“The GOP Crusade Against The UnInsured”: Republicans Are Doing Everything They Can To Sabotage Obamacare
When House Speaker John Boehner declared Obamacare the “law of the land” two days after his party took a drubbing in the election, the real reveal came in what happened next: he walked it back in record speed and re-affirmed his commitment to getting rid of it.
Having failed to repeal the Affordable Care Act at the national level, Republicans are now dedicating their efforts to botching its implementation at the state level. And having failed to invalidate the law at the Supreme Court, they’re now seeking alternate legal avenues to weaken its regulations.
Republican governors are turning down the law’s Medicaid expansion, a move made easier by the Supreme Court decision that made the expansion optional. Among them are Bobby Jindal of Louisiana, Phil Bryant of Mississippi and Nikki Haley of South Carolina. Given that the federal government pays the vast majority of the cost in the medium term, these states are, in effect, rejecting an extraordinarily generous financial incentive to insure their residents.
Implementing the expansion in full would insure about 17 million people. “If [many states] don’t accept the Medicaid expansion you’re going to have millions of low income Americans who will remain uninsured and without access to health care,” said Tim Jost, a health care expert at Washington and Lee University who supports the Affordable Care Act.
Some dozen Republican governors are refusing — and about a dozen more are considering refusing — to build state-based insurance exchanges, the law’s primary vehicle for expanding and improving coverage. These governors, which include John Kasich of Ohio, Rick Perry of Texas, Nathan Deal of Georgia and Mary Fallin of Oklahoma, are consequently empowering the federal government to build one for them.
The law does not set aside funds for the federal government to construct or operate exchanges, creating implementation headaches for the Obama administration. But it can be self-sustained through user fees, and Jost argues that state residents with governors who are uncommitted would be better served by a federal exchange that wants to cover them.
Conservative thinkers are also resurrecting their argument, championed by top Republicans, that federally-administered exchanges lack the legal authority to provide tax subsidies, which are critical to making them work. Although the language of the law is vague on this question, the IRS has said federal exchanges are permitted to provide the premium subsidies.
“I don’t believe they’re going to win on that one,” Jost said. “If they did win that would do serious damage to what Congress intended, which is to have a federal fallback exchange.”
Utah Gov. Gary Herbert (R) is flirting with continuing his state’s existing insurance exchange even though it does not comply with rules in the Affordable Care Act.
Meanwhile, conservative advocates are advancing a separate legal challenge to the law’s requirement that insurance plans cover contraception for women as part of a copay-free preventive services package. Cheered on by congressional Republicans, Catholic institutions such as the Archdiocese of Washington and University of Notre Dame are moving forward with lawsuits that could end up in the Supreme Court.
All in all, Republicans and conservatives are telegraphing that they’re not chastened by years of failed efforts to wipe away Obamacare. The crusade shows no signs of ending, and could still do serious damage to the law.
By: Sahil Kapur, Talking Points Memo, November 21, 2012
“Medicaid On The Ballot”: Unfortunately Mr. Romney, A Lack Of Insurance Does Kill People
There’s a lot we don’t know about what Mitt Romney would do if he won. He refuses to say which tax loopholes he would close to make up for $5 trillion in tax cuts; his economic “plan” is an empty shell.
But one thing is clear: If he wins, Medicaid — which now covers more than 50 million Americans, and which President Obama would expand further as part of his health reform — will face savage cuts. Estimates suggest that a Romney victory would deny health insurance to about 45 million people who would have coverage if he lost, with two-thirds of that difference due to the assault on Medicaid.
So this election is, to an important degree, really about Medicaid. And this, in turn, means that you need to know something more about the program.
For while Medicaid is generally viewed as health care for the nonelderly poor, that’s only part of the story. And focusing solely on who Medicaid covers can obscure an equally important fact: Medicaid has been more successful at controlling costs than any other major part of the nation’s health care system.
So, about coverage: most Medicaid beneficiaries are indeed relatively young (because older people are covered by Medicare) and relatively poor (because eligibility for Medicaid, unlike Medicare, is determined by need). But more than nine million Americans benefit from both Medicare and Medicaid, and elderly or disabled beneficiaries account for the majority of Medicaid’s costs. And contrary to what you may have heard, the great majority of Medicaid beneficiaries are in working families.
For those who get coverage through the program, Medicaid is a much-needed form of financial aid. It is also, quite literally, a lifesaver. Mr. Romney has said that a lack of health insurance doesn’t kill people in America; oh yes, it does, and states that expand Medicaid coverage show striking drops in mortality.
So Medicaid does a vast amount of good. But at what cost? There’s a widespread perception, gleefully fed by right-wing politicians and propagandists, that Medicaid has “runaway” costs. But the truth is just the opposite. While costs grew rapidly in 2009-10, as a depressed economy made more Americans eligible for the program, the longer-term reality is that Medicaid is significantly better at controlling costs than the rest of our health care system.
How much better? According to the best available estimates, the average cost of health care for adult Medicaid recipients is about 20 percent less than it would be if they had private insurance. The gap for children is even larger.
And the gap has been widening over time: Medicaid costs have consistently risen a bit less rapidly than Medicare costs, and much less rapidly than premiums on private insurance.
How does Medicaid achieve these lower costs? Partly by having much lower administrative costs than private insurers. It’s always worth remembering that when it comes to health care, it’s the private sector, not government programs, that suffers from stifling, costly bureaucracy.
Also, Medicaid is much more effective at bargaining with the medical-industrial complex.
Consider, for example, drug prices. Last year a government study compared the prices that Medicaid paid for brand-name drugs with those paid by Medicare Part D — also a government program, but one run through private insurance companies, and explicitly forbidden from using its power in the market to bargain for lower prices. The conclusion: Medicaid pays almost a third less on average. That’s a lot of money.
Is Medicaid perfect? Of course not. Most notably, the hard bargain it drives with health providers means that quite a few doctors are reluctant to see Medicaid patients. Yet given the problems facing American health care — sharply rising costs and declining private-sector coverage — Medicaid has to be regarded as a highly successful program. It provides good if not great coverage to tens of millions of people who would otherwise be left out in the cold, and as I said, it does much right to keep costs down.
By any reasonable standard, this is a program that should be expanded, not slashed — and a major expansion of Medicaid is part of the Affordable Care Act.
Why, then, are Republicans so determined to do the reverse, and kill this success story? You know the answers. Partly it’s their general hostility to anything that helps the 47 percent — those Americans whom they consider moochers who need to be taught self-reliance. Partly it’s the fact that Medicaid’s success is a reproach to their antigovernment ideology.
The question — and it’s a question the American people will answer very soon — is whether they’ll get to indulge these prejudices at the expense of tens of millions of their fellow citizens.
By: Paul Krugman, Op-Ed Columnist, The New York Times, October 28, 2012
“A Man Of No Convictions”: You Can Never Meet The Same Mitt Romney Twice
To a skeptic, the most remarkable aspect of Mitt Romney’s presidential campaign has been how so flexible a politician can represent so dogmatic a party. Contemporary Republicanism is ideological to its core. Everybody who watched the GOP primary debates between Mitt and the Seven Dwarves (or were there nine? I forget) understands that there’s a black-and-white party line on almost every imaginable topic from tax policy to global warming.
Romney, on the other hand, appears to have no firm convictions at all. How anybody purports to know what the GOP candidate actually thinks about any issue other than the size of his own offshore bank accounts beggars my poor imagination. That most Republicans have temporarily persuaded themselves to trust him reflects mainly their fear and loathing of President Obama.
Equally remarkable, however, is the way the Obama campaign has let Romney get away with it. How can his evasiveness not be an issue? For that matter, how can it not be THE issue? Early on, a strategic decision was apparently made to depict the GOP candidate as the “severely conservative” politician he affected to be during the Republican primaries.
Well, it ain’t working. So many and so various are the GOP candidate’s self-contradictions and reinventions that the proverbial “low information” citizens who appear to constitute much of the swing vote are pretty much free to imagine any Mitt Romney that strikes their fancy.
Maybe it’s unpatriotic to say so, but an awful lot of people who manage their personal affairs competently enough simply refuse to understand the most elementary facts when they’re part of a political argument.
Sometimes you have to tell them a story. It helps if that story connects to something close to home; something they’ve had to think about realistically in their own lives.
Such as, what happens if you lose your health insurance and then get sick? Millions live in fear of this every day.
CBS News’ Scott Pelley recently asked Romney a simple question on 60 Minutes: “Does the government have a responsibility to provide health care to the 50 million Americans who don’t have it today?”
“Well, we do provide care for people who don’t have insurance,” Romney allowed. “If someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.”
“That’s the most expensive way to do it,” Pelley observed. Indeed, government figures show the average emergency room visit costs $922, vs. $199 for a doctor’s office visit.
Nor is it free. People do know that. Under the Emergency Medical Treatment and Active Labor Act signed by President Reagan, hospitals must treat sick and injured patients regardless of their ability to pay. A civilized society can do no less; much less one that hopes to head off deadly epidemics.
But the law doesn’t say the hospital can’t perform what’s cynically called a “wallet biopsy” and send you a bill. Indeed, many states allow hospitals to hire collection agencies, garnish wages and seize assets in pursuit of payment. For this reason, many people stay away until they’re at death’s door.
Others abuse the privilege and stick the rest of us with the bill.
Back in 2006, the politician Bill Clinton calls “Moderate Mitt” recognized the problem. Hewrote a Wall Street Journal column objecting to the way deadbeats game the system.
“By law, emergency care cannot be withheld,” he wrote. “Why pay for something you can get free? Of course, while it may be free for them, everyone else ends up paying the bill, either in higher insurance premiums or taxes.”
Writing in Time, Kate Pickert catches Moderate Mitt as recently as 2008, explaining the conservative origins of “Romneycare” in Massachusetts.
“They shouldn’t be allowed just to show up at the hospital and say somebody else should pay for me, so we said no more free riders… We said if you can afford insurance, then either have the insurance or get a health savings account, pay your own way, but no more free ride… I think it’s the conservative approach—to make sure that people who can afford insurance are getting it at their expense, not at the expense of the taxpayers or the government. That, I consider a step towards socialism.”
Ah, but then came “Obamacare,” basically Romneycare with a less expensive per capita price tag. Yesterday’s conservative solution turned into today’s Bolshevism. Severely Conservative Mitt played along.
So what would Romney do if elected?
Who knows? To paraphrase the ancient Greek philosopher Heraclitus: You can never encounter the same Mitt Romney twice. Whatever he says today, he’ll say something different tomorrow.
Here’s the question President Obama should be asking: Would you buy a used health insurance policy from this man?
By: Gene Lyons, The National Memo, October 17, 2012
“Death By Ideology”: Among The Lying Liars, Mitt Romney Doesn’t See Dead People
Mitt Romney doesn’t see dead people. But that’s only because he doesn’t want to see them; if he did, he’d have to acknowledge the ugly reality of what will happen if he and Paul Ryan get their way on health care.
Last week, speaking to The Columbus Dispatch, Mr. Romney declared that nobody in America dies because he or she is uninsured: “We don’t have people that become ill, who die in their apartment because they don’t have insurance.” This followed on an earlier remark by Mr. Romney — echoing an infamous statement by none other than George W. Bush — in which he insisted that emergency rooms provide essential health care to the uninsured.
These are remarkable statements. They clearly demonstrate that Mr. Romney has no idea what life (and death) are like for those less fortunate than himself.
Even the idea that everyone gets urgent care when needed from emergency rooms is false. Yes, hospitals are required by law to treat people in dire need, whether or not they can pay. But that care isn’t free — on the contrary, if you go to an emergency room you will be billed, and the size of that bill can be shockingly high. Some people can’t or won’t pay, but fear of huge bills can deter the uninsured from visiting the emergency room even when they should. And sometimes they die as a result.
More important, going to the emergency room when you’re very sick is no substitute for regular care, especially if you have chronic health problems. When such problems are left untreated — as they often are among uninsured Americans — a trip to the emergency room can all too easily come too late to save a life.
So the reality, to which Mr. Romney is somehow blind, is that many people in America really do die every year because they don’t have health insurance.
How many deaths are we talking about? That’s not an easy question to answer, and conservatives love to cite the handful of studies that fail to find clear evidence that insurance saves lives. The overwhelming evidence, however, is that insurance is indeed a lifesaver, and lack of insurance a killer. For example, states that expand their Medicaid coverage, and hence provide health insurance to more people, consistently show a significant drop in mortality compared with neighboring states that don’t expand coverage.
And surely the fact that the United States is the only major advanced nation without some form of universal health care is at least part of the reason life expectancy is much lower in America than in Canada or Western Europe.
So there’s no real question that lack of insurance is responsible for thousands, and probably tens of thousands, of excess deaths of Americans each year. But that’s not a fact Mr. Romney wants to admit, because he and his running mate want to repeal Obamacare and slash funding for Medicaid — actions that would take insurance away from some 45 million nonelderly Americans, causing thousands of people to suffer premature death. And their longer-term plans to convert Medicare into Vouchercare would deprive many seniors of adequate coverage, too, leading to still more unnecessary mortality.
Oh, about the voucher thing: In his debate with Vice President Biden, Mr. Ryan was actually the first one to mention vouchers, attempting to rule the term out of bounds. Indeed, it’s apparently the party line on the right that anyone using the word “voucher” to describe a health policy in which you’re given a fixed sum to apply to health insurance is a liar, not to mention a big meanie.
Among the lying liars, then, is the guy who, in 2009, described the Ryan plan as a matter of “converting Medicare into a defined contribution sort of voucher system.” Oh, wait — that was Paul Ryan himself.
And what if the vouchers — for that’s what they are — turned out not to be large enough to pay for adequate insurance? Then those who couldn’t afford to top up the vouchers sufficiently — a group that would include many, and probably most, older Americans — would be left with inadequate insurance, insurance that exposed them to severe financial hardship if they got sick, sometimes left them unable to afford crucial care, and yes, sometimes led to their early death.
So let’s be brutally honest here. The Romney-Ryan position on health care is that many millions of Americans must be denied health insurance, and millions more deprived of the security Medicare now provides, in order to save money. At the same time, of course, Mr. Romney and Mr. Ryan are proposing trillions of dollars in tax cuts for the wealthy. So a literal description of their plan is that they want to expose many Americans to financial insecurity, and let some of them die, so that a handful of already wealthy people can have a higher after-tax income.
It’s not a pretty picture — and you can see why Mr. Romney chooses not to see it.
By: Paul Krugman, Op-Ed Columnist, The New York Times, October 16, 2012
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