“Think The Midterms Don’t Matter?”: Tell That To 70,000 Poor, Uninsured People In Maine
The stakes of the 2014 midterm elections, as many have noted, seem awfully low. Yes, control of the Senate is up for grabs, but there’s only so much Republicans will be able to accomplish in the face of the veto and filibuster. As my own colleagues have pointed out, this is an overly sanguine view of the matter. But the tendency to underplay the election is especially misplaced when it comes to races for governor and state legislature. Consider Maine, where a new development in the race for governor may well have just won some 70,000 people health coverage.
Maine’s current governor is Paul LePage, a Republican elected in the 2010 Tea Party wave whose defining legacy—even more than outrageous comments such as telling the NAACP to “kiss my butt,” saying President Obama “hates white people” and comparing the IRS to the Gestapo—will be his profound antipathy to the social safety net that so many people rely on in Maine, New England’s poorest state. As the Wall Street Journal recently summarized, LePage, a former millworker who was the eldest of 18 children in an abusive home and a teenage runaway, “pushed for new laws that required drug testing for certain beneficiaries linked to drug crimes and created stricter income limits on childless workers who collected Medicaid. He also let a food-stamp waiver expire, a move that effectively terminates benefits for able-bodied childless workers after three months. His changes to food stamps, Medicaid and cash-assistance programs helped cut the beneficiary rolls from recent peaks by 11%, 12%, and 56%, respectively.”
And he has vetoed—not once, but thrice—the expansion of Medicaid under the Affordable Care Act, which would cover nearly 70,000 people in the state—that is, more people than live in Portland, the state’s largest city. This explains Maine’s remarkable singularity on the lower of these two eye-catching maps, where it stands out as the only state in New England with large numbers of uninsured.
How did Maine, a state that went for Barack Obama by more than 15 points in 2012, elect such a person as its governor? By a fluke. LePage got only 38 percent of the vote in 2010, but that was enough to win, as Democrats split their votes between Eliot Cutler, a wealthy businessman running as an independent, and Libby Mitchell, the Democratic state Senate president.
And as cringe-inducing as LePage’s tenure has been for a state known for a more sober form of politics, it’s been looking like LePage might just pull a repeat. Cutler is running again this year alongside a different Democrat, Congressman Mike Michaud. Cutler’s drawing less support than he got in 2010, when he far surpassed Mitchell, but he’s been getting more than enough to pose a real problem for Michaud: a Portland Press-Herald poll released over the weekend found LePage getting 45 percent to Michaud’s 35 percent, with Cutler drawing 16 percent. As averse as Maine liberals are to see LePage reelected, many simply have felt more drawn to Cutler than to Michaud, himself a former millworker who is more conservative than Cutler on abortion, gun rights, and other issues. (Michaud came out as gay last year, yet even national gay rights groups have been ambivalent about backing him over Cutler.) After months of LePage’s being declared one of the most endangered governors in the country, his prospects were improbably looking up.
Until Wednesday. At a morning press conference, Cutler sent a cryptic message that, while far short of a resignation from the race, was taken by many as a hint that it was time for his supporters to put beating LePage above all else. “I truly believe in democracy and the ultimate authority of voters to vote for whomever they want for whatever reason and I don’t think any voter, whether a supporter of mine or not, now needs or ever has needed my permission or my blessing to vote for one of my opponents,” Cutler said. “Nevertheless, I want to reiterate what I said six months ago: Anyone who has supported me but who now worries that I cannot win and is thereby compelled by their fears or by their conscience to vote instead for Mr. LePage or Mr. Michaud should do so.”
If this message was a bit too ambiguous for the liking of some Michaud supporters, it was given a whole lot more clarity later in the day. Angus King, the highly popular former governor and now U.S. senator who is an independent but caucuses with the Democrats in Washington, announced that he was switching his endorsement from Cutler to Michaud. “Like Eliot, I too am a realist. After many months considering the issues and getting to know the candidates, it is clear that the voters of Maine are not prepared to elect Eliot in 2014,” King said. “The good news is that we still have a chance to elect a governor who will represent the majority of Maine people: my friend and colleague, Mike Michaud. And today, I’d like to offer him my support….This was not an easy decision, but I think the circumstances require that those of us who have supported Eliot look realistically at the options before us at this critical moment in Maine history.”
This was surely not an easy concession for Cutler (and secondarily King) to make, but they deserve credit for acknowledging, if somewhat belatedly, where things were heading. Politics is about real people, and in the case of Maine, starkly so. Tens of thousands of low-income Maine residents are far more likely to get a lot more economic security as a result of what happened on this one day.
By: Alec MacGillis, The New Republic, October 29, 2014
“Who Knew?”: Obamacare Is Such A Disaster That Even More Insurers Want To Be Part Of It
There are still plenty of days when Obamacare looks bad. Tuesday wasn’t one of them.
The Department of Health and Human Services announced that more insurers were joining the Affordable Care Act’s new marketplaces—you know, the places where people can buy coverage on their own and, depending on their incomes, qualify for subsidies. How many more insurers are participating? Quite a few, it turns out. According to HHS, the net increase is more than 25 percent. That should translate to more options for people buying coverage. The increased competition should also help keep premiums relatively low.
The data is preliminary, based on 44 states for which HHS had information. And of course the sheer number of insurers offering coverage is just one sign of how the law is doing. If you’re actually buying insurance, you don’t simply want choices. You want good choices. You want to know that the insurance will give you access to doctors and hospitals when you need them. You want to know that the coverage pays your bills adequately. And so on.
Still, Obamacare critics hadn’t predicted the markets would evolve this way. On the contrary, they expected that young and healthy people would stay far away from the new marketplaces, because the new coverage would be pricier than what they were paying before. Without enough business, the argument went, insurers would get skittish and withdraw. At best, the marketplaces would all become oligopolies and monopolies, with just a handful of insurers continuing to sell policies. At worst, the whole scheme would fall apart. That quite obviously isn’t happening.
Trouble could still arise. By design, Obamacare includes a series of provisions designed to insulate insurers from major losses in the first three years. I usually describe them as “shock absorbers.” Many other policy wonks refer to them as the three Rs, for reinsurance, risk corridors, and risk adjustment. Two of the three, risk corridors and reinsurance, are temporary measures set to expire in 2016. More knowledgeable critics of the law, like Bob Laszewski and Megan McArdle, have warned that more insurers could abandon the market or at least jack up their premiums once those measures expire.
I can’t tell you with certainty whether they are right or wrong. Always in motion is the future, as a famous prophet once said. But keep in mind that gloomy, even dire, predictions about Obamacare’s marketplaces are nothing new. One of my favorites was an op-ed that ran in the Wall Street Journal at the end of last year. The author was John Cochrane, a professor of finance at the University of Chicago. The headline was “What to Do When Obamacare Unravels”—not “if,” mind you, but “when.”
At the time, with unexpected plan cancellations and the website problems very much on people’s minds, betting against the program working probably seemed like a good idea. Who wants to make that kind of bet now?
By: Jonathan Cohn, The New Republic, September 24, 2014
“Collaborating With The Enemy”: Can Republicans Be Convinced To Help Improve The Affordable Care Act?
When the Affordable Care Act was passed in early 2010, people made lots of predictions about how its implementation would proceed, in both practical and political terms. While the law’s opponents all agreed that it would be a disaster from start to finish, the law’s supporters were slightly less unanimous, if nevertheless optimistic. Most figured that though there would probably be problems here and there, by and large the law would work as it was intended, enabling millions of uninsured Americans to get coverage and providing all of us a level of health security we hadn’t known before.
And that’s what has happened. But there was one other assumption among the supporters that’s worth examining anew, now that most of us agree the law isn’t going to be repealed. Like every large and complex piece of social legislation, it was said, the ACA would have to be tweaked and adjusted over time. For instance, when it was passed in 1935, Social Security excluded agricultural and domestic workers, just coincidentally shutting most African-Americans out of the program. Those workers were added later on, and other changes were made as well, like adding cost of living adjustments to account for inflation. Medicare, too, has undergone changes both large (like adding a prescription drug benefit) and small. So what are the possibilities for adjusting the ACA in the near future? In the current atmosphere—one not just of intense partisanship, but one in which one party has made venomous opposition to this law the very core of its political identity—can we hope to actually fix the things about the law that might need fixing?
The administration has already made some changes to the law using its executive authority. Most notably, it has delayed the employer mandate; as it stands now, the mandate won’t fully take effect until 2016. As it happens, few people are particularly enthused with the employer mandate in its current form; conservatives have never liked it, and more than a few liberals have their doubts about it. As Mike Konczal recently explained, there’s an alternative:
The employer mandate has been another major roadblock for the ACA. The current “Obamacare” plan requires employers with more than 50 full-time workers to pay a part of the health care costs for employees who work more than 30 hours a week, or pay a fine. This is unpopular with employers, and it fuels larger worries that workers are getting their hours capped or that expanding businesses are hitting a major road bump the moment they reach 50 employees.
As the Roosevelt Institute’s Richard Kirsch writes, the way the final House bill tackled this issue was much smarter: Under the House plan, employers that didn’t provide health care to their employees would pay a percentage of payroll as a tax to cover health care. Consequently, there would be no incentive to juke the number of new hires or their hours. Also, current health insurance premiums don’t vary according to an employee’s income, which discourages employers from hiring lower-wage workers. Charging a percentage of payroll for coverage would help companies cover the costs even as the system moves towards the exchanges.
If you were a Republican who cared about this issue, this would be a perfect opportunity to change the law in a way you’d like. It wouldn’t be giving up something to get half a loaf, it’d be giving up nothing to get half a loaf. Democrats and Republicans could agree to change the mandate, whether it’s to more closely resemble the original House version of the bill, or something else. I’m sure that creative legislators could come up with any number of ways to produce the maximum number of people with employer-sponsored coverage—or even, now that the exchanges seem to be working quite well, devise a new way for employees to use them without employers just getting off the hook for providing coverage.
But we all understand the present reality, which is that no Republican is willing to work with Democrats to improve the ACA, even in ways that address particular complaints conservatives have about the law, because that’s considered collaboration with the enemy and would guarantee you the wrath of the Tea Party and a primary challenge from the right. Within the GOP, changing the law for the better is actually thought to be a terrible sin, while making futile gestures in opposition to the law while tacitly accepting its existence in its current form is thought to be the height of ideological integrity.
It’s possible that over time, as the repeal fantasy looks more and more ridiculous, Republicans will begin to grow more open to legislation making changes to the ACA to improve its operation. That’s what logic would dictate, but anything other than fist-shaking opposition to the ACA may remain politically toxic for a long time in the GOP.
But maybe there’s something Democrats can do to affect that conversation. It’s easy for them to just say:
“If Republicans really cared about improving people’s lives they’d join with us to make improvements, but instead they’d rather just have talking points.” It’s even true. But that doesn’t get you anywhere. So perhaps Democrats could try getting more specific. They could come up with whatever they think is the best way to deal with a weakness in the law, like the current form of the employer mandate. Turn that into a bill. Start moving it through the legislative process in the Senate. Force Republicans to answer specific questions about it, like: “Congressman, you’ve criticized the current employer mandate. Tell me why you think this new proposal isn’t an improvement.”
I’m not naïve enough to think that all Republican opposition to improving the ACA is going to melt before the power of those questions. But it only helps Republicans if they can stay vague in their discussions of the law. The more specific the discussion gets, the harder it is for them. And at least you could introduce the idea of Republicans joining with Democrats to improve the law, which is something barely anyone has brought up until now.
By: Paul Waldman, Contributing Editor, The American Prospect, September 8, 2014
“The Medicare Miracle”: Everything The Usual Suspects Have Been Saying About Fiscal Responsibility Is Wrong
So, what do you think about those Medicare numbers? What, you haven’t heard about them? Well, they haven’t been front-page news. But something remarkable has been happening on the health-spending front, and it should (but probably won’t) transform a lot of our political debate.
The story so far: We’ve all seen projections of giant federal deficits over the next few decades, and there’s a whole industry devoted to issuing dire warnings about the budget and demanding cuts in Socialsecuritymedicareandmedicaid. Policy wonks have long known, however, that there’s no such program, and that health care, rather than retirement, was driving those scary projections. Why? Because, historically, health spending has grown much faster than G.D.P., and it was assumed that this trend would continue.
But a funny thing has happened: Health spending has slowed sharply, and it’s already well below projections made just a few years ago. The falloff has been especially pronounced in Medicare, which is spending $1,000 less per beneficiary than the Congressional Budget Office projected just four years ago.
This is a really big deal, in at least three ways.
First, our supposed fiscal crisis has been postponed, perhaps indefinitely. The federal government is still running deficits, but they’re way down. True, the red ink is still likely to swell again in a few years, if only because more baby boomers will retire and start collecting benefits; but, these days, projections of federal debt as a percentage of G.D.P. show it creeping up rather than soaring. We’ll probably have to raise more revenue eventually, but the long-term fiscal gap now looks much more manageable than the deficit scolds would have you believe.
Second, the slowdown in Medicare helps refute one common explanation of the health-cost slowdown: that it’s mainly the product of a depressed economy, and that spending will surge again once the economy recovers. That could explain low private spending, but Medicare is a government program, and shouldn’t be affected by the recession. In other words, the good news on health costs is for real.
But what accounts for this good news? The third big implication of the Medicare cost miracle is that everything the usual suspects have been saying about fiscal responsibility is wrong.
For years, pundits have accused President Obama of failing to take on entitlement spending. These accusations always involved magical thinking on the politics, assuming that Mr. Obama could somehow get Republicans to negotiate in good faith if only he really wanted to. But they also implicitly dismissed as worthless all the cost-control measures included in the Affordable Care Act. Inside the Beltway, cost control apparently isn’t considered real unless it involves slashing benefits. One pundit went so far as to say, after the Obama administration rejected proposals to raise the eligibility age for Medicare, “America gets the shaft.”
It turns out, however, that raising the Medicare age would hardly save any money. Meanwhile, Medicare is spending much less than expected, and those Obamacare cost-saving measures are at least part of the story. The conventional wisdom on what is and isn’t serious is completely wrong.
While we’re on the subject of health costs, there are two other stories you should know about.
One involves the supposed savings from running Medicare through for-profit insurance companies. That’s the way the drug benefit works, and conservatives love to point out that this benefit has ended up costing much less than projected, which they claim proves that privatization is the way to go. But the budget office has a new report on this issue, and it finds that privatization had nothing to do with it. Instead, Medicare Part D is costing less than expected partly because enrollment has been low and partly because an absence of new blockbuster drugs has led to an overall slowdown in pharmaceutical spending.
The other involves the “sticker shock” that opponents of health reform have been predicting for years. Bulletin: It’s still not happening. Over all, health insurance premiums seem likely to rise only modestly next year, and they are on track to be flat or even falling in several states, including Connecticut and Arkansas.
What’s the moral here? For years, pundits and politicians have insisted that guaranteed health care is an impossible dream, even though every other advanced country has it. Covering the uninsured was supposed to be unaffordable; Medicare as we know it was supposed to be unsustainable. But it turns out that incremental steps to improve incentives and reduce costs can achieve a lot, and covering the uninsured isn’t hard at all.
When it comes to ensuring that Americans have access to health care, the message of the data is simple: Yes, we can.
By: Paul Krugman, Op-Ed Columnist, The New York Times, August 31, 2014
“Another Republican Gives Up Obamacare Fight”: Unfortunately For Corbett, It’s Probably Too Late To Save His Re-Election Campaign
Governor Tom Corbett of Pennsylvania is the latest Republican to retreat from the Obamacare wars.
On Thursday, the federal government approved Governor Corbett’s plan to expand Medicaid in the Keystone State, making it the 27th state in the nation to adopt the controversial provision of the Affordable Care Act. Corbett had initially opposed expanding Medicaid at all, but earlier this year he bowed to mounting political pressure by offering a plan that would expand Medicaid with a number of Republican-friendly conditions, such as a work requirement and the authority to charge premiums for recipients living below the poverty line. Those did not make it into the final deal.
The agreement should be a boon to Pennsylvania’s working poor; at least 500,000 Medicaid-eligible Pennsylvanians will now be able to sign up for coverage starting on January 1. It will also save the state $4.5 billion over the next eight years, according to Corbett (independent studies have pegged the savings to be even higher)
Corbett clearly hopes that the news will provide a political boost as well. The governor’s announcement of the agreement, which calls it “historic,” “innovative,” and “truly a Pennsylvania solution,” is just about the nicest thing that any elected Republican has ever said about the Affordable Care Act. Meanwhile, Medicaid expansion is wildly popular in Pennsylvania. And as of last week, the Republican governors on the ballot in 2014 who have adopted Medicaid expansion were polling an average of 8.5 percent better than those who hadn’t. It’s not hard to understand what prompted Corbett’s change of heart.
Unfortunately for Corbett, it’s probably too late to save his re-election campaign; the terminally gaffe-prone governor trails his Democratic challenger Tom Wolf by 16.6 percent according to the RealClearPolitics polling average. But plenty of other Republicans have also realized that it makes sense to buck the party line on Medicaid expansion. As The Washington Post’s Greg Sargent has documented, GOP senate candidates such as Scott Brown in New Hampshire, Tom Cotton in Arkansas, Joni Ernst in Iowa, Terri Lynn Land in Michigan, and Thom Tillis in North Carolina have tied themselves in knots trying to explain how they would repeal the Affordable Care Act without getting rid of any of the popular parts.
It’s almost as if voters would rather expand health care coverage than burn billions of dollars to thumb their noses at the White House.
Of course, this wasn’t supposed to happen. For over a year, Republicans have been promising that Obamacare would be the anchor that sinks every Democrat on the ballot and sparks a GOP wave in November. Instead, many Republicans are now either embracing sections of the law, or just ignoring it altogether. It appears that we can add this blown prediction to long list of Obamacare disasters that stubbornly refused to materialize.
By: Henry Decker, The National Memo, August 29, 2014
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