Affordable Care Act

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Repealing the Affordable Care Act

The Republicans have made a mantra out of repealing the ACA aka Obamacare.  I’ve lost track of how many times they have voted to repeal it, but close to 60, I think.  The surprising thing is how unprepared they really are to “repeal and replace”.  They seem to have the repeal part down, but in all the years it has been since the law was enacted, they haven’t come up with a replacement plan.  I think that even supporters of the ACA know that some things need fixing but no Republicans were willing to work with Democrats and President Obama to do so.

They could just repeal it.  This would create chaos in the health care system and upset millions.  I don’t think they want to deal with loss of support right away.  I’m not sure that voters who say they don’t like the ACA understand that things like free vaccinations, physical exams, and mammograms are part of the Act.  On the other hand, Republicans cannot seem to agree on a plan to replace the ACA.  There are a lot of ideas, but no plan and not even a framework for a plan as far as I can tell.

In the January 4 edition of the New York Times, Robert Pear had an interesting and informative article, Republicans’ 4-Step Plan to Repeal the Affordable Care Act.  In it he outlines the things that have to happen before Repeal.

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Vice President-elect Mike Pence, second from right, listened as the Senate majority leader, Mitch McConnell, spoke after a Republican luncheon on Wednesday.

Step One is to pass a budget resolution that is filibuster proof in the Senate.

The Senate intends to pass a budget resolution next week that would shield repeal legislation from a Democratic filibuster. If the Senate completes its action, House Republican leaders hope that they, too, can approve a version of the budget resolution next week. Whether they can meet that goal is unclear.

Step Two would add details.

Republicans say they will delay the effective date of their repeal bill to avoid disrupting coverage and to provide time for them to develop alternatives to Mr. Obama’s law. They disagree over how long the delay should last, with two to four years being mentioned as possibilities.

Step Three adds in ideas from President Trump.

Within days of taking office, President-elect Donald J. Trump plans to announce executive actions on health care. Some may undo Obama administration policies. Others will be meant to stabilize health insurance markets and prevent them from collapsing in a vast sea of uncertainty.

“We are working on a series of executive orders that the president-elect will put into effect to ensure that there is an orderly transition, during the period after we repeal Obamacare, to a market-based health care economy,” Mr. Pence said at the Capitol on Wednesday.

Step Four is replacement.  For which there is no consensus.

Meanwhile Democrats are also taking action.

In the Senate next week, Democrats will demand votes intended to put Republicans on record against proposals that could protect consumers. Defenders of the law also hope to mobilize groups like the American Cancer Society and the American Heart Association to speak up for patients.

This process is far from over.  Even Republicans put implementation of a new health care law a minimum of 2 years out – just in time for mid-terms- and more likely, 4 years away – just in time for the next Presidential election.

Photograph:  Doug Mills/The New York Times

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Spring in Vermont

I’ve been gardening like crazy.  My husband and I have taken out 90% of what the previous owners had planted including the trees and have replaced them with lilacs, blueberry bushes, forsythia, and a serviceberry bush.  We also replaced two maples with a stewartia tree. (I put in a link because you probably never heard of one before. We hadn’t.)  Plus annuals and lots of perennials.  I figure that you can always take stuff out next year that doesn’t work.  All of this has helped take my mind off the mostly bad news that seems to keep coming.

Our young Stewartia tree with flowers.

Our young Stewartia tree with flowers.

Last week we caught a little break.  The Supreme Court made two decisions that, contrary to the dissenters, I think will be positive in the long run.  The first upheld the subsidies for the Affordable Care Act; the second, legalized marriage for everyone in all states.

Marriage equality began here in New England as all the local media have proudly told us.  Vermont legalized civil unions and Massachusetts was the first to sanction marriage.  As one news reader noted, “Today’s decision doesn’t really effect New England as same-sex marriage in already legal in all six states.”  That is a paraphrase, but a fact of which most New Englanders are very proud and contrasts to the defiant words from some of the Republican Presidential candidates.  Reminds me of the governors who wanted to stand in front of the school house door to prevent school integration.  Conservatives are always arguing that marriage leads to more stability so I can’t really understand why they aren’t pleased that more people will be getting married.

On the ACA, I wonder if some of the New England states like Vermont that are struggling with the necessary automation and connections to the federal exchange will just move to the federal exchange all together.  And I also wonder if states that never expanded Medicare will do so now.  But with Congressional leaders and most of the Republican Presidential candidates still hoping to repeal “Obamacare”, that is probably not likely.  In the meanwhile, more people are getting insurance and as they begin to get preventative care, costs should continue to drop.  Insurance companies, like most of us, like stability something the pro-repeal Republican should remember.

As spring slowly turns to summer here in Vermont, I’ve been thinking a lot about race.  As with many things we seem to be taking one step forward and two back.  Who would have predicted in 1964 that in 2015 we would need a new voting rights act?    Or that the unspoken racism of one of the major political parties would lead to a mass shooting in a black church?  Yes, I mean the Republican party with opposition to everything proposed by President Obama.  You can’t convince me that if the current Democratic president were someone like Jerry Brown or Tim Kaine opposition would be as virulent.  Race is at the core.  All those Senate Republicans who want to be president could prove me wrong by supporting the new voting rights legislation.  As the Washington Post pointed out, they once did so.

The Sunday after Charleston my husband and I drove down to Boston to attend church.  We wanted to attend his home church, an historically black church of which he became the first white member over twenty years ago.  The service is still traditionally African-American, but the worshippers are black, white, and Asian.  It was comforting to sit with people I have known for so many years as well as with the newcomers.  The young pastor spoke first about being “sick and tired of being sick and tired” and went on to talk about faith.  We were all given little packets of mustard seed by the children to remind us to keep the faith.  I’m finding that gardening is another way to find a measure of peace and faith that things change.  In the garden one can see the entire cycle:  planting, growth, blooms, death.  And then it begins again next spring.  We just need to keep the faith.

Photograph:  Bob Wyckoff

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As the dust settles

on the first enrollment period of the new Affordable Care Act, we are learning that a lot more people than a lot of people predicted have signed up for insurance.  President Obama is claiming 7.1 million people signed up on the health insurance exchanges – along with unknown numbers of others who signed up directly with insurance companies.  There was a claim yesterday that 90% of the enrollees had actually paid a first premium, a crucial step to being able to actually use the insurance.  We all know that there will be hassles when people go to their medical provider, when insurance cards don’t arrive in the mail, when someone with expanded Medicaid goes to a doctor who doesn’t accept that plan, but then, there have always been hassles with health insurance.  This will be nothing new.  What will be new is the massive number of new people suddenly looking for a provider.  Adjustments will have to be made all around.

But the biggest losers as of this morning would seem to be the opponents of the ACA or Obamacare as they call it.  Here is Dan Wasserman’s cartoon from this morning’s Boston Globe.

obamacare wasserman

 

And then there is this story from Politico.

Back in the fall, conservatives seized on the flubbed Obamacare rollout as proof that President Barack Obama’s brand of liberalism doesn’t work.

Now, the law’s opponents aren’t about to say that critique was wrong — but they’ve lost the best evidence they had.

On Tuesday, Obamacare sign-ups passed 7 million, six months after the launch of a federal website that could barely sign up anybody. There are still a lot of questions about how solid that figure is, but the idea that the law could even come close to the original goal after such a disastrous start would have been laughable even a few weeks ago.

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That’s left the critics questioning the early numbers or changing the subject. It’s a reminder that the attacks on the website were more than complaints about technology, but a proxy for a much deeper argument about what government should do and what it can’t do

But the Republicans do seem to be suffering from a compulsion disorder.  Here is Representative Paul Ryan quoted in the Politico story

And House Budget Committee Chairman Paul Ryan, who on the same day released a budget plan that would repeal the law, wasn’t fazed by the enrollment news.

“I think Obamacare is a slow-rolling fiasco. I think it’s a Pyrrhic victory,” the Wisconsin lawmaker said during a conference call with reporters Tuesday, at the same time that Obama was giving his victory speech in the Rose Garden.

But it was so much easier when they could just say the federal government can’t tie its own shoelaces. Now, they have to acknowledge that the government fixed the problem — and enrollment came roaring back.

Louisiana Governor Bobby Jindal is set to release his health care plan – I guess he is running for President.  According to the Washington Post

Louisiana Gov. Bobby Jindal will announce Wednesday a plan to repeal and replace President Obama’s health-care law, an effort by the Republican to insert himself into the increasingly competitive early maneuvering for his party’s presidential nomination.

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In his 26-page plan, Jindal lays out a lengthy critique of the health law — which he refers to throughout as “Obamacare” — and reiterates his belief that it needs to be entirely done away with. In its place, he sets forth a bevy of ideas that have run through conservative thought for years, in some cases renaming them and in other cases suggesting new variations on old themes.

These themes appear to include giving those on Medicare a subsidy to buy private insurance and giving Medicaid money to the states to provide whatever care they decide on.  I have a feeling that this every-state-for-itself  idea will be proven to be a real problem as people in states that didn’t accept the expanded Medicare under the ACA are faced with citizens who won’t understand why Uncle Charlie can get health insurance subsidies and they can’t.  I don’t think this is a plan people will go for – especially after they get a feel for what is covered under ACA – but at least Jindal has something.

President Obama’s poll numbers are creeping up.  Democrats running for re-election would do well to be cautious about running away from the ACA, and optimistic me says that Nate Silver might just be wrong this time with is prediction that the Republicans have the edge in the mid-terms.  It won’t be easy for the Democrats:  They have to turn out their base in larger numbers than is usual for a mid-term, but it can be done.  Nate did favor Duke which lost in the first round of the NCAA men’s basketball tournament.

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Anita Hill and Sandra Fluke: Does 20 years really make a difference?

Tonight while I was surfing around looking for updates on the Malaysian jet still missing somewhere between Malaysia and Vietnam – or perhaps somewhere else – I happened upon a long story in the New York Times about the new documentary about Anita Hill.  Sheryl Gay Stolberg’s review of the movie is actually a long profile of Hill.  I’m very happy that Hill allowed the documentary to be made because it means that a whole new generation of young men and women will be introduced to a remarkable person.

Back then there was no social media, no Facebook, no Twitter but the word still spread quickly among women that someone was about to accuse a nominee for the United States Supreme Court of sexual harassment.  No one knew exactly who she was, but we knew this was going to be important.  I was in Washington, D.C. that day at a meeting, but I remember sitting in a bar that afternoon with several other women all of us transfixed by what was happening on the television.  I was astounded that none of the men, and the Judiciary Committee was all white men, had any clue.  Stolberg puts it this way

“I think this event changed the course of her life and gave her a public mission that she took on,” said Fred Lawrence, the Brandeis president and a Yale Law School classmate of Ms. Hill’s. “It’s not a duty that she volunteered for, but I think she understood that the circumstances had put her in a unique role, and gave her a voice.”

The hearings were a surreal spectacle, as senators prodded an obviously uncomfortable Ms. Hill through awkward testimony about penis size, pubic hair and a pornographic film star known as Long Dong Silver — shocking public discourse at the time. When the hearings ended, Ms. Hill returned to teaching commercial law at the University of Oklahoma, trying, as she says in the film, to find “a new normal.” It proved difficult.

Ms. Hill at the hearings.

Ms. Hill at the hearings.

And I think every women who watched the hearings remembers that electric blue suit.

There were thousands of letters of support, but also death threats, threats to her job. Conservative state lawmakers wanted her fired; fortunately, she had tenure. Even years later, she felt “a discomfort,” she said. One dean confided that he had tired of hearing colleagues at other schools remark, “Isn’t that where Anita Hill is?”

In Washington, her testimony reverberated. Sexual harassment claims shot up. “Our phones were ringing off the hook with people willing to come forward who had been suffering in silence,” said Marcia D. Greenberger, founder and co-president of the National Women’s Law Center in Washington, where Ms. Hill serves on its board.

Congress passed a law allowing victims of sex discrimination to sue for damages, just as victims of racial discrimination could. Waves of women began seeking public office. In 1991, there were two female senators. Today there are 20.

Clarence Thomas was confirmed even though, as Hill puts it

“I believe in my heart that he shouldn’t have been confirmed,” she said in a recent interview, acknowledging that it irritates her to see Justice Thomas on the court. “I believe that the information I provided was clear, it was verifiable, it was confirmed by contemporaneous witnesses that I had talked with. And I think what people don’t understand is that it does go to his ability to be a fair and impartial judge.”

And there are still those who believe she made the whole story up. Then I started thinking about a more recent woman’s experience with Congress. This is from a story in the Daily Beast.

Rep. Darrell Issa’s Thursday hearing went off the rails early. “What I want to know,” demanded Rep. Carolyn Maloney, D-NY, as she looked at the all-male panel of clerics before her, “is, where are the women?”

The hearing, titled “Lines Crossed: Separation of Church and State. Has the Obama Administration Trampled on Freedom of Religion and Freedom of Conscience,” was about religious freedom, Issa said, but it took place against the backdrop of a national controversy regarding the White House’s mandate that all employers provide birth control as part of their insurance plans.

As it happens, there was one woman present prepared to testify on the issue of birth control. Sandra Fluke, a 30-year-old Georgetown University Law School student, had been contacted earlier in the week by committee minority leaders after Democrats saw a video of her speaking about the mandate at the National Press Club on February 9.

Sandra Fluke

Sandra Fluke

Congress had a woman to ask the question, but the panel was all men.  Fluke went on to testify at an informal hearing arranged by Democratic women.  The Huffington Post described it this way

This week she received almost rock-star treatment as the lone witness at an unofficial Democratic-sponsored hearing. While the rest of the Capitol was mostly empty, Democratic leader Nancy Pelosi, three other Democrats and dozens of mainly young women supporters crowded into a House office building room to applaud Fluke as she spoke of the importance of reproductive health care to women.

Prominently displayed by Rep. Carolyn Maloney, D-N.Y., was a photo of five religious leaders, all men and all appearing at the invitation of the Republican majority, testifying last week with Fluke visible in the background, sitting in the visitors’ section.

Democrats pounced on that image of a hearing discussing contraceptive rights being dominated by men while the one person Democrats had asked to appear on the witness stand, a woman, was turned away. Pelosi, D-Calif., said they had since heard from 300,000 people urging that women’s voices be heard on the issue.

“We almost ought to thank the chairman for the lack of judgment he had,” in denying a seat to Fluke, Pelosi said.

Committee chairman Darrell Issa, R-Calif., had said at last week’s hearing that the panel’s focus was on whether the administration policy was a violation of religious freedom. He said at the time that Fluke, invited by Democrats in her capacity as former head of Georgetown Law Students for Reproductive Justice, was not qualified to speak on the religious rights question.

“I’m an American woman who uses contraceptives,” Fluke said, when asked Thursday by Rep. Elijah Cummings, D-Md., about her qualifications to speak on the issue.

So maybe we have made progress in the years since Anita Hill.  Some Republican men don’t seemed to have learned much, but there were plenty of woman and men in Congress who wanted to hear Fluke’s testimony.  And we can thank Anita Hill for her part in making change happen.

Photograph of Anita Hill: American Film Foundation

Photograph of Sandra Fluke:  Getty Images

Daily Beast story: Matthew DeLucca

Huffington Post story: Jim Abrams

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The state of health care reform

As everyone knows, the rollout of the Affordable Care Act has been pretty bumpy what with website problems, Congress not providing funding for getting the word out, and states refusing expanded Medicaid even if it is free money.  There have been surprises also.  The red state of Kentucky with a Democratic Governor, Steve Beshear, is running a successful program.  Connecticut has an online program that it is thinking of selling to other states.  Massachusetts with the original universal health care program hired the same folks that messed up the federal website resulting in problem after problem resulting in a backlog in processing paper applications.

In the meanwhile, the Congressional Republicans would still like to either eliminate or defund the ACA, but as Greg Sargent wrote recently in the Washington Post people are beginning to move away from supporting those actions.

Obamacare is a disaster for Democrats, and a certain winner for Republicans. That’s what we keep hearing, anyway.

So why does it look as if the percentage of Americans who favor repeal may have actually shrunk since its rollout problems began?

That’s what the February tracking poll for the Kaiser Family Foundation suggests. To be sure, the new poll finds that opinion of the law is more negative than positive: 47 percent of Americans view the law unfavorably, while 35 percent view it favorably (though opinions have improved a bit since October).

But unfavorable views have not translated into support for the GOP position of repeal; indeed the repeal position may have lost ground since the October rollout problems, while a clear majority favors keeping and improving the law.

Some Kaiser survey results

Some Kaiser survey results

I think most people, including President Obama, would say that the ACA could be improved.  Any piece of legislation of that scope is going to have parts that don’t work well or have unintended consequences which need fixing.  And they need fixing in a systematic way and not just on the fly through delays and exceptions as the administration has been trying to do.  The poll results show support for making fixes.

The poll shows that 48 percent want to keep and improve the law, and another eight percent want to keep it as is — for a total of 56 percent who want to keep it. (50 percent of independents want to keep and fix.)

Meanwhile, 19 percent want to repeal the law and not replace it, while 12 percent want to repeal and replace with a GOP alternative — totaling 31 percent.

Back in October Kaiser found that 37 percent want repeal/replace or just repeal, versus 47 percent who want to keep/expand it. There was a temporary spike for repeal in December, at the height of the problems; now it appears to be back down to below where it was.

In fairness, the wording is not directly parallel. The new poll offers respondents the option of keep and improve, while the October poll offered folks keep or expand. But this underscores the point: When people are offered keep and improve — the Dem stance — support for keeping the law grows.

Paul Krugman pointed out in his last New York Times column that Republican attempts to find horror stories have so far not really succeeded.

Remember the “death tax”? The estate tax is quite literally a millionaire’s tax — a tax that affects only a tiny minority of the population, and is mostly paid by a handful of very wealthy heirs. Nonetheless, right-wingers have successfully convinced many voters that the tax is a cruel burden on ordinary Americans — that all across the nation small businesses and family farms are being broken up to pay crushing estate tax liabilities.

You might think that such heart-wrenching cases are actually quite rare, but you’d be wrong: they aren’t rare; they’re nonexistent. In particular, nobody has ever come up with a real modern example of a family farm sold to meet estate taxes. The whole “death tax” campaign has rested on eliciting human sympathy for purely imaginary victims.

And now they’re trying a similar campaign against health reform.

Krugman cites the Response to the State of the Union Address.

 In the official G.O.P. response to the State of the Union address, Representative Cathy McMorris Rodgers alluded to the case of “Bette in Spokane,” who supposedly lost her good health insurance coverage and was forced to pay nearly $700 more a month in premiums. Local reporters located the real Bette, and found that the story was completely misleading: her original policy provided very little protection, and she could get a much better plan for much less than the claimed cost.

Louisiana is running ads about people losing health care insurance with actors.

In Michigan, Americans for Prosperity is running an ad that does feature a real person. But is she telling a real story? In the ad, Julia Boonstra, who is suffering from leukemia, declares that her insurance has been canceled, that the new policy will have unaffordable out-of-pocket costs, and that “If I do not receive my medication, I will die.” But Glenn Kessler of The Washington Post tried to check the facts, and learned that thanks to lower premiums she will almost surely save nearly as much if not more than she will be paying in higher out-of-pocket costs. A spokesman for Americans for Prosperity responded to questions about the numbers with bluster and double-talk — this is about “a real person suffering from blood cancer, not some neat and tidy White House PowerPoint.”

Even supporters of health reform are somewhat surprised by the right’s apparent inability to come up with real cases of hardship. Surely there must be some people somewhere actually being hurt by a reform that affects millions of Americans. Why can’t the right find these people and exploit them?

The most likely answer is that the true losers from Obamacare generally aren’t very sympathetic. For the most part, they’re either very affluent people affected by the special taxes that help finance reform, or at least moderately well-off young men in very good health who can no longer buy cheap, minimalist plans. Neither group would play well in tear-jerker ads.

There is about a month left to sign-up before one has to pay a tax penalty for not having coverage for 2014.  The last number reported was 4 million sign-ups.  A priority:  Get the young and healthy to sign-up.

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Chart from Kaiser via the Washington Post

Picture of buttons from sites.tufts.edu