“A Steady Drumbeat”: Republican Governors Buck Party Tenets To Seek Expanded Medicaid
Republican governors are pressing forward to expand Medicaid even after being stymied by lawmakers in their own party.
As the Obama administration vows to help develop plans that will pass muster with conservatives, the governors of Utah and Wyoming said they still want the health care program for the poor broadened. Georgia Gov. Nathan Deal, who declined to act in 2013, may seek a federal waiver to make insurance available to more residents. Louisiana’s Republican legislature also opened a legal door.
Their views challenge party orthodoxy, even if some governors are crafting their own proposals and denying that what they’re doing is expanding Medicaid. Twenty states have refused the expansion under President Barack Obama’s 2009 health care overhaul because of cost and ideological opposition. The resistance is easing as states see a chance to recoup tax dollars and help hospitals get paid for charity care.
“This is about your citizens’ financial and health security, and it’s also about the economic health of your states,” Sylvia Mathews Burwell, U.S. secretary of health and human services, said Saturday at a National Governors Association meeting in West Virginia. “We want to help you design a system.”
This month, Alaska became the 30th state to expand, including 10 with Republican governors, according to the nonprofit Kaiser Family Foundation, a health-research group in Menlo Park, California. Gov. Bill Walker, a first-term independent, used his authority under state law to accept the expansion unless the legislature returns by September 1 and votes it down.
“I did it unilaterally because it was the right thing to do,” Walker said in an interview.
Governors in Tennessee, Utah, and Wyoming lack the ability to act alone, and their Republican-led legislatures declined to adopt expansion this year.
Even so, Utah’s Gary Herbert plans to meet with legislative leaders this week and said he hopes to call a special session in September to pass what he’s calling an alternative to Medicaid expansion.
Herbert’s program also would require a waiver from Medicaid officials for elements designed to appeal to Republicans, such as having applicants get job training.
“I’m optimistic,” Herbert said in an interview. “I think our approach is better than traditional government-assistance Medicaid.”
In Georgia, lawmakers last year blocked the governor from expanding Medicaid without their approval. A provision tucked into this year’s budget, though, allows the state to pursue a waiver.
Wyoming Gov. Matthew Mead called his expansion effort “a colossal failure.” Still, he hopes to bring it back in February’s budget session or in 2017.
“It’s going to take probably some time and continued work by all of us to eventually get to that point,” Mead said.
Tennessee Gov. Bill Haslam, a Republican, said he doesn’t know whether he’ll try next year after failing in February.
While Louisiana Gov. Bobby Jindal, a Republican presidential candidate, has been an adamant opponent, his state still could move, said Joan Alker, executive director of the Center for Children and Families at Georgetown University.
Jindal leaves office at year’s end, and Republicans running to replace him have all expressed support for expansion in some form, she said. The legislature has passed a provision requiring hospitals to pay the state’s share of expansion.
“I don’t think we are going to see a super-large number of states moving forward,” Alker said. “But it is a steady drumbeat.”
By: Mark Niquette and Margaret Newkirk, The National Memo, July 29, 2015
“The Obamacare Resistance Regroups”: Delving Even Deeper Into Denial
The 16th Amendment to the Constitution, authorizing the federal income tax, was ratified in 1913. Still, every once in a while, the news will report the arrest of some right-wing kook who has failed to pay his income tax on the grounds that it’s illegal. Also in 1913, the 17th Amendment, requiring the popular election of senators (who before then were often appointed by state legislatures) took effect. And yet many conservatives still want to repeal it — and not just kooks, or at least influential kooks and not just completely marginal and obscure kooks. And those things happened more than a century ago.
So how long will the Obamacare resistance live on? A long, long time.
Obamacare has survived when it appeared to be dead in Congress in 2009, then even more dead the next year, and then survived a Supreme Court case, a presidential election, a rollout crisis, and another Supreme Court case. National Journal’s Josh Kraushaar has lovingly tended the flickering flame of health-care repeal for years. In 2013, he predicted that barring “an unlikely fourth quarter comeback,” Congressional Democrats would soon join with Republicans to repeal the law over a presidential veto. In the wake of the King v. Burwell verdict, Kraushaar regroups with a new column laying out a path. Kraushaar refers repeatedly to the law’s “unpopularity,” which is … barely correct:
Proceeding from this shaky premise, he argues that, if they win the presidency, enough Senate Democrats might join Republicans to create a filibuster-proof supermajority:
The third group, which Sasse labels the “Replacement Caucus,” would make significant changes to the law after campaigning on a reform-oriented health care agenda in the presidential election. That’s the most tenable approach — and the fact that Sasse, a hard-line Senate conservative, is calling for something other than outright repeal is telling. (Sasse still supports repealing the law but only with a replacement plan in hand.)
If Republicans win the presidency, the political momentum — and votes for rolling back core elements of Obamacare — would be in place. In that scenario, Republicans would have won three out of four elections, and a depleted Democratic Party would be in disarray. Republicans could credibly claim a health care mandate, given how prominently the issue played in recent elections.
Kraushaar allows that these “significant changes” to Obamacare would fall short of repeal, though he does not indicate what those changes would entail. He links to a National Review column by Republican Senator Ben Sasse, which also fails to describe what changes should be implemented. The closest Sasse comes to specifying a proposal is calling for an “understandable, common-sense, patient-centric alternative.” Of course, Republicans have been urging other Republicans to come up with a common-sense, patient-centric health-care plan since the health-care debate began six years ago. They have remained stuck in the same unsolvable problem: Their actual health-care policy ideas are either all less popular than the specific policies in Obamacare, unworkable, or both. When Republicans start naming actual policy changes they would implement, they would do things like let insurance companies deny coverage to people with preexisting conditions, or stop covering popular services like maternity care. That’s why the only specific partial changes Republicans actually want to vote on simply attack the law’s financing provisions. They’re not willing to eliminate Obamacare’s benefits, but they’re happy to stop paying for them. That plan (keep the benefits, oppose the taxes) is pretty much the party’s approach to other established social insurance programs like Medicare and Social Security. If Republicans win the presidency, they may bite the bullet and repeal Obamacare because their base demands it, but they won’t have Democrats on their side and it won’t be popular.
Even farther into denial is Michael Cannon, a Cato Institute scholar who played a leading role in promoting the King v. Burwell lawsuit. The basis for that lawsuit was seizing on an errant line of text implying that tax credits would be available only for customers using state-established exchanges, ignoring many other parts of the law, as well as massive amounts of evidence before, during, and after the debate implying the opposite. For a while, Cannon, the founder of the anti-Universal Coverage club, nurtured hopes of un-insuring 6 million Americans. He finds himself in the position of a despondent young Montgomery Burns mourning the destruction of his biological weapon (“My germs, my precious germs! They never harmed a soul. They never even had a chance!”)
Cannon, unlike Burns, does not seem to be accepting defeat. His Twitter bio continues to describe him as “the man who could bring down Obamacare,” a now-moot prediction. His new column argues, “Even in defeat, King threatens Obamacare’s survival, because it exposes Obamacare as an illegitimate law.” Cannon bases this claim on the fact that he believes, or purports to believe, that Obamacare is not what the Supreme Court says it is but a chimerical, never-implemented, doomed-to-fail alternative that will live on forever in his dreams. A century from now, right-wingers will emerge from their fortified mountain compounds, clutching Cannon’s writings and claiming to be following the True Obamacare.
By: Jonathan Chait, Daily Intelligencer, New York Magazine, July 10, 2015
“Particularly Shameless”: Rick Scott Lied On His Mother’s Grave — And Blew A Hole In The GOP’s Anti-ObamaCare Argument
When it comes to ObamaCare’s expansion of Medicaid, it may seem like a matter of simple logic for states to take the money that’s on offer. It would both help their most vulnerable citizens and pump lots of money into local economies.
Alas, logic and the contemporary Republican Party have little relation to each other, so most GOP-controlled statehouses have turned down the offer. But few have done so in a more clownish manner, or exposed the contradictions in the Republican position more clearly, than Florida Gov. Rick Scott.
Scott has flip-flopped on Medicaid, first opposing it, then supporting it, then opposing it again. This is bad, if not entirely unusual, political behavior. But Scott was particularly shameless, citing his recently deceased mother as his justification for suddenly embracing the expansion in 2013.
As he has now revealed, however, Scott was lying on his mother’s grave. He pretended to embrace the Medicaid expansion to secure a federal waiver for privatizing Florida’s Medicaid system, then quietly dropped his support once the waiver was granted. (The Obama administration’s decision to give the quid without first getting the quo, given who they were dealing with, was not its finest hour.)
So Scott used his deceased mother as a shield to lie about his motives in order to funnel federal taxpayer money to Florida businesses, then reneged on his part of the deal, leaving many poor Floridians to needlessly suffer and in some cases die. All par for the course for Scott, who before entering politics oversaw a massive amount of Medicare fraud as CEO of a large for-profit hospital operator.
At this point, one could say that, rank dishonesty and opportunism aside, at least Scott is standing on principle. He is turning down federal dollars to protect state sovereignty. Not a very attractive principle, but at least a principle, right?
Nope. Before the Affordable Care Act, the federal government made money available to states to create Low-Income Pools (LIP) that would reimburse hospitals that treated patients who couldn’t afford to pay for emergency services. Florida is receiving more than $1 billion a year in federal funds from LIP. The ACA, however, makes the LIP obsolete. It addresses problems of uncompensated hospitals by expanding Medicaid, greatly reducing the number of patients who cannot pay their bills.
The federal government has told Florida that it will not make the LIP funds available, pointing to the Medicaid funding which remains available. But Scott wants to have his cake and eat it, too. Not only is he demanding that the federal funding continue, he has actually filed a frivolous lawsuit arguing that the federal government is obligated to give Florida the LIP money. The Obama administration, having been burned by Scott already, is unmoved.
This lawsuit builds on the Supreme Court’s already shaky holding that allowed states to opt out of the expansion, pushing it to an extreme that would be too absurd even for the Roberts Court. It has virtually no chance of succeeding.
But the decision to file it is instructive. On the one hand, Scott is arguing that taking an extraordinarily good offer from the federal government to insure its poor citizens would be an intolerable intrusion on the sacred sovereignty of the state of Florida. On the other hand, Scott is arguing that Florida has a right to another source of federal tax dollars for health care.
There is, in other words, no actual principle involved here — not even a bad “states’ rights” one. It’s just pure partisan politics, with Florida’s poor people being punished as a result.
As Michael Hilzik of the LA Times observes, Scott’s disgraceful behavior reflects broader trends in Republican governance. The decision of Republican officials at the state level to reject the Medicaid expansion, while misleading their constituents about the dread ObamaCare, continues to have disastrous results for their citizens.
The ensuing mess in Florida — where a huge hole has been blown in the state budget because anti-ACA fanatics won’t take the Medicaid expansion — does at least provide a glimmer of hope for the longer term. Red-state legislators may not particularly care about the many poor people being needlessly denied access to medical care. But they will start to increasingly care about the medical professionals and hospitals who are also being screwed. Once Obama leaves office, it’s likely that more and more states will grudgingly take the federal money.
In the meantime, however, the consequences of misrule in these states will continue to be grim.
By: Scott Lemieux, The Week, May 18, 2015
“Rick Scott’s Hissy Fit”: Impatiently Snapping His Fingers At Sylvia Burwell Won’t Do Him Any Good
Rick Scott’s clearly a man who expects others to snap to it when he asks for something. But his demand that the Obama administration instantly give him assurances they’ll agree with his construction of an incredibly technical interplay between the Medicaid expansion option he’s now flip-flopped a second time to oppose, and an existing Low-Income Pool program who’s beneficiaries overlap with Medicaid’s, is now turning into a hissy fit, per this report from The Hill‘s Peter Sullivan:
Florida Gov. Rick Scott (R) on Wednesday demanded an answer from the Obama administration “right now” on the renewal of federal funds for hospitals in his state, amid a showdown over ObamaCare’s Medicaid expansion.
“I’ve let them know our timeline and we need an answer right now,” Scott told reporters outside the Department of Health and Human Services headquarters in Washington after meeting with Health and Human Services (HHS) Secretary Sylvia Mathews Burwell.
According to HHS, Burwell gave Scott the “preliminary view” that the state’s current proposal falls short of the administration’s requirements.
At issue are federal funds to reimburse hospitals in Florida for treating uninsured people, known as the Low Income Pool (LIP). Scott is suing the Obama administration, alleging that the administration is withholding the funds in an effort to force the state to expand Medicaid under ObamaCare.
The administration counters that Florida is free to expand Medicaid or not, and that the decision on LIP funding will be made “regardless” of whether the state expands Medicaid.
You don’t have to go all the way down into the weeds to understand this; the administration obviously does want to keep the pressure up on Scott to do the right thing, and Florida hospitals are probably giving their Governor holy hell for not only rejecting the cornucopia of dollars from a Medicaid expansion, but jeopardizing their existing federal funds while he’s at it. But in any event, HHS has a good excuse for delaying any final decision on Scott’s proposal for a larger LIP program than would normally be the case:
HHS pointed out that the proposal is still in the middle of a 30-day public comment period in Florida, a step before its final decision on the proposal.
“HHS is continuing to engage with Florida on the state’s LIP proposal, even as the period for public comment in Florida is underway,” the readout said. “HHS heard the Governor’s request for a timely response to help the state meet its budget timeline. HHS believes completion of the public comment period, on-going discussions with the state, and the state’s submission of its proposal to CMS are the next steps in the process.”
That doesn’t meet Scott’s politically driven timetable, of course, so he’s impatiently snapping his fingers at Sylvia Burwell.
Don’t think it will do him any good.
By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, May 7, 2015
“A Bold Truth-Teller”: What If A 2016 GOP Candidate Told The Truth About Obamacare?
If you’re a Republican presidential candidate, there aren’t too many ways you can distinguish yourself from your primary opponents on the issue of health care — I hate Obamacare, you hate Obamacare, we all hate Obamacare. But maybe there’s another way, for someone who has the courage to shift his rhetoric and present themselves as a bold truth-teller.
To put that in context, let’s look at some new developments on the Obamacare front.
A study just out from the Rand Corporation — not exactly a hotbed of socialist thinking — finds that after the coverage provisions in the Affordable Care Act took effect: “we estimate that 22.8 million people became newly insured and that 5.9 million lost coverage, for a net increase of 16.9 million with insurance as of February 2015.”
In addition, a new Gallup poll shows that 43 percent of Americans say they’re satisfied with the government’s work in health care, which doesn’t sound so great until you learn it’s the highest number this question has received since the organization began asking it in 2001.
We already know that all the predictions Republicans made about the ACA — a decline in health coverage, skyrocketing medical spending and premiums, massive job losses — failed to come true. One seemingly sensible response to the facts about Obamacare is to pretend they aren’t true, which is how prominent Republicans have handled things until now. After all, there hasn’t been much punishment for spreading falsehoods about the law, and the public is still woefully uninformed about it. For example, for every American who knows that the law has proven much less expensive than was originally estimated, there are eight who mistakenly believe it ended up being more expensive.
Nevertheless, the good news continues to pile up, and at least some of it may be penetrating to the public, albeit slowly (approval of the law has been ticking up of late). Which could create the opening for a Republican willing to say something different from his peers.
Let’s imagine a presidential candidate who said something like this to GOP primary voters:
“I know that just saying ‘Repeal Obamacare!’ is a good applause line. And believe me, I wish it had never passed. But we’ve had over 50 votes to repeal it in Congress, and it’s still here. Like it or not, it’s becoming entrenched. If we repealed it tomorrow, it would mean that millions of Americans would lose the coverage they’ve got. We can’t object to people losing their plans because of Obamacare, and then say it’s no big deal if a much larger number of Americans lose their coverage when we repeal the law. And Obamacare does a few things that we Republicans favor.
“So instead of just saying ‘Repeal it now!’, I’m going to give you a plan to keep the good things, ditch the bad things, and move toward a better health care system. We’ve spent the last five years banging our heads against the wall over this law, and some of my opponents think more banging is the answer. But I want to solve the problem.”
The Republican who said that would, of course, be branded a traitor by some. But he’d also get a wave of adoring press coverage, in which he’d be characterized as a straight-talking man of courage and the only one willing to have an adult conversation about health care.
The outcome of the King v. Burwell lawsuit could also help make his case. If the Supreme Court rules in Republicans’ favor, millions of Americans will lose their health coverage when subsidies are taken away, and efforts for a legislative fix are uncertain at best. The experience will make it clear even to many Republicans that “Burn it down!” isn’t always the wisest approach.
Yes, a Republican who turned his back on “repeal” to focus on “replace” would be taking a huge risk, since GOP primary voters are not necessarily going to be thoughtful and measured in their response to someone proposing something less than all-out war against Barack Obama and everything he ever touched. But it might just be crazy enough to work.
By: Paul Waldman, Senior Writer, The American Prospect; The Plum Line Blog, The Washington Post, May 7, 2015
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