“The Other Mitt”: No Health Insurance? Romney Says “Freeloading” In The ER Is Now All Good
Whether you support the candidacy of Mitt Romney or not, we all should be able to agree that his experience as Governor of Massachusetts—at the time when the first universal healthcare law in the nation was conceived and placed into operation—makes him something of an expert on the subject of health care economics.
And that is precisely what makes his comments during last night’s edition of “60 Minutes” all the more bizarre.
When asked whether the nation has a responsibility to provide health care to the 50 million Americans who do not currently have coverage, the Governor responded;
“Well, we do provide care for people who don’t have insurance. 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.”
Never mind that ‘60 Minutes’ interviewer Scott Pelly was quick to accurately point out that ER care is the most expensive form of treatment that one can access. What is far more interesting is that the remark so clearly puts Governor Romney at odds with the other candidate seeking the presidency—and I don’t mean Barack Obama.
I refer, of course, to the ‘other’ Mitt who seems to come and go at various moments in the campaign, offering up direct contradictions to the positions of the Mitt Romney we watched last night on the CBS news show.
You see, it was the ‘other’ Mitt who said during a 2010 interview over at MSNBC—
“It doesn’t make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility.”
And it was the ’other’ Mitt who told Glenn Beck in a 2007 interview—
“When they show up at the hospital, they get care. They get free care paid for by you and me. If that’s not a form of socialism, I don’t know what is. ”
Apparently, when 2002 Mitt Romney decided to divorce himself and split into two, distinct entities, the ‘other’ Mitt Romney gained possession of the Governor’s cognitive skills —including the ability to recall why Romney supported the Massachusetts universal care effort in the first place. It was, after all, 2002 Mitt Romney who often highlighted the inefficiency of emergency room care as the sole option for uninsured Massachusetts residents, allowing them to get free care while those who are insured are left to pay the bill.
It would also appear that it was the ‘other’ Mitt Romney who gained custody of the understanding that while our laws require emergency rooms to treat patients in an effort to stabilize their health condition, the law does not require the treatment that can ultimately restore all of these patients to health.
As noted by the current incarnation of the GOP candidate, when a patient turns up at the ER with severe stomach pain, that patient will be treated until her condition is stabilized. But it is the ‘other’ Mitt Romney who understands that, when the tests administered in the ER reveal that the patient has Stage One stomach cancer, it will not be up to the ER to administer the six months of chemotherapy that will be required to save the patient’s life. For that, the patient better be insured or face a truly precarious situation.
The ‘other’ Romney understands that ER care is insufficient to truly treat many patients and that, even when it was possible to get the desired result via ER care, it is the worst possible way to administer health care.
Here’s a thought—maybe current candidate Romney should consider getting rid of his failing campaign staff and see if he can entice the ‘other’ Mitt Romney to join the campaign as a strategist and adviser.
At the end of the day, I think we’d all be better off for it.
By: Rick Ungar, Contributor, Forbes, September 24, 2012
“Trust Me, I’ll Figure It Out”: Mitt Romney Re-Explains Why He Can’t Be Trusted On Health Care
Over the weekend, Mitt Romney muddied the waters about where he stands on health-care reform with a series of vague statements from himself and his campaign about health insurance for people with pre-existing conditions.
His floundering is a subset of a larger problem: He has committed himself to a set of positions that won’t allow for a replacement of Obamacare with something that actually fixes the problem of tens of millions of Americans without health insurance, including those with pre-existing conditions.
Sarah Kliff of the Washington Post describes Romney’s progression on pre-existing conditions:
It started with the Republican presidential candidate saying during an appearance on “Meet the Press” that he liked the Affordable Care Act’s provision that requires insurers to cover preexisting conditions, and would support something similar. Hours later, his campaign clarified he did not, however, support a federal ban against denying coverage for preexisting conditions. Around 10 p.m., the Romney camp had circled back to the same position it held back in March: that the governor supports coverage for preexisting conditions for people who have had continuous coverage.
The “continuous coverage” distinction is key: In order to retain the right to insurance that covers your pre-existing condition, you need to make sure to pay health insurance premiums every month. But often, the reason people lose health insurance because they have lost their job. Telling the recently unemployed to pay out of pocket for continuous coverage, typically at a cost of several hundred dollars a month for an individual or more than $1,000 for a family, is often not viable.
It’s worth noting that the purpose of the continuous coverage requirement is similar to the purpose of the individual mandate: It provides an incentive for healthy people to stay in insurance pools, avoiding a “death spiral” in which only sick people buy insurance.
Unaffordability is not a fatal problem for Romney’s continuous coverage proposal. It could be fixed with a range of subsidies that make it affordable for people to maintain continuous health coverage. Essentially, that’s what Obamacare does, and what Romney’s health plan in Massachusetts did.
For a conservative approach to fix at least part of the affordability problem, see this article from National Affairs by James Capretta and Tom Miller. Capretta and Miller propose to combine a Romney-style proposal on pre-existing conditions with significantly expanded funding for high-risk insurance pools, in hopes of covering up to 4 million uninsured Americans with pre-existing conditions.
But Capretta and Miller estimate that their plan would cost somewhere on the order of $200 billion over 10 years. Where is the indication that Romney plans to make such a significant financial commitment, let alone get one out of a Republican Congress? Romney’s platform is full of expensive promises — restore $700 billion in Medicare cuts, grow defense spending to 4 percent of GDP, cut tax rates. It funds these promises in part by drastically cutting spending on health care for the non-elderly. Implementing something like the Capretta-Miller proposal would be a significant reversal of course.
And what about the tens of millions of Americans who are uninsured not because they have pre-existing conditions but simply because they cannot afford insurance coverage? Romney says he wants to replace Obamacare, but his plans do not signal much help for them.
Romney has talked about leveling the playing field for individual purchasers of insurance, so they would get the same favorable tax treatment as businesses buying insurance for their employees. This would make it easier for individuals to buy their own health plans, but it’s not a substitute for Obamacare-style subsidies. Any way you structure a tax incentive, it’s likely to over-subsidize the wealthy and under-subsidize the poor, leaving huge swaths of America still unable to afford insurance.
Romney hasn’t said exactly how his tax incentive would work. But it would probably be a tax credit (whose value is static across incomes) or a tax deduction (whose value rises with income). In 2008, John McCain proposed a $5,000 per family tax credit for health insurance. Scaled up for health-care inflation, that would likely be closer to $6,000 today.
The average health plan premium for a family is now $15,745. Some middle- and upper-middle-income families can be expected to cover a gap of about $9,000. But poorer people need a larger subsidy if we hope to get them covered.
(It is also worth noting that if Romney plans to convert the existing tax exclusion for employer-provided health care into some other health-care subsidy, he cannot also use it as an area for tax-base broadening to pay for his cuts in tax rates, and he needs a lot of base-broadening to make his tax-cut math work.)
The key to the subsidy structure in both Romney’s Massachusetts plan and Obamacare is that the subsidies decline in value as people’s incomes rise. Under Obamacare, people with incomes up to 133 percent of the poverty line get Medicaid, which has very little cost to the beneficiary. Above that, they get sliding-scale subsidies for private insurance; the poorest beneficiaries pay just 2 percent of their incomes. Middle-income people get smaller subsidies, and wealthy people have to pay their own way.
Republican rejection of the Medicaid expansion is especially problematic, because Medicaid is cheaper than private insurance, and people earning less than 133 percent of the poverty line have almost no money of their own to contribute toward premiums.
Telling these people the federal government will pay 40 percent of their health insurance premiums will not get them insured. The options aside from Medicaid are to provide them private insurance at significantly higher taxpayer cost than in Obamacare, or leave them uninsured. It is easy to guess which option Republicans in Congress would prefer.
Romney doesn’t want to get into these details about who will get what subsidies. But the details are important. They are the difference between expanding health insurance coverage to the vast majority of Americans, and leaving tens of millions of Americans without access to the health care they need. And they are the difference between actually making it possible for people with pre-existing conditions to get the coverage they need, and not making it possible.
As on so many issues, Romney’s line on health reform is essentially, “Trust me, I’ll figure it out.” But uninsured Americans stand to gain a lot from the implementation of Obamacare. They have no particular reason to believe that Romney’s vague alternative would bring them similar benefits.
By: Josh Barro, Bloomberg, September 13, 2012
“Terrifying Implications”: Texas Says “No Thanks” To Women’s Health Care
If you haven’t been worn down reading about Todd Akin’s bizarre and ignorant views about the female reproductive system, now turn to Texas, where women’s uteruses may soon have to move out of state to find health care. Late Tuesday night, a federal court of appeals ruled that Texas can exclude Planned Parenthood from the Women’s Health Program, which provides basic preventative care—like birth control and cancer screenings—for low-income women. The decision has terrifying implications in a state where women’s access to health care is already poor.
One in four women in Texas is uninsured, and the state also has the third-highest rate of cervical cancer in the country. In Texas, women’s health-care clinics serving low-income populations rely on two sources of funding: the Women’s Health Program and general state family-planning dollars. Lawmakers have attacked both streams.
In 2011, the state legislature slashed state funding for family planning—you know, the thing that prevents abortions—by two-thirds. A recent report from the Texas Observer revealed that 60 family planning facilities have already closed as a result of the cuts. While a full picture of the effect is still emerging, the Legislative Budget Board, a bipartisan committee, had estimated that when all was said and done, the cuts would lead to 20,000 additional births (which Medicaid would have to pay for). Projections show that around 180,000 women would lose health services.
Then there’s the damage to the state Women’s Health Program (WHP), a separate program that serves 130,000 low-income women. Created in 2005, the WHP is a crucial state service that provides preventative health care and family-planning services. It’s run through Medicaid, so the feds paid for 90 percent of the $40 million program. While it only serves women who are not pregnant, it saved around $75.2 million in 2009 by preventing a projected 6,700 births. The program seemed like a win-win; it decreased unplanned pregnancies and abortions, while increasing access to health care.
But the WHP may soon not exist, or at least not in a recognizable way. Lawmakers added new rules in 2011 that excluded Planned Parenthood from receiving funding. The trouble is, Planned Parenthood provided services to nearly half the women covered under the program and received about 25 percent of the program’s total funding last year. Barring the organization leaves many wondering whether those clinics left would meet demand.
Furthermore, the state violated federal policy by slashing Planned Parenthood funding, which means Medicaid can no longer foot the bill for the Women’s Health Program. Texas supposedly has a plan to transition to a state-run program by November 1; that plan will continue to exclude Planned Parenthood. The influential organization is fighting the state’s decision, and in October, the two parties begin court proceedings on whether Texas can permanently exclude the main provider of women’s health from its Women’s Health Program.
Yesterday’s decision means that between now and the court case, Texas can halt funding to Planned Parenthood clinics. It’s only a few months, but the clinics are already reeling from the family-planning cuts. The loss of WHP funding is a double whammy. Twelve Planned Parenthood clinics have already shut down, alongside the many clinics with no relation to the organization. Meanwhile, if the courts ultimately decide Texas cannot exclude Planned Parenthood from the WHP, the state may opt to shut down the program entirely.
Many, including the attorney general and Governor Rick Perry, celebrated the decision, and the state Health and Human Services Commission announced it would immediately halt funding to the group. Meanwhile, for the hundreds of thousands of low-income women in the state, there are fewer and fewer health-care options.
By: Abby Rapoport, The American Prospect, August 22, 2012
“Lest We Forget”: Medicaid, Not Medicare Is Biggest Target For Conservatives
At the risk of sounding like a broken record on this subject, I devoutly hope that in their rush to tie Mitt Romney to Paul Ryan’s Medicare proposal, progressives don’t forget that there has never been much space between the two running-mates on the national health care program Ryan’s budget would really destroy: Medicaid. Wonkblog’s Suzy Khimm has a reminder today:
Paul Ryan’s Medicare overhaul may be the most controversial part of his budget.But the proposed cuts to the program are not the biggest cuts in the plan.
As Ezra notes, Ryan’s cuts to Medicare “are only 60 percent as large as the cuts to Medicaid and other health-care programs.” What’s more, his biggest change to Medicare wouldn’t kick in until 2023—the start date for his voucher-based premium support program. By comparison, Ryan’s cuts to Medicaid are more drastic, and they start sooner: Between 2013 and 2022, it would make nearly $1.4 trillion in cuts to Medicaid that “would almost inevitably result in dramatic reductions in coverage” as well as enrollment, according to the non-partisan Kaiser Family Foundation.
Over the next 10 years, the Ryan plan would cut Medicaid by $642 billion by repealing the Affordable Care Act and by $750 billion through new caps on federal spending—a 34 percent cut to Medicaid spending over the next decade, according to Edwin Park of the Center and Budget and Policy Priorities.
Who would that impact? First, by overturning the ACA, the Ryan plan would prevent 11 million people from gaining Medicaid coverage by 2022, according to the Congressional Budget Office’s latest estimates….
If states maintained their current level of spending for each Medicaid patient, 19 million more people would have to be cut from the program in 2021 because of Ryan’s block-grant reform, according to the Kaiser Family Foundation. If states managed to curb health-care spending growth in Medicaid, 14 million beneficiaries would still lose Medicaid coverage under the Ryan plan. And that’s on top of the 11 million Americans who would lose Medicaid coverage because the Ryan plan would repeal Obamacare. So all in all, Ryan’s cuts could mean as many as 30 million Medicaid beneficiaries lose their coverage.
Yeah, yeah, I know, old folks vote and in the last two cycles a majority have voted Republican, and po’ folks don’t vote so much, and far more already vote Democratic. But Lord a-mighty: 30 million people potentially losing their health insurance because Romney and Ryan think they need to show more moral fiber. Given Romney’s support for the entire Ryan Budget, that doesn’t even get into the damage wreaked on efforts to help the poor escape from total dependence on cash assistance or private charity by the combined cuts to Medicaid, food stamps, and the earned income tax credit that budget contemplates. And on top of all that, many millions of indigent seniors depend on Medicaid for nursing home care.
So before progressives decide to devote all their time to endless arguments over exactly which term to use for what the Ryan Budget proposes to do to Medicare—vouchers, cost-shifts, abandonment, abolition-of-Medicare-as-we-know it—don’t forget about Medicaid. That’s the Great Society safety net program with the biggest bullseye painted on it.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, August 13, 2012
“A Slave To The Right Wing”: Romney’s Health Care Dilemma Returns
Mitt Romney has been so busy securing his Republican base that he hasn’t had time to court independent voters, the ones who will actually decide this election. But now, probably by accident, he has an opportunity to show them that he’s something other than a slave to his party’s right wing. Will he take it?
When Romney spokesperson Andrea Saul committed the apparently unpardonable sin of praising the health care law Mitt Romney passed as governor of Massachusetts, was she making a horrible mistake that made everyone in Romney headquarters gasp in horror, or was she just reflecting what her candidate actually believes? The answer to that question would tell us where Romney is going to go from here on health care, and whether he may at long last try to find some issue on which he can convince voters he’s something more than a vessel for whatever his party’s right wing wants to do to the country.
Most everyone, myself included, initially assumed that Saul just spoke out of turn. After all, Romney had been trying to avoid any discussion of health care all through the primaries. And from a logical standpoint, there really is no good argument for him to make. Since what Romney did in Massachusetts and what President Obama did with the Affordable Care Act are identical in their major features, either they were both wise policy moves or they were both horrible mistakes, but it just can’t be the case that one was great and the other was a nightmare. That is, in fact, the argument Romney makes when he’s forced to talk about the Massachusetts reform, but you can tell he realizes how absurd what he’s saying is, and he wants to change the subject as soon as possible.
But Noam Scheiber argues that it’s oversimplified to just say that Romney has turned his back on Romneycare in order to assure Republicans that he hates Obamacare as much as they do:
As we await the Romney campaign’s decision about Saul’s fate, it’s worth reflecting on one under-reported aspect of this latest conservative blow-up: Saul was saying precisely what her superiors in the Romney campaign believe, not least of them Mitt Romney.
I spent a lot of time talking to Romney campaign officials while reporting my recent profile of Stuart Stevens, his chief strategist. The unmistakable impression I got from them is that, to this day, Romney remains extremely proud of having passed health care reform in Massachusetts.
And why wouldn’t he be? He approached a difficult problem, then came up with a solution acceptable to both parties, and by all accounts the resulting policy has been a success. There are only a small number of uninsured people left in Massachusetts, and the reform is widely popular within the state. It was without a doubt the most significant accomplishment of Romney’s one term as governor. The fact that he is running a campaign for president in which he dares not mention the best thing he did in the one job he had that was something of a preparation for the job he wants is quite insane.
Of course, it’s one thing for him to be justifiably proud of Romneycare, and it’s another for him to actually talk about it on the campaign trail. If he were to do that, it would require two things he has little desire to do: angering his base, and admitting, at least tacitly, that Barack Obama actually did something right. The former is really the biggest problem; there has not been a single occasion during this campaign (or the one he ran in 2008, for that matter), when Mitt Romney has said or done anything he thought might get the right wing of the Republican party upset. The chances that he’ll start now are slim to none.
By: Paul Waldman, Contributing Editor, The American Prospect, August 10, 2012
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