“The Obama Political Obituaries Are Way Premature”: Nothing That Happened In 2013 Is Nearly As Humiliating As What Bush Endured
If President Obama saw the columns and news stories I keep reading lately, he’d probably have half a mind to resign and scurry back to Chicago in time to see the Bears lose a playoff game. “Tanking” approval numbers, no accomplishments, rudderlessness, and of course the website fiasco; they all add up, the conventional wisdom seems to say, to a presidency that is already all but finished, unless John Podesta can somehow save it. The Washington Post reported this week that among second-term presidents in the polling era, only Richard Nixon had a lower approval rating at this point than Obama does now.
Nixon? Is it really that bad? (By the way, there’s still a considerable distance between the two—Obama sits at 43 percent in the Post poll, while Nixon was down at 29.) I can read numbers, and I know what’s happened over the past year. Obama has lost support among core Democratic groups such as women and Latinos, and one suspects that the failure—not his failure; the failure, a distinction not enough people are evidently making—to pass immigration reform was disillusioning for these cohorts. And obviously the HealthCare.gov fiasco is the governing reality here. It’s been a messy year.
At the same time, everything that’s happened can be rebounded from. Let’s look, by way of comparison, at where President Bush was at the end of 2005. He’d started out the year, you might recall, saying, “I have political capital, and I intend to use it.” Actually, he said that right after he beat John Kerry. Bush didn’t yet reveal how he meant to use that capital, but soon enough it became clear that he meant Social Security privatization, or partial privatization.
Bush staked a lot on that project. If you were around then, you remember those endless town halls, filled with plants and ringers offering their most plangent testimonials about how they couldn’t wait to get Uncle Sam’s heavy hand out of their purses and invest their own retirement money as they saw fit, as any real Murican would insist. This was how Bush and Karl Rove were going to create the permanent Republican majority, through the new ownership society.
What happened? Congress, even Republicans in Congress, wanted nothing to do with it. It was basically dead by Memorial Day. So that was going to be the signature issue of Bush’s second term—with a House and a Senate, remember, that were also in Republican hands at the time. And it went up in flames.
Nothing that has happened to Obama in 2013 is nearly as humiliating as what Bush endured—and that was before Katrina hit in August 2005. You could make an immigration comparison, but they’re hardly the same, because Bush’s party controlled both houses of Congress. If the Democrats were running the House right now, there’s little question the immigration bill would have passed. I don’t expect the general public to make such distinctions, but that doesn’t mean I can’t make them. Being smacked down by the opposite party, which has shown its contempt for you a hundred times already, isn’t remotely the same thing as being smacked down by your own party. The Bush privatization failure was devastating not only to his standing as president but as head of his own party.
Obama hasn’t suffered anything like that. He’s been the victim of a couple of ginned-up “scandals,” the IRS most especially, that had no truth to them but nevertheless took a bite out of his ratings. The Republicans are a constant irritant, willing to sacrifice their own standing as long as they can drag him down with them. But he has not launched a huge, historic initiative on which history has slammed the sarcophagus lid screaming “Failure!”
Health care? Come on. You’re joking. That was a bad first inning. Granted, a really, really bad first inning, but a first inning all the same. There is a lot of ball yet to be played. Even now, we’re only in the top of the second in terms of implementation of this law. And every week brings new reports that the troubles are of the past. The information that’s supposed to be getting to insurance companies is getting to them now, and providers are about to start advertising heavily to potential enrollees. Jeff Zients, the man who fixed the site, is leaving, but he’s being replaced by a Microsoft exec, Kurt DelBene, who presumably knows a thing or two about state-of-the-art operating systems. I’ve said it before and I will say it again. Obamacare is going to have, for most Americans who come face to face with it, a happy ending, and I think sooner rather than later.
That is the big error the Republicans are making. They truly seem to think it’s game-set-match on Obamacare. It isn’t even close. And the media, espying bad Obama poll numbers, go along, because then, instead of the bad poll numbers being just bad poll numbers, they can be woven into a Meta-Narrative Think Piece about how second terms in the modern presidency are graveyards.
Obama isn’t close to any graveyard yet. The Obamacare story is going to keep getting better. And the economy, if you hadn’t noticed, has grown at 3 percent for the last two quarters. That’s not just good considering the circumstances of the meltdown and an opposition party that’s been trying actively to harm the economy. That’s just plain old good.
Predicting a politician’s standing a year out is a mug’s game, so I won’t do that. But I’ll comfortably make the claim that nothing that has happened to Obama in 2013 rules out a rebound. Far be it from me to question The Washington Post’s poll numbers, but Bush was in far worse shape at this point. Obama’s second term will not likely match the list of accomplishments of his first. But even if the second term is nothing more than the successful implementation of Obamacare for 30 million or 40 million Americans, that’s plenty. Public opinion will catch up.
By: Michael Tomasky, The Daily Beast, December 19, 2013
“Extending The Hardship Exemption”: You Can Still Have Weak Health Insurance Under Obamacare, For Now
If you liked your old skimpy health plan, you may not be able to keep it. But now you can get a new, somewhat skimpy health plan instead, at least for a little while.
That’s a rough translation of an Obamacare policy change that the Administration announced on Thursday. The change, first reported by Louise Radnofsky of the Wall Street Journal, represents yet another effort to help people about to lose their existing insurance policies, usually because those policies do not comply with the Affordable Care Act’s standards for benefits and pricing. Those old policies left out major benefits, were sold only to people without pre-existing conditions, and so on.
As you know, plan cancellations have been a source of tremendous controversy—and, for the president, immense political grief. Some estimates have suggested several million people received these cancellation notices. The vast majority of those people have already found new coverage, either directly through insurers or through one of the Obamacare exchange websites, according to the Administration. While some are paying more money, others have discovered that the new policies are cheaper—or, at least, are grateful for the extra protection. Lucia Graves of National Journal wrote about some of their stories the other day.
But some people still haven’t found insurance. Administration officials think, based on conversations with state regulators and insurers, that about half a million people fall into this category. That’s half a million people who could, because of the individual mandate, face tax penalties because they have declined to get affordable coverage.
Now, however, people with cancelled policies have a new option. The individual mandate has always contained a hardship exemption: If you qualify for it, you don’t have to pay the penalty and you have access to the cheaper, slightly less comprehensive catastrophic insurance plans otherwise available only to people under 30. The only question with the hardship exemption has been who gets it. The law gives the administration flexibility over that question and, on Thursday, Health and Human Services Secretary Kathleen Sebelius announced that it would apply to people who just lost their policies and are unable to find replacements that cost the same or less money.
HHS made the announcement by posting a guidance and sending a letter to a half-dozen more conservative members of the Senate Democratic caucus. And neither document answers all of the relevant questions, like how strictly the government will apply the new criteria or for how long this exemption will last. (Administration officials say it will be temporary.)
Conceptually, making the change is not so different from allowing more people to have grandfather protection for their existing coverage—after all, it’s basically telling people who have bare-bones coverage now that they can take out bare-bones policies next year. And imposition of the individual mandate was always supposed to be a gradual process. The financial penalty starts out relatively low, but will increase in 2015 and 2016. The administrative flexibility over the hardship exemption was designed to give the administration some leeway over enforcing the mandate, particularly early on, in order to ease the transition to a new and reformed insurance market. (The Massachusetts reforms, which were a model for the Affordable Care Act, also included a hardship exemption and called for increasing penalties over time.)
Administration officials don’t seem to think many people will take up this new option. They are probably right about that. Catastrophic policies aren’t dramatically different in coverage from the “bronze” policies, which cover 60 percent of the typical person’s medical expenses and comply with all Obamacare requirements. But if you buy a catastrophic policy, you’re not eligible for federal tax credits. If you buy a bronze policy, you are. As a result, most lower- and middle-income people would probably still find the bronze policies a better deal.
Still, some people—primarily, the ones who don’t qualify for subsidies—will opt for the catastrophic policies because they will be moderately cheaper. And some people will opt not to get insurance at all. That will mean fewer people in good health paying premiums for the exchange policies. That’s a potential problem for insurers, who count upon those premiums to offset the medical bills of people in poor health. (For health policy wonks: The catastrophic policies are an independent risk pool, separate from other policies in the exchanges. So for every person who selects one of those policies, that’s one fewer person putting premiums into the larger pot of money for the exchange policies.) There’s also a danger that, as Ezra Klein points out, the administration will come under more pressure to pull back on the mandate for other people. “This latest rule change could cause significant instability in the marketplace and lead to further confusion and disruption for consumers,” said Karen Ignani, president of America’s Health Insurance Plans.
Yes, insurers say those sorts of things all the time. And this singular change probably won’t cause serious, irreparable harm, any more than any of the previous ones did. The number of people whose behavior changes is likely to be small and the new system is more resilient than most people realize. But even minor changes can become major if there are enough of them.
Note: This item has been updated. As a friend reminds me, even the catastrophic plans under Obamacare aren’t that skimpy. They still cover all essential benefits, for example, and the actuarial value really isn’t much different from bronze plans.
By: Jonathan Cohn, The New Republic, December 21, 2013
“Running On Empty”: Republicans Can’t Repeal Or Replace Obamacare, And They’re Too Scared To Fix It
More than three million people have already signed up for health insurance as of last Friday through the exchanges set up by the Affordable Care Act (ACA). That number is growing rapidly, with 15,000 new enrollments a day in California alone.
And the Republican plan to deal with Obamacare generally remains what it has been since 2010 — repeal.
This means the millions of men, women and children covered under plans could either see their plans invalidated by insurance companies no longer required to cover pre-existing conditions or have their Medicaid coverage completely erased. Republicans who spent the last three months screaming about how terrible insurance cancelations are would have to explain what happens next for millions of uninsured Americans.
Repeal is a fantasy, a fundraising opportunity that all Republicans — except the few who take Senator Ted Cruz (R-TX) seriously — know would never happen. And if it did, they would end up owning every aspect of a crumbling health care system the same way Democrats are currently responsible for every splinter in every tongue depressor.
The Washington Post‘s Greg Sargent looks at recent polling and finds that though Americans are largely dissatisfied with the rollout of the Affordable Care Act, they generally support the federal government’s taking a role in getting people affordable health insurance. More importantly, most are still willing to give the law a chance.
“Only 37 percent support repealing Obamacare entirely,” he writes, “while 53 percent say there are good things in the law and that changes are needed to make it work better.”
Republicans are now in what Sargent calls “The GOP Repeal Trap,” which essentially requires them to vow repeal and pray that somehow the law collapses on its own.
While it may seem absurd to those who care about governing, it makes perfect sense strategically because ”replace” is an even bigger fantasy than repeal.
Until it became socialism incarnate, the ACA was the conservative reform to the health care system. So to replace it completely, conservatives would need to go further to the right and destroy the entire employer-provided health insurance paradigm that provides about 85 percent of working adults with their coverage.
That’s what the proposal John McCain ran for president on in 2008 would have done, canceling the insurance of about 20 million Americans, four times the number who had to find new coverage under Obamacare.
Are there conservative fixes that could be made to the ACA that Democrats would be willing to trade for reforms of their own?
Health economist Austin Frakt has listed more than a dozen possible conservative-leaning fixes for the law, starting with their all-time favorite, tort reform, which actually would do very little to lower health care costs but would be a huge win for the right in their never-ending war against trial lawyers.
So why doesn’t some brave Republican — say Governor Chris Christie (R-NJ) — step forward with a set of conservative reforms to the ACA?
The answer is easy: Republican primaries.
Michigan Senate candidate Terri Lynn Land suggested that the law would be fixed and was forced to flip-flop on that position in less than 24 hours, likely in fear that she might end up with a Tea Party challenger. Georgia Senate candidate Rep. Jack Kingston did nearly the exact same thing.
Christie is already saddled with being the only 2016 GOP frontrunner who accepted Medicaid expansion. If he became the face of fixing Obamacare, he would be appealing to the majority of voters but antagonizing if not actually declaring war on those in the base who refuse to accept that Obamacare is here to stay, and also refuse to consider any candidate who tells them what they do not want to hear. (Even if the governor could win the primary backed by the business and more independent wings of his party, he could end up inspiring a Tea Partier to run as a third-party candidate, virtually guaranteeing a Democratic victory in 2016.)
For the foreseeable future, Republican candidates — even those in states and districts President Obama won — are stuck running in the general election with the “problematic” stand of wanting to take health insurance from millions, some of whom may actually show up to vote.
And if they win, they can return to blaming President Obama for never making their repeal fantasy come true. It’s the only safe move.
By: Jason Sattler, The National Memo, December 19, 2013
“A Closer Look At Those Falling Into The Wingnut Hole”: Nearly 80% Of People In The Health Care Coverage Gap Reside In The South
Yesterday the Kaiser Family Foundation released some badly needed data on the characteristics of Americans who fall into what I’ve dubbed the “wingnut hole,” and that others just call the Coverage Gap. These are the people too poor to qualify for Obamacare subsidies for purchasing insurance in the exchanges, but too “rich” to qualify for the Medicaid benefits the drafters of the ACA assumed they would get but that their state governments blocked once the Supreme Court let them make the choice. Here’s the Kaiser Family Foundation’s take on the problem:
Medicaid eligibility for adults in states not expanding their programs is quite limited—the median income limit for parents in 2014 will be 47% of poverty, or an annual income of about $9,200 a year for a family of three, and in nearly all states not expanding, childless adults will remain ineligible. Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults will fall into a “coverage gap” of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits…. Nationwide, nearly five million poor uninsured adults are in this situation.
Who are they? Well, they’re mostly southerners:
The nearly five million poor uninsured adults who will fall into the “coverage gap” are spread across the states not expanding their Medicaid programs but are concentrated in states with the largest uninsured populations…. More than a fifth of people in the coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility. Sixteen percent live in Florida, eight percent in Georgia, seven percent live in North Carolina, and six percent live in Pennsylvania. There are no uninsured adults in the coverage gap in Wisconsin because the state will provide Medicaid eligibility to adults up to the poverty level in 2014.
The geographic distribution of the population in the coverage gap reflects both population distribution and regional variation in state take-up of the ACA Medicaid expansion. As a whole, more people—and in particular more poor uninsured adults— reside in the South than in other regions. Further, the South has higher uninsured rates and more limited Medicaid eligibility than other regions. Southern states also have disproportionately opted not to expand their programs, and 11 of the 25 states not expanding Medicaid are in the South. These factors combined mean nearly 80% of people in the coverage gap reside in the South
They’re also hard to define by race or ethnicity:
The characteristics of the population that falls into the coverage gap largely mirror those of poor uninsured adults. For example, because racial/ethnic minorities are more likely than White non-Hispanics to lack insurance coverage and are more likely to live in families with low incomes, they are disproportionately represented among poor uninsured adults and among people in the coverage gap. Nationally, about half (47%) of uninsured adults in the coverage gap are White non-Hispanics, 21% are Hispanic, and 27% are Black (Figure 3).
And they’re often the people left behind in wave after wave of incremental reforms based on expanding Medicaid and S-CHIP benefits to kids and their parents.
The characteristics of people in the coverage gap also reflect Medicaid program rules in states not expanding their programs. Because non-disabled adults without dependent children are ineligible for Medicaid coverage in most states not expanding Medicaid, regardless of their income, adults without dependent children account for a disproportionate share of people in the coverage gap (76%)…. Still, nearly a quarter (24%) of people in the coverage gap are poor parents whose income places them above Medicaid eligibility levels. The parent status of people in the coverage gap varies by state….due to variation in current state eligibility.
What doesn’t vary state by state is how outrageous it is to exclude the people who by the accident of a court decision fall into the “wingnut gap” of benefits available to people just above them on the income scale. They are for the most part the “working poor,” people with part-time or small-business jobs that don’t come with private health insurance.
They are ineligible for publicly-financed coverage in their state, most do not have access to employer-based coverage through a job, and all have limited income available to purchase coverage on their own.
You can argue that these people are those most in need of the Affordable Care Act, yet most likely to be excluded from its benefits.
These are also people with an unusually large personal stake in the outcome of the 2014 elections–the kind of people conservatives are thinking of when they conclude Obamacare has created a “tipping point” wherein actual or potential beneficiaries of government programs are essentially being bribed into voting Democratic. But if there’s been any growing groundswell of political mobilization of people in the “wingnut hole,” it has been very quiet. So they will likely become objects of anti-redistribution propaganda from the Right without becoming subjects of any major Democratic comeback.
The latest hope for people in the “wingnut hole” has been enthusiasm for securing Medicaid expansion by very broad waivers allowing states to work their will on the Medicaid program as a whole. To be very blunt about it, such “deals” have tended towards broadening the base of people eligible for Medicaid while degrading its benefits, with the federal government paying almost all the cost of implementation and sharing the political risk that it might fail. The situation is a reminder that about a hundred fifty years after the end of the Civil War, southern states are still fighting the “Reconstruction” potential of federal funds to interfere with the region’s grim perpetuation of inequality.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 18, 2013
“No Way Out”: GOP Eyes “Obamacare Trap” Warily
Rep. Marlin Stutzman (R) held an event in his Indiana district this week, at which health care was a major topic of conversation. According to a local press account, not everyone in this Republican area necessarily opposes “Obamacare.”
But Stutzman seemed to realize at the event that simply condemning what he doesn’t like won’t be enough. “What are you replacing it with? That’s what everybody is asking right now,” the congressman said, adding, “There’s several Republican plans that are competing with each other right now just internally. After the first of the year, we are going to try to sort through that.”
That last part was actually rather newsworthy – we didn’t know that House Republicans are planning to finally present their alternative to the Affordable Care Act sometime in 2014. In fact, Byron York reported that intra-party talks are still underway.
[I]n private discussions, House Republicans stress their differences over the details of an Obamacare alternative. For example, there’s no agreement on precisely how to fix the tax inequity for people who don’t receive health coverage at work. There are similar disagreements over all sorts of other points of policy. “Getting unanimity is a tall order for a divided, leaderless party,” says the GOP aide.
As Democrats can attest, getting unanimity is a tall order for a united party with strong leaders, too.
Regardless, while York describes an “Obamacare trap” in which Republican lawmakers struggle with whether to fix or destroy the existing system, the circumstances lead me to believe a very different kind of trap is set.
Let’s say, after five years of effort, House Republicans finally emerge from behind closed doors with a health care reform package they’re proud of and willing to present to the public. What then? The GOP plan will be subjected to some policy scrutiny, which is where the party is likely to run into some trouble.
It’s easy to imagine a side-by-side comparison, in which the Affordable Care Act is tested against the Republican alternative. Which covers more uninsured Americans? Which reduces the deficit more? Which offers the stronger consumer protections? Which is more effective in controlling long-term costs?
I’d bet good money that on all of these questions, the GOP plan will lose – not because Republican policies are necessarily worse than Democratic policies, but because Republicans have already said their approach to health care would eschew regulations and public investments. And while it’s possible to create a health care plan without spending or safeguards, it’s not possible to create a good health care plan without them.
Ultimately, that’s the “trap” GOP officials need to be mindful of. On the one hand, they can continue to offer nothing in the way of an alternative, effectively telling the public they’re not serious about the issue and they prefer to take cheap shots rather than govern. On the other, they can build a consensus around an Obamacare alternative that almost certainly won’t be nearly as good as the ACA. (Remember, the basic framework of the Affordable Care Act was the Republican policy up until a few years ago.)
The trap is set. The question isn’t whether Republicans will fall in, but rather, whether they can get out.
By: Steve Benen, The Maddow Blog, December 18, 2013
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 