A Flea in the Fur of the Beast

“Death, fire, and burglary make all men equals.” —Dickens

Tag: obamacare

How Not To Govern

by evanmcmurry

Pierce points us to two shining examples of modern conservative governance. First up, South Carolina is passing a law punishing anybody in their state who tries to implement Obamacare:

A proposed bill, on special order in the state Senate, would allow the state attorney general to take businesses, including health insurers, to court if he “has reasonable cause to believe” they are harming people by implementing the law. The bill already has passed the House. If it passes, the bill could push South Carolina to the forefront of Obamacare resistance, giving the state’s Republican leaders a national stage. It also could push South Carolina into yet another costly legal battle in the federal courts that, critics say, is unnecessary and avoidable. [E.A.]

Cuz nothing says “responsible use of taxpayer dollars” like a multimillion dollar court battle over a pointless piece of legislation. Speaking of fiscal responsibility, the House is passing an amendment explicitly forbidding any funding of ACORN—which hasn’t existed in three years, but hey, Republican congressmen get to go home to their district bragging about how they took it to those liberal election fixers in the “urban” parts.

This is what happens when you elect people who are not for smarter, leaner government, but explicitly against governing at all.

Obamacare Could Help Turn Texas Blue

by evanmcmurry

Ezra Klein has a good summary of a Rand report on what’s going to happen to states that refuse Obamacare the Affordable Care Act’s expansion of Medicare:

The study, by the Rand corporation, looks at the 14 states that have said they will opt out of the new Medicaid funds. It finds that the result will be they get $8.4 billion less in federal funding, have to spend an extra $1 billion in uncompensated care, and end up with about 3.6 million fewer insured residents.

So then, the math works out like this: States rejecting the expansion will spend much more, get much, much less, and leave millions of their residents uninsured. That’s a lot of self-inflicted pain to make a political point.

Note that refusing isn’t just bad for the people who don’t get insured. When those people get sick, they will become a drain on publicly-funded services. Which means these states, rather than spend money up front and have healthier people, will spend money later on sicker people. This is the position Rick Perry, et al, are selling as morally and financially responsible.

Klein points to one unintended consequence: poking poor people with a stick might not be such a good idea electorally, especially if the people you’re callously leaving uninsured are part of a demographic that’s already set to imperil your party’s vice-like grip on state government.

In Texas, for instance, 38 percent of the Hispanic population is uninsured. Will having that security so near, and then learning that it’s been blocked by their government, activate that voting bloc in the way Prop 187 did in California? It’s a possibility National Journal columnist Ron Brownstein raised in a recent article. “In 1994, California Republican Gov. Pete Wilson mobilized his base by promoting Proposition 187, a ballot initiative to deny services to illegal immigrants. He won reelection that year—and then lost the war as Hispanics stampeded from the GOP and helped turn the state lastingly Democratic. Texas Republicans wouldn’t be threatened as quickly, but they may someday judge their impending decision on expanding Medicaid as a similar turning point.”

For some time now, Texas GOP town criers have been running around ringing a warning bell  about the growing Hispanic population, and what it will do the GOP’s monopoly if the party doesn’t act. Perry’s war on Medicare expansion will only exacerbate this exodus. I believe that’s what those in the biz call an “unforced error.”

Obamacare Opponents Now Basing Arguments Off Pop-up Ads They Found On The Internet

by evanmcmurry

News about Obamacare the Affordable Care Act had been getting good and better until this Forbes article that claimed the ACA would raise rates in California from 64-146%. This was in stark contrast to all the data emerging from the state’s new insurance exchange, which looked to be lowering rates. What gives?

Well…

What policies, I wondered, had Avik used as his point of comparison in reaching his startling conclusion?

I soon had my answer as Roy revealed where he had acquired his data, writing, “But in 2013, on eHealthInsurance.com (NASDAQ:EHTH), the median cost of the five cheapest plans was only $92.”

I must admit that it took a moment to sink in as my first reaction was to laugh. eHealthInsurance.com? Seriously?

Was Avik really using teaser rates published on the Internet by eHealthInsurance.com as his point of comparison? I mean, you don’t have to be a healthcare policy expert to know that websites like eHealthInsurance.com always flash low rates in front of you—prices that maybe one person in a thousand might actually hope to achieve—to tickle the interest of a potential customer.

This is like comparing the bus ticket you just bought to MegaBus’ “$1 FARES!” ad.

Obamacare Is A Train Wreck, If By Train Wreck You Mean Working Better Than Expected, Pt. 2

by evanmcmurry

Followers of this blog/author will recall that it/he has been saying for some time that those states that got on board early with Obamacare the Affordable Care Act Medicaid expansion would soon be leaving their fellow states in the Tenth Amendment, crowded-ER dust.

Ahem:

California is a particularly important test for Obamacare. It’s not just the largest state in the nation. It’s also one of the states most committed to implementing Obamacare effectively. Under Gov. Arnold Schwarzenegger — remember how that really happened? — California was the first state to begin building its insurance exchanges. The state’s outreach efforts are unparalleled. Its insurance regulators are working hard to bring in good plans and make sure they’re playing fair. If California can’t make the law work, perhaps no one can. But if California can make the law work, it shows that others can, too.

[snip] The way this competition can drive down rates is already evident in Oregon. There, one insurer came in with monthly premium costs in the $169 range, while other insurers asked to charge more than $400. But then, seeing  what their competitors were charging, two insurers came back to the state’s regulators and asked if they could refile at lower rates. Otherwise, they wouldn’t be competitive in the exchange. The Obama administration was ecstatic to see this: It’s exactly what they’re hoping will happen across the country.

Klein goes on to say that this will be embarrassing for Texas come 2016, when California’s health care system is blossoming and Texas’ is a mess. This assumes anybody in the Capitol Building or Governor’s Mansion in Austin cares, which they don’t.

Obamacare Is a Trainwreck, If By Trainwreck You Mean Working Better Than Expected

by evanmcmurry

Via Jonathan Cohn:

On Thursday, officials in that state offered the first detailed glimpse of what consumers buying health benefits on their own can expect to pay next year. And from the looks of things, these consumers will be getting a pretty good deal.

Based on the premiums that insurers have submitted for final regulatory approval, the majority of Californians buying coverage on the state’s new insurance exchange will be paying less—in many cases, far less—than they would pay for equivalent coverage today. And while a minority will still end up writing bigger premium checks than they do now, even they won’t be paying outrageous amounts. Meanwhile, all of these consumers will have access to the kind of comprehensive benefits that are frequently unavaiable today, at any price, because of the way insurers try to avoid the old and the sick. 

[snip] On Thursday, officials and consumer advocates were talking about a very different kind of sticker shock: Premium bids that were lower than expected. “For plan after plan, we’re getting the best-case scenarios,” said Peter Lee, executive director of Covered California.

The reasons? Cohn points to a combo: insurers competitively pricing premiums to get new market shares; agencies in California having wide authority to keep offers competitive; and insurers actually playing ball for the purposes of making policy functional. I know, that last one’s crazy—we’re so used to wingnuts intentionally sabotaging policy for political gain we forgot that occasionally organizations make choices based on more than ideological self-immolation. Who knew?

Aaaaaaaaaand the kicker:

Unfortunately, millions of uninsured and under-insured Americans live in places like Florida and Texas, where there is far less sympathy—and a great deal more hostility—to the idea of Obamacare. It’s entirely possible that the insurance bids in those states will be a lot higher, precisely because state officials there are doing nothing to help and quite a bit to hurt implementation. But if that happens, blame won’t belong with the heath care law or the federal officials in charge of its management. It will belong with the state officials who can’t, or won’t, deliver to their constituents the benefits that California’s officials appear to be providing theirs.

On the bright side, if you apply for unemployment in Texas or Florida, you’ll get drug tested, so you got that going for you.

Today In Things That Are Working The Way They’re Supposed To

by evanmcmurry

Blah blah blah IRS blah blah blah Benghazi, etc. Howevs:

The federal deficit is shrinking more quickly than expected, and the government’s long-term debt has largely stabilized for the next decade, the Congressional Budget Office said Tuesday in a report that could strengthen the Obama administration’s hand in the budget battles with congressional Republicans.

[snip] The deficit projection for this year — $642 billion — is almost 25% less than the deficit the budget office had forecast as recently as February. At the new level, the annual deficit would be back to where it was before President Obama took office. It would continue to fall for the rest of Obama’s tenure, the budget office now projects. 

[snip] Three major factors account for most of the long-term improvement: a better economy, a continued slowdown in the rate of medical inflation — which reduces the cost of Medicare and Medicaid — and higher taxes that Congress approved as part of the “fiscal cliff” deal in January, the budget office said.

Kevin Drum has a good exegesis on that slowdown: namely, it’s been happening for a while, based on numerous factors, some of which may be temporary, or not.

Drum notes it’s far too early to claim that Obamacare the Affordable Care Act is responsible. To which I say: good! One of the primary arguments behind the ACA was that it would drive down health costs by keeping people healthier earlier, thus avoiding more costly illnesses and preventing expensive ER visits and such down the line. If this is true—still an if—and costs are already decreasing, then the ACA should accelerate that decrease—which was stated aim of the legislation.

Here’s the requisite reminder that the House just voted to repeal the bill, again. It’s been repealed by the House so many times that nobody can even agree on a number—somewhere between 33 and 37, depending on whom you ask.

So yeah, IRS Benghazi etc. But one party’s decreasing both the deficit and health care costs, and the other is still throwing a tantrum.

Republicans Are Less Likely To Support Obamacare After SCOTUS Ruling, Which Makes Sense Until You Think About It

by evanmcmurry

Dave Brockington at LGM with a good find from yesterday’s NPR poll:

Perhaps the most interesting finding from this survey, at least most likely to induce a chuckle, is the response to this question (page 9):

Does the fact that the Supreme Court said the health care law is constitutional make you more likely to support the law, less likely to support the law, or does the Supreme Court decision have no effect on your support for the law?

Overall, 21% are more likely to support the ACA, 16% less likely, and it makes no difference to 58% (again, supporting the hypothesis that it’s all about pre-existing partisanship).  [Battleground] voters are a near exact replication of the overall sample (21/17/58). However, when limited to Republican respondents, the numbers are 8/30/56.

30% of Republican respondents are less likely to support the ACA because the Republican led Supreme Court ruled it constitutional.  One might excuse the 6% of Democrats believing this, but Republicans?

This is clearly a wording issue. The question was “are you more or less likely to support the ACA since SCOTUS upheld it?” and what 30% of Republican respondents heard was “are you more or less pissed off that SCOTUS upheld the ACA?” But still, an open-ended follow-up would have been fascinating in this case: “What specifically about John Roberts’s decision made you less likely to support health care reform? Use additional sheets if necessary.”

We Need To Stop Making Things Up About Health Care, Medicaid Edition

by evanmcmurry

Aaron Carroll on just one of the stubborn memes against health care reform:

I get a bit annoyed when people claim that we can’t “afford” more government intervention or, god-forbid, single-payer. That kind of statement willfully ignores the fact that every country that has MORE government intervention spends LESS.

He has more. Full post is worth a read. (via The Incidental Economist)

Bill Keller Has A Happy

by evanmcmurry

Bill Keller takes a break from his normal schedule of pointless, anodyne stupidity to craft a decent defense of health care. There’s still plenty of marshmallow in his article—still that sense that Keller is explaining the world slowly to a befuddled man he found wandering around in the Dean & Deluca downstairs—but it also contains lines like this, on the idea that Obamacare is a federal takeover of the health care system: “Let’s be blunt. The word for that is ‘lie.'” It’s like Keller remembered he used to run a major American newspaper or something. The befuddled will be thrilled.

Newt Gingrich Takes A Break From The Crazy To Make A Decent Point About Legislating

by evanmcmurry

Take it from a veteran observer: Newt Gingrich’s id-consumed-extemporaneous-word-salad-stream-of-consciousness-zoogastic performance art occasionally yields dividends.

Today, Gingrich was asked about John Roberts’s switcheroo to simultaneously uphold the individual mandate, save health care, balloon Obama’s election chances, deflate conservative momentum in the Supreme Court, and completely alter the political arithmetic of the judiciary. I’ve been over the various ways conservatives are attempting to spin this to their advantage, with less and less success. But Newt’s never been one for the script. He’s the GOP’s method actor, and he just goes with the moment, man:

What Roberts has said is, “Yes, it’s constitutional because of a gigantic tax increase, and if you don’t want the gigantic tax increase you’ve got to beat Obama.” You don’t just get to come to the Supreme Court to bail you out. And I happen to think that part of it is probably healthy for the country to be forced to confront, that it’s their burden.

That’s…not a bad point. You know when Gingrich and Gin & Tacos agree on a basic point that something’s up. Here’s G&T on the same subject:

Simply put, there is a good argument to be made that the Supreme Court is resolving a greater number of political issues because the actual political process – Congress and state legislatures, presidents and governors – refuses to do so. Our elected officials, rather than make decisions about hot button issues and risk infuriating half of their constituents, willingly punt to the guys who can’t be punished on Election Day.

Consider the choice facing members of Congress. One option is to introduce a bill about some controversial topic – abortion, gay marriage, healthcare reform, etc. – and then go on record for or against it. Another is to tread water, maintain the status quo, talk out of both sides of one’s mouth on the issue, and wait for the Supreme Court to issue a decision that may end up being unpopular. Rational self-interest suggests that the second option is superior for most elected officials. Consider the Republican House majority after 2010, which could very well have debated and voted on one of the “repeal and replace” bills for “Obamacare” that candidates talked about so much during the election. In practice, and recognizing how popular some (but not all) parts of the law are among the public, they decided to wait and let the Supreme Court strike it down. Obviously that strategy failed…

It is popular in recent years to write about the failure of leadership in today’s political class, often by resorting to sophomoric references to “common sense” and “guts”…Perhaps it is a lack of resolve; perhaps it is simply a rational response to the incentives laid out in our elections, particularly the financial incentive to placate the greatest number of interest groups to the greatest possible extent. Regardless, the Federal bench and the Supreme Court in particular resolve contentious political questions for an uncomplicated reason: someone has to, and the lawmakers won’t.

Gingrich goes on to spout words in no particular order about how Roberts’s decision is a victory for Grover Norquist, and how this is going to be Obama’s worst nightmare (Obama does often dream of being reelected), and all in all resumes his place as a semi-irrelevant upside-down slam poet of the right.

But credit where credit’s due: Gingrich’s point, that the judiciary can’t be counted on to do the work of dysfunctional legislatures anymore, is a solid one. And he can put all the conservative english on it he wants, but only one party is responsible, on a state and federal level, for that dysfunction. Which means Republican lawmakers should think twice before voting along intractable party lines against any and every bill that doesn’t fit their tea party pledges, as there might not be a judicial escape hatch later in the process. And omitting yourself from the legislative process out of ideological petulance, as David Frum told them oh so many years ago, is a good way to get booted out of governing entirely.

Gingrich may or may not have intended his comment as a warning to younger conservatives; either way, it should be taken as one.