change. With a few exceptions (like Kentucky and Idaho) these are blue states. Everywhere else, people would immediately lose the tax credits they received to buy insurance, reverting to the pre-ACA status quo. That means more people without insurance, and a system that is generally more cruel and unforgiving. The states that are Democratic-controlled or divided but haven’t yet set up an exchange, like Pennsylvania, New Jersey, and Maine, would probably move to do so in order to restore those subsidies to their citizens. Once it all shook out, you’d have a situation in which, for all intents and purposes, the most consequential social legislation passed through Congress in nearly half a century was operative in only half the country.
If that were to happen (and maybe even if it doesn’t), Republicans are likely to see a new means to accomplish their policy goals on any number of issues. If you can’t repeal a federal law you don’t like, maybe you can have it apply only to Blue America. Get a few creative lawyers together, and you can come up with a rationale for a lawsuit to allow states to opt out of almost any law; few can deny now that no matter how thin the legal reed you hang such a suit on, there will always be conservative judges who will embrace your logic. We could see a proliferation of opt-out amendments in Congress, as each significant piece of legislation is accompanied by an effort to give Republican states the ability to exempt themselves.
And don’t be surprised if perpetually vulnerable red state Democrats end up supporting those amendments from time to time, so they can give their party the votes it needs to pass bills, but also tell the folks back home that they stood up for states’ rights.
In 1932, Justice Louis Brandeis wrote in a dissenting opinion:
It is one of the happy incidents of the federal system that a single courageous state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.
But the assumption has always been that when states act as laboratories of democracy, they’re exploring different ways to arrive at common goals. Increasingly, liberals and conservatives can agree only on the most abstract goals, like prosperity and freedom, but on almost none of the specifics. With the ACA as an example, Washington could become the new laboratory of division, where federal legislation and federal lawsuits become the means to drive Red America and Blue America further apart.
By: Paul Waldman, Contributing Editor, The American Prospect; Published in The Plum Line, The Washington Post, July 23, 2014
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