“Romney’s Cliff Notes Version Of The Ryan Plan”: Your Guide To “Ending Medicare As We Know It”
It’ll be the next argument in the campaign, so it’s a good time to brush up.
Yesterday, President Obama went to Florida and told seniors that Mitt Romney wants to end Medicare as we know it, and it appears that this argument (and some related ones) will be a central feature of the Obama campaign’s message in the coming days. It’s entirely possible, as Jonathan Chait has suggested, that all the Obama campaign’s attacks on Romney’s finances and record at Bain Capital are the first stage of a two-stage strategy that culminates with an attack on the Ryan budget. Since we’ll be talking about this a lot soon, I thought it might be worthwhile to refresh our memories on what this is all about, particularly with regard to Medicare, and how it relates to the current campaign.
First: Is it fair to tar Mitt Romney with the Ryan plan? No question. While Romney’s own policy proposals are quite a bit more vague than the Ryan plan is, they follow the same contours, and when Romney is asked about the Ryan plan he never hesitates to praise it. When asked about it last month, Romney’s chief strategist Eric Fehrstrom said of his boss, “He’s for the Ryan plan.” Or in Romney’s own words, “I’m very supportive of the Ryan budget plan. It’s a bold and exciting effort on his part and on the part of the Republicans and it’s very much consistent with what I put out earlier.” Enough said.
Next: Does the Ryan plan actually “end Medicare as we know it”? This is the phrase that Democrats have used in the past to describe it, and that Obama will continue to use. Republicans claim the phrase is unfair and demagogic. But while it would be inaccurate to simply say the Ryan plan “ends Medicare,” because if the plan were enacted there would still be a program going by the name of “Medicare,” it is fair to say that Medicare would be a drastically different program, and some of the critical things that make it so successful would no longer exist.
Today’s Medicare is an insurance program. If you’re a senior, you go to your doctor, and your doctor gets paid by Medicare. It is a single-payer program that covers every senior, and though it doesn’t pay for every conceivable procedure, because of Medicare’s universality there are essentially no uninsured seniors in America, no seniors who are subject to the tender mercies of the notoriously unmerciful insurance companies, no seniors who need to worry about their pre-existing conditions or their lifetime limits or any of the other ways those companies find to screw their customers, and almost no seniors who find it impossible to pay their insurance premiums (seniors do contribute premiums to Medicare, but they are quite modest).
The Ryan plan in its initial incarnation eliminated Medicare as an insurance program, and replaced it with “premium support.” There’s an argument about whether premium support can be described accurately as a “voucher,” but that’s nothing more than a silly disagreement about semantics; premium support in practice is no different from any voucher. Under this plan, seniors would have to get their insurance from private companies, and the government would pay part of the cost. If those private premiums go up, then seniors will have to pay more out of their own pockets; indeed, this is a feature, not a bug, of the Ryan plan. The whole point is to limit government spending on Medicare by limiting how much seniors get in their vouchers/premium support.
And those limits could be vicious. The Ryan plan caps the growth of Medicare at GDP growth plus 0.5 percent. If health costs rise faster than that, seniors will have to pick up more and more of the tab. That means that if the Ryan plan were enacted, there would likely be many seniors who couldn’t afford private premiums and would have no health coverage. This feature of the plan eliminates one of the fundamental pillars of Medicare: that it is an entitlement, meaning that if you qualify, you’re entitled to the benefit. If this year’s costs are higher than we’d like, we can make changes to the program for next year, but nobody goes without coverage. Under the Ryan plan, that would no longer be true.
But here’s an important thing to keep in mind: After Ryan released the first version of his plan in 2011 and caught a whole bunch of flak for basically destroying Medicare, he came back with a revised plan earlier this year that has one critical difference: it allows seniors, if they so choose, to stay on traditional Medicare. Mitt Romney’s Medicare plan does the same thing (Romney’s plan, such as it is, is basically a Cliff Notes version of the Ryan plan). In other words, under political pressure they embraced a public option. But since the plan still caps overall spending at GDP+.05, seniors would likely have to pay more and more out of their own pockets, likely thousands of dollars.
At this point, it’s good to remind ourselves that Medicare does a far better job of controlling costs than private insurance does, partly because of the negotiating power it has and partly because it spends just a fraction of what private companies do on overhead (around 98 percent of Medicare’s costs go to paying for care, while private companies often spend 20 percent or more of their costs on administration, marketing, underwriting, and so on). Yet Republican philosophy tells us that no matter what the facts say, this is just impossible. A government program can’t possibly be cheaper and more efficient (and deliver service that its customers love, by the way) than a private sector alternative. So if we introduce private competition, then costs will of course come down.
But there isn’t much reason to believe they will, which means seniors will be left holding the bag, and most importantly, lose the security they have now. Anyhow, to return to the question we started with: Is it fair for the Obama campaign to charge that Mitt Romney wants to end Medicare as we know it? If you define “Medicare as we know it” as an insurance program that provides affordable, efficient, and most importantly secure health coverage for every American senior, then the answer is clearly yes.
By: Paul Waldman, Contributing Editor, The American Prospect, July 20, 2012
“Unexpanded Medicaid”: Millions Of Women Could Remain Uninsured If States “Opt Out”
It can seem like just a mirage created by the summer heat: only a few weeks ago the Supreme Court actually handed down a decision that progressives could celebrate. It held that the Affordable Care Act is constitutional, including the individual mandate, meaning that implementation can roll on full steam ahead. I was one of the first to celebrate, in particular for all the ways that the law will help women who need healthcare (which is all of us). As Katha Pollitt recently wrote here, women will benefit dramatically from the ACA. The law bars practices like charging women more just for being women, dropping women’s coverage if they become pregnant or sick, and denying coverage due to “pre-existing conditions” like having had breast cancer or being a victim of domestic violence. It adds new benefits like birth control coverage at no cost to the patient, expanded coverage of preventative services like prenatal care, mammograms, pap smears, and bone-density screenings through Medicare, and requiring insurance companies to cover maternity care.
But one aspect of the Supreme Court’s decision could have some very bad results for women: the ruling that states can opt out of the Medicaid expansion. While this could end up harming men and women, women in particular stand to suffer if states refuse to participate in the program.
The Medicaid expansion is a crucial component of the law’s overall goal of extending coverage to over 30 million uninsured Americans by 2019, covering almost half of the total number of people the bill promised to insure. Originally, the law included a provision that the federal government could take away all of a state’s Medicaid funding if it refused to go along with the expansion, which all but ensured participation. But the Court ruled that such a maneuver was unconstitutional. Just a few days after the decision was announced, seven Republican governors said they would flat out reject the money to expand Medicaid rolls, with at least eight more looking to follow suit. More have said no since then.
This could create a no-man’s land for those who earn less than 100 percent of the Federal Poverty Line, making them ineligible for tax subsidies to help them buy insurance, but don’t qualify for their state’s (unexpanded) Medicaid program. These Americans are surely struggling to get by, but not quite enough to get health coverage promised to those above and below them.
And women are likely to fall into this chasm. Remember that unexpanded Medicaid does not cover most childless adults. Currently, a woman must meet both categorical and income criteria to qualify for Medicaid: she must be pregnant, a mother of a child under age 18, a senior citizen, or have a disability, and each category has income criteria, which differ state by state. Given that women are more likely to be pregnant (duh) but also to fall into the other categories, they are already the majority of enrollees in the program. However, given that many women don’t meet categorical criteria, many don’t qualify no matter how poor they are. Over 17 million women lived in poverty last year, compared to 12.6 million men.
By 2016, 13.5 million women were expected to get coverage under the Medicaid expansion. That figure is now in danger. As the Kaiser Family Foundation reported before the Supreme Court decision, “Medicaid will be the foundation of health coverage expansions to very low-income women.” But not if some Republican governors get their way.
Many of the states already rejecting the expansion are home to the greatest number of women who would benefit. Texas and Florida top the list for the most uninsured women in their states: about 2.4 million and 1.5 million, respectively, and both states plan to refuse the expansion. (Some of these women were supposed to get coverage through the Medicaid expansion, but some will still qualify for the subsidies and be able to buy insurance in the state exchanges.)
Using Kaiser’s predictions, I calculate that there are over 4.2 million women who would be eligible for the Medicaid expansion by 2014 in the states either refusing or indicating they will refuse to participate. That’s a huge chunk of the 10 million women that were expected to be covered by that time through Medicaid.
Those are the immediate impacts on low-income, uninsured women. The ruling may have other far-reaching impacts on women’s lives, however. As Jessica Mason Pieklo writes at RH Reality Check, the idea that the federal government can’t withdraw all Medicaid funds from states that don’t follow federal requirements might have other consequences. The first may be states that are trying to prevent Medicaid from contracting with providers that also offer abortions (i.e., in many cases, Planned Parenthood). Such a case is going on in Indiana right now. As Pieklo writes,
Thanks to the majority in NFIB v. Sebelius, conservative states looking to enact state-wide funding bans may have the framing necessary to pin the federal government. That’s because the language of Roberts’ opinion as to the Medicaid expansion is vague enough to argue that the federal government can’t coerce a state into funding Planned Parenthood by threatening to withhold all of that state’s federal Medicaid money, especially, since conservative states argue, they believe cutting Medicaid funds is the only way to guarantee state dollars do not fund abortion services.
Planned Parenthood and its affiliate centers provide services to 3 million people annually, including 4 million tests for sexually transmitted infections, 770,000 Pap tests, and 750,000 breast exams. Banning Medicaid from contracting with Planned Parenthood will hurt the low-income women who need these services—but states may now have a legal leg to stand on if they try to do just that.
Perhaps the worst thing of all? The excuse that Republican governors are using to get out of the Medicaid expansion may not even hold up. They claim to be worried that even though the federal government will pick up the whole tab for the first few years, the portion they’ll have to pay after that (10 percent) is too burdensome on their budgets. Yet there is evidence that expanding Medicaid could actually help their finances. Rejecting the Medicaid expansion may not even make fiscal sense, but no matter what it doesn’t make moral sense. It could leave millions of women exposed, unable to afford health insurance but not able to participate in Medicaid.
By: Bryce Covert, The Nation, July 17, 2012
“Radical And Anti-Thought”: Remember The Party Of Personal Responsibility?
The House Republicans are going to vote today to repeal the ACA, and the message they’re going to be sending to people who have cancer or diabetes or any number of other diseases but don’t have insurance is simple, and forgive my bluntness in this non-family newspaper where such language, I’m given to understand, is occasionally permisslbe. The message is: Fuck off.
Matt Miller put the matter powerfully in his Post column yesterday:
Here’s what you should do, Mr. President. In the debates this fall, pull out a small laminated card you’ve had made as a prop for this purpose. Then remind Mitt Romney that the ranks of the uninsured today are equal to the combined populations of Oklahoma, Connecticut, Iowa, Mississippi, Kansas, Kentucky, Arkansas, Utah, Oregon, Nevada, New Mexico, West Virginia, Nebraska, Idaho, Maine, New Hampshire, Hawaii, Rhode Island, Montana, Delaware, North Dakota, South Dakota, Alaska, Vermont and Wyoming.
Read that list slowly, Mr. President. Then ask your opponent: Would America turn its back on the citizens of these 25 states if everyone there lacked basic health coverage? That’s what we’ve been doing for decades. You knew it was right to act when you were governor of Massachusetts, Mitt. How can you pretend we don’t need to solve this for the nation? And how can you object with a straight face when your own pioneering plan was my model?
Can I get an amen to that? And then he might add something like, “As you said many times yourself, Governor, the point of requiring people to buy insurance is to instill a sense of personal responsibility. No free riders. No trips to the emergency room that the rest of us pay for. Why did you believe in personal responsibility then but are against it now?”
I swear, as I noted yesterday, this is starting to smell to me like an issue the Democrats can win votes on this fall. Believe me, if I thought the opposite, I’d say so. I did think the opposite just a few weeks ago. What changed?
John Roberts, basically. Politically, his signing on to the decision lends a bulletproofness to the Democratic position, changes the whole mentality of the debate. If it had been Kennedy with the liberals, meh. But Roberts’ stamp of approval on the plan allows the Democrats some room to play offense. And that offense is built around one simple claim: Republicans would deny coverage to sick people and let them die.
Sprinkling a little personal responsibility sugar on top can’t hurt. Use their blind extremism against them. Here is a position that was once theirs, that they came up with and that they’ve now abandoned, just because Obama took it up. It’s a great marker of how radical and anti-thought they’ve become, that they’re now willing to let people suffer and die in the hopes that they can defeat a political adversary.
By: Michael Tomasky, The Daily Beast, July 11, 2012
“Insane Economic Policy”: GOP’s Rejection Of Medicaid Funds Is One More Ideologically Driven Bad Idea
My emotions after the Supreme Court’s ruling on the Affordable Care Act last week went through various stages: confusion (thanks, CNN), shock and finally sheer joy. It was a complete surprise to have the highest court uphold the entire law, including the individual mandate. Liberals rightly celebrated the ruling as a historic step toward ensuring a better quality of life for all Americans.
But in the jubilation hangover, some more sober analysis has taken its place. One important aspect of the Court’s decision gives no reason to celebrate: the ruling that the federal government can’t withdraw all Medicaid funds from governors who refuse to expand Medicaid rolls in their states, essentially making it possible for them to opt out. The Medicaid expansion is meant to give coverage to about 17 million Americans by 2019, accounting for almost half of the 32 million people the bill promised to insure. Yet as Sarah Kliff reported, if states opt out of expanding Medicaid, it could leave some of the poorest Americans stuck in a no-man’s land in which they don’t qualify for Medicaid but also don’t qualify for subsidies to buy insurance. Beyond literally being a matter of life or death for many uninsured Americans, it’s also an economic issue: the White House calculated that expanding the number of Americans with insurance would increase economic well-being by about $100 billion a year, or about two-thirds of a percent of GDP.
It seems foolhardy for governors to reject what is basically free money to help more people in their own states gain health insurance. Josh Barro wrote just after the ruling that while the White House’s stick was taken away, its carrot—the federal government’s picking up 100 percent of the states’ Medicaid expansion tab for the early years, gradually declining to 90 percent after that—would be enough to incite states to participate. And they stand to see other economic benefits. States that already provide coverage and care to people living at 133 percent of the poverty line would no longer shoulder those costs, saving them millions. Even for those that don’t offer such coverage, the bill stands to save all states money by getting rid of the “hidden tax” they pay in higher insurance premiums that account for the cost of covering the uninsured, also potentially saving millions.
Yet Republican governors are already contemplating rejecting the money. The Hill reported this week that fifteen governors are either flat-out planning to reject the Medicaid expansion money or are leaning in that direction. Firm nos have come from Florida, Iowa, Kansas, Louisiana, Nebraska, South Carolina and Wisconsin. Eight more are still undecided yet appear to be following suit: Alabama, Georgia, Indiana, Mississippi, Missouri, Nevada, Texas and Virginia. Yet Brian Beutler reports today that these very states have some of the country’s highest uninsured rates and would stand to see the biggest benefits. Florida ties with Nevada and New Mexico in second to last place in the country at 21 percent uninsured, and South Carolina and Louisiana come in with 19 and 17 percent rates, respectively.
An indignant refusal of federal money in these states may sound familiar. Alabama, Louisiana, Mississippi, South Carolina and Texas were among the handful of states to say they would reject federal stimulus money way back in early 2009. The argument was similar back then: as with the Medicaid expansion money, the states were expected to change some policies to protect more of their residents from economic harm. In the case of the stimulus money, they had to expand unemployment benefits to more people. That’s what made GOP governors too cranky to accept the funds. Eventually all fifty accepted federal funds, although some still turned away the money meant to increase those unemployment benefits. Meanwhile, the last holdout, South Carolina, had the nation’s second-highest unemployment rate at the time that it was contemplating rejecting the funds on ideological grounds.
But other federal money was later rejected outright. After President Obama’s 2010 State of the Union, he called for building a high-speed rail network and pledged $8 billion in stimulus money for rail projects in various states. Yet four Republican governors—New Jersey’s Christie, Wisconsin’s Walker, Ohio’s Kasich and Florida’s Scott—refused to take money for the projects. They would have created tens of thousands of jobs in each state—an estimated 16,000 in Ohio, 10,000 in Wisconsin and 10,000 in Florida.
Meanwhile, as research my colleague Mike Konczal and I conducted showed, ultraconservative Republican governors across the country have been enacting policies that hurt their economies, and therefore the entire economy, in other ways. In the midst of a massive jobs crisis, the eleven states that flipped red after the 2010 midterms and Texas accounted for 70 percent of public sector job losses last year, either laying off or pushing these workers out through attrition. The rest of the states lost only an average of .5 percent of their government workforces. Without these massive waves of job losses, our unemployment rate would likely be closer to 7 percent.
What ties all of these conservative state-level actions together? An adherence to ideology over what’s best for the economy—even their own state economies. The belief that government spending should be shrunk at all costs has steamrolled over policies that shouldn’t be about party affiliation. Taking federal money for much-needed updates to our infrastructure that would also create thousands of jobs is clearly the right choice. Throwing government workers out of their jobs at a time of sky-high unemployment is clearly the wrong choice. And now these conservative states are threatening to keep millions of Americans out of health insurance policies because they worry about higher state spending in the long run. This despite the fact that their residents and their budgets stand to see huge benefits now. The Republican Party’s abhorrence of government is driving bad economic decision-making—and that’s hurting all of us.
By: Bryce Covert, The Nation, July 5, 2012
“Bereft Of Discernible Principles”: Our Strange Ideological Divide
When Democrats pursue centrist solutions to problems, Republicans react as though we were all just herded onto collective farms.
If you knew nothing about the Affordable Care Act (ACA), the picture you saw last Thursday of liberals celebrating and conservatives lamenting the end of American liberty would have convinced you that a monumental shift to the left had just taken place. Was the military budget cut by two-thirds or higher education made free for all Americans, you might have asked? At the very least, a universal, public health-insurance program must have been established. But no, the greatest ideological battle in decades was fought over a law that solidifies the position of private health-insurance companies.
That isn’t to ignore that those companies will be subject to greater regulation, outlawing their cruelest abuses of their customers, and millions will be added to the insurance program for the poor. The ACA is a very, very good thing, but after its full implementation we will still have the least socialized health-care system of any advanced country in the world. Yet to hear the ACA’s opponents tell it, the law will twist America into a socialist republic just a couple of short steps from Poland circa 1972. In other words, Democrats managed to pass a useful but rather centrist social reform, and Republicans reacted as though all private property were confiscated and we were herded onto collective farms. It’s enough to make one wonder what might have happened if a real-live liberal were to become president and pursue an agenda that even remotely resembles the caricature Republicans present of Barack Obama’s.
One thing we can be fairly sure of is that the ideology represented by that agenda would play almost no role in its chances for success or failure. Through no fault of his own, Obama has made sure of that. Republicans’ burning hatred of him has set the template for them, one they are likely to use again and again. When he embraced a health-care plan with Republican origins (an individual mandate plus subsidies) or a market-based notion of how to handle climate change (cap and trade), they not only turned away from those ideas but in the process also ran to the right even faster than they had been moving before. At the same time, they went about purging their ranks of anyone who had shown anything less than contempt for the other side. Those moderate (and many not-so-moderate) Republicans purged by Tea Party opponents in primaries will not be coming back.
The result is that in future debates, anything Democrats want to do—almost regardless of its content—will be met with cries of “socialism!” Obama could propose that the entire system of public education be dismantled in favor of private school vouchers, and Republicans would promptly declare the idea to be Marxist social engineering and come out for a system of private education without any taxpayer funds at all. The next Democratic presidential nominee could be Bernie Sanders or Joe Lieberman, and his ideas would be met with precisely the same response.
In many ways, Mitt Romney is the perfect candidate for this version of the GOP, bereft of discernible principles and willing to trot to the right at a moment’s notice. You may have noticed that despite the predictions of many a pundit, Romney did not “move to the center” upon becoming his party’s de facto nominee. There is not a single position he has taken that is at odds with the hard-right persona he established during the primaries—not a single radical nutball he has repudiated, not a single signal he has sent that he will be anything but what the Republican base wants him to be.
And what if Romney loses? The loudest voices in the party will insist that it was only because he was not conservative enough, and the pressure will be on to choose a nominee next time around who genuinely believes all the things Romney pretends to believe (get ready for Santorum ’16). Yet there may be a countervailing force within the party, likely led by Karl Rove, arguing that the GOP’s problem is a demographic one (Rove understands this well). It has increasingly become the party of white men, an evolution accelerated when its presidential primaries feature endless fear-mongering about immigration and slut-shaming of any woman more free-spirited than Queen Victoria. That demographic narrowing could prove disastrous this year. Ruy Teixeira, one of the clearest-eyed observers of electoral and demographic trends, argues that because of the growth in the minority populations that overwhelmingly support Obama, the president could lose white working-class voters by 28 points and white college-educated voters by 19 points and still win. In other words, he could do just as poorly with whites as Democrats did in the 2010 blowout and still be re-elected.
If that happens, will the Republicans try to moderate ideologically? The truth is, they don’t really have to. They were more conservative than ever in 2010 and won a historic electoral victory. Or consider the last Republican president. When he first took control of his party’s nominating contest in 2000, George W. Bush was hailed by innumerable commentators as a “different kind of Republican”—someone who could reach out to all kinds of voters with his “compassionate conservatism.” He was particularly good at convincing Latino voters that he bore them no ill will and lost their votes by a measly 9 points in 2004 (in the latest polls, Romney trails Obama among Latinos by more than 40 points). Yet what was the policy substance of Bush’s presidency? Massive tax cuts for the wealthy, needless wars costing trillions, a gargantuan expansion of the national-security state, a federal judiciary filled with movement conservatives—in other words, an eight-year orgy of conservative wish fulfillment.
Democrats certainly warned from the beginning that there was less compassion than conservatism in Bush’s ideas. But they had nothing like the collective freak-out that Republicans had over Barack Obama, casting his center-left accommodationism as a terrifying program to achieve radical socialist tyranny. They will say the same about the next Democratic president, no matter what his or her true leanings. Their own ideology, on the other hand, will be something that most Americans have only the vaguest sense about, and their policy radicalism will be no bar to winning elections. All it will take is the right economic conditions and some symbolic toning-down of their rhetoric to cover the twisted face of anger, resentment, and outright hate that increasingly defines their soul. They’ve done it before, and there’s no reason they can’t do it again.
By: Paul Waldman, Contributing Editor, The American Prospect, July 3, 2012
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