“Anybody try to sign up for the Obamacare? It’s impossible, and everybody’s furious. The Republicans are upset about Obamacare because something they tried to stop now won’t get started.” –David Letterman
“Anybody try to sign up for the Obamacare? It’s impossible, and everybody’s furious. The Republicans are upset about Obamacare because something they tried to stop now won’t get started.” –David Letterman
Republicans have been doing everything possible to avoid real discussion of health care reform. They are sometimes aided by journalists who do not understand the complexity of health care policy, and who want to report a scandal when none exists. Recent misleading media reports on people being “booted” from their health care plan is encouraging Republicans to make a lot of nonsense noise leading Greg Sargent to conclude, correctly, that normal debate about Obamacare is impossible. He wrote, “the GOP outrage about Americans supposedly “losing” coverage is largely just more of the same old misdirection. It’s a subset of a larger Republican refusal to have an actual debate about the law’s tradeoffs — one in which the law’s benefits for millions of Americans are also reckoned with in a serious way.”
The question of whether people can keep their current insurance is comparable to the faux controversy I recently discussed over whether people can keep the same doctor they now have. The real point in these arguments is over whether people who are happy with their coverage will continue to have the same type of insurance care and medical coverage (with added protections they do not have now). Conservative groups have been spreading all sorts of misinformation to make people think that there would be a drastic change under Obamacare. I’ve had heard from numerous Medicare patients who believed that Obama was ending Medicare. (No, it is the Republican plan which would wind up doing that). One patient emailed me recently asking if she had to give up her Medicare and sign up for Obamacare, upset that she would have to give up having me as her physician. Many with private insurance also believed that they would lose that coverage and be forced into a government run health system. None of these scare stories are true.
It is with this backdrop that reassuring people that they can keep their current type of insurance and continue to see their current doctor has been important. This does not mean everyone will have exactly the same insurance plan and that nobody would every wind up changing doctors. It is a fact of life in the old system that a variety of factors would cause insurance plans to change, and people could wind up having to change doctors. Only seventeen percent of purchasers on the individual market typically purchase the same plan for two or more years. Short of total government control of all medical practices, which nobody wants, it is impossible for the government to guarantee that nothing will change. What is different is that people will no longer lose their insurance, or access to their doctor, because of issues such as insurance companies dropping them when they get sick or not being able to afford insurance if their financial situation changes.
As many others have, I recently received a letter from my insurance carrier that my current policy will not be available as it does not meet the requirements under the Affordable Care Act. The insurance company had the option of grandfathering subscribers and continuing the old plan versus offering another policy from the same company. When I went to check on line I found that they were also offering several other plans. I never had this choice before. There are also more choices from other companies. I purchased my current plan when my previous plan decided to get out of the individual market in the area by raising their rates to levels which were exorbitant even by the standard of health insurance costs. At the time there were no options available which included routine office calls and prescription drugs. Coverage of both are now required, which is why my current plan is no longer offered. Instead I will wind up with another policy from the same company which covers more at a modestly higher price.
I am probably one of the biggest losers in this situation, but I’m not complaining. I will have to pay more for insurance, but not an outrageous amount. I do not qualify for subsidies, and I do not have significant medical costs, so I will wind up a bit behind. Many others will benefit from the added coverage while paying far less than current premiums thanks to the subsidies. Other people will also wind up saving more money due to the increased coverage, making up for the increased premiums.
My new coverage won’t cost that much more. Some people will probably see a bigger jump in premiums, until the subsidies are taken into consideration. Some insurance plans cover so little they should barely even be considered insurance. Via Steve Benen, Erik Wemple presented a misleading example from Fox from someone complaining about having to change to a more expensive policy. More information gave a different picture than what was presented on Fox.
More coverage may provide a deeper understanding of the ins and outs of Barrette’s situation: Her current health insurance plan, she says, doesn’t cover “extended hospital stays; it’s not designed for that,” says Barrette. Well, does it cover any hospitalization? “Outpatient only,” responds Barrette. Nor does it cover ambulance service and some prenatal care. On the other hand, says Barrette, it does cover “most of my generic drugs that I need” and there’s a $50 co-pay for doctors’ appointments. “It’s all I could afford right now,” says Barrette.
In sum, it’s a pray-that-you-don’t-really-get-sick “plan.” When asked if she ever required hospitalization, Barrette says she did. It happened when she was employed by Raytheon, which provided “excellent benefits.” Ever since she left the company and started working as an independent contractor, “I haven’t been hospitalized since then, thank God.” Hospitalization is among the core requirements for health-care plans under Obamacare.
Maybe at present this is all she can afford, but she will be able to afford more due to the subsidies under the Affordable Care Act, and will really save a lot of money if she winds up in the hospital again. As bad as this policy sounds, I have seen people with even worse.
While it might come as a shock to some reporters and Republicans that some people will have to change plans due to meet the current core requirements, this was never a secret. There is nothing misleading about this. Think Progress has cited several sources which discussed this during the initial health care debate. It is only a surprise to those who failed to understand the law, or those who want to make misleading attacks.
As for the Republicans, the problem is that they were intentionally absent from the debate, deciding to vote against any health care reform and refusing to take part in framing any form of bipartisan plan. It is a valid argument that perhaps people should be able to purchase more limited plans. I, and many Republican voters, are capable of paying for out-patient services not covered by our insurance and perhaps we should be able to purchase less expensive plans. (Of course there is also the option of the bronze plans for those who do want to reduce insurance premiums and can afford to take on more risk, and people under thirty can purchase inexpensive catastrophic plans). If Republicans felt more choices should have been available, they should have brought it up during the health care debate. Republicans could have exacted plenty of compromises in return for passing a plan with greater bipartisan support. As Republicans failed to participate in the process, it is hard to take their complaints seriously now.
Update: I initially left out the fact that insurance companies could grandfather subscribers who had old plans and were not forced under the Affordable Care Act to have people change plans. Initially I left this out to keep the discussion simpler, not thinking it was important that this option existed if insurance companies chose not to offer to continue the old plan. As discussion of this issue is increasingly turning into the accuracy of old statements versus whether insurance companies are at fault. More in this post.
It is much less likely that raising the Medicare eligibility age from 65 will be on the table now that the CBO has dramatically decreased their projection as to how much money would be saved. The CBO estimates that raising the Medicare age gradually from 65 to 67 would save just $19 billion over 10 years. In 2012, the CBO had estimated that this would save $113 billion in the first 10 years. The change in the projection is because people in this age range cost Medicare less than older beneficiaries and because more 65 and 66 year old individuals will be eligible for employer-sponsored insurance for their primary coverage, costing Medicare less as a secondary policy.
It is also possible that delaying Medicare coverage could wind up costing more money for some individuals should there be people who fall through the cracks in the Affordable Care Act and do not receive other coverage. Delaying treatment of chronic medical problems which are common at this age could lead to shifting cost of treatment until a later age, and possibly costing more as untreated problems have become more severe.
Conservatives just can’t catch a break in polls since the shutdown. One might expect that at very least the numbers supporting Obamacare might have dropped considering how terrible the initial opening of the exchanges has gone. No, instead approval has increased in several recent polls, including Gallup.
Despite the highly publicized technical issues that have plagued the government’s health insurance exchange website that went live on Oct. 1, Americans’ views of the Affordable Care Act are slightly more positive now than they were in August. Forty-five percent now approve of the law, while 50% disapprove, for a net approval score of -5. In June and August, net approval was slightly lower, at -8.
Keep in mind that any poll regarding approval of the Affordable Care Act can falsely show decreased support because many of those who oppose the law do so because they believe it should do more, or want a single payer plan. There is also considerable misunderstanding of the law, with many people supporting the components of Obamacare when polled while also saying they oppose Obamacare when asked separately.
There are a couple of reasons why support might be going upwards despite the computer problems. This could be part of the overall backlash against Republicans and everything they stand for seen in recent polls. I wonder if coverage of what the exchanges are intended to do is leading to more support for the Affordable Care Act, which is more meaningful than probable temporary computer glitches. The administration has had excellent success with computers when used to revolutionize politics. I think that at times they are also overly optimistic about what computers can do, from handling the complexity of the insurance exchanges to their views on electronic medical records. We have lived with computers long enough to know that glitches are common with a new product, but this does not mean that we don’t adopt the new technology over time. Plus, in this situation, the use of computer exchanges to purchase health coverage says nothing about the quality and affordability of care once insurance coverage is purchased. The most important outcome so far is that insurance costs do appear to be lower than expected due to the exchanges.
We also must keep in mind that the Affordable Care Act is far from perfect, and the final law is not exactly what most people wanted. The question is not whether Obamacare is perfect, but whether it is a major improvement over what was in place in the past. Greg Sargent also reminds us that Obamacare passes another important comparison despite the initial problems: “We can keep two ideas in our heads at the same time. The first: Obamacare’s rollout is awful and demands accountability. The second: GOP criticism of the rollout is deeply incoherent and indicative of a larger refusal — one that has gone on for years — to participate seriously in the basic governing necessary to solve this pressing national problem.”
Most conservatives cannot keep these two ideas in their head (and few can even manage one). They see the problems with the roll out as indicative of problems in the overall concept. Others such as Ross Douthat realize that the failure of the conservative aspects of the plan could lead to an even more liberal alternative. Mike Konczal has argued that the exchange problems stem from more conservative or neoliberal ideas included in the Affordable Care Act (which was essentially the conservative Heritage Foundation’s alternative to Hillarycare). He looked at the politics and argued that a true government-run plan “while conceptually more work for the government, can eliminate a lot of unnecessary administrative problems.”
Some of the more cartoony conservatives argue that this is a failure of liberalism because it is a failure of government planning, evidently confusing the concept of economic “central planning” with “the government makes a plan to do something.”
However, the smarter conservatives who are thinking several moves ahead (e.g. Ross Douthat) understand that this failed rollout is a significant problem for conservatives. Because if all the problems are driven by means-testing, state-level decisions and privatization of social insurance, the fact that the core conservative plan for social insurance is focused like a laser beam on means-testing, block-granting and privatization is a rather large problem. As Ezra Klein notes, “Paul Ryan’s health-care plan — and his Medicare plan — would also require the government to run online insurance marketplaces.” Additionally, the Medicaid expansion is working well where it is being implemented, and the ACA is perhaps even bending the cost curve of Medicare, the two paths forward that conservatives don’t want to take.
The old status quo in which insurance companies profited by finding ways to deny coverage to those with expensive medical problems and affordable insurance was becoming increasingly difficult to obtain was not a viable option. The choices were either continuation of private insurance with increased government involvement, as with the Affordable Care Act, or a single-payer plan. Conservatives should be happy about the outcome if they are willing to back away from the extremism of opposing everything which Obama supports. If the exchanges turn out to be too complicated, especially with Republicans attempting to prevent their success (or as Ed Kilgore put it, have unclean hands) as opposed to participating in the process, the choice then become a more simple single-payer plan, not turning to the incoherent alternatives being proposed by Republicans.
How long will Americans remember recent events? At the moment this CNN/ORC International survey does not look favorable for Republicans:
According to the survey, 54% say it’s a bad thing that the GOP controls the House, up 11 points from last December, soon after the 2012 elections when the Republicans kept control of the chamber. Only 38% say it’s a good thing the GOP controls the House, a 13-point dive from the end of last year.
This is the first time since the Republicans won back control of the House in the 2010 midterm elections that a majority say their control of the chamber is bad for the country…
“John Boehner fares just as badly as the GOP,” CNN Polling Director Keating Holland said. “Sixty-three percent of all Americans think that Boehner should be replaced as Speaker of the House, a view shared by roughly half of all Republicans.”
According to the poll, only 30% of the public says Boehner, who became Speaker in January 2011, should continue in that role.
However, the election is still over a year away. Democrats need a substantial majority opposed to Republican control of the House due to gerrymandering, along with the concentration of Democratic voters in a smaller number of urban districts.
New issues could shift the balance in either direction. How the Affordable Care Act works out might have an impact. At the moment this doesn’t help the Democrats, but the problems do not appear significant enough to help the Republicans either. A Washington Post/ABC News Poll found that 56 percent of Americans think that the computer problems with the roll are part of a broader problem with the law’s implementation. However this does not translate into agreeing with the Republicans on repeal:
The poll finds that only 41 percent approve of Obama’s handling of the law’s implementation, versus 53 percent who disapprove. Fifty six percent say the website problems are a symptom of broader implementation issues — meaning the public is adopting a very harsh view of these problems.
But even despite this, only one third of Americans support repealing the law. A sizable bloc of those who oppose the law want it to continue, anyway.
The poll finds that 46 percent support the law, versus 54 percent who oppose it or are unsure of their feelings about it. But that second bloc breaks down into 33 percent who oppose and want repeal, versus 20 percent who oppose the law and want to let the law go ahead. That means a total of 66 percent either support the law or oppose it but want it to go forward.
I doubt that this issue will wind up helping Republicans. First of all, computer problems regarding signing up with the plans have nothing to do with the bulk of the benefits of the plan. Once people obtain insurance, any difficulties with the web site will no longer be significant. If anything, the exchanges should help the Democrats as people find they can obtain more comprehensive insurance at a lower rate, even if they could not qualify to purchase insurance in the past due to preexisting conditions. Secondly, the exchanges only affect about eighteen percent of the population, and most people will not vote based upon this.
It is looking like looking back at their behavior in school can provide important insights on Republican leaders. During the last presidential campaign we learned that Mitt Romney was a bully and a homophobe while a student at Cranbrook. Rand Paul, who, like Mitt Romney, regularly makes up facts to support his position, showed that he understood how to use misinformation while in medical school. National Journal found that Paul even admitted it:
Rand Paul was talking with University of Louisville medical students when one of them tossed him a softball. “The majority of med students here today have a comprehensive exam tomorrow. I’m just wondering if you have any last-minute advice.”
“Actually, I do,” said the ophthalmologist-turned-senator, who stays sharp (and keeps his license) by doing pro bono eye surgeries during congressional breaks. “I never, ever cheated. I don’t condone cheating. But I would sometimes spread misinformation. This is a great tactic. Misinformation can be very important.”
He went on to describe studying for a pathology test with friends in the library. “We spread the rumor that we knew what was on the test and it was definitely going to be all about the liver,” he said. “We tried to trick all of our competing students into over-studying for the liver” and not studying much else.
“So, that’s my advice,” he concluded. “Misinformation works.”
That was a perfect lead-in for an article on the misinformation Rand Paul continues to spread:
“Under Obamacare and the current evolution of things, we have 18,000 diagnostic codes. We’re going to 144,000 diagnostic codes,” Paul told them. It wasn’t the first time he had implied that the number of codes—complete with seemingly absurd categories for injuries from macaws, lampposts, and burning water skis—was exploding as a result of the Affordable Care Act. But fact-checkers across the spectrum, from the conservative website The Blaze to USA Today to the liberal site Think Progress, had thoroughly debunked that notion months earlier. As Paul must know, the new diagnostic codes were approved by the Bush administration and have nothing to do with Obamacare.
Later in the article:
But then, there are the half-truths, cherry-picked factoids, and outright errors that Paul seems steadfastly unwilling to relinquish.
Take health care. Although he’s a doctor, Paul repeatedly misrepresents aspects of the Affordable Care Act. For example, all of those crazy-sounding new billing codes he implies are the spawn of Obamacare were in fact released by the World Health Organization 20 years ago and, as The Blaze reported, approved by the Bush administration in 2008, scheduled for 2011, delayed until 2013, and then delayed again until late 2014, so they’ll finally take effect the same year as most of the ACA.
In discussing the expenses the law will impose on consumers, Paul rarely mentions the subsidies many people will receive, and he sometimes says a single person making $30,000 a year will have to pay $15,000 a year in premiums. The government is going to require somebody to pay 50 percent of their income for health insurance? “It depends on circumstances,” Paul replies. “I can’t tell you where the cutoff is for single without kids. But I think there will be people who are single without kids who don’t get subsidies who will struggle to pay $15,000 for insurance.” PolitiFact labeled that assertion “especially off the mark.” Citing available facts, PolitiFact said such a person would pay at most about $3,000 and could pay far less due to the law’s caps, subsidies, and bare-bones coverage options.
The Louisville med students were worried and curious about Obamacare, which could greatly affect their future. “I will continue to fight to make it less bad, at the very least,” Paul told them. It sounded like he wanted to fix or improve the law. Later, away from those students, asked how he would improve the law, he told National Journal he would try to delay and defund as much of it as possible in hopes of eventually getting rid of it entirely, because “the whole thing is rotten.”
Paul’s logic in justifying the GOP drive to kill Obamacare is dicey, too. He says that while the president won reelection by “a small majority” in 2012, “a majority of the people believe Republicans should be in charge of the House” and therefore don’t want something like the law that was passed solely by Democrats. Obama won last year by nearly 5 million votes. Some people might consider that a small majority. But while Republicans won a majority of House districts, it’s not accurate to say a “majority of the people” wanted a GOP House. Democrats won the House popular vote by more than 1.7 million votes nationwide, the Federal Election Commission reported in July.
On another front, Paul routinely exaggerates the size of the annual federal deficit, pegging it at $1 trillion. In fact, the deficit for fiscal 2013 fell to an estimated $642 billion, heading toward $378 billion in two years, according to a Congressional Budget Office report in May.
Paul, like most Republicans, is also dishonest in blaming the size of the deficit on Obama when Ronald Reagan and George W. Bush were the biggest spenders in recent years. The current deficit problem is a consequence of George Bush passing on a combination of unfunded expenses and tax cuts to his successor.
It appears that the Republicans are backing down on their brinkmanship with John Boehner now prepared to allow the full House to vote on a compromise bill despite lack of Republican support. Of course the shutdown and fears of default, which have harmed the economy, could have been prevented if Boehner had allowed this previously. The Republicans will likely play a political price for showing how much they are willing to compromise the interests of the nation to give in to ideological extremists. Support for Republicans has fallen dramatically. The Tea Party has been hurt the most as an increasing number of American voters have come to realize that, despite their name, the Tea Party is a dangerous, extremist group which opposes the ideals of the Founding Fathers, opposes our Constitutional form of self-government, and is pushing the Republican Party in a direction which would bring financial ruin to the United States. A Pew Research Center survey found:
The Tea Party is less popular than ever, with even many Republicans now viewing the movement negatively. Overall, nearly half of the public (49%) has an unfavorable opinion of the Tea Party, while 30% have a favorable opinion.
The balance of opinion toward the Tea Party has turned more negative since June, when 37% viewed it favorably and 45% had an unfavorable opinion. And the Tea Party’s image is much more negative today than it was three years ago, shortly after it emerged as a conservative protest movement against Barack Obama’s policies on health care and the economy…
By a 50% to 31% margin, whites now have a more unfavorable than favorable view of the Tea Party; four months ago whites were about evenly divided in their opinions. Over the same period of time there has been little change in opinions of the Tea Party among blacks or Hispanics, who already held a negative opinion of the Tea Party in June.
And although favorable ratings of the Tea Party have declined across most age groups, there has been a 12-point drop among 18-29 year olds, just 25% of whom now have a positive view of the Tea Party movement…
In the current debate over the debt limit, nearly seven-in-ten (69%) of Tea Party Republicans think that the country can go past the deadline for raising the debt limit without major economic problems, and fully 52% say the debt limit does not need to be raised at all.
The shutdown has also hurt the Republican’s chances to win the Senate per findings of a Public Policy Polling survey.
As people have turned against the Republicans and the Tea Party, some are also rejecting the right wing’s opposition to Obamacare. A Democracy Corps poll found that “Just 38 percent now clearly oppose the Affordable Care Act. While likely voters divideevenly on the plan, 8 percent oppose the law because it does not go far enough. As a result, just 38 percent oppose the law because it is big government.” Opponents of the Affordable Care Act have generally exaggerated their numbers by including both those who oppose government action and those who oppose the ACA because it doesn’t go far enough. In addition, surveys about the actual components of the law have done much better than polling on the name due to the considerable amount of misinformation being spread.
A year is a long time in politics and many people are likely to forget recent events when voting next year. These events still may increase Democratic chances at taking the House next year. Some voters will remember, and it is likely many will become more aware of other extremist moves by the Republican Party which under other circumstances might be ignored. The shutdown has assisted the Democrats in recruiting House candidates, making them more competitive in swing districts. Greg Sargent wrote:
Though the shutdown mess has given Dems a sizable lead in the generic House ballot matchup, that will almost certainly fade. But it could have a lasting impact if it enables Dems to recruit good candidates right now, which could matter to the outcome.
In an interview, DCCC chair Steve Israel told me a number of new recruits would be announced in coming days, thanks to GOP damage sustained in the crisis.
“Conservatively, you will see another three — it could be as many as five,” Israel told me. “In a number of districts we had top-tier, all-star potential candidates who several months ago didn’t see a path to victory. They reopened the doors. These are competitive districts. They tend to be moderate and have large concentrations of independent voters. Those voters are now seeing the Tea Party implement their agenda.”
Three to five new top recruits would not be insignificant, since Dems need to flip 17 seats to take back the House, but Dave Wasserman, who tracks House races for the non-partisan Cook Political Report, estimates that Dems are well short of the number of recruits they need. He says that given how few seats are truly competitive, Dems need between 35 and 40 high-quality recruits to have any shot at putting the House in play, and estimates that they only have two dozen serious recruits at present.
Israel says Dems will meet that goal. “I think we’ll get it into the range of 40,” he said. “I don’t accept that we’re at 20-25 top recruits. I would put it right now in the mid-30s.”
Carl Bernstein had some harsh words for the Republicans:
Journalist and author Carl Bernstein said Wednesday that Republican Party leadership is “cancerous” and has put the United States at risk by letting the tea party lead the GOP.
“The Republican Party today has become a rabid organization from the top down. The leadership is cancerous,” the former Washington Post reporter said on MSNBC’s “Morning Joe” on Wednesday.
Bernstein called the current situation a “terrible moment in our history” and said only segregation politics offers a comparison.
“You have to go back to the party, the Democratic Party of segregation to find this kind of scorched-earth politics putting the national interests nowhere and putting ideology and ideology above all else,” Bernstein said. “The full faith and credit of the United States, our reputation abroad, our stability, our national security has been endangered by [Senate Majority Leader Mitch] McConnell, by [House Majority Leader Eric] Cantor, who have embraced and cowardly appeased these forces who are know-nothings.”
Incidentally, most people are aware that the old southern Democrats who supported segregation ultimately moved to the Republican Party after passage of the Civil Rights Act 1964. It is worth a quick mention as I actually received a comment from a Republican supporting Republicans over Democrats because of the support for segregation by Democrats. That clearly has no meaning in terms of choosing current candidates.
The two parties have often been described as the mommy and daddy parties. The Democrats were the mommy party, desiring the nurture the country and the economy and give people things such as affordable health care coverage. The Republicans were considered the daddy party, more concerned with enforcing order. Josh Barro had a great line regarding this today:
“If Republicans were once the daddy party, now they’re the abusive ex-husband with a substance abuse problem party.”
He went on to write:
Instead of telling hard truths, Republicans are wildly misleading voters, both about policy (“America is going to be destroyed by Obamacare”) and political reality (“Democrats are feeling the heat” because Republicans shut down the government).
Instead of warning about resource limitations, Republicans are manufacturing them. President Obama’s deficit spending did not result in the debt crisis that conservatives warned it would, so Republicans have been actively trying to create one by making dangerous threats over the debt ceiling.
Republicans have abandoned the pretense of trying to run the government like an efficient business. What kind of business periodically tells its workers they won’t get paid but they should keep working, and clients that it’s going to shut down operations for a while with no clarity on when they will resume?
With Republicans having gone completely off the rails, Democrats have been left trying to play the role of mommy and daddy at the same time.
It’s Democrats who are mindful of the financial markets and striving to avoid roiling them with the prospect of payment default. It’s Democrats who are finding ways to control health care costs. It’s President Obama who is trying to get Republicans to cut a deal to slow the growth of old-age entitlement spending.
There is a lot of speculation as to how Congress will get out of the Republican-created crisis leading to the shutdown of the government, as well as the upcoming need to increase the debt ceiling. There has been some talk of a grand bargain, and more realistic speculation that they will need a smaller deal. I’m not certain to what degree to trust Robert Costa’s inside sources, but his report in The National Review on Republican strategy does sound realistic:
It hasn’t been announced, and you won’t hear about it today, but the final volley of the fiscal impasse, at least for House Republicans, is already being brokered. And according to my top sources — both members and senior aides — it won’t end with a clean CR, or with a sprawling, 2011-style budget agreement. It’ll end with an offer — a relatively modest mid-October offer that concurrently connects a debt-limit extension, government funding, and a small, but strategically designed menu of conservative demands.
At least that was the word late Thursday, when the leadership and groups of Republicans huddled. There is a growing acceptance, especially among the leading players, that the debt-limit talks will soon blend into the shutdown talks and force Republicans to negotiate a delicate peace that can win the support of a majority of the conference (or close to it), as well as a smattering of Democrats. To that end, recent quiet, freewheeling discussions — some hosted by the leadership, others by Paul Ryan — aren’t so much about whipping toward such a deal, but about deciding how to frame it.
So far, it has been an uneasy process, but not futile. Many of the GOP’s more centrist members are asking Boehner and Ryan to not put too much on the table, or else risk turning off Democrats and extending the shutdown. On Wednesday afternoon, during a series of meetings in Boehner’s office, they pressed the speaker to avert a default on the nation’s debt. But Boehner, though with them in spirit on averting default, told his colleagues to hang tight for the moment and swallow hard as the shutdown continues. One Boehner ally tells me the speaker first has to balance his various conservative blocs before he can even privately articulate a final pitch.
But details are floating to the surface as the leadership reaches out to internal power brokers about what’s within the realm of the possible. What I’m hearing: There will be a “mechanism” for revenue-neutral tax reform, ushered by Ryan and Michigan’s Dave Camp, that will encourage deeper congressional talks in the coming year. There will be entitlement-reform proposals, most likely chained CPI and means testing Medicare; there will also be some health-care provisions, such as a repeal of the medical-device tax, which has bipartisan support in both chambers. Boehner, sources say, is expected to go as far as he can with his offer. Anything too small will earn conservative ire; anything too big will turn off Democrats.
It will probably be necessary to give something to the Republicans so they can save face and agree to a deal, unless public pressure becomes so great that they have no choice except to give in. Revenue-neutral tax reform is something which both sides could agree to, and even might be beneficial. That assumes that Republican tax reform doesn’t simply consist of lowering taxes on the wealthy and increasing taxes on the middle class as they have generally favored. Repeal of the medical-device tax, assuming it appears to be part of a bigger bargain and not simply capitulation by Democrats to a Republican demand, is feasible. This is a part of the Affordable Care Act which assists with financing the plan, but which is not a part of the law which supporters would consider to be important. Entitlement reforms would need to be viewed cautiously to avoid giving in unnecessarily on cuts to Social Security or Medicare.
Democrats have the upper hand and might be willing to give Republicans something so they can feasibly give in, but the Democrats have other options. Bargaining might become unnecessary if the Democrats are able to use a discharge petition to bring a clean bill to the House floor which could pass with the support of most Democrats and a small number of moderate Republicans. Greg Sargent explained how this might work in a post today, with more at Roll Call. Republicans might also be forced to give in due to demands from big business, with further evidence of business being unhappy with the Republicans in addition to what I discussed earlier in the week.
The government has been shut down due to the Republican inability to govern and contempt for the democratic process. Lately even the Iranians are appearing more rational. The question now is what happens next. Some believe that the shutdown makes it less likely for the Republicans to refuse to raise the debt ceiling. On the other hand, if the Republicans are still not willing to act in good faith on the budget, is there really reason to believe they will suddenly become more sensible on the debt ceiling?
This crisis is purely re Republican creation. John Boehner can end this any time he chooses. Instead Boehner prefers to play political games, such as with the latest games he is playing over veterans. If Boehner wants to end the shutdown he can do so by allowing a handful of moderate Republicans to vote along with the Democratic minority to pass a clean budget which does not attempt to reverse the results of the last election, eliminate a law which has passed Congress and been upheld by the Supreme Court. Besides, if allowed to see what Obamacare really contains, a vast majority support it:
Here are figures from Kaiser’s March 2013 poll:
Tax credits for small businesses to buy insurance: 88% in favor.
Closing the Medicare drug benefit doughnut hole: 81% in favor.
Extension of dependent coverage to offspring up to age 26: 76% in favor.
Expanding Medicaid: 71% in favor.
Ban on exclusions for preexisting conditions: 66% in favor.
Employer mandate: 57% in favor.
If you agree with those provisions, congratulations: You love Obamacare. Yet when respondents are asked how they feel about “Obamacare,” they’re against it.
Maybe that is the point. Republican leaders realize they have to stop Obamacare now because Americans will love it once it is fully in effect. Plus they will no longer be able to lie about what is contained in the law.
The Tea Baggers in Congress show no likelihood of compromise or rational action. Ideological fervor combined with vast ignorance is a dangerous combination. Maybe this will end by Boehner giving in and allowing a bipartisan House majority to pass a clean budget bill. Maybe he will be forced to give in, if not by public opinion than by one of the Republicans main constituencies, big business. There is not much future left for the Republican Party if their actions cause big business to defect to the Democrats, and there are signs that this is now happening. Just as old fashioned country club Republicans never had much use for the religious right, businessmen have no use for the Tea Party if it continues to act in a manner which cripples the economy.
As the irresponsible extremists in control of the Republican Party are bringing us to the brink of a government shutdown, polls show a majority opposing how the Republicans are handling the budget battle. A CNN/ORC International poll shows that the Republicans would receive the bulk of the blame:
According to the poll, which was conducted Friday through Sunday, 46% say they would blame congressional Republicans for a government shutdown, with 36% saying the president would be more responsible and 13% pointing fingers at both the GOP in Congress and Obama.
Support for Congress has dropped to 10 percent. Opposition to the Tea Party has increased to a new high:
The unfavorable numbers for the tea party movement are also at an all-time high in CNN surveys.
Thirty-one percent say they see the tea party in a favorable light, while 54% hold an unfavorable view of the of the movement now in its fifth year.
A poll from Morning Consult shows that only 33 percent believe the Affordable Care Act should be delayed, repealed, or defunded as the Republicans are demanding. A margin of 66-33 believe that the 2012 election “represented a referendum on moving forward with implementation of the 2010 health care law.” Two thirds also believe the law should be given a chance to succeed (even if skeptical or ignorant of what the law contains).
These numbers don’t tell the entire story. Republican members of Congress are often from Congressional districts were voters believe the Republican line on the deficit and the Affordable Care Act and these voters are more likely to reward than vote against members of Congress who are acting against the interests of the country. Republican politicians benefit from the manner in which they promote ignorance and misunderstanding of the issues.
The numbers are also not static, with some polls showing an increase in the number of people who blame both sides. This may be a consequence portions of the media which promote such a false equivalency, either due to a false concept of objectivity or due to conservative control.
This might turn out to be a question of whether Obama can utilize the bully pulpit of the presidency more effectively than he often has in the past. We are seeing some signs of this with comments such as these:
I’m always willing to work with anyone of either party to make sure the Affordable Care Act works better, to make sure our government works better. I’m always willing to work with anyone to grow our economy faster, or to create new jobs faster, to get our fiscal house in order for the long run.
I’ve demonstrated this time and time again, oftentimes to the consternation of my own party.
But one faction, of one party, in one House of Congress, in one branch of government doesn’t get to shut down the entire government just to re-fight the results of an election. Keeping the people’s government open is not a concession to me. Keeping vital services running and hundreds of thousands of Americans on the job is not something you give to the other side…
he American people sent us here to govern. They sent us here to make sure that we’re doing everything we can to make their lives a little bit better – to create new jobs, to restore economic security, to repair the prospects of upward mobility. That’s what they expect.
And they understand that there are differences between the parties. And we’re going to be having some tough fights around those differences. And I respect the fact that the other parties are not supposed to agree with me 100 percent of the time, just like I don’t agree with them.
But they do also expect that you don’t bring the entire government to a halt or the entire economy to a halt just because of those differences.
That’s what they deserve. They’ve worked too hard for too long to recover from previous crises just to have folks here in Washington manufacture yet another one that they have to dig themselves out of.
So Congress needs to keep our government open, needs to pay our bills on time, and never, ever threaten the full faith and credit of the United States of America.
Jesse Pinkman explained the benefits of the Affordable Care Act on Saturday Night Live last night. He talked about a school teacher with a family who developed lung cancer..
Perhaps the Republicans will back down from harming the economy in the dangerous game of chicken they are playing, but for now John Boehner appears powerless to stop the extremists who effectively control the Republican Party. They still continue to push for a delay to Obamacare before they will agree to avoid a government shutdown. An example of why their demands really have nothing to do with fiscal responsibility can be seen in their demand to end the tax on medical devices.
The Affordable Care Act, in contrast to big spending measures which came from Republicans when George Bush was in the White House, was written with means to pay for the new costs it will generate. This includes a 2.3% tax on medical devices. The short-sighted medical device industry denies that having more people covered will lead to increased sales and higher profits. They have been lobbying heavily to have the tax repealed. The Republicans have two choices. They can take up the cause of a business interest, or they can support fiscal responsibility and support this means of paying for the Affordable Care Act. There shouldn’t have been any doubt on where they would fall on that question.
The Republicans have no real interest in fiscal responsibility or reducing the deficit. As usual, Republican policies are purely centered on reducing taxes for their supporters.
Barack Obama has made some excellent responses to the GOP’s terrorist tactics:
“I’m not going to start setting a precedent, not just for me, but for future presidents, where one chamber in Congress can basically say each time there needs to be a vote to make sure Treasury pays its bills, we’re not going to sign it unless our particular hobby horse gets advanced.
Imagine if you had a Republican president and a Democratic speaker, and the Democratic speaker said, well, we’re not going to pass the debt ceiling unless we raise corporate taxes by 40 percent or unless we pass background checks on guns or whatever other list of agenda items Democrats were interested in. Does anybody actually think that we would be hearing from Republicans that that was acceptable behavior? That’s not how our constitutional system is designed. We are not going to do it.” (source)
“Paying America’s bills is not a concession to me. That’s not doing me a favor.” (source)
The right wing blogs and publications continue to spread scare stories such as that insurance costs will rise under the Affordable Care Act, often using funny math and outright lies. The Affordable Care Act has already cut costs for many people with measures such as requiring coverage of routine preventative studies to covering young adults up to age twenty-six on their parents’ policies. The most important savings is that insurance coverage cannot be lost–a problem which has been a widespread cause of bankruptcy in t his country. As we are now getting more data, we are finding that insurance coverage which will soon be offered on the exchanges will cost less than many predicted based upon information released in a report from the Health and Human Services Department.
According to the new report, the average premium nationally for the second-lowest cost “silver” plan will be $328 a month before tax credits — 16 percent below projections from the nonpartisan Congressional Budget Office. As many as 95 percent of the uninsured who are potentially eligible to use the exchanges live in states with average premiums below the CBO projections.
The options available to consumers will vary significantly depending on their health care market. In Wyoming, for example, the average lowest-cost bronze plan is $425, while it is $144 in Minnesota. In Jackson, Miss., after receiving tax credits, a 27-year-old could potentially pay as little as $8 a month for a bronze plan.
In the federally-run exchanges, states with the lowest average premium tend to have a higher average number of issuers offering qualified health plans, according to HHS. Those 36 states have an average of eight different health insurers participating in the exchange system. About one in four of these insurance companies are offering health plans on the individual market for the first time ever, signaling that insurers are eager to compete for the new business, Gary Cohen of the Centers for Medicare and Medicaid Services told reporters Tuesday.
Cohen said consumers will have a “good and very transparent shopping experience” on the exchanges, contending the range of options shouldn’t be too confusing.
“We have requirements that there be a meaningful difference between plans available,” he said. “Consumers will be able to make side by side comparisons… they’ll be able to select the characteristics of the plan they want to see.”
The exchanges will offer a choice of platinum, gold, silver, and bronze plans which vary based upon coverage and out-of-pocket expenses. Those with chronic diseases which require frequent health care expenditures might be better off with the more expensive plans. For others it will be a choice based upon affordability and how much risk they want to take with higher deductibles or copays.
Cost should not be the only consideration in choosing a plan. There is valid concern as to which doctors will be included in each plan, as insurance plans might be motivated to limit choice in the hopes of keeping costs down. Current laws rules require all plans on the exchanges to offer a sufficient number and a variety of physicians in their networks. It will be necessary for those who are concerned about keeping their own doctor to investigate this before signing up for a plan–considering both their preferred primary care physicians and the specialists they want access to.
I suspect that in many areas there will continue to be nearly as large a choice for consumers as they have now (which does mean potential limitations, as are currently experienced). Physicians have joined together into networks to jointly negotiate with health care plans. The network I practice in includes virtually every physician in town making it hard for insurance companies to limit choice. Another concern is how the plans created for the exchanges wind up paying physicians. If they attempt to pay poorly to keep costs down, it is possible that many physicians will decide not to accept the plan.
Location will also play a part in how much the premiums are for a variety of reasons, including actions by some Republican controlled state governments to attempt to sabotage the Affordable Care Act and taking actions which lead to higher costs.