“Mythical Republican Reform”: Will Romney Pretend to Have a Health Plan?
The health-care ruling has exposed a delicate dance within the Republican Party. Romney does not want to run on the health-care issue. To the extent that he wants to invoke the issue, it’s to flay Obama for having focused on it as a distraction from the economy, not as an ideological crusade against Big Government. But conservative activists want to be sure that, if Romney wins, he will commit his political capital to repealing the Affordable Care Act. Thus their current focus on demanding that Romney pledge to repeal the law (see Avik Roy, Keith Hennessey, Rich Lowry, and David Brooks, among many others).
The interesting thing about these conservatives’ arguments is that they are all committed, to varying degrees, to upholding the pretense that the Republican Party really wants to impose a more technocratically sound version of health-care reform. To be sure, they insist they are advocating a vastly different philosophical vision centered around self-empowerment and free markets and other wonderful things. But all of them say, or imply, that they share the basic goals of the Affordable Care Act, which is to make coverage available to all Americans and to control cost inflation. So, for instance, Lowry argues, “The two central selling points of the law — insuring millions more people and keeping people with pre-existing conditions from getting locked out of insurance — can be addressed with policies that are cheaper and less disruptive (a tax credit for purchase of insurance and high-risk pools, respectively).”
I see two problems with this hopeful scenario, both fatal.
The first is that the mythical Republican reform plan is really hard to pass. Conservatives may think they have a cheaper way to fix the system, but it still costs money. And Republicans have never appropriated any money to cover the uninsured. Indeed, all their plans divert money that already exists to cover people who need health care for other purposes. Conservatives hopefully propose turning the health-care tax deduction into a more progressive tax credit. Great idea! Except the plans put forward by Romney and Paul Ryan plow the savings from eliminating that tax deduction back into lower tax rates. And it leaves no budgetary provision for high-risk pools or any other mechanism to subsidize coverage for the poor and sick.
Now, you could suppose that maybe this is all one giant oversight. Republicans failed to craft an alternative plan during the health-care debate, then voted to just straight repeal Obamacare with no replacement, then voted for a budget that just straight repeals Obamacare with no replacement, but when they have power, then they’ll really come up with a plan.
But where is the evidence that they have any desire to do so? Sunday, the two most powerful Republicans in Congress appeared on interview shows and were asked what they plan to do for the uninsured. Mitch McConnell hilariously danced and weaved, admitting that covering the uninsured is “not the issue”: http://youtu.be/QvZvNSKrOZ4
Paul Ryan, as he is apt to do, offered a much smoother take, couching his position in philosophical abstractions:
What — what Mrs. Kennedy and others were saying is this is new government-granted right. We disagree with the notion that our rights come from government, that the government can now grant us and define our rights.
Those are ours. Those come from nature and God, according to the Declaration of Independence, a huge difference in philosophy.
What this blather actually means is that he does not accept that the government has an obligation to ensure that all Americans have access to health care.
If Republicans really wanted to replace Obamacare with some more “market-friendly” alternative, then there’s a simple way they could go about it. They could promise to repeal the law only if they packaged the repeal with a replacement that did not increase the number of uninsured. But they’ll never do that, because the magic, cheaper free-market alternative does not exist, and the GOP has no interest in diverting resources to cover the poor and sick.
Hennessey, who lays out the most specific vision for repealing Obamacare, asserts, “Repeal and replacement should be separate legislative efforts.” This means, of course, that the actual plan is first to get rid of Obamacare, then pretend to work on a replacement before eventually discovering that it’s expensive and unpopular. Oh well. The only interesting question here on any level is why so many conservatives feel bound to pretend that the Republicans really are going to formulate some other plan to care for the poor and sick.
By: Jonathan Chait, Daily Intel, July 4, 2012
“Call It A Penalty, Call It A Fine, Don’t Call It A Tax”: Debunking The Individual Mandate “Tax”
Having lost their Supreme Court fight against the Affordable Care Act, opponents of health care reform have in recent days been attacking the individual mandate provision of the law as a “tax” on the middle class. This line of reasoning only makes sense if you think penalties for littering, speeding, or engaging in other irresponsible behavior are also “taxes.”
Yes, it’s true that conservative Chief Justice John Roberts used a tax rationale when upholding the constitutionality of the individual mandate—and the entire law—last week. But Roberts was making a technical argument and using the word “tax” in a way that really only makes sense in an arcane legal context.
First, some background: The health care law’s so-called “individual mandate” provision requires people who can afford to buy health insurance to do so, and when it’s phased in, it will assess a penalty of up to 2.5 percent of household income on those who don’t. That’s only fair, since the health care costs of the uninsured are borne by the rest of us.
You don’t need a law degree to understand the difference between a fine and a tax, and this one falls pretty neatly into the former category, as we explain below. Moreover, the vast majority of Americans—rich, poor, or middle class—will never be assessed what’s more rightly understood as the “freeloader penalty” at the center of this debate.
Still, while the tax-themed attack on the individual mandate is incoherent, it remains dangerous. Opponents of health reform well understand the power of the T-word to fire popular resentment, and will try to confuse the public about what the individual mandate is and how it works. Here are some facts to keep in mind.
Unlike taxes, this penalty is avoidable
Taxes are, for the most part, involuntary. We pay taxes on our income and when we buy things. The only way to avoid taxes is to earn less money and consume less. Penalties and fines, however, are quite different. We can avoid fines by avoiding bad behavior.
The individual mandate presents people with a choice: Either have health insurance or pay an annual penalty. The only people who will pay this penalty are those who willfully neglect to take responsibility for getting health insurance—and then stick the rest of us with the bill when they get sick or injured.
People who have health insurance will never pay the penalty
More than 80 percent of Americans today have health insurance, and the health reform law will dramatically expand coverage. When the law is fully phased in, only 6 percent of Americans will face the choice of either buying private insurance they can afford or paying a penalty, according to the Urban Institute. And only 1.2 percent of Americans will actually pay the penalty, according to congressional estimates.
Americans who can’t afford insurance will have it provided for them
Under the law, people who can’t afford to buy insurance will receive Medicaid coverage or the government will split with them the cost of buying private health insurance. Therefore, the penalty will only apply to people who can afford health insurance but would rather have taxpayers—you and me—bail them out when they need medical attention.
The individual mandate is grounded in conservative principles of individual responsibility
The idea that people should be required to purchase health insurance if they can afford to do so was first popularized by the conservative Heritage Foundation in 1989 and first implemented in law by former Massachusetts Gov. Mitt Romney—a Republican. The idea then and today is to promote individual responsibility and to prevent self-sufficient people from relying on public assistance. “[E]ach household has the obligation, to the extent it is able, to avoid placing demands on society by protecting itself,” Heritage wrote in defense of the individual mandate.
Happily, the evidence suggests that the individual mandate penalty will apply nationwide to a small fraction of the population. Less than 1 percent of residents of Massachusetts, the only state with an individual mandate in place, were assessed the penalty in 2009.
Once the federal law takes full effect in 2014 and Americans see that the individual mandate penalty only applies to a small number of freeloaders, the antitax argument should lose all power.
It already appears to be waning in some very telling quarters. An advisor to Romney on Monday said that the presumptive GOP presidential nominee agrees with President Barack Obama that the individual mandate penalty is not a tax.
By: Gadi Dechter, Center for American Progress, July 3, 2012
“Failures Of Spin”: Republicans Really Don’t Give A Crap About The Uninsured
Republican Senate leader Mitch McConnell is ordinarily a spinner of unusual skill. He’s relentlessly focused on his message and doesn’t let any interviewer frame a question in a way he (McConnell) doesn’t like. Which is why it was a little odd to see Fox News’ Chris Wallace catch him without a handy talking point when it came to covering the uninsured. This excerpt is a little long, but you have to see the whole thing:
WALLACE: All right, let’s move on. If voters elect a Republican president and a Republican Senate, your top priority will be, you say, to repeal and replace “Obama-care.” And I want to drill down into that with you. One of the keys to “Obama-care” is that it will extend insurance access to 30 million people who are now uninsured. In your replacement, how would you provide universal coverage?
MCCONNELL: Well, first, let me say the single the best thing we could do for the American health care system is to get rid of “Obama- care,” get rid of that half a trillion dollars in Medicare cuts, get rid of the half a trillion dollars in taxes. In other words, the single biggest step we could take in the direction of improving American health care is to get rid of this monstrosity.
WALLACE: But if I may, sir, you’ve talked about repeal and replace. How would you provide universal coverage?
MCCONNELL: I will get to it in a minute. The first step we need to take is to get rid of what is there, this job-killing proposal that has all of these cuts to existing health care providers. Secondly, we need to go step by step to replace it with more modest reforms. There will not be a 2,700-page Republican alternative. We will not take a meat axe to the American health care system. We will pull out a scalpel and go step by step and make the kinds of more modest changes that would deal with the principal issue which is cost. Things like interstate sales of health insurance. Right now you don’t have competition around the country in the selling of health insurance. That is a mistake. Things like lawsuit reform. Billions and billions of dollars are lost every year by hospitals and doctors in defensive medicine. Those kinds of steps…
WALLACE: But respectfully sir, because we are going to run out of time and I just want to ask, what specifically are you going to do to provide universal coverage to the 30 million people who are uninsured?
MCCONNELL: That is not the issue. The question is, how can you go step by step to improve the American health care system? It is already the finest health care system in the world.
(CROSSTALK)
WALLACE: But you don’t think the 30 million…
MCCONNELL: What our friends on the other…
(CROSSTALK)
WALLACE: You don’t think the 30 million people that were uninsured is an issue?
MCCONNELL: Let me tell you what we are not going to do. We are not going to turn the American health care system into a Western European system. That is exactly what is at the heart of “Obama- care.” They want to have the federal government take over all of American health care.
And there you have it. Obviously, McConnell can’t come out and speak the truth, which is that while there are a few changes Republicans would like to see on health care, not only isn’t it an issue they care very much about, they really don’t give a crap about people who don’t have insurance. Never have, and probably never will. First of all, those just aren’t their people, and second of all, actually helping the uninsured requires things they don’t like, such as expanding Medicaid.
But that doesn’t mean there’s nothing they can say. McConnell ought to know that when asked questions like this, Republicans are supposed to say, “The way you expand coverage to everyone is to increase competition and unleash the free market, not through big government blah blah blah.” That way it looks like you’ve actually responded to the question, even though you haven’t actually said anything. The great thing about conservative talking points is that they can be used almost anywhere, no matter how empty they are. McConnell is seriously off his game.
I stand by my prediction that Republicans are going to stop talking about health care within a few days. They just don’t feel comfortable with the topic.
By: Paul Waldman, Contributing Editor, The American Prospect, July 2, 2012
“The Wingnut Line”: Rick Scott Announces Florida Won’t Take Medicaid Money
It’s not shocking that Rick Scott becomes the first governor to announce officially that his state (Florida) won’t accept the new Medicaid money under the health-care law. In case you’re not up on the deets, it’s the subsidies for poor and working-class people, up to 133 percent above the poverty line, to buy insurance.
Funny. I seem to remember a time when Scott was quite eager to take Medi-CARE money! That wasn’t his. You remember what I’m talking about.
So this is what social programs mean to Scott. As a private-sector businessman, something to steal from. As a public “servant,” something to play political games with. Floridians will die so that he can be first in the wingnut line.
I don’t know the precise number, but in a state that size, surely a couple million people/families who’ll be eligible for care under the new law in 2014–families of four up to $88,000 are eligible for the subsidies–will be denied the chance to buy coverage at subsidized rates because Scott has refused this money. From a policy perspective, this is the next battleground, the pressure point of resistance for the hard-shell ideologues. How many states will really sacrifice billions in federal dollars for the sake of ideology, and how many will do it before the election so they get a gold star from Rove?
Those interested in what we used to call facts may want to read through this nice primer from the Center on Budget and Policy Priorities, which describes the Medicaid transfer from the feds to the states and explains how the federal government will actually be picking up 93 percent of the costs over the next nine years.
As to biggest health-care news of the weekend, the John Roberts switch reported by CBS yesterday, I will have much more to say about that story tomorrow. But watch these Republican governors. If not for the poor people in their states, I say fine, let them refuse it. Saves me money since I live in Maryland and they’re mostly moocher states anyway. It’s just a few more of my tax spare change not going to Mississippi. All right by me.
By: Michael Tomasky, The Daily Beast, July 2, 2012
“Completely Disingenous”: Can Romney Remain Absurd Until November?
If you will forgive yet another post on the implications of the Supreme Court’s ACA decision, it is important to understand that for all the “excitement” and “motivation” it may create among “base voters,” this development also makes every day on the campaign trail a tightrope for Mitt Romney. He was already going to have to navigate his way to November talking constantly about the economy and the federal budget even as he was stuck with economic and budget policies that would horrify swing voters if they were aware of them. And now there will be no escape from the subject of a national health reform initiative modeled on his own plan in a gubernatorial administration that now seems about a million years away from where he has landed ideologically in order to win his party’s presidential nomination.
National Journal‘s Michael Hirsh refers to Romney’s current positioning on health care as presenting an “Absurd Romney:”
The difficulty of Absurd Romney’s task is pointed up by Jonathan Gruber, an MIT economist who helped Romney design his 2006 health insurance program in Massachusetts. He says that the then-governor used reasoning and language very similar to that of Chief Justice John Roberts in arguing for the necessity of an individual mandate. While Roberts said that Congress did not have the right to mandate behavior, it did retain the right to “tax and spend,” including penalizing people for not buying health care.
“It’s a penalty for free riding on the system. That’s the way Gov. Romney talked about it,” says Gruber, who later became one of the key architects of President Obama’s Affordable Care Act, which was modeled in part on the Romney law. “Justice Roberts used similar language today.” Back in the 2000s, when Gruber demonstrated to Romney with computer models that, absent an individual mandate, one-third of Massachusetts’ poorest and sickest would remain uninsured (and drive up costs for everyone), Romney jumped on the point, instantly converted, says Gruber. Romney went at the problem “like a management consultant or an engineer” with no ideological taint, even against the advice of his conservative political advisers, Gruber says. “They were concerned about the politics of universal health care. He argued them down.”
Today, says Gruber, Romney is being “completely disingenuous” in arguing against a law whose principles he once embraced. And somewhat absurd. Gruber says Romney’s suggestion that, as in Massachusetts when he was governor, states should be permitted to decide on their health care plans is also disingenuous. Massachusetts could devise its health care law only because it had access to a large amount of federal money, a $385 million Medicaid grant that it needed to use to extend care to the poor. “He says the states could do it but not the federal government. Well, actually the states can’t do it” because they don’t have the money, says Gruber. “What he should be saying is that he ‘ll give the states a trillion dollars to come up with their own plans, but he’s not going to do that.”
Now some readers will say Romney and most of his supporters don’t give a damn about consistency, logic, or avoiding the appearance of being Absurd, and will just brazen it out. That may be true. But the thing about lying all the time about who you are, what you’ve done, and what you intend to do is that it frequently causes even the most disciplined dissembler to screw up or at least fail to make sense to voters with even minimal discernment. That’s the risk Romney is going to have to take nearly every time he opens his mouth over the next four months.
By: Ed Kilgore, Washington Monthly Political Animal, June 29, 2012
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