Healthcare confusion

Let’s start with Jen Sorensen

Jen Sorenson

A lot of people are confused about what the Affordable Care Act does and don’t seem to realize that their insurance will actually come from a combination of Medicaid (or Medicare (for those who qualify) and a private insurer or just from a private insurer.  This is  the kind of insurance many got (I understand there are fewer offered these days) when they retired and got Medicare Advantage from a private insurer through their former employer as I do.  My retiree’s Medicare Advantage is partly subsidized by the City of Boston but I pay a monthly premium just as I pay a monthly premium for Medicare.  The ACA changes none of this for me.  And it changes nothing about employees who get qualified plans through their employers.  But to hear some of the Republicans carry on you would think that some staffer from the Department of Health and Human Services – or maybe Kathleen Sebelius herself will be performing medical exams.

As Gail Collins explained in her New York Times column today

The Democrats are depressed. The Republicans enjoy pointing out that the Obamacare rollout has been a mess. But they obviously can’t pretend to be upset that people are finding it hard to sign up for a program their party wanted to kill, eviscerate and stomp into tiny pieces, which would then be fed to a tank of ravenous eels.

Well, actually, they can.

“I haven’t heard one of you apologize to the American public,” Representative David McKinley of West Virginia sternly told government contractors who had worked on the HealthCare.gov Web site. McKinley’s party recently shut down everything from the national parks to preschool programs, while costing the economy an estimated $24 billion. Nobody apologized. Perhaps they’ll write a note this weekend.

“I’m damned angry that I and 700,000 Texans I represent have been misled, misled and misled,” said Representative Pete Olson. The only thing that could conceivably make Olson angrier would be if the Obamacare site was working so well that Texans could get health insurance as easily as they can order a chrome scarf holder from Amazon.com.

I thought these guys would be happy that people couldn’t get insurance and that the whole enterprise was a flop.  But maybe it is just the technical failures with the website that they don’t like.  I’m very confused.  As Andy Borowitz posted ” I guess once the Obamacare website is fixed the Republicans will be totally on board.”

But I don’t think the news will be good in the long run for the Republicans who want to repeal the ACA even if access to the sign-up website gets fixed.  This post from Sarah Kliff on Ezra Klein’s Wonkblog is likely just the start.

More than 330,000 people have managed to get deep enough into new government health insurance Web sites to learn how much financial assistance they will receive purchasing coverage, the Internal Revenue Service said Saturday.

That figure is arguably the most robust measure released to date by the Obama administration of how many Americans are successfully applying for financial help in purchasing a private insurance plan.

Calculations of financial assistance is a step that follows filing an application and tells applicants how much of a tax credit–if any–they can use to purchase a private health plan. This figure does not include shoppers who were found to likely qualify for Medicaid earlier in the shopping process.

The IRS said it has also received and responded to more than 1.3 million requests from the marketplace for personal data used to apply for Affordable Care Act programs, such as household income and family size.

The IRS said it is currently receiving about 80,000 such data requests each day. It is one of about a half-dozen agencies that send information to a federal data hub, along with the Department of Homeland Security and the Social Security Administration.

“Our IT systems are working well and providing both the historical tax data and the computation service accurately and quickly through the government’s data hub,” IRS spokesman Terry Lemons said. “The requests are being processed within seconds.”

This federal data hub determines eligibility for premium tax credits for the 36 states using the federal insurance marketplace and also for some, but not all, of the state-based exchanges. California, for example, opted to use its own technology to determine who qualifies for which programs.

The federal data hub was built by the contracting firm QSSI. The Obama administration announced Friday that QSSI would take on a new role as HealthCare.gov’s general contractor, overseeing efforts to fix the Web sites’ problems.

HealthCare.gov pings this federal data hub to verify a consumer’s identity and also when shoppers indicate in their applications that they would like to apply for financial assistance with coverage. Health and Human Services has said that, as of Thursday, 700,000 applications have been filed through the federal and state insurance exchanges.

People were slow to sign up when Massachusetts rolled out Romeycare and now there is close to universal coverage.  ACA sign-up, despite the problems is going even faster.

mass_enrollment_blue

The real danger: The FISA Court

Congress and the President can say all they want to that everything about the surveillance is approved by the FISA Court.  OK.  But what do we know about this secret court?  Some revelations this past weekend by the Wall Street Journal and the New York Times tell us a great deal that I, for one, didn’t know.  For example, did you know that Chief Justice John Roberts was in charge?

The Ezra Klein/Evan Soltas Wonkblog had a great summary this morning.

The laws we live by aren’t just the bills Congress passes and the president signs. It’s what the courts decide those bills actually mean.

We’re used to that. The Affordable Care Act, for instance, says that states that don’t accept the Medicaid expansion lose all their Medicaid money. The Supreme Court decided that went too far. The law might still say that if you read the underlying bill, but it no longer means that. Now states can reject the Medicaid expansion without jeopardizing the rest of their Medicaid money — and many are.

But here’s the thing: When judges make the laws, Congress can always go back and remake the laws. The changes the court makes are public, and so is their reasoning. Both the voters and Congress know what the court has done, and can choose to revisit it.

Well, usually.

The Foreign Intelligence Surveillance Court (FISA court) that governs the national surveillance state is also remaking the law. But it’s remaking the law in secret. The public has no opportunity to weigh in, and Congress can’t really make changes, because few know what the court is deciding, and almost no one can discuss the decisions without endangering themselves.

So that’s a real Catch 22.

Surveillance types make a distinction between secrecy of laws, secrecy of procedures and secrecy of operations. The expectation is that the laws that empower or limit the government’s surveillance powers are always public. The programs built atop those laws are often secret. And the individual operations are almost always secret. As long as the public knows about and agreed to the law, the thinking goes, it’s okay for the government to build a secret surveillance architecture atop it.

But the FISA court is, in effect, breaking the first link in that chain. The public no longer knows about the law itself, and most of Congress may not know, either. The courts have remade the law, but they’ve done so secretly, without public comment or review.

These rules have been remade in a court where the government is the only witness, and there’s no possibility for appeal, and all 11 judges were chosen by Chief Justice John Roberts, and 10 of the 11 judges were Republican appointees to the federal bench. This is not a court like any other court in the United States save for the secrecy. It’s a court pretty much unlike any other in the United States.

When asked who watches over the National Security Agency’s surveillance efforts, the administration says that the FISA courts do. Trite as it may be, that leads to the age-old question: Well, then who watches over the watchers?

The answer would be to rewrite the law but how does one do that with a dysfunctional Congress and a law with impacts that no one can discuss without violating it?  As I said, a Catch-22.  But there is a proposal by Senator Jeff Merkley of Oregon and a bi-partisan group of other senators to end some of the secrecy.

We should be discussing ways to rein in the FISA Court and modify the Patriot Act.  Forget Edward Snowden.  He can stay at the Moscow airport or get smuggled to South American.  Fixing the law is what is important.

Let me end with Tom Tomorrow.

This Modern World

This Modern World

Republican gerrymandering

With the Supreme Court saying that Section 4 of the voting rights act needs a do over thus making Section 5 void, many of us are not happy.  The odds of Congress coming up with a new formula are pretty slim.  But, all may not be lost.

We know that the Republican controlled state houses used the 2010 Census to draw districts that allowed them to hold on to the House last year.  This despite Section 4 in at least some of those states.  This morning, Politico.com published a story by Alex Isenstadt in which he points out that this gerrymandering may have unintended consequences for them.

No one disputes Republicans used the once-a-decade redistricting process to  lock in their House majority — almost certainly through 2014 and possibly until  the next round of line-drawing in 2020.

But the party could pay a steep price for that dominance.

Some top GOP strategists and candidates warn that the ruby red districts the  party drew itself into are pushing House Republicans further to the right —  narrowing the party’s appeal at a time when some GOP leaders say its future  rests on the opposite happening. If you’re looking for a root cause of the  recurring drama within the House Republican Conference — from the surprise  meltdown on the farm bill to the looming showdown over immigration reform — the  increasingly conservative makeup of those districts is a good place to start.

Opposition to immigration reform by the Tea Party.

Opposition to immigration reform by the Tea Party.

These gerrymandered districts are also less diverse.

Gerrymandering and partisanship, of course, aren’t new phenomena in the  House. But the post-2010 redistricting process driven by GOP-controlled state  legislatures — Republicans wielded line-drawing power in nearly five times as  many districts as Democrats — produced significantly more districts that are  overwhelmingly conservative.

Of the 234 House Republicans, just four now represent districts that favor  Democrats, according to data compiled by The Cook Political Report. That’s down  from the 22 Republicans who resided in Democratic-friendly seats following the  2010 midterms, prior to the line-drawing.

They’re also serving districts that are increasingly white. After  redistricting and the 2012 election, according to The Cook Political Report, the  average Republican congressional district went from 73 percent white to 75  percent white. And even as Hispanics have emerged as America’s fastest-growing  demographic group, only about one-tenth of Republicans represent districts where  the Latino population is 25 percent or higher.

My Ezra Klein Wonkbook email this morning pointed out

The conventional wisdom around Washington these days is that the Republican Party needs to pass immigration reform if it’s going to survive. But remember: House Republicans aren’t the same thing as “the Republican Party.” And they probably don’t need to pass immigration reform to keep their majority. In fact, passing  immigration reform — at least with a path to citizenship — might put them in more danger. Two figures from Janet Hook in the Wall Street Journal show why.

First, “only 38 of the House’s 234 Republicans, or 16%, represent districts in which Latinos account for 20% or more of the population.”

Second, “only 28 Republican-held districts are considered even remotely at risk of being contested by a Democratic challenger, according to the nonpartisan Cook  Political Report.”

So for about 200 of the House’s Republicans, a primary challenge by conservatives angry over “amnesty” is probably a more realistic threat than defeat at the hands of angry Hispanic voters, or even angry Democrats. “Our guys actually do primary over immigration,” a top House Republican aide who wants to get immigration done told me.

Of course, that leaves some 34 Republicans who have reason to fear a Democratic challenge. And  it leaves dozens who privately support immigration reform and don’t have much to fear from either Democratic or Republican challengers.

So the Republican House members mostly represent people like themselves and need to become more conservative, not less, to keep their seats.  We aren’t talking just about immigration reform here, but a whole range of issues.  It also explains why the House’s favorite vote is to repeal the Affordable Care Act.

What does all this mean for Democratic chances to take back the House in the next election?  Isenstadt writes

New York Rep. Steve Israel, chairman of the Democratic Congressional Campaign  Committee, argued that Republicans in moderate suburban and exurban areas will  find themselves under increasing pressure in the months leading up to the  midterms.

“The problem for many Republicans in these specific districts is that if  they’re less partisan, they face a primary from the right. If they protect  themselves from a primary by being more partisan, they’re in trouble in the  general election,” Israel said. “They’re getting squeezed. We’re going to make  sure that hole is very small.”

The question is:  Are there enough of those districts for the Democrats to take the House?

It would appear that much of what is holding up legislation in the House are internal Republican fights.

When House Republicans have rallied behind legislation, it’s often been for  something deeply conservative. Two weeks ago, Republicans passed a measure that  would ban abortions after the 20th week of pregnancy. Just six GOP members  opposed the bill, including two because it didn’t go far enough.

To the conservatives, softening the GOP’s positions isn’t what’s going to  save the party in the long run.

“Political success doesn’t come from moderation,” said Arizona Rep. David  Schweikert, a Republican who opposed the farm bill and supported the  anti-abortion measure. “It’s from having principles and articulating them in a  forthright fashion.”

Schweikert, who represents a conservative Scottsdale-area district that Mitt  Romney carried with nearly 60 percent of the vote, called the Senate immigration  bill a “nonstarter.” His district is 12 percent Hispanic.

The bottom line is that so-called national Republican leaders who currently do not hold elective office along with some governors and Senators who have to run statewide campaigns can call for the party to moderate positions all they want.  The House has hitched its horse to some very conservative ideals so Republican members can get re-elected.  In the long run, this is probably good for the Democrats.

Photograph:  AP

What’s on your money?

Back in January I wrote about the new Treasury Secretary nominee’s signature.  Today, the Treasury unveiled Jack Lew’s new Hancock.

Here it is thanks to the Wonkblog on the Washington Post.

Lew sig on bill

Remember his original signature looked like this.

lew-sig old

He did promise President Obama that at least one letter would be legible and the “J” for Jacob is readable so he kept his promise.  I can’t wait until the money starts being issued.

Don’t think Ted Cruz understands government

Senator Cruz has not exactly endeared himself to his fellow Senators in the short time he has been there.  Even those in his own party.  He has been entertaining in a scary kind of way.  It’s hard to believe that he was only elected last year.  I’ve thought for awhile that he didn’t understand governing – and that that is what Senators do after all – and now maybe I understand why:  He doesn’t understand the basics of government.  Here is Ezra Klein.

Texas Republican Sen. Ted Cruz knows how to deal with the Internal Revenue Service: Get rid of it!

We ought to abolish the IRS and instead move to a simple flat tax, where the average American can fill out our taxes on a postcard. Put down how much you earn. Put down a deduction for charitable contributions and home mortgage. And put down how much you owe.

OK.  But to whom should you mail the card?  And who will check the math?

That does sound simple! But what if some citizen somewhere declines to fill out the postcard? Well, I guess we need some bureaucrat that will send them a follow-up postcard making sure they got the first postcard. If they don’t fill out that postcard, we need someone who will give them a call to make sure they’re getting these postcards.

The bottom line is follow-up and enforcement.  That is one of the things that government agencies do.  Remember your civics, Senator?  The legislature (that’s the House and Senate) passes laws, the President signs them and then someone has to make sure it happens.  This is not a function of a legislative committee.  Their role is to go back and make sure that everything functions as the law intended.  If it doesn’t, you don’t then abolish the agency but you make sure it gets fixed.  But some seem to operated on the principle that is the bath water is dirty, but throw it AND the baby out together.

And Cruz’s flat tax is actually a bit more complicated than most. It includes deductions for mortgages and charitable contributions. What if everyone says they gave a million dollars to charity and own a huge home? Who’s going to check all that out? Well, some well-meaning flat-tax collection agents, I guess.

The people doing all this need to sit somewhere. The place they sit doesn’t need to be called “The Internal Revenue Service.” It can be called “The Agency of Tax Freedom.” But it is, in effect, the Internal Revenue Service.

Ted Cruz

Maybe we have finally found the bottom line for Senator Cruz and his friends.  They want the benefits that can accrue from government, but they don’t actually understand or like it.

His plan?  That a subject to a whole ‘nother post.

Photograph from Salon.com

Taxes, taxes, taxes

Who was it that said, “Nothing is certain but death and taxes”?  They should have added tax loopholes and exemptions to that list.

Here in Massachusetts we have a Senate candidate who took at $281,000 tax credit for agreeing not to made changes to the facade of his home located in a historic district.  I don’t know how this works in other states but here local city and town councils can pass by-laws regulating historic districts.  Cohasset, the town where Gabriel Gomez lives, has a by-law on the books that says owners of homes in the historic district may not change the facades of their homes.  So Mr. Gomez basically took a tax credit for something he was prohibited from doing anyway.  Adrian Walker wrote this in the Globe this morning.

Challenged to explain, a testy Gomez set a new standard for chutzpah. He claimed that his tax break is really the fault of his opponent, Ed Markey — because in 1981, Markey voted for the law that established tax breaks for historical preservation.

OK.  So maybe taking the tax break was not illegal, but there is something about it that makes me – and it appears – other voters wonder if this is the guy we want representing us.  Plus there is the fact that most of us don’t make $281K over many years much less get to take that much off our taxes.

Walker continues

Andy Hiller of WHDH-TV cornered Gomez and asked a few questions about it, or tried to. What he got back from Gomez was this: “I don’t apologize for any success I’ve had. Absolutely not. I’m proud of everything I’ve done. I’ve worked for everything I’ve done. I’ve earned everything I’ve done.”

Gomez is an accomplished military veteran who has earned many things in his life, but he certainly didn’t earn this. Even the Internal Revenue Service has decried the historical-preservation deduction he took as a farce.

The questions about Gomez’s taxes probably haven’t ended, either.

On a financial disclosure form filed in March, Gomez said that under his separation agreement from the private equity firm Advent International, he received something called “carried interests.”

Carried interests are fees paid to equity firms and hedge funds to manage portfolios. They are taxed as capital gains, at a rate of 20 percent, rather than the top income rate of 39.5 percent.

Carried interests are fees paid to equity firms and hedge funds to manage portfolios. They are taxed as capital gains, at a rate of 20 percent, rather than the top income rate of 39.5 percent.

The carried interest rate — which costs taxpayers an estimated $1.3 billion a year — has long been the subject of dispute, with some critics arguing that this is one of the first tax loopholes lawmakers should close.

How much of Gomez’s income falls under the “carried interest” loophole is unclear from the disclosure form.

Gabriel Gomez is running as a reformer, as an outsider but as Walker points out, he already knows all the tricks.  Maybe we need someone like him to help reform the tax code – not!

Internal Revenue Service Building

Internal Revenue Service Building

Taxes are also at the heart of what the Republicans hope will be the scandal that brings down the Obama Administration if Benghazi doesn’t work out for them.  According to the New York Times this is what we know.

The Internal Revenue Service’s special scrutiny of small-government groups applying for tax-exempt status went beyond keyword hunts for organizations with “Tea Party” or “Patriot” in their names, to a more overtly ideological search for applicants seeking to “make America a better place to live” or “criticize how the country is being run,” according to part of a draft audit by the inspector general that has been given to Capitol Hill.

The head of the division on tax-exempt organizations, Lois Lerner, was briefed on the effort in June 2011, seemingly contradicting her assertion on Friday that she learned of the effort from news reports. But the audit shows that she seemed to work hard to rein in the focus on conservatives and change it to a look at any political advocacy group of any stripe.

Since last year’s elections, Republicans in Congress have struggled for traction on their legislative efforts, torn between conservatives who drove the agenda after their 2010 landslide and new voices counseling a shift in course to reflect President Obama’s re-election and the loss of Republican seats in the House and the Senate.

But the accusations of I.R.S. abuse are sure to fuel an effort that appears to be uniting dispirited Republicans and their conservative political base: investigating Mr. Obama and his administration. Republicans are pushing a portrayal of an administration overreaching its authority and punishing its enemies.

“The bottom line is they used keywords to go after conservatives,” Representative Darrell Issa of California, the chairman of the House Oversight and Government Reform Committee, said Sunday on the NBC News program “Meet the Press.” He requested the inspector general’s audit along with another Republican, Representative Jim Jordan of Ohio. As an audit, it will not find blame or refer anyone for criminal prosecution.

This all goes back to the Citizens United decision by the Supreme Count and the flood of organization, most it seems on the right to register as 501(c)4 social welfare groups.  This leaves me puzzled.  How can a group which supports political lobbying be tax exempt?  I give money to Planned Parenthood to support clinics.  I also give money for the political operations.  The first is tax exempt, the second is not.  So maybe the problem is, once again, with the tax code.  Ezra Klein explains.

Let’s try to keep two things in mind simultaneously: The IRS does need some kind of test that helps them weed out political organizations attempting to register as tax-exempt 501(c)4 social welfare groups. But that test has to be studiously, unquestionably neutral.

The story thus far seems both chilling and cheering. Employees at the agency’s Cincinnati branch did employ a test that, in effect, targeted tea party groups. Whether they meant it to be discriminatory or they simply created one that was discriminatory is in contention, but ultimately immaterial. The IRS, more so than almost any other agency, must act in ways above  reproach.

But when the Cincinnati group explained their test to IRS exempt organizations division chief Lois G. Lerner, she objected to it and it was changed. A few months later, the IRS would release new guidance that suggested scrutinizing “political action type organizations involved in limiting/expanding Government, educating on the Constitution and Bill of Rights, social economic reform movement,” and after that, “organizations with indicators of significant amounts of political  campaign intervention (raising questions as to exempt purpose and/or excess private benefit.)”

The context for all this is that after Citizens United and some related decisions, the number of groups registering as 501(c)4s doubled. Because the timing of that doubling coincided with a rise in political activism on the right rather than the left, a lot of the politicized groups attempting to register as 501(c)4s were describing their purpose in tea party terms. A popular conceit, for  instance, was that they existed to educate on the Constitution — even if the particular pedagogical method meant participating in Republican Party primaries and pressuring incumbent politicians.

In looking for that kind of language in 2010, the Cincinnati employees were attempting to create a usable shortcut. Like Willie Sutton robbing banks, they were going where the action was. But they needed a clearer test that also identified the language of the left, even if left-leaning  groups weren’t exhibiting the same surge in activism. And, frankly, it shouldn’t have been left to career employees in Cincinnati. The IRS needed clearer rules coming from the top. But the top didn’t know what to do with these 501(c)4s, in part because it feared a situation precisely like this one.

It is worth remembering an important fact here: The IRS is supposed to reject groups that are primarily political from registering as 501(c)4s. If they’re going to do  that, then they need some kind of test that helps them flag problematic applicants. And that test will have to be a bit impressionistic. It will mean taking the political rhetoric of the moment and watching for it in applications. It will require digging into the finances and activities of groups on the left and the right that seem to be political even as they’re promising their activities are primarily non-political.

If we’re not comfortable with that, then we need to either  loosen the definition of 501(c)4s or create a new designation that gives explicitly political groups the benefits of the 501(c)4s (namely, they don’t have to pay taxes and they can keep their donors anonymous). But either way, as I wrote on Friday, the only way to make sure this doesn’t keep happening is for the IRS — or the Congress and White House that control it — to make some tough decisions about 501(c)4s.

To make things look even more suspicious, Ms. Lerner appears to have been confused about the order in which events unfolded.  But, is there a scandal here?   It does not appear that any group, on the right or left has been denied 501(c)4 status.  I believe that to get 501(c)3 status which most community development groups and organizations like the Girl Scouts and the Boys and Girls clubs have one must provide a lot of information including board membership and by-laws.  The problem here is that many these new groups appear to be political organizations regardless of whether or not they claim to be educational.  I question whether any of these groups, right or left, should be tax exempt.

“Tax-exempt social-welfare groups organized under section 501(c)(4) of the Internal Revenue Code are allowed to engage in some political activity, but the primary focus of their efforts must remain promoting social welfare. That social-welfare activity can include lobbying and advocating for issues and legislation, but not outright political-campaign activity. But some of the rules leave room for IRS officials to make judgment calls and probe individual groups for further information. Organizing as such a group is desirable, not just because such entities typically don’t have to pay taxes, but also because they generally don’t have to identify their donors.” John D. McKinnon and Siobhan Hughes in The Wall Street Journal.

The odds are against Mr. Gomez being elected to the Senate and they are likely to be against the Republicans making a credible argument about the IRS, but taxes and tax exemptions are clearly land mines for anyone in politics today.  But if the Republicans are right, that is a place where the Obama Administration and I will part company.  As my Congressman Mike Capuano said today, “There’s no way in the world, I’m going to defend that. [if the accounts are true] Hell, I spent my youth vilifying the Nixon administration for doing the same thing.”

Photograph:  Reuters

Jack Lew, Secretary of the Treasury UPDATED

If Jack Lew is confirmed, we have a great thing to look forward to according to Ezra Klein.

The Treasurer signs our money.  This is Lew’s signature.

lew sig

I can’t wait to get my first bills signed by him.

But as Klein cautions

Obviously, that would turn American currency into the best money
ever. Unfortunately  there’s always the chance that Lew could ruin everything by
making his signature less, well, loopy. That’s what the fun destroyer Timothy
Geithner didwhen he became treasury secretary.

We can only hope that Mr. Lew is true to himself and we have great money for the next four years.  Don’t change your signature, Mr. Lew!

 

UPDATED:

President Obama had this today about his signature

“I had never noticed Jack’s signature” until media coverage of the looping letters on Wednesday, Obama said at the East Room ceremony where he announced his nomination of Lew. “I considered rescinding my offer to appoint him.”

Obama said he’s asked Lew to “make at least one letter legible in order to not debase our currency should he be confirmed as secretary of the Treasury.”