Spitfire List Web site and blog of anti-fascist researcher and radio personality Dave Emory.

News & Supplemental  

The GOP Pulls Off the Medicaid Band-Aid. Ouch.

A con­se­quence of last year’s Supreme Court rul­ing that upheld Oba­macare — but allowed states to opt out of the Med­ic­aid expan­sion — is that we would see GOP state gov­er­nors placed in a real dilemma: They could either accept the Med­ic­aid expan­sion and receive bil­lions of dol­lars for their state health care sys­tems from the Fed­eral gov­ern­ment at the risk of enrag­ing their far-right base of sup­port­ers. OR the gov­er­nors could reject the Med­ic­aid expan­sion, leav­ing mil­lions with­out cov­er­age but still being able to say they stood up to that evil social­ist plot to destroy Amer­ica. Deci­sions, deci­sions...:

Talk­ing Points Memo
What The ‘Oba­macare’ Deci­sion Means For Med­ic­aid
Sahil Kapur June 28, 2012, 4:58 PM

In a sur­prise move in its deci­sion to uphold the ‘Oba­macare’ man­date, the Supreme Court declared that states may opt out of the law’s Med­ic­aid expan­sion with­out los­ing all fed­eral funds for the pro­gram.

“In the 47 year his­tory of the pro­gram, there has never been a suc­cess­ful chal­lenge to any of the Med­ic­aid expan­sions, so this was rather unusual,” said Ron Pol­lack, direc­tor of the con­sumer group Fam­i­lies USA.

The deci­sion is expected to at least slow down imple­men­ta­tion of the new Med­ic­aid pro­vi­sions. If states refuse to par­tic­i­pate en masse, it could lead to sig­nif­i­cantly fewer peo­ple than the pro­jected 17 mil­lion being cov­ered under the Med­ic­aid expansion.

The Supreme Court held that the Med­ic­aid expan­sion in itself con­sti­tu­tional. But it essen­tially decreed it a new pro­gram, which means states can­not be pun­ished for turn­ing it down. The court rejected the Obama administration’s argu­ment that states must accept the expan­sion or risk los­ing all fed­eral Med­ic­aid funds.

“The prac­ti­cal effect is that it will make the Med­ic­aid expan­sions go more slowly,” said Sara Rosen­baum, a pro­fes­sor of health law at George Wash­ing­ton Uni­ver­sity. She added that it may be left to future courts to deter­mine which parts of the Med­ic­aid expan­sion count as a new pro­gram and which parts are merely addi­tions to the exist­ing one.

Repub­li­can gov­er­nors will face pres­sure to reject the Med­ic­aid expan­sion or risk being accused by con­ser­v­a­tives of will­ingly embrac­ing a big part of ‘Oba­macare.’ But there’s an incen­tive in the other direc­tion; namely: a huge cash gift from the fed­eral gov­ern­ment, which cov­ers the full cost of the first three years of expansion.

...

One of the prob­lems with not accept­ing the Med­ic­aid expan­sion is that a key assump­tion behind the cost-cutting in Oba­macare cen­ters around the idea that Med­ic­aid receipts to hos­pi­tals would go down per patient but there would be more peo­ple cov­ered by Med­ic­aid over­all. Hos­pi­tals could make up the lower per-patient rev­enue with higher vol­umes. In the states that don’t expand their Med­ic­aid cov­er­age, how­ever, the hos­pi­tals will still get paid less per Med­ic­aid patient but they won’t get the increased vol­ume of patients due to the increased cov­er­age. So it isn’t just unin­sured poor peo­ple that are in the cross-hairs of this fight. The hos­pi­tals get hurt too, along with their staff and patients. Non-profit hos­pi­tals that serve large num­bers of Med­ic­aid patients will be espe­cially hurt:

Bloomberg
Hos­pi­tals Pre­pare to Cut Care in Med­ic­aid Opt-Out States
By Stephanie Armour — May 14, 2013 12:06 PM CT

With 15 U.S. states opt­ing out of Pres­i­dent Barack Obama’s Med­ic­aid expan­sion, hos­pi­tals that treat poor and unin­sured patients are ask­ing the gov­ern­ment to delay $64 bil­lion in planned fund­ing cuts.

Med­ic­aid funds to hos­pi­tals with a dis­pro­por­tion­ate share of low-income patients will be cut 50 per­cent, or $14.1 bil­lion, from fis­cal 2014 through 2019, accord­ing to draft reg­u­la­tions to be pub­lished in the Fed­eral Reg­is­ter tomor­row. The Amer­i­can Hos­pi­tal Asso­ci­a­tion wants to delay by two years the start of the cuts for Med­ic­aid and for $49.9 bil­lion in reduc­tions by Medicare, the health pro­gram for the elderly and disabled.

“They decided not to look at the effect of health care reform,” Tom Nick­els, senior vice pres­i­dent for fed­eral rela­tions in Wash­ing­ton for the hos­pi­tal asso­ci­a­tion, said in a tele­phone inter­view today. “They don’t penal­ize states that have cho­sen not to expand.”

The reduc­tions are man­dated by Pres­i­dent Barack Obama’s Afford­able Care Act, and were sup­posed to be off­set by an increase in the num­ber of patients who would gain insur­ance through an expan­sion of state Med­ic­aid pro­grams. With some Republican-led states decid­ing not to coop­er­ate, a loss of fund­ing with­out a gain in more insured patients would ham­per hos­pi­tals abil­ity to keep car­ing for under­served populations.

“It’s a kick in the gut,” said John Blu­ford, chief exec­u­tive offi­cer of Tru­man Med­ical Cen­ters in Kansas City, Mis­souri, which esti­mates it may lose as much as $150 mil­lion in Med­ic­aid pay­ments over seven years. “These are real dol­lars. It would wipe out our margins.”

Tenet Profit

The rules being cir­cu­lated this week show Med­ic­aid would reduce the so-called DSH pay­ments by $500 mil­lion in the fis­cal 2014 year start­ing in Octo­ber. For 2015, $600 mil­lion more would be cut with the annual reduc­tions reach­ing $5.6 bil­lion in 2019.

For the first two years, the fund­ing cuts won’t be based on whether states have opted to expand Med­ic­aid. Tenet Health­care Corp. (THC), the third-largest for-profit hos­pi­tal chain in the U.S., esti­mated in Feb­ru­ary the Med­ic­aid and Medicare cuts would cost it $35 mil­lion in gov­ern­ment pay­ments in the fourth quar­ter. Dallas-based Tenet has 26 per­cent of its beds in Florida and 20 per­cent in Texas, both states where the Repub­li­can gov­er­nors have opted not to expand Medicaid.

HCA Hold­ings Inc. (HCA), the largest for-profit U.S. hos­pi­tal chain, has 25 per­cent of its beds in Texas and 25 per­cent in Florida, accord­ing to said Brian Tan­quilut, an ana­lyst at Jef­feries LLC in Los Angeles.

Sav­ing Grace

For-profit hos­pi­tals like Tenet are unlikely to pass along the costs of the cuts to con­sumers in the way of rais­ing rates to non-government pay­ers, Tan­quilut said. “They’ll eat it.”

Cuts in the Medicare DSH pay­ments also will be off­set by a sep­a­rate April 26 reg­u­la­tory pro­posal that would lead to a 0.8 per­cent net raise in over­all Medicare pay­ments for ser­vices that elderly and dis­abled patients get after being admit­ted to hos­pi­tals, Tan­quilut said by telephone.

The over­all Medicare rate — which includes the Medicare cuts to hos­pi­tals that treat a large num­ber of low-income patients — should keep HCA’s earn­ings before inter­est, taxes and amor­ti­za­tion expenses within its Feb­ru­ary 2013 guid­ance, R. Mil­ton John­son, pres­i­dent and chief finan­cial offi­cer, said on an April con­fer­ence call with investors.

The sav­ing grace for for-profit hos­pi­tals, Tan­quilut said, is that the Afford­able Care Act will bring finan­cial ben­e­fits that non­profit and pub­lic hos­pi­tals like Tru­man Med­ical won’t see. Large, urban hos­pi­tals that pro­vide the biggest share of char­ity care and treat more Med­ic­aid patients are most at risk, Moody’s Investors Ser­vice Inc. said in a March 14 report.

Tight Bind

With only about one-fifth of their patients hav­ing com­mer­cial insur­ance, these safety-net hos­pi­tals typ­i­cally have profit mar­gins of about 2.3 per­cent, a third of the indus­try­wide aver­age for all hos­pi­tals, accord­ing to 2010 data from the National Asso­ci­a­tion of Pub­lic Hos­pi­tals and Health Sys­tems. Los­ing Med­ic­aid fund­ing and not gain­ing more insured patients would swing that mar­gin from a profit to a loss of 6.1 percent.

Hos­pi­tals may try to recoup losses by lim­it­ing the amount of care they pro­vide to the unin­sured or reduc­ing staff, John Graves, an assis­tant pro­fes­sor at the Van­der­bilt Uni­ver­sity School of Med­i­cine in Nashville, Ten­nessee, said by telephone.

“They’re in a tight bind,” Graves said. “They have to recoup those losses through fewer ser­vices, shut­ting down.”

...

Death By A Thou­sand Cuts Indi­rect Hostage-Taking

To the sur­prise of many, the Obama admin­is­tra­tion called for a delay in the Med­ic­aid cuts for states that opt-out of the expan­sion. So are the hos­pi­tals out of the dan­ger zone? Well....another pre­dictable con­se­quence of all this is that, given the choice to expand health­care cov­er­age for poor peo­ple vs stick­ing it to Obama, stick­ing it to Obama was going to be a clear win­ner in a lot of states. What wasn’t obvi­ous, how­ever, was that the GOP might be will­ing to shut down the Fed­eral gov­ern­ment in order to stop Obamacare’s imple­men­ta­tion. Granted, they were most likely going to threaten to shut down the gov­ern­ment over some­thing, but lim­it­ing health­care access to poor peo­ple was never the obvi­ous play from the GOP’s play­book:

Talk­ing Points Memo
Con­ser­v­a­tives Step Up Push To Under­cut GOP On Oba­macare
Sahil Kapur Sep­tem­ber 13, 2013, 6:00 PM

Oba­macare is becom­ing a huge headache for the Repub­li­can Party.

Con­ser­v­a­tive advo­cacy groups are ral­ly­ing behind House leg­is­la­tion backed by 43 Repub­li­cans to threaten a gov­ern­ment shut­down unless Oba­macare is defunded, under­cut­ting GOP lead­ers’ efforts to lock in low spend­ing lev­els by goad­ing the party into a self-defeating confrontation.

Within 24 hours of its Thurs­day release, Sen. Mike Lee (R-UT) threw his sup­port behind the bill, as did the well-funded groups Club For Growth, Free­dom­Works and Her­itage Action.

“The Club for Growth strongly sup­ports the leg­is­la­tion offered by Con­gress­man Tom Graves to save Amer­ica from Oba­macare,” said Chris Chocola, the group’s pres­i­dent, boast­ing that “momen­tum is build­ing” to stop the health care reform law.

House GOP lead­ers, who have few votes to spare, are deter­mined to pass their pro­posal to con­tinue spend­ing at seques­tra­tion lev­els and force a Sen­ate vote to defund Oba­macare with­out risk­ing a shut­down. House lead­er­ship is open to tweak­ing the specifics but they want to achieve three goals: con­tinue the sequester, give Sen­ate Repub­li­cans a chance to fight Oba­macare and main­tain lever­age against the health care going into the debt limit fight. The 43 Repub­li­cans behind the Graves bill haven’t implic­itly com­mit­ted to oppos­ing lead­ers’ version.

...

Con­ser­v­a­tives, mean­while, are under­cut­ting — and infu­ri­at­ing — Repub­li­can lead­ers who want to be prag­matic about what they can achieve in the con­tin­u­ing res­o­lu­tion. Democ­rats, they rec­og­nize, are vul­ner­a­ble on spend­ing lev­els but won’t cave on Oba­macare. As a result, if the hard right’s desires get in the way of reaf­firm­ing seques­tra­tion cuts (even tem­porar­ily), the GOP may lose on all fronts. Vet­eran Repub­li­cans real­ize the party out of power will be blamed if the gov­ern­ment shuts down, and their nego­ti­at­ing hand weak­ened over how much it should spend upon re-opening.

The con­ser­v­a­tive oppo­si­tion to Oba­macare has become unap­peasable and it’s tear­ing the GOP apart. The base is anx­ious to make a stand now because imple­men­ta­tion of the law is set to accel­er­ate on Oct. 1 and its major com­po­nents poised to take effect on Jan. 1. Advo­cates pri­vately gloat about their chances of stick­ing it to GOP lead­ers as they mobi­lize in favor of a stand­off. Stare down Pres­i­dent Barack Obama until he blinks on his own sig­na­ture achieve­ment, they demand of the GOP, even if it means shut­ting down the gov­ern­ment. But Repub­li­can lead­ers aren’t opti­mistic that he’ll blink, and worry that ini­ti­at­ing this bat­tle could dam­age their already weak brand and threaten their oth­er­wise secure House majority.

The House GOP lead­er­ship pro­posal entails a two-pronged bill to fund the gov­ern­ment until Dec. 15 at seques­tra­tion lev­els and force the Sen­ate to vote on defund­ing Oba­macare. The Sen­ate can reject the Oba­macare com­po­nent, as is expected, and send the rest of the con­tin­u­ing res­o­lu­tion straight to the president’s desk.

Repub­li­can lead­ers ten­ta­tively plan on bring­ing up a stop­gap mea­sure next week, and aides main­tain an air of con­fi­dence about suc­cess. They face a tough road to secur­ing the votes for just about any bill to keep the gov­ern­ment open. Will they succeed?

“That remains to be seen,” said a House GOP lead­er­ship aide.

The lat­est pro­posal by House Major­ity Whip Eric Can­tor to threaten a default on the US debt in place of a gov­ern­ment shut­down threat is another very non-obvious play for the GOP to call at this point. It’s not actu­ally all that out of char­ac­ter for the GOP, but threat­en­ing to default on the national debt unless we all agree to keep lim­it­ing health care to the poor isn’t the obvi­ous best move for the GOP in this sit­u­a­tion. Every­one is used to a lit­tle zealotry for the GOP at this point but this just might be another over­reach:

TPMDC
Can­tor: If We Can’t Defund Oba­macare, Let’s Delay It
Sahil Kapur Sep­tem­ber 12, 2013, 10:40 AM

In order to per­suade con­ser­v­a­tives law­mak­ers to vote to keep the fed­eral gov­ern­ment funded past Sept. 30, House Repub­li­can lead­ers are propos­ing to stare down Pres­i­dent Barack Obama over the debt ceil­ing by seek­ing a one-year delay of Obamacare.

At a closed-door meet­ing Tues­day, House Major­ity Leader Eric Can­tor (R-VA) floated a strat­egy to delay the roll­out of Oba­macare for one year in exchange for lift­ing the debt ceil­ing. The meet­ing was focused on pitch­ing a plan that lets Repub­li­cans vote to defund Oba­macare with­out risk­ing a gov­ern­ment shut­down if the Sen­ate rejects the idea, a move that is meet­ing fierce resis­tance on their right flank, which wants to go further.

A senior Repub­li­can aide famil­iar with Cantor’s remarks said he was essen­tially try­ing to per­suade his mem­bers that the debt limit, which the fed­eral gov­ern­ment is expected to hit in mid-October, pro­vides a bet­ter oppor­tu­nity than a threat­ened gov­ern­ment shut­down to under­mine Obamacare.

“He didn’t draw any red lines,” said the GOP aide. “He said it’s a bet­ter oppor­tu­nity than [the con­tin­u­ing res­o­lu­tion] and a delay there is very doable.” The aide added that the con­ces­sion wouldn’t nec­es­sar­ily just involve Oba­macare; there could be other reforms. The aide admit­ted that it depends in part on what the pres­i­dent is will­ing to give up.

It all sounds far-fetched. After all, trad­ing a gov­ern­ment shut­down for default would be like trad­ing a com­mon cold for can­cer. And it remains to be seen whether GOP lead­ers would let the econ­omy col­lapse if they don’t get their way, or if they’re merely say­ing what they have to say to get through the shut­down crisis.

An upside to propos­ing the debt ceil­ing idea now is that it helps per­suade Repub­li­can law­mak­ers not to with­hold their sup­port for keep­ing the gov­ern­ment open. Cantor’s sug­ges­tion this week comes as Repub­li­cans are tak­ing heavy fire from con­ser­v­a­tive advo­cates for refrain­ing from risk­ing a gov­ern­ment shut­down over Oba­macare. House lead­ers have post­poned con­sid­er­a­tion of the con­tin­u­ing res­o­lu­tion until next week to build support.

Last month, Speaker John Boehner (R-OH) floated the idea of delay­ing or defund­ing the health care reform law in a debt ceil­ing pack­age. But he, too, stopped short of draw­ing any red lines. A lead­er­ship aide described it at the time as an “option.”

Despite the anti-Obamacare frenzy con­sum­ing their right flank, Repub­li­can lead­ers rec­og­nize that both a shut­down and default would be a dis­as­ter for their party, poten­tially threat­en­ing their House major­ity ahead of a mid-term elec­tion when they hope to win back the Sen­ate. Their bal­anc­ing act to sat­isfy con­ser­v­a­tives enough to avert a shut­down but not to cre­ate expec­ta­tions that threat­en­ing debt default is the way to go.

...

Then again, maybe this isn’t over­reach at all that we’re look­ing at. Maybe it’s really an incred­i­bly sneaky plan to simul­ta­ne­ously limit access to health­care for peo­ple (a core value held by much of the con­tem­po­rary GOP base) AND blame it all on Oba­macare. At least in some states...states that don’t accept the Med­ic­aid expan­sion. Because by threat­en­ing to shut­down the gov­ern­ment or default­ing on the debt over their oppo­si­tion to Oba­macare the GOP is still going to destroy the finances of hos­pi­tals in the states that refuse to accept the Med­ic­aid expan­sion. That’s because that delay in the Med­ic­aid cuts that the Obama admin­is­tra­tion agreed to in May can’t actu­ally be imple­mented until Con­gress passes a bud­get. Now all they have to do is ensure that the pub­lic blames all the hos­pi­tal clo­sures and health­care prob­lems that results from these cuts on Oba­macare and not the per­pet­ual bud­get and health­care war­fare waged by the GOP which shouldn’t be too hard to do. If this wasn’t an acci­dent, it was kind of bril­liant. Except for the part about how the GOP has to explain shut­ting down the gov­ern­ment or default­ing on the national debt. So it’s pos­si­ble that the GOP is oper­at­ing in “Mad Dog” mode right now, and given the larger debt bat­tles that are swirling around this issue, this is poten­tially a much scarier story about polit­i­cally and ideologically-driven attempts to restrict health care to poor peo­ple than sto­ries about polit­i­cally and ideologically-driven attempts to restrict health care to poor peo­ple nor­mally are:

TPM­Livewire
With­out New Bud­get, HHS Final­izes $1.1 Bil­lion in Med­ic­aid Hos­pi­tal Cuts
Dylan Scott 4:58 PM EDT, Fri­day Sep­tem­ber 13, 2013

Because a grid­locked Con­gress won’t be pass­ing a new bud­get any­time soon, the U.S. Depart­ment of Health and Human Ser­vices final­ized a rule Fri­day for $1.1 bil­lion in Med­ic­aid cuts to hos­pi­tals under the Afford­able Care Act, cuts that could hit hos­pi­tals par­tic­u­larly hard in states that don’t expand Med­ic­aid through the law.

Pres­i­dent Obama pro­posed post­pon­ing the cuts one year in his FY 2014 bud­get because not every state is expand­ing Med­ic­aid as orig­i­nally planned. The cuts, which are to pay­ments for hos­pi­tals that per­form a lot of uncom­pen­sated care, were included in Oba­macare because the law would cover more peo­ple, decreas­ing the over­all amount of uncom­pen­sated care.

The president’s pro­posal reflected the real­ity that 20-plus states have refused to expand Med­ic­aid cov­er­age under the health care reform law. If the cuts went into effect, hos­pi­tals in those non-expanding states would receive smaller reim­burse­ments from HHS with­out the com­pen­satory expan­sion of cov­er­age.

But with­out a new bud­get from Con­gress, HHS wasn’t able to imple­ment the president’s proposal.

“HHS has no flex­i­bil­ity to insti­tute a delay of the DSH allot­ment reduc­tions with­out con­gres­sional action,” the rule released Fri­day said.

...

For those gov­er­nors that still fear a dystopian world free of unin­sured poor peo­ple It might worth remind­ing them that there would still unin­sured peo­ple left in their states even if they accept it. It’s a long shot, but it just might work.

Discussion

47 comments for “The GOP Pulls Off the Medicaid Band-Aid. Ouch.”

  1. No man­ner what one may think about Oba­macare, the Repub­li­can have noth­ing to offer. Even my dog under­stands that.

    Posted by David | September 15, 2013, 5:13 pm
  2. @David: What makes the whole sit­u­a­tion even sad­der is that the GOP used to have an alter­na­tive to offer before Oba­macare was cre­ated. That alter­na­tive was, of course, Oba­macare:

    Mother Jones
    25 Repub­li­cans Who Sup­ported Oba­macare Before Obama

    —By Erika Eichel­berger
    | Tue Aug. 27, 2013 3:00 AM PDT

    Repub­li­cans have pulled out all the stops to kill Oba­macare, the president’s land­mark health care law that requires every Amer­i­can to pur­chase health insur­ance by 2014. There have been law­suits; there have been bills (40 in the House so far); there has been a Supreme Court case—all aimed at rolling back a law that that the GOP says is an assault on indi­vid­ual lib­erty. Now, with only a few more months to go until the indi­vid­ual mandate—the require­ment that we all have coverage—kicks in, Repub­li­cans are fran­tic; some are even threat­en­ing to force the United States to default on its debts if Democ­rats don’t agree to delay the law.

    This is odd because the indi­vid­ual man­date, the cor­ner­stone of Oba­macare, was orig­i­nally a con­ser­v­a­tive idea. It was first pro­posed by the Her­itage Foun­da­tion in 1989. And scores of Repub­li­cans—not just Mitt Rom­ney—have backed the idea in the past cou­ple of decades. Here are some of the GOP­ers who sup­ported Oba­macare before Obama:

    1. Rick San­to­rum? The Allen­town Morn­ing Call reported sev­eral times in 1994 that San­to­rum wanted to “require indi­vid­u­als to buy health insur­ance rather than forc­ing employ­ers to pay for ben­e­fits.” San­to­rum denies alle­ga­tions that he ever sup­ported an indi­vid­ual mandate.

    2. Pres­i­dent George H.W. Bush: In 1991, Mark Pauly, an adviser to the first Bush, and now a con­ser­v­a­tive health econ­o­mist, came up with a Heritage-style health care pro­posal for the pres­i­dent as an alter­na­tive to the employer-based man­date that Democ­rats were push­ing at the time.

    3. For­mer Vice Pres­i­dent Dan Quayle: He was down with the Her­itage idea too.

    4. Mitt Rom­ney: Rom­n­ey­care was Romney’s sig­na­ture leg­isla­tive achieve­ment as gov­er­nor of Mass­a­chu­setts, and it served as a model for Oba­macare. Dur­ing the 2012 cam­paign, the pres­i­den­tial con­tender had trou­ble decid­ing what his posi­tion was on Oba­macare, and he deflected the blame for hav­ing con­ceived a sim­i­lar plan; at one debate he noted that “we got the idea of an indi­vid­ual mandate…from [Newt Gingrich].”

    5. Newt Gin­grich: Though he reversed his posi­tion in May 2011, Gin­grich had been a big sup­porter of the indi­vid­ual man­date since his early days in the House. In 1992 and 1993, when Repub­li­cans were look­ing for alter­na­tives to Hillary Clinton’s health care plan, many, includ­ing then-House minor­ity whip Gin­grich, backed the Her­itage idea. (Gin­grich has said that most con­ser­v­a­tives sup­ported an indi­vid­ual man­date for health insur­ance at the time.)

    Twenty of his fel­low GOP­ers cospon­sored a 1993 health care bill which included an indi­vid­ual man­date and vouch­ers for poor peo­ple. As health scholar Avik Roy wrote at Forbes in 2012, “Given that there were 43 Repub­li­cans in the Sen­ate of the 103rd Con­gress, these 20 com­prised nearly half of the Repub­li­can Sen­ate Cau­cus at that time.” Here are those lawmakers:

    ...

    Posted by Pterrafractyl | September 16, 2013, 8:35 am
  3. Here’s a nice pre­view of what’s com­ing:

    TPM­LiveWire
    Rubio: Obama Should Stop Threat­en­ing Gov­ern­ment Shutdown

    Igor Bobic – Sep­tem­ber 18, 2013, 3:26 PM EDT

    Sen. Marco Rubio (R-FL) thinks Pres­i­dent Barack Obama is the one who should stop threat­en­ing to shut down the gov­ern­ment, despite a newly announced plan by House Repub­li­cans adding lan­guage to a stop­gap mea­sure that would defund Oba­macare in order to avert a gov­ern­ment shutdown.

    “The Amer­i­can peo­ple have made clear they want Wash­ing­ton to keep the gov­ern­ment open but also need pro­tec­tion from ObamaCare’s harm­ful effects,” Rubio said in a state­ment. “Today’s announce­ment would accom­plish what the Amer­i­can peo­ple have been ask­ing of Congress.”

    “A solu­tion is within sight in order to avert another cri­sis of Washington’s cre­ation,” he added. “Pres­i­dent Obama and his allies in Con­gress should aban­don their threats of shut­ting down the gov­ern­ment and instead work with Repub­li­cans to pass this pro­posal that would keep gov­ern­ment open while pre­vent­ing tax­payer dol­lars from being used to inflict ObamaCare’s dam­age on people’s jobs, incomes, cur­rent health plans and doc­tor relationships.”

    If that sounds famil­iar, it’s because it’s a pre­view we’ve seen before:

    The Hill
    Rubio blames Obama for threats of shut­down
    By Jonathan Easley — 07/25/13 09:44 AM ET

    Sen. Marco Rubio (R-Fla.) argued Thurs­day that it’s Pres­i­dent Obama, not Repub­li­can lead­ers in the House and Sen­ate, who is respon­si­ble for threats of a gov­ern­ment shut­down over the imple­men­ta­tion of ObamaCare.

    “This Sep­tem­ber, Con­gress will have to pass another short term spend­ing bill to fund the fed­eral gov­ern­ment,” Rubio wrote in an op-ed for Fox News.

    “We should pass one that keeps the gov­ern­ment open, but doesn’t waste any more money on Oba­maCare. The pres­i­dent and his allies – and even some Repub­li­cans – will accuse us of threat­en­ing to shut down the gov­ern­ment. In fact, it is Pres­i­dent Obama who insists on shut­ting down the gov­ern­ment unless it funds his failed Oba­maCare exper­i­ment.

    Sen. Mike Lee (R-Utah) says he’s recruited more than a dozen Repub­li­can col­leagues will­ing to shut down the gov­ern­ment by block­ing a con­tin­u­ing res­o­lu­tion to fund the gov­ern­ment beyond Sept. 30 if it includes fund­ing for ObamaCare.

    The sec­ond– and third-ranking mem­bers of Repub­li­can lead­er­ship, Sens. John Cornyn (Texas) and John Thune (S.D.), have said they sup­port Lee’s plan, as do influ­en­tial con­ser­v­a­tives and poten­tial pres­i­den­tial can­di­dates Sens. Marco Rubio (Fla.) and Ted Cruz (Texas).

    ...

    Rubio on Thurs­day said the law should be replaced with “market-based” reforms.

    “It is time to admit that Oba­maCare isn’t going to work, decide not to waste a sin­gle cent more on it, and replace it with market-based reforms that will give peo­ple more health insur­ance choices and options,” he wrote.

    Posted by Pterrafractyl | September 19, 2013, 8:04 pm
  4. What’s that? The Cleve­land Clinic just announced a bunch of lay­offs that are all caused by that das­tardly Obamacare?

    Cleve­land Clinic announces job cuts to pre­pare for Obamacare

    By Kim Palmer

    CLEVELAND | Wed Sep 18, 2013 5:23pm EDT

    (Reuters) — The world-renowned Cleve­land Clinic said on Wednes­day it would cut jobs and slash five to six per­cent of its $6 bil­lion annual bud­get to pre­pare for Pres­i­dent Barack Obama’s health reforms.

    The clinic, which has treated celebri­ties and world lead­ers such as musi­cian Lou Reed, for­mer Ital­ian Prime Min­is­ter Sil­vio Berlus­coni and for­mer Olympic gold medal skater Scott Hamil­ton, did not say how many of its 44,000 employ­ees would be laid off. But a spokes­woman said that $330 mil­lion would be cut from its annual budget.

    “Some of the ini­tia­tives include offer­ing early retire­ment to 3,000 eli­gi­ble employ­ees, reduc­ing oper­a­tional costs, stricter review of fill­ing vacant posi­tions, and lastly work­force reduc­tions,” said Eileen Sheil, Exec­u­tive Direc­tor of Cor­po­rate Com­mu­ni­ca­tions for the Cleve­land Clinic Foundation.

    The clinic is Cleveland’s largest employer and the sec­ond largest in Ohio after Wal-Mart. It is the largest provider in Ohio of Med­ic­aid health cov­er­age for the poor, the pro­gram that will expand to cover unin­sured Amer­i­cans under Obamacare.

    “We know we are going to be reim­bursed less,” under Med­ic­aid, Sheil said.

    Cleve­land Clinic has almost 100 loca­tions around Ohio employ­ing 3,000 doc­tors. Its main cam­pus is world renowned for can­cer and car­dio­vas­cu­lar treatment.

    “To pre­pare for health­care reform, Cleve­land Clinic is trans­form­ing the way care is deliv­ered to patients,” Sheil said with­out elaborating.

    ...

    A 2009 study by the clinic con­cluded that it accounts for nearly eight per­cent of the eco­nomic out­put of north­east Ohio.

    A key part of Oba­macare, offi­cially known as the Afford­able Care Act, goes into effect on Octo­ber 1, when states are sup­posed to begin offer­ing Amer­i­cans health insur­ance options through online exchanges to com­pare prices.

    Uh oh, it sounds like Oba­macare is a job killing destroyer of worlds...it’s just like Fox News warned us!

    Oh wait, no it isn’t:

    The Atlantic
    Oba­macare Isn’t Really Tak­ing Away Jobs: Cleve­land Clinic Edi­tion
    The pres­ti­gious sys­tem says bud­get cuts have more to do with the need to find effi­cien­cies. “We felt health-care reform was absolutely nec­es­sary,” a spokes­woman said.
    David A. Gra­ham Sep 20 2013, 11:08 AM ET

    As the clock ticks down to full imple­men­ta­tion of the Afford­able Care Act, a trickle of sto­ries about job losses related to the law has turned into a steady flow. Over the week­end, the story was that Emory Health­care was axing 100 jobs in response — an expla­na­tion that turned out not to be true.

    It didn’t take a long time for another exam­ple of hos­pi­tals cut­ting back in the face of Oba­macare to pop up, though. On Wednes­day, the Cleve­land Clinic announced it would cut its bud­get and staff. Here’s how Reuters reported the news:

    The world-renowned Cleve­land Clinic said on Wednes­day it would cut jobs and slash five to six per­cent of its $6 bil­lion annual bud­get to pre­pare for Pres­i­dent Barack Obama’s health reforms.

    The clinic, which has treated celebri­ties and world lead­ers ... did not say how many of its 44,000 employ­ees would be laid off. But a spokes­woman said that $330 mil­lion would be cut from its annual budget.

    Later on, the story quoted Eileen Sheil, the clinic’s Exec­u­tive Direc­tor of Cor­po­rate Com­mu­ni­ca­tions, say­ing, “We know we are going to be reim­bursed less” under Medicaid.

    That expla­na­tion seemed ques­tion­able, because the cost reduc­tions to Med­ic­aid in the ACA are much smaller than reduc­tions to Medicare — the gov­ern­ment will reim­burse providers less for giv­ing care to Medicare patients than before. While the mech­a­nisms aimed at pro­vid­ing uni­ver­sal insur­ance have got­ten more atten­tion, this is part of the law’s other goal: an attempt to “bend the cost curve” (administration-speak for slow­ing the growth of health-care spend­ing) in the law Dur­ing the 2012 pres­i­den­tial cam­paign, the Rom­ney cam­paign attacked Obama for cut­ting Medicare, though the admin­is­tra­tion says patients should receive the same care; will just be paid less for it.

    In fact, the “Oba­macare is killing jobs” story isn’t really accu­rate. It’s not totally false — the Cleve­land Clinic will in fact take in less money because of the law — but it’s a more com­pli­cated story about changes in med­i­cine. When I reached Sheil on Thurs­day, she seemed a bit con­fused by the empha­sis on Oba­macare in reports. “We’ve been work­ing on reduc­ing costs for years,” she said.

    “We felt health-care reform was absolutely nec­es­sary,” Sheil said. “This is the new nor­mal. This is where hos­pi­tals have to focus to be viable in the long run. This is not dooms­day for the clinic. We’re still grow­ing — we’re still hir­ing. The hard­est thing is when it affects people.”

    Actu­ally, much of what the Cleve­land Clinic sys­tem is doing fol­lows the rec­om­men­da­tions of health-care ana­lysts closely. For exam­ple, it has con­sol­i­dated closely located neona­tal inten­sive care units, because high vol­umes tend to lead to bet­ter results. It’s work­ing to reduce the num­ber of pro­ce­dures its staff per­forms, since in the cur­rent sys­tem “physi­cians are rewarded to do more, not to do the right thing for the patient,” as Sheil put it. And there’s a new focus on chronic dis­eases, which are an increas­ingly impor­tant and costly area for treatment.

    Think of it this way: These are all steps that the Cleve­land Clinic was likely to take, but Oba­macare imple­men­ta­tion is act­ing as a cat­a­lyst, spurring the clinic to adopt them now rather than on a slower timeline.

    This isn’t to absolve the ACA of any role in the cuts at all. The rev­enue reduc­tion because of the law is real. Pretty much every­one agrees that the spi­ral­ing costs of health care in the U.S. threaten — through Med­ic­aid and Medicare — the nation’s long-term fis­cal health.

    ...

    Ah, so it looks like all planned cuts to health care costs — includ­ing the reduc­tion in Med­ic­aid reim­burse­ments and uncom­pen­sated care (pay­ments for ser­vices to peo­ple with­out health­care) that are vital to attempts to “bend the [health­care cost] curve” — are going to be por­trayed as some sort of sign that Oba­macare is destroy­ing health­care in America...even in the states that reject the Med­ic­aid expan­sion:

    UPDATE 1-Obamacare sup­port­ers in Ohio begin peti­tion drive to expand Med­ic­aid
    Thu Sep 19, 2013 7:20pm EDT
    By Mary Wisniewski

    (Reuters) — An Ohio panel on Thurs­day approved a peti­tion designed to pres­sure the Republican-led state leg­is­la­ture to expand the Med­ic­aid health pro­gram for the poor as part of Pres­i­dent Barack Obama’s health reform law.

    The aim is to allow about 275,000 addi­tional Ohio res­i­dents to be eli­gi­ble for Med­ic­aid under the new reform law, a pro­posal sup­ported by Repub­li­can Gov­er­nor John Kasich but not yet acted on by state lawmakers.

    ...

    Kasich, who opposes Oba­macare, had endorsed the expan­sion of Med­ic­aid last Feb­ru­ary, rais­ing hopes that Ohio would join some 25 states and the Dis­trict of Colum­bia mov­ing for­ward with expand­ing Med­ic­aid. Another 22 states are opposed to Med­ic­aid expan­sion and three, includ­ing Ohio, are still debat­ing the issue, accord­ing to the Kaiser Fam­ily Foundation.

    The expan­sion of Med­ic­aid is a major plank of the health reform law which aims to ensure that all Amer­i­cans have access to afford­able health insurance.

    The bal­lot board’s deci­sion came a day after the world-renowned Cleve­land Clinic, Ohio’s largest provider of Med­ic­aid cov­er­age, announced that it would cut jobs and slash five to six per­cent of its bud­get, partly because of an expected decline in fed­eral reim­burse­ments for the cost of treat­ing poor peo­ple who lack insurance.

    Oba­macare will begin reduc­ing pay­ments to hos­pi­tals for uncom­pen­sated care for the poor next year. But hos­pi­tals in states that expand Med­ic­aid are expected to require sub­stan­tially less money, because more of their poor patients will have health cov­er­age through the expansion.

    Posted by Pterrafractyl | September 23, 2013, 7:56 am
  5. Well this is kind of inter­est­ing: the fight over Oba­macare and the Med­ic­aid expan­sion is cre­at­ing a split between the Tea Party base and what’s left of the non-Tea Party con­tin­gent of the GOP. Deny­ing health care to poor peo­ple and higher rev­enues for big busi­nesses are rarely in con­flict, but right now they are. And, to their credit, the Tea Party is advo­cat­ing the non-revenue-maximizing pol­icy. If sense­lessly deny­ing health care to poor peo­ple wasn’t so morally rep­re­hen­si­ble one could almost con­grat­u­late the Tea Party for their prin­ci­pled stance:

    Bloomberg
    Hos­pi­tals Brace as Repub­li­cans Fight Over Med­ic­aid
    By Mark Niquette & Brian Chap­patta — Sep 19, 2013 12:24 PM CT

    Phil Ennen runs a rural hos­pi­tal sys­tem in north­west Ohio that admits about 2,500 peo­ple a year, many of them poor or elderly. He’s got the only emer­gency car­diac catheter­i­za­tion lab between Toledo and Fort Wayne, Indiana.

    Ennen esti­mates he’d be out $1.3 mil­lion a year and strug­gle to stay inde­pen­dent if busi­ness groups and Gov­er­nor John Kasich can’t per­suade fel­low Repub­li­cans to expand Med­ic­aid to cover more poor peo­ple under Pres­i­dent Barack Obama’s Afford­able Care Act.

    “I don’t have any time to be polit­i­cal about this,” Ennen, 50, said in a tele­phone inter­view from Bryan. “I’m going to have peo­ple walk­ing through our door need­ing care who should have a source of pay­ment and won’t, and that’s frustrating.”

    Ohio is among U.S. states where Tea Party Repub­li­cans have blocked Med­ic­aid expan­sion, in some cases over the objec­tions of other Repub­li­cans and busi­ness lob­bies that have tra­di­tion­ally sup­ported the party. Hos­pi­tal lead­ers say the cost will be lost pay­ments and jobs. The finan­cial effect is evi­dent: Facil­i­ties in states broad­en­ing the pro­gram are already enjoy­ing lower bor­row­ing costs.

    The fight reflects an inten­si­fy­ing rift between busi­ness and the Tea Party over high-profile issues, said John Green, a Uni­ver­sity of Akron political-science pro­fes­sor. Besides Med­ic­aid, they include efforts in states includ­ing Indi­ana and North Car­olina to halt or delay Com­mon Core edu­ca­tion stan­dards to pre­pare stu­dents for col­lege or careers, the right to bring guns to work in Alabama and on immi­gra­tion in sev­eral places.

    Break­ing Ranks

    “Once upon a time, if the big eco­nomic inter­ests said, ‘This is what we’re for,’ almost all Repub­li­cans would get in line,” Green said in a tele­phone inter­view. “The cal­cu­lus is just a lot dif­fer­ent today.”

    Twenty-five states and the Dis­trict of Colum­bia are pro­ceed­ing with Med­ic­aid expan­sion, includ­ing eight with Repub­li­can gov­er­nors. Twenty-two aren’t and debate is con­tin­u­ing in New Hamp­shire, Ohio and Ten­nessee, accord­ing to the Kaiser Fam­ily Foun­da­tion, a non­profit group that stud­ies health in Menlo Park, Cal­i­for­nia.
    State Lines

    In Ohio, a pres­i­den­tial bat­tle­ground that Obama won twice, Repub­li­cans con­trol all statewide offices and the leg­is­la­ture. Its law­mak­ers have blocked a push to expand Med­ic­aid by Kasich, the state Cham­ber of Com­merce and groups includ­ing the anti-abortion orga­ni­za­tion Ohio Right to Life.

    A coali­tion of busi­ness groups is col­lect­ing sig­na­tures to force a ref­er­en­dum on the ques­tion next year if law­mak­ers won’t act, and Kasich is con­sid­er­ing ways to open the pro­gram with­out a vote by the full legislature.

    If all states par­tic­i­pated in the Med­ic­aid expan­sion, hos­pi­tals would see a $12.5 bil­lion spend­ing boost in 2014, accord­ing to an analy­sis by Bloomberg Gov­ern­ment. About $7.8 bil­lion, or 63 per­cent, won’t be spent in the 25 states that have so far decided not to expand. The increased spend­ing in Ohio would be $458.4 mil­lion, the analy­sis said.

    Ohio hos­pi­tals will lose $7.4 bil­lion dur­ing the next decade from reduced reim­burse­ments if the state doesn’t expand Med­ic­aid, said Mike Abrams, pres­i­dent of the Ohio Hos­pi­tal Association. Hos­pi­tals that are the largest employ­ers in 78 of Ohio’s 88 coun­ties may fire employ­ees or close, he said.

    ...

    Cov­er­ing Action

    The gov­er­nor is try­ing to appeal to inde­pen­dents for his re-election in 2014, while busi­ness groups and the “hospital-industrial com­plex” are exag­ger­at­ing to get “free money,” said Matt Mayer, pres­i­dent of Oppor­tu­nity Ohio, a Colum­bus group that pro­motes free markets.

    “It doesn’t solve the busi­ness prob­lem, which is how do we make sure that our vul­ner­a­ble pop­u­la­tions who truly need med­ical care and access thereto that’s afford­able, get it?” Mayer said by phone. He called hos­pi­tals’ threats “a scare tac­tic,” and said states oppos­ing expan­sion are sav­ing the nation bil­lions of dollars.

    Even so, investors in the $3.7 tril­lion municipal-debt mar­ket are already penal­iz­ing bonds from hos­pi­tals in states that aren’t expand­ing Med­ic­aid com­pared with those in states that are.

    ...

    Repub­li­can lead­ers who cater too much to busi­ness are out of step with the rank and file, said Whit­ney Neal of Free­dom­Works, a Washington-based group con­nected with the Tea Party movement.

    “You’re see­ing the guys that care about their con­stituents ver­sus the guys that care about the peo­ple who they’re beholden to, the spe­cial inter­est groups,” Neal said in a tele­phone interview.

    Sup­port­ing issues such as Med­ic­aid expan­sion could draw a pri­mary oppo­nent for Repub­li­can law­mak­ers in con­ser­v­a­tive dis­tricts, Green said. The abil­ity of party lead­ers to influ­ence pol­icy also has waned as social media and tech­nol­ogy con­nected con­ser­v­a­tives and gave them a plat­form, said Kevin Mad­den, a Repub­li­can strate­gist in Wash­ing­ton who advised Mitt Romney’s 2012 pres­i­den­tial campaign.

    “Tech­nol­ogy has really empow­ered a lot of grass­roots voices within the party,” Mad­den said in a tele­phone inter­view. “As a result, I think that they’ve gained a much greater mar­ket share of influ­ence in these debates in states and in Washington.”

    Ah, the Tea Party, fight­ing for the lit­tle guy. When you have patri­ots like this look­ing out for the com­mon good hav­ing a gov­ern­ment almost seems unnec­es­sary!

    TPM LiveWire
    Poll: Vast Major­ity Of Tea Party Prefers Gov­ern­ment Shut­down Over Com­pro­mise
    Tom Kludt – Sep­tem­ber 23, 2013, 1:42 PM EDT
    A huge major­ity of tea party types want like­minded law­mak­ers to defend by their con­vic­tions even if it results in a gov­ern­ment shut­down, plac­ing the ultra-conservative con­tin­gent sharply at odds with the rest of the country.

    The lat­est find­ings released Mon­day by Pew Research Cen­ter found 71 per­cent of tea party Repub­li­cans want law­mak­ers who share their views to stand by their prin­ci­ples even if doing so leads to a gov­ern­ment shut­down. Only 20 per­cent of tea partiers said they want those law­mak­ers to com­pro­mise, even if it leads to a bud­get with which they dis­agree. Repub­li­cans in gen­eral were more divided, but a plu­ral­ity — 49 per­cent — still said they would rather have their law­mak­ers stand by their prin­ci­ples rather than compromise.

    ...

    Another poll released Mon­day found a major­ity of Amer­i­cans opposed to a gov­ern­ment shut­down over the quixotic effort to defund the health care law.

    Posted by Pterrafractyl | September 23, 2013, 1:43 pm
  6. It’s increas­ingly look­ing like the GOP’s grand strat­egy for the Oba­macare government-shutdown deba­cle is going cen­ter around pre­tend­ing that it’s the Democ­rats that are threat­en­ing a gov­ern­ment shut down/debt default while simul­ta­ne­ously bask­ing on the Tea Party glory that comes from obstruct­ing the imple­men­ta­tion of Oba­macare. It’s a boldly strange strat­egy. Bombs away Teddy! You’re right on tar­get:

    TPM LiveWire
    Ted Cruz: Harry Reid Engag­ing In Brinkman­ship Over Bud­get, Debt

    Igor Bobic – Sep­tem­ber 23, 2013, 5:01 PM EDT

    Sen. Ted Cruz (R-TX) believes Sen­ate Major­ity Leader Harry Reid (D-NV) is the one engag­ing in brinkman­ship over the bud­get and debt limit, and he staged a series of pro­ce­dural motions Mon­day that involve defund­ing Oba­macare in order to say so.

    After Reid objected to Cruz’s request for unan­i­mous con­sent to pass a House GOP con­tin­u­ing res­o­lu­tion that funds the gov­ern­ment but also defunds Oba­macare on the Sen­ate floor, the junior sen­a­tor from Texas cast the major­ity leader as the one threat­en­ing to take the coun­try over the edge.

    “I wish the major­ity leader had agreed to my request to take a gov­ern­ment shut­down off the table by pass­ing the House con­tin­u­ing res­o­lu­tion,” Cruz said. “If we lis­ten to the Amer­i­can peo­ple, we will, num­ber two, take any default on the debt off the table. I wish the major­ity leader had not objected to doing so right now.”

    “I wish the major­ity leader had not said he intends to con­tinue to use the threat of a default to engage in brinkman­ship to try to force it on the Amer­i­can peo­ple — to try to force oba­macare on the Amer­i­can peo­ple,” he added.

    Posted by Pterrafractyl | September 23, 2013, 6:25 pm
  7. This is kind of amus­ing: One of the con­se­quences of reject­ing the Med­ic­aid expan­sion in states like Ohio and Texas is that the future cost of health­care in those states is going to be a lot more depen­dent on the costs of the new pri­vate health insur­ance exchanges that are about to open. So these states should be cheer­ing the news that the cost of these pri­vate options looks to be 16% lower, on aver­age, than orig­i­nally pro­jected. Then again, maybe gov­er­nors like Rick Perry in states that rejected the Med­ic­aid expan­sion don’t feel like remind­ing peo­ple that — by forc­ing lower-income patients onto pri­vate health insur­ance instead of Med­ic­aid and leav­ing more peo­ple unin­sured than oth­er­wise would be — they’re also push­ing up the costs of pri­vate insur­ance for every­one else in their state:

    Dal­las News
    Study says Texas pre­mi­ums will rise with Med­ic­aid expan­sion opposition

    By ROBERT T. GARRETT

    Austin Bureau

    rgarrett@dallasnews.com

    Pub­lished: 02 Sep­tem­ber 2013 10:54 PM

    Updated: 02 Sep­tem­ber 2013 11:26 PM

    AUSTIN — Texas’ refusal to expand Med­ic­aid will cause pri­vate health insur­ance pre­mi­ums to rise by an aver­age of 9.3 per­cent for peo­ple who buy their own cov­er­age, a new study finds.

    GOP law­mak­ers, strongly encour­aged by Gov. Rick Perry, decided not to add poor adults to Medicaid’s rolls. That means about 1.3 mil­lion fewer Tex­ans will have health cov­er­age by 2016 than if the fed­eral Afford­able Care Act were fully imple­mented in the state, accord­ing to the study by the non­profit research orga­ni­za­tion Rand Corp.

    About 320,000 adult Tex­ans just above the poverty line will take advan­tage of the Afford­able Care Act’s fed­eral sub­si­dies and buy cov­er­age in the indi­vid­ual insur­ance mar­ket, the researchers said. Those are peo­ple who would have been enrolled in Med­ic­aid as the fed­eral law was writ­ten and before that part of it was altered by a Supreme Court ruling.

    The study said that because low-income peo­ple gen­er­ally are not as healthy as wealth­ier peo­ple, their inclu­sion in pri­vate health insur­ance exchanges will increase costs. That will force a 9.3 per­cent increase in pre­mi­ums for all 3 mil­lion Tex­ans who will be enrolled in the indi­vid­ual mar­ket by 2016, the study said.

    In Texas, the pri­vate health insur­ance exchange that will open next month will be run by the fed­eral Health and Human Ser­vices Depart­ment because Perry threat­ened in 2011 to veto a Repub­li­can House lawmaker’s bill call­ing for a state-run exchange.

    In this year’s leg­isla­tive ses­sion, no Repub­li­can pro­posed a state-run exchange, and the Oba­macare debate was mainly about Perry’s insis­tence that Texas shouldn’t enlarge Med­ic­aid, even if it meant turn­ing down about $100 bil­lion more in fed­eral match­ing money over the com­ing decade.

    He and other Repub­li­cans have said the Med­ic­aid expan­sion would be too costly. Although the fed­eral gov­ern­ment would pay nearly all the cost of the expan­sion, crit­ics say the pro­gram is not sustainable.

    Offi­cials also have noted that the cost of car­ing for the unin­sured falls largely to county tax­pay­ers who sup­port large pub­lic hos­pi­tals, such as Dal­las’ Park­land hos­pi­tal, rather than to the state itself.

    The study sug­gests that the fed­eral health care leg­is­la­tion will cause more than a tripling of the share of Texas’ nonelderly pop­u­la­tion that will be enrolled in the indi­vid­ual insur­ance mar­ket in 2016 — from 2.9 per­cent, if the leg­is­la­tion had not passed, to 11.3 percent.

    Spurring that increase is the Afford­able Care Act’s sub­si­dies that the study says could go to 69 per­cent of peo­ple buy­ing their own coverage.

    If Texas expanded Med­ic­aid, the per­cent­age of the state’s nonelderly pop­u­la­tion that would be unin­sured would drop in 2016 from 28.2 per­cent to 12.4 per­cent, the study said.

    ...

    Hmmm...so by deny­ing the Med­ic­aid expan­sion, gov­er­nors like Rick Perry are increas­ing costs to hos­pi­tals AND the pub­lic at large. What’s not to love?

    Texas Pub­lic Radio
    Perry Rejects Med­ic­aid Expan­sion (Again), But Still Wants Fed­eral Block Grant Waiver
    12:17 pm Tue Sep­tem­ber 24, 2013

    By Ryan Poppe

    Gov. Rick Perry has sent the final instruc­tions to the state’s health com­mis­sioner ahead of a meet­ing with fed­eral offi­cials regard­ing the imple­men­ta­tion of Med­ic­aid expan­sion in Texas.

    The let­ter sent this week to Texas Health and Human Ser­vices Com­mis­sioner Dr. Kyle Janeck begins by ques­tion­ing the wis­dom behind the Obama administration’s expan­sion of Med­ic­aid cov­er­age under the Afford­able Care Act.

    Perry tells the com­mis­sioner he wants a fed­eral block grant that would allow Texas to set up its own form of Med­ic­aid with a waiver. Other states that have filed sim­i­lar waivers have been denied.

    Lance Lunsford with the Texas Hos­pi­tal Asso­ci­a­tion said Perry’s waiver wouldn’t extend cov­er­age to 1.6 mil­lion Tex­ans who don’t qual­ify for Med­ic­aid and can’t afford pri­vate healthcare.

    “When you look at the fact that the pri­vate mar­ket has to account for that uncov­ered pop­u­la­tion through cost-shifting you’re look­ing at $1,800 a year on aver­age in higher pri­vate health insur­ance pre­mi­ums due to uncom­pen­sated care for the unin­sured,” Lunsford said.

    Lunsford said he doesn’t expect the fed­eral gov­ern­ment to approve the request for a block grant, leav­ing unin­sured Tex­ans the option of going to local hos­pi­tal ERs to be treated.

    ...

    While this is obvi­ously a deci­sion rooted in love, it’s still not very rea­son­able. Maybe it’s a faith-based thing.

    Posted by Pterrafractyl | September 25, 2013, 11:43 am
  8. Ohio’s Gov­er­nor Kasich ® sup­ports Med­ic­aid expan­sion. The prob­lem is the GOP dom­i­nated leg­is­la­ture. My state sen­a­tor (D) said on a local radio pro­gram that the leg­is­la­ture will not sup­port the expan­sion because it’s asso­ci­ated with Obama and “Oba­macare”. Period. Even Kasich knows this; he advised my sen­a­tor not to invoke “Obama” in any dis­cus­sion of Med­ic­aid with the GOP leg­is­la­tors. He also told him to ouse term “Med­ic­aid Reform”, not “Med­ic­aid Expansion”.

    Posted by Kathleen | September 25, 2013, 1:47 pm
  9. @Kathleen: It’s one of those unset­tling signs of the times that John Kasich is a voice of rel­a­tive san­ity. But here we are, where if you can refrain from com­par­ing expanded health­care cov­er­age for the poor to the threat of Nazi Ger­many you’re damn near qual­i­fied to win a “Good­ness” award.

    In related news, the set of demands com­ing out of the House GOP in exchange for not shut­ting down the gov­ern­ment just got a lot longer and cra­zier:

    ...
    The bill, obtained by the National Review, tacks on items includ­ing a one-year delay of Oba­macare; tax reform in the image of Rep. Paul Ryan (R-WI); approval of the Key­stone pipeline; expanded off­shore drilling and other pro-oil and coal energy reforms; increases in mil­i­tary spend­ing cou­pled with deeper cuts to domes­tic pro­grams; repeal­ing a fund in the finan­cial reg­u­la­tory reform bill; means test­ing for Medicare; repeal­ing the Oba­macare pre­ven­tion and pub­lic health fund and med­ical mal­prac­tice reform.
    ...

    Posted by Pterrafractyl | September 26, 2013, 2:13 pm
  10. I’m glad to hear PBO and mem­bers of his admin­is­tra­tion call­ing them out for what they are. And, yes, the fact that Kasich seems rel­a­tively not bat crap crazy is scarey. How low is the bar!

    Posted by Kathleen | September 26, 2013, 3:54 pm
  11. Accord­ing to Paul Ryan, it’s pre­pos­ter­ous to believe that Obama won’t read­ily agree to nego­ti­ated with the GOP’s threat to shut down the gov­ern­ment and/or default on the US debt. After all, these kinds of “nego­ti­a­tions” have been going on for years. This is all per­fectly nor­mal and expected behav­ior:

    TPM­LiveWire
    Ryan: ‘Nobody Believes’ Obama Won’t Nego­ti­ate On Debt Limit

    Daniel Strauss – Sep­tem­ber 28, 2013, 4:50 PM EDT

    Nobody actu­ally believes Pres­i­dent Barack Obama’s vows to not nego­ti­ate on rais­ing the debt ceil­ing, House Bud­get Com­mit­tee Chair­man Paul Ryan (R-WI) said.
    “Oh, nobody believes that. Nobody believes that. He him­self nego­ti­ated Bowles Simp­son on the debt limit with Democ­rats. That was Kent Conrad’s require­ment,” Ryan told National Review. “He him­self nego­ti­ated the Bud­get Con­trol Act with the debt limit. Gra­ham Rud­man. Bush Andrews Air­force Base. Clin­ton Gore ‘97. All of those major bud­get agree­ments were debt limit agree­ments. I see this time as no dif­fer­ent and I believe he does too. I think most peo­ple believe he’s just pos­tur­ing for now.”

    Ryan’s com­ments come as the House seeks to pass a new con­tin­u­ing res­o­lu­tion bill that also delays Oba­macare for one year and also includes a med­ical device tax repeal. Top Democ­rats were quick to crit­i­cize the pro­posal after it was unveiled.

    Ryan also said he expects the ongo­ing fight over fund­ing the gov­ern­ment to even­tu­ally fold into nego­ti­a­tions over rais­ing the debt ceiling.

    “I think it will fold into the debt ceil­ing fight. I think that’s inevitable. And prefer­able in my opin­ion. I like com­bin­ing all of our lever­age, which is sequester and the debt limit,” Ryan told the magazine.

    ...

    Yes, this is all just part of the stan­dard gov­ern­ing process. His­tor­i­cally, every bill that the minor­ity party found ide­o­log­i­cally dis­pleas­ing was treated like a hijacked air­plane on a sui­cide mis­sion head­ing towards the cap­i­tal:

    Think Progress
    GOP Con­gress­man Com­pares Repub­li­cans Try­ing To Take Down Oba­macare To Heroes Of 9/11

    By Judd Legum on Sep­tem­ber 28, 2013 at 3:39 pm

    This after­noon, House Repub­li­cans decided to tie con­tin­ued fund­ing of the fed­eral gov­ern­ment — which will run out of funds on Mon­day — to a one year delay of Oba­macare and a repeal of a tax on med­ical devices. The move, by all accounts, makes a gov­ern­ment shut­down quite likely.

    Dur­ing a meet­ing of the House Repub­li­can Cau­cus, Con­gress­man John Cul­ber­son (R-TX) com­pared the relent­less Repub­li­can effort to defund Oba­macare to the heroic efforts of the pas­sen­gers on United Air­lines Flight 93 who over­pow­ered ter­ror­ists who had gained con­trol of the plane.

    Benjy Sar­lin
    @Benjy Sarlin

    Rep. Cul­ber­son (R-TX) on the big applause moment after GOP resolved to vote for CR: “I said, like 9/11, ‘lets roll!’”
    12:00 PM — 28 Sep 2013

    Asked lasted about the anal­ogy by a skep­ti­cal reporter, Cul­ber­son didn’t back down call­ing it “a good his­tor­i­cal anal­ogy.”

    The path for­ward endorsed by Speaker Boehner and the House GOP lead­er­ship is quite pop­u­lar with the more extreme ele­ments of the party. Michele Bach­mann gushed, “this is exactly what we asked for and we got it.”

    But there’s still the ques­tion of what the GOP lead­ers and their bil­lion­aire back­ers really want. Sure there are the obvi­ous moti­va­tions: A good cry that just let’s it all out. Uncon­di­tional love. Feel­ing like you belong. These are all pos­si­ble moti­va­tions. Another pos­si­bil­ity, of course, is that all of this act­ing out is merely reflect­ing a pent up desire to ful­fill a long held pledge...to drown peo­ple in bath­tubs. So it could be a loy­alty thing. But if so, nor­mal­iz­ing the idea of a gov­ern­ment shut­down and default is also sort of a neces­sity because when you pub­licly pledge to drown peo­ple in the bath­tubs for years on end, the only way to truly accom­plish that pledge is to con­vince enough of your neigh­bors that you are, in fact, pro­tect­ing them by drown­ing peo­ple in bath­tubs. You’re drown­ing the com­mu­nity for the greater good. And a great baby-step towards get­ting peo­ple to accept the idea of drown­ing the com­mu­nity is by first con­vince your neigh­bors that shut­ting down the gov­ern­ment and default­ing on the debt are tiny prices to pay to thwart the exis­ten­tial threat pre­sented by health­care for the poor. Once you’ve accom­plished that, drown­ing peo­ple in bath­tubs doesn’t sound all that unrea­son­able.

    Posted by Pterrafractyl | September 28, 2013, 5:11 pm
  12. Now that the House GOP has decided to fol­low Grover’s lead and demand a one year delay to the Indi­vid­ual man­date and cre­ation of indi­vid­ual mar­ket­places. In return for the Democ­rats accept­ing this “com­pro­mise” the GOP will refrain from shut­ting down the gov­ern­ment and/or default­ing on the debt. So, pre­vi­ously, we were informed by the GOP that Oba­macare rep­re­sented a mor­tal threat to the health of both the Amer­i­can econ­omy and the Amer­i­can pub­lic itself. Now, it appears, a delay of the indi­vid­ual man­date for small busi­nesses will give Con­gress enough time to fix all the kinks and cre­ate a pos­i­tive, work­able bill that can achieve bipar­ti­san sup­port. Time, it appears, really does heal all wounds. Health insur­ance cov­er­age also helps with the heal­ing process but it will have to wait. Because that’s how we roll.

    Posted by Pterrafractyl | September 29, 2013, 1:47 am
  13. What do you do when you’re hostage tak­ing scheme isn’t going as planned? You take more hostages of course!

    The New York Times
    Ryan Links Bud­get Impasse to Debt Ceil­ing Fight
    Oct 1, 6:50 pm
    Jeremy W. Peters

    WASHINGTON — Rep­re­sen­ta­tive Paul D. Ryan of Wis­con­sin, chair­man of the House Bud­get Com­mit­tee, sug­gested on Tues­day that the gov­ern­ment shut­down may not be resolved for more than two weeks.

    That would come, he said, when the coun­try reaches its debt limit.

    Not­ing that pre­vi­ous agree­ments over the bud­get had come together around the dead­line when the coun­try has reached its statu­tory bor­row­ing limit, Mr. Ryan said, “We think that will be the forc­ing mech­a­nism to bring the two par­ties together. Our goal and moti­va­tion here is to get a bud­get agree­ment. And we think this is a way to do that.”

    Yep, first you take more hostages, but that’s not all. You also need to strap your­self with even more explo­sives and then demand that nego­tia­tors on the other side pub­licly decry val­ues they hold dear while slit­ting their throats on live TV. It’s only after your nego­tia­tors real­ize that you’re bat­shit insane that they’ll begin to take you seri­ously:

    The Hill
    Ryan says grander endgame pos­si­ble on debt ceil­ing
    By Erik Was­son — 09/26/13 01:46 PM ET

    House Bud­get Com­mit­tee Chair­man Paul Ryan (R-Wis.) told reporters Thurs­day that he still thinks the upcom­ing debt ceil­ing fight could yield mas­sive changes to enti­tle­ments like Medicare and Med­ic­aid, even though such changes are not pro­posed in the House’s new list of debt ceil­ing demands.

    Ryan sup­ports the lead­er­ship plan, and his com­ments appeared directed at some House con­ser­v­a­tives who are push­ing for more spend­ing cuts in the pack­age unveiled by Speaker John Boehner (R-Ohio).

    The House is seek­ing smaller enti­tle­ment and reg­u­la­tory reforms in addi­tion to a timetable for tax reform, approval of the Key­stone XL pipeline and a delay in Oba­maCare in exchange for avoid­ing a debt ceil­ing default.

    Absent from the bill are the kind of major changes Ryan has pushed for years, such as the par­tial pri­va­ti­za­tion of Medicare, block grant­ing Med­ic­aid or par­tially con­vert­ing Social Secu­rity into a sys­tem of pri­vate accounts.

    The House-passed bud­get con­tains the Medicare and Med­ic­aid proposals.

    “We are at the begin­ning of these nego­ti­a­tions. Our goal is to get a big fis­cal pack­age at the end of the day,” Ryan said. “Don’t con­fuse our tac­tics with our end goal.”

    Ryan said that just because larger reforms are not in the offer “does not pre­clude these things from being in a final pack­age” after nego­ti­a­tions with the Sen­ate and Pres­i­dent Obama.

    “We want to get a big down pay­ment on the debt; we want to delay Oba­maCare; we want pro-growth solu­tions. This is our way of enter­ing into these nego­ti­a­tions,” he said.

    ...

    To reit­er­ate: When being an insane ass­hole doesn’t get the job done, just be a big­ger, even more insane ass­hole. Only then will you see your plans come to fruition:

    Think Progress
    GOP May Hold Debt Ceil­ing Hostage To Enact Paul Ryan’s Budget

    By Igor Vol­sky on July 7, 2013 at 12:09 pm

    House Repub­li­cans will hold the national debt ceil­ing increase hostage until Pres­i­dent Obama agrees to manda­tory spend­ing cuts to Social Secu­rity, Medicare, and Med­ic­aid, the National Jour­nal reports, and will seek to use the lever­age of default to force Democ­rats to enact the poli­cies in Rep. Paul Ryan’s (R-WI) bud­get.

    Since slash­ing dis­cre­tionary spend­ing to his­toric lows — the dis­cre­tionary side of the ledger has grown at a slower rate than infla­tion since 2007 and now makes up a smaller share of the econ­omy than it did before the Great Reces­sion — the GOP has shifted from demand­ing dollar-for-dollar imme­di­ate spend­ing cuts and is now focus­ing on draft­ing a range of options to sig­nif­i­cantly restruc­ture manda­tory ben­e­fit programs.

    The idea is to throw in the “kitchen sink” and allow Obama to pick and choose the cuts. “If what makes it eas­ier to find the deal is to go in and pick and choose among a dozen dif­fer­ent pro­grams and just grab a lit­tle bit from all 12 — instead of a lot from one them — then that works just fine,” Rep. Rob Woodall (R-GA), who heads the Repub­li­can Study Committee’s bud­get and spend­ing task force, told the Journal:

    For a long-term deal, one that gives Trea­sury bor­row­ing author­ity for three-and-a-half years, Obama would have to agree to pre­mium sup­port. The plan to pri­va­tize Medicare, per­haps the most con­tro­ver­sial aspect of the Ryan bud­get, is the holy grail for con­ser­v­a­tives who say major deficit-reduction can only be achieved by mak­ing this type of cut to manda­tory spend­ing. “If the pres­i­dent wants to go big, there’s a big idea,” said Rep. Steve Scalise, chair­man of the Repub­li­can Study Committee.

    For a medium-sized increase in the debt-limit, Repub­li­cans want Obama to agree to cut spend­ing in the SNAP food stamp pro­gram, block-grant Med­ic­aid, or tin­ker with chained CPI.

    For a smaller increase, there is talk of means-testing Social Secu­rity, for exam­ple, or end­ing cer­tain agri­cul­tural subsidies.

    While the menu includes plenty of vari­ables, the under­ly­ing strate­gic goal is to reduce manda­tory spend­ing — what­ever the scope of the deal. Even at the small­est end of the spec­trum — another months-long exten­sion of debt-limit — there is talk of push­ing back the eli­gi­bil­ity age for Social Secu­rity by an equal num­ber of months.

    ...

    Hostage-taking can be a fun and enjoy­able expe­ri­ence for peo­ple of all ages. Just be sure to remem­ber what you’ve been taught and every­thing should be fine.

    Posted by Pterrafractyl | October 1, 2013, 8:06 pm
  14. And we’ve almost hit the “we’re going to do a ‘Grand Bar­gain’ and extract entitlement-cuts”-phase of the GOP’s prin­ci­pled oppo­si­tion. How does an appar­ently sui­ci­dal mad­man with a nuke strapped to his chest pull him­self off the ledge? By threat­en­ing an even big­ger explo­sion once he gets more nukes and climbs back on:

    The National Review
    Boehner to GOP: Grand Bar­gain in the Works
    By Robert Costa
    Octo­ber 2, 2013 6:36 PM

    House Repub­li­cans tell me Speaker John Boehner wants to craft a “grand bar­gain” on fis­cal issues as part of the debt-limit delib­er­a­tions, and dur­ing a series of meet­ings on Wednes­day, he urged col­leagues to stick with him.

    The rev­e­la­tion came qui­etly. Boehner called groups of mem­bers to his Capi­tol office all day, tak­ing their tem­per­a­ture on the shut­down and the debt limit. It became clear, mem­bers say, that Boehner’s chief goal is con­fer­ence unity as the debt limit nears, and he’s look­ing at poten­tially blend­ing a government-spending deal and debt-limit agree­ment into a larger bud­get pack­age.

    “It’s the return of the grand bar­gain,” says one House Repub­li­can, who requested anonymity to speak freely. “There weren’t a lot of specifics dis­cussed, and the meet­ings were mostly about just check­ing in. But he’s look­ing hard at the debt limit as a place where we can do some­thing big.”

    Beyond Boehner’s office, the lead­er­ship is send­ing out a sim­i­lar mes­sage through its emis­saries. The House GOP’s most influ­en­tial fis­cal strate­gists, Dave Camp and Paul Ryan, are pri­vately reas­sur­ing ner­vous Repub­li­cans that the fed­eral shut­down may be painful in the short term, but a bud­get deal is in the works — and they should be enthused about what they’re cook­ing up.

    “Ryan is sell­ing this to every­body; he’s get­ting back to his sweet spot,” says a sec­ond House Repub­li­can who’s close with Ryan. “He and Camp are going to be Boehner’s guys. That’s why Boehner put them on the CR con­fer­ence com­mit­tee; he knows these guys are going to be his point men.”

    And dur­ing Wednes­day hud­dles, Ryan, Camp, and other House Repub­li­cans spoke openly about what kind of con­ces­sions they could poten­tially win from Democ­rats. Late Wednes­day, “the CR-debt limit idea was what peo­ple were talk­ing about on the floor,” says a GOP aide.

    Per sources, enti­tle­ment reforms, such as chained CPI, an elim­i­na­tion of the medical-device tax, and delays to parts of Oba­macare are all on the table as trades for delay­ing aspects of seques­tra­tion and extend­ing the debt limit. Camp, espe­cially, is push­ing to have a tax-reform frame­work included.

    From what I hear, this com­bined deal is being softly sold to mem­bers; Wednesday’s talks were about get­ting them engaged. And it’s all about what Repub­li­cans could win – and lit­tle about what they’ll give in return.

    What’s not being dis­cussed: increased tax rates or rev­enues. That doesn’t mean, how­ever, that rev­enue as part of a tax-reform pact has been ruled out.

    ...

    We just have to wait and see at this point to find out the “Grand Bar­gain” talk being bandied about in the GOP cau­cus is about a “Grand Bar­gain” or a “Grand Bar­gain” but it’s unclear how it could end up being the for­mer because that would sort of require the lead hostage nego­tia­tor deal­ing with a pack of sui­cide bombers agree­ing to defuse the sit­u­a­tion by putting on his own sui­cide vest and blow­ing it up in close prox­im­ity to the old­est and poor­est hostages. It’s just not a very com­pelling offer.

    One thing is becom­ing clear: by being as bat­shit crazy as they’ve been, Ted Cruz and the House GOP have man­aged to, uh, ‘posi­tion’ Grover Norquist and Paul Ryan as “com­pro­mis­ers” that are merely inter­ested in the Ryan Bud­get. They’ll offer the only way out of this sit­u­a­tion, and there­fore be prac­ti­cal and rea­son­able:

    Wash­ing­ton Post
    Grover Norquist on Ted Cruz: ‘He pushed House Repub­li­cans into traf­fic and wan­dered away’

    By Ezra Klein, Pub­lished: Octo­ber 2 at 2:58 pm

    Grover Norquist is the pres­i­dent of Amer­i­cans for Tax Reform and the cre­ator of the anti-tax pledge that nearly every Repub­li­can in Con­gress has signed. We spoke on Tues­day about the gov­ern­ment shut­down and its con­se­quences for his agenda. A tran­script of our con­ver­sa­tion, edited for length and clar­ity, follows.

    Ezra Klein: So, do you think a shut­down is good for the issues and ideas you’re try­ing to push?

    Grover Norquist: Not nec­es­sar­ily. I think the orig­i­nal plan for the Repub­li­cans was to move the con­tin­u­ing res­o­lu­tion past the debt ceil­ing and then to sit down with Obama and decide whether he would be will­ing to trade some relax­ation of the sequester for sig­nif­i­cant reforms of enti­tle­ments. That was some­thing Obama might well do. Democ­rats in the House and the Sen­ate are very con­cerned about caps and lim­its in seques­tra­tion. Repub­li­cans could get sig­nif­i­cant long-term enti­tle­ment reform — all on the spend­ing side, I’m assured by lead­er­ship — for some relax­ation of sequester.

    Some­thing like that might’ve worked out. There was also the pos­si­bil­ity, and I was an advo­cate, of push­ing for delay. I thought Obama might do that. And even if he didn’t, I liked the idea of a two-month con­ver­sa­tion over how Obama has delayed Oba­macare for big busi­ness and big con­trib­u­tors and orga­nized labor but not for you. So how about all Amer­i­cans get treated equally and we have rule of law and delay every­thing? Obama was thought­ful enough to time Oba­macare and its taxes to kick in after he was safely reelected. Those sen­a­tors run­ning in 2014 were not given the same cour­tesy. Why not give them that?

    EK: That sounds like the strat­egy that got us the shut­down, though.

    GN: No, the lever­age isn’t the debt ceil­ing. It’s not the CR. It’s the sequester. Democ­rats think this is des­per­ate pri­va­tion. It’s like the Kennedy kids with only one six-pack. They feel they’ve never been so mis­treated. So there’s some­thing they want. And there’s some­thing Repub­li­cans want. So you could see a deal there. And the lever­age was the sequester. That’s what struck me as what lead­er­ship was think­ing about, and it made a great deal of sense.

    The sec­ond thought was to have a con­ver­sa­tion over the one-year delay. A two-month con­ver­sa­tion about delay would be healthy for the body politic. And maybe you’d get the delay. There’s no shame in the delay. Microsoft is always delay­ing Office. You could do it with­out humil­i­at­ing the president.

    But that’s not what we did. Ted Cruz, from left field, said we have to defund Oba­macare per­ma­nently in this CR. If they offered the Key­stone pipeline and the pri­va­ti­za­tion of Fan­nie and Fred­die you couldn’t take that. We only want this, and we only want it on Tues­day — Wednes­day is no good. The debt ceil­ing is no good. So that got locked in as a prin­ci­ple. And peo­ple went out on talk radio and said if you’re not for this you’re a cow­ard, you’re a RINO.

    EK: And that got in the way of the larger strategy?

    GN: I’m cheer­ful because every Repub­li­cans is for repeal of Oba­macare. When’s the last time we passed a big gov­ern­ment enti­tle­ment and every Repub­li­can opposed it and kept point­ing out that it’s a mis­take? There’s una­nim­ity among Repub­li­cans. They all voted against the thing being cre­ated and for it being repealed.

    The only con­fu­sion that comes out is that Cruz stood on the side and con­fused peo­ple about the fact that every Repub­li­can agrees. He said if you don’t agree with my tac­tic and with the spe­cific struc­ture of my idea, you’re bad. He said if the House would sim­ply pass the bill with defund­ing he would force the Sen­ate to act. He would lead this grass-roots move­ment that would get Democ­rats to change their mind. So the House passed it, it went to the Sen­ate, and Ted Cruz said, oh, we don’t have the votes over here. And I can’t find the e-mails or ads tar­get­ing Democ­rats to sup­port it. Cruz said he would deliver the votes and he didn’t deliver any Demo­c­ra­tic votes. He pushed House Repub­li­cans into traf­fic and wan­dered away.

    So then the House said, break­ing com­pletely with Cruz because Cruz thinks if you’re not defund­ing the whole thing it’s trea­son, that there’s delay. There’s get­ting rid of med­ical device taxes. They’ve done a series of things to hold together Repub­li­cans and break with Cruz. But because we started with the Cruz approach this got to the shutdown.

    EK: What do you think hap­pens next?

    GN: I think the pres­i­dent must think he can spin a gov­ern­ment shut­down. I think he’s already screwed it up. Putting up bar­ri­ers so guys in wheel­chairs can’t go to the World War II memo­r­ial. It’s an open-air memo­r­ial. They put up those bar­ri­ers in the mid­dle of the night. They did it on overtime!

    ...

    EK: Walk me through the endgame though. The day before the shut­down ends, what will have hap­pened in Washington?

    GN: Unlike some other insti­tu­tions in this town, I work to give some rea­son­able advice to mem­bers of Con­gress and shape pub­lic opin­ion. But I don’t micro­man­age the nego­ti­a­tions of House and Sen­ate guys with the White House or stand out­side the nego­ti­a­tions and announce some­body should lay down a non­nego­tiable demand with a tac­tic and a date attached to it.

    Repub­li­cans have their prin­ci­ples. Let’s have health-care be more consumer-oriented, let’s not raise taxes, let’s reform gov­ern­ment. I could imag­ine many things that would work inside those prin­ci­ples, but I’m not in Obama’s head. I don’t know how he val­ues those things. If I were him I’d trade some money off the sequester today for reforms in enti­tle­ments that take place a long time from now. Those reforms will be done by some­body. You might as well get some­thing for them. Some­day Repub­li­cans will hold the White House and the Sen­ate and they’ll pass the Ryan plan. You might as well get some­thing for it.

    EK: One aspect of this that you men­tion quite a bit, but that’s been some­what lost in the debate, is that Repub­li­cans have really man­aged to hold the spend­ing lev­els in the CR down. They’re below the orig­i­nal Ryan bud­get, for instance, and well below what Pres­i­dent Obama and the Sen­ate Democ­rats wanted. Yet Repub­li­cans feel like they’re fail­ing because they’re focused on Oba­macare. Do you think Repub­li­cans are win­ning on spending?

    GN: Yes, absolutely. We won in 2011 and then again with the pres­i­dent mak­ing 85 per­cent of the Bush tax cuts per­ma­nent. We really did get caps and seques­tra­tion that lim­its gov­ern­ment spend­ing. If we just went home and put the gov­ern­ment on autopi­lot it would be a win. This Repub­li­can Con­gress has made a fun­da­men­tal shift in the size of gov­ern­ment equation.

    Sequester is the big win. It defines the decade. You still have to fix long-term enti­tle­ments, but the other team isn’t will­ing to do that. So you either wait for a Repub­li­can pres­i­dent and the Ryan plan or you get peo­ple so con­cerned about seques­tra­tion that they’re will­ing to come to the table and fix enti­tle­ments long-term.

    ...

    Oh my, well it sounds like Grover is propos­ing some­thing real in return for sub­stan­tial enti­tle­ment cuts. It’s some­thing grander than the pos­si­ble res­o­lu­tion from the cur­rent Shutdown/default show­down. Grover sees the real “lever­age” for the GOP resid­ing in a nego­ti­a­tion of removal of the sequester that was put in place as a part of the res­o­lu­tion to the 2011 bud­get con­nip­tion fit.

    Since the sequester is sched­uled to stay in place even if the cur­rent shutdown/default cri­sis is resolved this isn’t a triv­ial con­ces­sion. The sequester involves a large amount of unhelp­ful aus­ter­ity poli­cies. It is a grand bar­gain­ing con­ces­sion indeed! Like the sui­cide bomber offer­ing to remove the not only his new bomb-vest, but also his old one at the same time! How noble. And the only thing Obama and the Democ­rats have to do to get this awe­some deal is agree to blow every­one up with the Paul Ryan Bud­get Plan. And hey, Grover sug­gests, why not just embrace the Ryan Plan as an act of pre­emp­tive defeat because, at some point, a Repub­li­can House and Con­gress will come along and imple­ment the Ryan Plan any­ways so the Democ­rats might as well do the imple­men­ta­tion of the Ryan plan them­selves if they want to get any con­ces­sions. Accord­ing to Grover.

    It’s a fas­ci­nat­ing strat­egy we’re see­ing unfold because Paul Ryan and Grover Norquist are now being cast as the ‘adults’ in the room rel­a­tive the the Ted Cruzites. But Grover’s pro­posed “rea­son­able” strat­egy is, in his own words, cen­tered around the same goal as Ted Cruz. “Every­one [in the GOP] agrees” on the same goals (the insane Ryan Plan) it’s over methods.

    And the new method Grover is advo­cat­ing for the GOP appears to involve pub­licly acknowl­edg­ing that the GOP has adopted a per­ma­nent pol­icy of push­ing for enti­tle­ment cuts that will be much harsher than what the Democ­rats would dare con­sider. When Grover says “If I were him I’d trade some money off the sequester today for reforms in enti­tle­ments that take place a long time from now. Those reforms will be done by some­body. You might as well get some­thing for them. Some­day Repub­li­cans will hold the White House and the Sen­ate and they’ll pass the Ryan plan. You might as well get some­thing for it,” that sure sounds like the imple­men­ta­tion of the Ryan Plan is non-negotiable with the GOP per­ma­nently. So the Oba­macare fight is about the become the Oba­macare + pri­va­ti­za­tion of enti­tle­ments fight. What an awe­some new GOP brand­ing effort.

    Posted by Pterrafractyl | October 2, 2013, 11:27 pm
  15. David Atkins has a good sum­mary piece on why the GOP almost can’t win the show­down with the debt-ceiling/default: Even if Grover gets every­thing in his wish­list, the polit­i­cal “win” will be due almost entirely to threats and tac­tics. Actual pub­lic sup­port for the Grover Norquist/Paul Ryan long-term vision for soci­ety only exists in the Tea Party base, and that same Tea Party base deter­mines which GOP­ers actu­ally end up in Con­gress due to overzelous GOP con­gres­sional redis­trict­ing in 2010. And as David points out, long-term spend­ing poli­cies are rel­a­tively easy to change as some point (as evi­dence by the demands for long-term enti­tle­ment cuts by Grover & Friends...it’s self-apparent that these laws can change).

    So even if Grover wins in the short-run, Grover can’t really win in the long-run unless the US is some­how pre­vented from ever revers­ing Norquist-inspired poli­cies. And pre­vent­ing a rever­sal of Grover’s laws is going to be increas­ingly dif­fi­cult as the GOP’s tra­di­tional vot­ing base shuf­fles off to demo­graphic obliv­ion. In other words, the sta­ble polit­i­cal equi­lib­rium for the GOP over the next decade (due to ger­ry­man­der­ing) that is dri­ving the cur­rent shut­down fever is simul­ta­ne­ously desta­bi­liz­ing the GOP’s long-term prospects by forc­ing deeply unpop­u­lar poli­cies.

    Sure, it could be argued that the US is aging over­all and the elderly have his­tor­i­cally voted for the GOP. But the elderly of the future may not be so pro-GOP when they have no mean­ing­ful Social-Security or Medicare. Grover & Friends can’t really have a viable elec­toral future unless doing things like pri­va­tiz­ing enti­tle­ments actu­ally leads to a more secure future for the vast major­ity of Amer­i­cans. It’s not just demo­graphic trends that are ruin­ing the GOP’s long-term via­bil­ity. Grover’s far-right socioe­co­nomic utopia had bet­ter actu­ally work because the “implo­sion of gov­er­ment would be fun and awe­some!”-meme only works as long as a soci­ety is still wealthy enough to afford the gov­ern­ment pro­grams needed to avoid mass poverty. The “gov­ern­ment isn’t the solu­tion, it’s the problem”-meme isn’t going to be a very easy sell after you’ve already trashed the gov­ern­ment. It’s kind of like the GOP’s cur­rent Oba­macare conun­drum: Telling the pop­u­lace that Oba­macare would destroy lives and ruin the nation is a pretty easy sales pitch...as long as Oba­macare is never allowed to actu­ally come into effect.

    While the GOP’s long-term trou­bles are, gen­er­ally, a sign of hope for the future, they also raise a chill­ing ques­tion: If the GOP’s oligarch-run utopia really does become an elec­toral impos­si­bil­ity, would folks like the Koch Broth­ers and Peter Thiel even be will­ing to just sit back, makes tons of money, and relin­quish their pecu­liar dreams for dom­i­nat­ing the future of human­ity? Or will smash­ing economies for power and profit be replaced with smash­ing economies for revenge? Then again, maybe the elites will finally drop the mask, smash the econ­omy into the ground and shift their focus to a com­pletely dif­fer­ent set of solu­tions to prob­lem of win­ning elections...the kind of solu­tions that don’t require elec­tions. Or maybe the solu­tion will some­thing like what’s going on in the euro­zone. But poten­tially much big­ger.

    Posted by Pterrafractyl | October 3, 2013, 10:54 pm
  16. Paul Krug­man has a post that high­lights the seri­ous exis­ten­tial dam­age the GOP is risk­ing to itself with the shutdown/default cri­sis enter­ing its sec­ond week. It’s becom­ing increas­ingly dif­fi­cult for a grow­ing num­ber of stake­hold­ers in the GOP to avoid the real­ity that their party has gone insane in a highly destruc­tive man­ner with poten­tially long-term repur­cus­sions:

    The Con­science of a Lib­eral
    Octo­ber 5, 2013, 3:51 pm
    Short­ing Out The Wiring
    Paul Krugman

    For the moment, at least, the shut­down and the gen­eral scene of insan­ity in Con­gress is clearly hurt­ing the Repub­li­can brand. And there’s a whole small indus­try of crunch­ing num­bers on the 1995–6 shut­down, etc., to esti­mate the likely impact on next year’s elec­tions. For now the con­ven­tional wis­dom is that the impact will be small, not nearly enough to restore Demo­c­ra­tic control.

    I have no idea whether that’s right. But as I was read­ing the var­i­ous news reports, it occurred to me that there’s a sub­tler but pos­si­bly pro­found form of dam­age the GOP is doing to itself, one that will cast its shadow for a long time.

    It goes back to some­thing Josh Mar­shall of Talk­ing Points Memo used to say — that Wash­ing­ton is, in effect, wired for Repub­li­cans. Ever since Rea­gan, the Belt­way has treated Repub­li­cans as the nat­ural party of gov­ern­ment. Sun­day talk shows would fea­ture a pre­pon­der­ance of Repub­li­cans even if Democ­rats held the White House and one or both houses of Con­gress. John McCain was fea­tured on those shows so often you would think he won in 2008.

    And there was a gen­eral pre­sump­tion of Repub­li­can com­pe­tence. It’s hard to believe now, but Bush was treated as a highly effec­tive leader who knew what he was doing right up to Kat­rina, while Clin­ton — now viewed with such respect — was treated as a bungling inter­loper for much of his pres­i­dency. Even in the last few years there was a rush to can­on­ize Paul Ryan as a super­wonk, when it was quite obvi­ous if you looked that pol­i­tics aside, he was just incom­pe­tent at number-crunching.

    But I think the last two years have finally killed that pre­sump­tion. It wasn’t just that Rom­ney lost — his shock, the obvi­ous degree to which his cam­paign was deluded, was an eye-opener. And now the antics of the Boehner bumblers.

    Sud­denly the old Will Rogers line — I’m not a mem­ber of any orga­nized polit­i­cal party,I’m a Demo­c­rat — has lost its sting; the upper hand is on the other foot. And that’s going to color nar­ra­tives and shape cam­paigns for a long time.

    Part of what makes the GOP’s aggres­sive pub­lic aban­don­ment of the “we’re the adults in the room” man­tle is that it was always sort of inevitable that it would come to this. Or some­thing kind of like this...some sort of seem­ingly unre­solv­able cri­sis. It was just a mat­ter of the tim­ing and the par­tic­u­lar nature of the cri­sis. While the cur­rent shutdown/default cri­sis is clearly a cri­sis of choice future crises that threaten the very foun­da­tions of the socioe­co­nomic struc­ture of soci­ety may not be so vol­un­tary because the entire socioe­co­nomic par­a­digm being put forth by the far-right archi­tects of the Tea Party — bil­lion­aires like the Koch broth­ers and Peter Thiel and their part­ners on Wall Street — is a deeply unsus­tain­able par­a­digm that neces­si­tates both eco­nomic and social col­lapse. Is that by design? Who knows, because these Tea Party bil­lion­aires are clever but also kind of nuts.

    Some sort of sys­temic col­lapse isn’t inevitable just because of corporate-driven poli­cies that are guar­an­tee­ing eco­log­i­cal col­lapse (which will even­tu­ally kill any soci­ety). A col­lapse of some sort is also being made inevitable by the ide­o­log­i­cal oppo­si­tion to the exis­tence of an empow­ered, well-informed middle-class oper­at­ing in a mean­ing­ful demo­c­ra­tic sys­tem. A middle-class with a real oppor­tu­nity to earn a liv­ing wage and have time to do other things with their life too. How are the market-driven soci­eties of the future — where cap­i­tal­ism replaces democ­racy and edu­ca­tion is lim­ited to those with par­ents that can pay — sup­posed to oper­ate with mass unem­ploy­ment and poverty and min­i­mal con­sumer demand? We know that economies can func­tion with mass poverty and gross inequal­i­ties but there aren’t really any exam­ples of those economies func­tion­ing well and in ways that solve long-term prob­lems. With­out a gov­ern­ment mak­ing invest­ments for the future and pro­vid­ing some sort of mean­ing­ful level of sup­port of the pop­u­lace, where exactly is the feed­back loop in the econ­omy going to come from where the prof­its accrued by the top 0.01% are fed back into the econ­omy? What’s going to drive the demand on behalf of the poor? Because there will be a lot of them. The bil­lion­aires plan­ning on replac­ing gov­ern­ment must have plans to do so. They should flesh them out more.

    And how do the Koch Broth­ers and Peter Thiels of the world pro­pose to address the real­ity of robot­ics and automa­tion dra­mat­i­cally upset­ting the bal­ance between the sup­ply and demand of labor between the elites and the rest of us? Is the global econ­omy going to be ded­i­cated to build­ing big­ger and bet­ter cas­tles and yachts and the robots to pro­tect them? You can only employ so many peo­ple to run the robots that build Ely­sium, so where does every­one else fit into this pic­ture? Is it going to be bil­lion­aires liv­ing in their pri­vate cities and pri­vate soci­eties vs every­one else liv­ing in larger, crap­pier quasi-privatized pub­lic soci­eties where the gov­ern­ment ser­vices are pro­vided by com­pa­nies owned and oper­ated by the peo­ple that live in the pri­vate cities? Is there any con­vinc­ing case pub­licly put for­ward by the top 0.01% that this end­less race of the bot­tom won’t result in socioe­co­nomic can­ni­bal­ism?

    And if the Tea Party’s bil­lion­aire bene­fac­tors haven’t made the case for how their utopian future could pos­si­bly work then when are we going to see a revolt by the mil­lion­aires and bil­lion­aires against folks the Tea Party bil­lion­aires? Are even lower taxes for plu­to­crats worth the risk of social upheaval? If every­one can agree that poverty and the avail­abil­ity of advanced tech­nol­ogy exac­er­bates the threat of ter­ror­ism and social upheaval then why is that the top 1% don’t view their Tea Party lead­ers (the Koch and Thiel-like fig­ure espe­cially) as vital threats to their futures? They’re sell­ing an aus­ter­ity future as the way for­ward per­ma­nently. It seems like an insane long-term strat­egy for the vast major­ity of mil­lion­aires and even billionaires.

    Imag­ine if the Gulf monar­chies didn’t even bother try­ing to pro­vide some sort of basic wel­fare to the pop­u­lace but instead just allowed for mass poverty while the Sheikhs accrued even more of the national wealth. How long would those gov­ern­ments have lasted?

    These larger ques­tions of the gen­eral sus­tain­abil­ity of the Tea Party par­a­digms are even more rel­e­vant now that the “defund Oba­macare or we shut down the gov­ern­ment” fight in Con­gress has mor­phed into a larger “defund enti­tle­ments or we shut down the econ­omy” war. It’s a long-term par­a­digm that’s alarm­ingly close a king­dom with­out a social con­tract. The only social con­tract in this Lib­er­tar­ian Tea Party future one can really see is the promise that legal con­tracts are enforced by the law. That’s pretty much it. Every­thing else is left up to the “free-market”, friends and fam­ily, or luck in the kind of future being offered by the peo­ple like Grover Norquist and Paul Ryan. And those two are the vision­ar­ies in the move­ment so what they say envi­sion is poten­tially the future. It’s scary.

    Why would we expect that kind of soci­ety to result in any­thing other than a highly frag­mented econ­omy of a hand­ful of ‘haves’ and hordes of ‘have nots’? How many mil­lion­aires and bil­lionares can exist in a soci­ety with just a hand­ful of ‘haves’ and hordes of ‘have-nots’ plus lots of robots? Some mil­lion­aires and bil­lion­aires will be there, by def­i­n­i­tion. But how many mil­lion­aires and bil­lion­aires will exist in Tea-topia soci­ety that aban­dons a social safety-net and embraces harsh “you’re on your own, get a job if you want your dis­ease treated, slacker!”-policies, say, 30 years from now com­pared to a soci­ety that, for instance, actu­ally tries pro­vide peo­ple with some mean­ing­ful eco­nomic and polit­i­cal power and resources — so the robots have some­thing to do other than chase peo­ple and the masses aren’t just utterly screwed — and also pro­vides gen­eral social jus­tice that can’t oth­er­wise be achieved through the “free-market”. Which soci­ety will have more mil­lion­aires and bil­lion­aires a gen­er­a­tion from now?

    That kind of multi-decade time­frame is what we need to be con­sid­er­ing in the US now that the gov­ern­ment shut­down fight over Oba­macare has begun to morph into a GOP threat to default on the US debt unless the nation agrees to the kinds of sig­nif­i­cant long-term enti­tle­ment cuts/privatizations that earn Grover Norquist’s approval. This is a con­tin­u­a­tion of the divide-and-extort strat­egy cham­pi­oned by Grover and intended to hand con­trol of soci­ety over to Grover’s Tea Pary bil­lion­aire back­ers and cre­ate a bor­der­line anarcho-capitalist future. That’s where this crew wants to take us and it’s a multidecade-long process.

    Robot­i­cally enforced cardiovascular-fitness regimes are, of course, fan­tas­ti­cally silly sce­nar­ios to think about. But it wasn’t that long ago that the idea of debas­ing the dol­lar would just become this casual thing that polit­i­cal par­ties do when the party really really doesn’t want to have to admit to their polit­i­cal base that the party has been lying to them for years about a par­tic­u­lar law. These are nearly unthink­able polit­i­cal threats that are being made rou­tine and in no instance have we seen any real indi­ca­tion that the GOP is inter­ested in giv­ing up this “give us what we want or it’s shutdown/default!” strat­egy now or for good. Even if there was a giant cave by the Obama admin­is­tra­tion next week and a mas­sive long-term enti­tle­ment cut was agreed upon in order to free up this budget/existential impasse is there any rea­son to believe this wouldn’t hap­pen again at the next oppor­tu­nity? Or at least dur­ing the rest of the Obama admin­is­tra­tion? Or dur­ing any future Demo­c­ra­tic admin­is­tra­tion? No mat­ter what they say? The Tea Party’s bil­lion­aires and their far-right cohorts around the world have been mak­ing it abun­dantly clear for years that they’re intent on fun­da­men­tally reshap­ing soci­ety. If the euro­zone expe­ri­ence is any indi­ca­tion, these folks are really really seri­ous. So who knows how far they’re will­ing to go to press an aus­ter­ity agenda but, at least in some of the worst case sce­nar­ios, your sur­viv­ing grand­chil­dren (the poor ones) will be in really really good shape and that should cut down on health­care costs.

    Posted by Pterrafractyl | October 6, 2013, 12:16 am
  17. Ok, yikes. Now they’re telling us that not rais­ing the debt ceil­ing “would bring sta­bil­ity to world mar­kets”:

    TPM Editor’s Blog
    Get Ready. It’s Going to Hap­pen.
    Josh Mar­shall – Octo­ber 6, 2013, 9:49 PM EDT

    The Post has a pro­file in motion of fresh­man House Repub­li­can Ted Yoho (FL). The focus is how he’s part of the fac­tion who forced John Boehner to trig­ger the gov­ern­ment shut­down and now wants to move along to default on the national debt. How bad will default be? “I think, per­son­ally, it would bring sta­bil­ity to the world mar­kets,” Yoho told the Post.

    Absorb that for a moment. He’s on the team that’s dri­ving this bus. What would at best be a huge jolt to the global econ­omy and more likely trig­ger a global finan­cial cri­sis and do irrepara­ble harm to the coun­try, he thinks will actu­ally improve things.

    ...
    So pro­fes­sional Repub­li­can spokes­men are freaked out by what they’re hearing.

    Cou­ple this with the Times arti­cle from this morn­ing detail­ing how the cur­rent shut­down and soon to be default cri­sis was planned by a work­ing group of top GOP money men and the major far right and Tea Party pres­sure groups in the imme­di­ate after­math of the 2012 election.

    There many roots of this cri­sis. Demo­graphic, ide­o­log­i­cal, regional, some parts tied to acci­dents of his­tory (the exis­tence of the debt ceil­ing itself), oth­ers to the struc­ture of our gov­ern­ment. But I think most peo­ple, as crazy as this looks, are under­es­ti­mat­ing the scope of the cri­sis we’re in the midst of. The pieces are in place to resolve the mat­ter quickly, in the nar­row sense of the votes. But the House Tea Party (and it really does look more like a dis­tinct party or fac­tion at this point) is forc­ing the mat­ter, despite hav­ing well under a hun­dred seats in the House. Behind them they have an aggrieved GOP base and sus­tain­ing them the vast tranches of money pro­vided by the Kochs and other top GOP mega-funders. John Boehner, not struc­turally in the sense of his office or posi­tion but per­son­ally, is sim­ply too weak a fig­ure to avert what’s com­ing. Get ready.

    So does that mean that I can just start selec­tively not pay­ing back my cred­i­tors (specif­i­cally US cred­i­tors) once I decide to get ‘deci­sive’ about tack­ing my debt? Because that might actu­ally be a really pop­u­lar pol­icy pivot although I’m not sure it would calm the mar­kets. Maybe it’s like 11-dimension Chess, Tea Party-style at work. On the other hand, keep in mind that the full descrip­tion of Rep. Yoho’s com­ment on the awe­some­ness of a default was:

    I think we need to have that moment where we real­ize [we’re] going broke,” Yoho said. If the debt ceil­ing isn’t raised, that will sure as heck be a moment. “I think, per­son­ally, it would bring sta­bil­ity to the world mar­kets,” since they would be assured that the United States had moved deci­sively to curb its debt.

    That sounds awfully sim­i­lar to one of the pop­u­lar memes float­ing around in the right-wing-o-sphere about how refus­ing to raise the debt ceil­ing won’t force a default at all because there will still be plenty of money left over to pay the inter­est on the debt with exist­ing rev­enue streams. All we have to do is casu­ally slash or elim­i­nate fed­eral pro­grams and enti­tle­ments to bal­ance the bud­get. We’ll just have to sud­denly decide that right now is a really impor­tant time to sud­denly sucker punch the econ­omy and cre­ate our own lit­tle GOP Troika of one to imple­ment the Ryan Plan. That’s all (because if we don’t we’ll go bank­rupt very soon). Once the Troika is sat­is­fied, the debt-limit will be lifted and every­thing will return to the new nor­mal. Elec­tions had con­se­quences. Now it’s all fun and games.

    Posted by Pterrafractyl | October 6, 2013, 9:43 pm
  18. With polls show­ing 70% dis­ap­proval for the GOP’s han­dling of the shutdown/default cri­sis, you have to won­der how how much time was spent plan­ning this whole thing. Because it’s not like there’s been a lack of time. Or money. Or expe­ri­enced secret plot­ters:

    The New York Times
    A Fed­eral Bud­get Cri­sis Months in the Planning

    By SHERYL GAY STOLBERG and MIKE McIN­TIRE
    Pub­lished: Octo­ber 5, 2013

    WASHINGTON — Shortly after Pres­i­dent Obama started his sec­ond term, a loose-knit coali­tion of con­ser­v­a­tive activists led by for­mer Attor­ney Gen­eral Edwin Meese III gath­ered in the cap­i­tal to plot strat­egy. Their push to repeal Mr. Obama’s health care law was going nowhere, and they des­per­ately needed a new plan.

    Out of that ses­sion, held one morn­ing in a loca­tion the mem­bers insist on keep­ing secret, came a little-noticed “blue­print to defund­ing Oba­macare,” signed by Mr. Meese and lead­ers of more than three dozen con­ser­v­a­tive groups.

    It artic­u­lated a take-no-prisoners leg­isla­tive strat­egy that had long per­co­lated in con­ser­v­a­tive cir­cles: that Repub­li­cans could derail the health care over­haul if con­ser­v­a­tive law­mak­ers were will­ing to push fel­low Repub­li­cans — includ­ing their cau­tious lead­ers — into cut­ting off financ­ing for the entire fed­eral government.

    “We felt very strongly at the start of this year that the House needed to use the power of the purse,” said one coali­tion mem­ber, Michael A. Need­ham, who runs Her­itage Action for Amer­ica, the polit­i­cal arm of the Her­itage Foun­da­tion. “At least at Her­itage Action, we felt very strongly from the start that this was a fight that we were going to pick.”

    Last week the coun­try wit­nessed the fall­out from that strat­egy: a stand­off that has shut­tered much of the fed­eral bureau­cracy and unset­tled the nation.

    To many Amer­i­cans, the shut­down came out of nowhere. But inter­views with a wide array of con­ser­v­a­tives show that the con­fronta­tion that pre­cip­i­tated the cri­sis was the out­growth of a long-running effort to undo the law, the Afford­able Care Act, since its pas­sage in 2010 — waged by a galaxy of con­ser­v­a­tive groups with more money, orga­nized tac­tics and inter­con­nec­tions than is com­monly known.

    With polls show­ing Amer­i­cans deeply divided over the law, con­ser­v­a­tives believe that the pub­lic is behind them. Although the law’s oppo­nents say that shut­ting down the gov­ern­ment was not their objec­tive, the activists antic­i­pated that a shut­down could occur — and worked with mem­bers of the Tea Party cau­cus in Con­gress who were excited about draw­ing a red line against a law they despise.

    A defund­ing “tool kit” cre­ated in early Sep­tem­ber included talk­ing points for the ques­tion, “What hap­pens when you shut down the gov­ern­ment and you are blamed for it?” The sug­gested answer was the one House Repub­li­cans give today: “We are sim­ply call­ing to fund the entire gov­ern­ment except for the Afford­able Care Act/Obamacare.”

    The cur­rent bud­get brinkman­ship is just the lat­est devel­op­ment in a well-financed, broad-based assault on the health law, Mr. Obama’s sig­na­ture leg­isla­tive ini­tia­tive. Groups like Tea Party Patri­ots, Amer­i­cans for Pros­per­ity and Free­dom­Works are all immersed in the fight, as is Club for Growth, a business-backed non­profit orga­ni­za­tion. Some, like Gen­er­a­tion Oppor­tu­nity and Young Amer­i­cans for Lib­erty, both aimed at young adults, are upstarts. Her­itage Action is new, too, founded in 2010 to advance the pol­icy pre­scrip­tions of its sis­ter group, the Her­itage Foundation.

    The bil­lion­aire Koch broth­ers, Charles and David, have been deeply involved with financ­ing the over­all effort. A group linked to the Kochs, Free­dom Part­ners Cham­ber of Com­merce, dis­bursed more than $200 mil­lion last year to non­profit orga­ni­za­tions involved in the fight. Included was $5 mil­lion to Gen­er­a­tion Oppor­tu­nity, which cre­ated a buzz last month with an Inter­net adver­tise­ment show­ing a men­ac­ing Uncle Sam fig­ure pop­ping up between a woman’s legs dur­ing a gyne­co­log­i­cal exam.

    The groups have also sought to pres­sure vul­ner­a­ble Repub­li­can mem­bers of Con­gress with score­cards keep­ing track of their health care votes; have burned faux “Oba­macare cards” on col­lege cam­puses; and have dis­trib­uted scripts for phone calls to Con­gres­sional offices, sam­ple let­ters to edi­tors and Twit­ter and Face­book offer­ings for fol­low­ers to present as their own.

    One sam­ple Twit­ter offer­ing — “Oba­macare is a train wreck” — is a com­mon refrain for Speaker John A. Boehner.

    As the defund­ing move­ment picked up steam among out­side advo­cates, Repub­li­cans who sounded tepid became tar­gets. The Sen­ate Con­ser­v­a­tives Fund, a polit­i­cal action com­mit­tee ded­i­cated to “elect­ing true con­ser­v­a­tives,” ran radio adver­tise­ments against three Repub­li­can incumbents.

    Her­itage Action ran crit­i­cal Inter­net adver­tise­ments in the dis­tricts of 100 Repub­li­can law­mak­ers who had failed to sign a let­ter by a North Car­olina fresh­man, Rep­re­sen­ta­tive Mark Mead­ows, urg­ing Mr. Boehner to take up the defund­ing cause.

    “They’ve been hugely influ­en­tial,” said David Wasser­man, who tracks House races for the non­par­ti­san Cook Polit­i­cal Report. “When else in our his­tory has a fresh­man mem­ber of Con­gress from North Car­olina been able to round up a gang of 80 that’s essen­tially ground the gov­ern­ment to a halt?”

    On Capi­tol Hill, the advo­cates found will­ing part­ners in Tea Party con­ser­v­a­tives, who have repeat­edly threat­ened to shut down the gov­ern­ment if they do not get their way on spend­ing issues. This time they said they were so alarmed by the health law that they were will­ing to risk a shut­down over it. (“This is exactly what the pub­lic wants,” Rep­re­sen­ta­tive Michele Bach­mann of Min­nesota, founder of the House Tea Party Cau­cus, said on the eve of the shutdown.)

    Despite Mrs. Bachmann’s com­ments, not all of the groups have been on board with the defund­ing cam­paign. Some, like the Koch-financed Amer­i­cans for Pros­per­ity, which spent $5.5 mil­lion on health care tele­vi­sion adver­tise­ments over the past three months, are more focused on sow­ing pub­lic doubts about the law. But all have a com­mon goal, which is to crip­ple a mea­sure that Sen­a­tor Ted Cruz, a Texas Repub­li­can and leader of the defund­ing effort, has likened to a hor­ror movie.

    “We view this as a long-term effort,” said Tim Phillips, the pres­i­dent of Amer­i­cans for Pros­per­ity. He said his group expected to spend “tens of mil­lions” of dol­lars on a “mul­ti­front effort” that includes work­ing to pre­vent states from expand­ing Med­ic­aid under the law. The group’s goal is not to defund the law.

    “We want to see this law repealed,” Mr. Phillips said.

    A Famil­iar Tactic

    The crowd was rau­cous at the Hilton Ana­tole, just north of down­town Dal­las, when Mr. Needham’s group, Her­itage Action, arrived on a Tues­day in August for the sec­ond stop on a nine-city “Defund Oba­macare Town Hall Tour.” Nearly 1,000 peo­ple turned out to hear two stars of the Tea Party move­ment: Mr. Cruz, and Jim DeMint, a for­mer South Car­olina sen­a­tor who runs the Her­itage Foundation.

    “You’re here because now is the sin­gle best time we have to defund Oba­macare,” declared Mr. Cruz, who would go on to rail against the law on the Sen­ate floor in Sep­tem­ber with a mono­logue that ran for 21 hours. “This is a fight we can win.”

    Although Mr. Cruz is new to the Sen­ate, the tac­tic of defund­ing in Wash­ing­ton is not. For years, Con­gress has banned the use of cer­tain fed­eral money to pay for abor­tions, except in the case of incest and rape, by attach­ing the so-called Hyde Amend­ment to spend­ing bills.

    After the health law passed in 2010, Todd Tiahrt, then a Repub­li­can con­gress­man from Kansas, pro­posed defund­ing bits and pieces of it. He said he spoke to Mr. Boehner’s staff about the idea while the Supreme Court, which upheld the cen­tral pro­vi­sion, was weigh­ing the law’s constitutionality.

    “There just wasn’t the appetite for it at the time,” Mr. Tiahrt said in an inter­view. “They thought, we don’t need to worry about it because the Supreme Court will strike it down.”

    But the idea of using the appro­pri­a­tions process to defund an entire fed­eral pro­gram, par­tic­u­larly one as far-reaching as the health care over­haul, raised the stakes con­sid­er­ably. In an inter­view, Mr. DeMint, who left the Sen­ate to join the Her­itage Foun­da­tion in Jan­u­ary, said he had been think­ing about it since the law’s pas­sage, in part because Repub­li­can lead­ers were not more aggressive.

    “They’ve been through a series of C.R.s and debt lim­its,” Mr. DeMint said, refer­ring to con­tin­u­ing res­o­lu­tions on spend­ing, “and all the time there was dis­cus­sion of ‘O.K., we’re not going to fight the Oba­macare fight, we’ll do it next time.’ The con­ser­v­a­tives who ran in 2010 promis­ing to repeal it kept hear­ing, ‘This is not the right time to fight this battle.’ ”

    Mr. DeMint is hardly alone in his dis­taste for the health law, or his will­ing­ness to do some­thing about it. In the three years since Mr. Obama signed the health mea­sure, Tea Party-inspired groups have mobi­lized, aided by a financ­ing net­work that con­tin­ues to grow, both in its com­plex­ity and the sheer amount of money that flows through it.

    A review of tax records, cam­paign finance reports and cor­po­rate fil­ings shows that hun­dreds of mil­lions of dol­lars have been raised and spent since 2012 by orga­ni­za­tions, many of them loosely con­nected, lead­ing oppo­si­tion to the measure.

    One of the biggest sources of con­ser­v­a­tive money is Free­dom Part­ners, a tax-exempt “busi­ness league” that claims more than 200 mem­bers, each of whom pays at least $100,000 in dues. The group’s board is headed by a long­time exec­u­tive of Koch Indus­tries, the con­glom­er­ate run by the Koch broth­ers, who were among the orig­i­nal financiers of the Tea Party move­ment. The Kochs declined to comment.

    While Free­dom Part­ners has financed orga­ni­za­tions that are push­ing to defund the law, like Her­itage Action and Tea Party Patri­ots, Free­dom Part­ners has not advo­cated that. A spokesman for the group, James Davis, said it was more focused on “edu­cat­ing Amer­i­cans around the coun­try on the neg­a­tive impacts of Obamacare.”

    The largest recip­i­ent of Free­dom Part­ners cash — about $115 mil­lion — was the Cen­ter to Pro­tect Patient Rights, accord­ing to the groups’ lat­est tax fil­ings. Run by a polit­i­cal con­sul­tant with ties to the Kochs and list­ing an Ari­zona post office box for its address, the cen­ter appears to be lit­tle more than a clear­ing­house for dona­tions to still more groups, includ­ing Amer­i­can Com­mit­ment and the 60 Plus Asso­ci­a­tion, both ardent foes of the health care law.

    Amer­i­can Com­mit­ment and 60 Plus were among a hand­ful of groups call­ing them­selves the “Repeal Coali­tion” that sent a let­ter in August urg­ing Repub­li­can lead­ers in the House and the Sen­ate to insist “at a min­i­mum” in a one-year delay of car­ry­ing out the health care law as part of any bud­get deal. Another group, the Con­ser­v­a­tive 50 Plus Alliance, deliv­ered a defund­ing peti­tion with 68,700 sig­na­tures to the Senate.

    In the fight to shape pub­lic opin­ion, con­ser­v­a­tives face well-organized lib­eral foes. Enroll Amer­ica, a non­profit group allied with the Obama White House, is wag­ing a cam­paign to per­suade mil­lions of the unin­sured to buy cov­er­age. The law’s sup­port­ers are also get­ting huge assis­tance from the insur­ance indus­try, which is expected to spend $1 bil­lion on adver­tis­ing to help sell its plans on the exchanges.

    “It is David ver­sus Goliath,” said Mr. Phillips of Amer­i­cans for Prosperity.

    ...

    It’ll be inter­est­ing to learn how much direct involve­ment Peter Thiel has with “Team David” in the show­down between a band of plucky bil­lion­aires and the Oba­macare Goliath. After all, Thiel views social safety-net poli­cies — like women vot­ing — as social can­cers. He was also an early investor in Cruz Co. So this seems like exactly the kind of issue that we should expect to receive more than just of spoon­ful of that sweet sweet Thiel sugar.

    Posted by Pterrafractyl | October 7, 2013, 2:34 pm
  19. It looks like the “What, me worry?” Con­gres­sional Brigade is still accept­ing mem­bers:

    USA Today
    Debt limit breach no big deal, some GOP law­mak­ers say
    Gre­gory Korte and Susan Davis, USA TODAY 9:26 p.m. EDT Octo­ber 7, 2013

    Every­one agrees that the nation is com­ing up against the $16.7 tril­lion debt ceil­ing. The debate is over when that will hap­pen, and what comes next.

    WASHINGTON — Repub­li­can law­mak­ers are voic­ing increas­ing skep­ti­cism about dire warn­ings that fail­ing to raise the debt ceil­ing would result in cat­a­strophic default.

    “I would dis­pel the rumor that is going around that you hear on every news­cast, that if we don’t raise the debt ceil­ing, we will default on our debt,” said Sen. Tom Coburn, R-Okla., Mon­day on CBS This Morn­ing. “We won’t. We’ll con­tinue to pay our interest.”

    Coburn and other Repub­li­cans argue that the Trea­sury Depart­ment could pri­or­i­tize inter­est pay­ments while delay­ing oth­ers. The House has passed a bill requir­ing the Trea­sury to do just that.

    “I think one of the things that’s been so dis­turb­ing about this period is that you’ve actu­ally had the House lead­er­ship pass pro­pos­als to imple­ment how you would do pri­or­i­ti­za­tion, as if that would be an accept­able solu­tion. It is not accept­able. Pri­or­i­ti­za­tion is default by another name,” said Gene Sper­ling, direc­tor of the National Eco­nomic Coun­cil, at a Politico break­fast Mon­day. He said Pres­i­dent Obama prefers a long-term raise in the $16.7 tril­lion debt limit, but did not rule out sup­port for a short-term increase.

    Washington’s atten­tion is turn­ing to the debt limit even as it enters its sec­ond full week of a par­tial shut­down caused by Con­gress’ inabil­ity to pass a spend­ing bill. Although most of the 350,000 civil­ian Defense employ­ees are going back to work this week, more than half a mil­lion fed­eral work­ers remain fur­loughed. The House voted Sat­ur­day to give all fed­eral work­ers back pay, but the Sen­ate has yet to sched­ule a vote on the measure.

    It’s increas­ingly likely that a bill end­ing the shut­down will be pack­aged with a mea­sure to raise the debt limit. But House Speaker John Boehner, R-Ohio, is seek­ing bud­get cuts from the White House as part of that measure.

    The White House says it wants a “clean” debt limit increase, and that it must hap­pen by Oct. 17. That’s the day Trea­sury Sec­re­tary Jacob Lew says the United States would run out of bor­rowed money, putting the gov­ern­ment in uncharted ter­ri­tory and cre­at­ing the prospect of a first-ever default.

    But some Repub­li­cans aren’t buy­ing it.

    “I will hear lan­guage like, ‘Well, we are head­ing toward the debt ceil­ing and you are going to default.’ Any­one that says that is look­ing you in the eyes and lying to you, either that or they don’t own a cal­cu­la­tor,” Rep. David Schweik­ert, R-Ariz., said in a House debate Friday.

    And Rep. Ted Yoho, R-Fla., even argues that reach­ing the debt limit could help the econ­omy, by show­ing the world the U.S. is seri­ous about its debt prob­lem. “I think, per­son­ally, it would bring sta­bil­ity to the world mar­kets,” he told The Wash­ing­ton Post Monday.

    “The bot­tom line is, Trea­sury has the abil­ity to man­age that, so the date is what­ever Sec­re­tary Lew claims the date will be,” said Rep. Jeb Hen­sar­ling, R-Texas.

    ...

    Veronique de Rugy, an econ­o­mist at the free-market Mer­ca­tus Cen­ter at George Mason Uni­ver­sity, said the debt ceil­ing will have to be raised sooner or later — and Repub­li­cans should know that.

    “I do not believe that past Oct. 17 the country’s going to hell,” she said. “But I agree that fail­ing to pay inter­est on our debt has very seri­ous con­se­quences. And there’s no bud­get out there that doesn’t require us to raise the debt ceil­ing. If Repub­li­cans put a bal­anced bud­get pro­posal out there, they would have a lot more cred­i­bil­ity in my eyes.”

    When folks like Veronique de Rugyfrom the Koch-financed Mer­ca­tus Cen­ter — are ques­tion­ing your debt-ceiling show­down tac­tics you know you’ve entered overreach-territory. Enjoy the ride.

    Posted by Pterrafractyl | October 7, 2013, 11:03 pm
  20. It’s time to get excited! America’s own lil’ home­grown Troika-system of Bil­lion­aire Jus­tice is com­ing soon:

    Esquire
    Oct 8, 2013
    Avengers, Assem­ble!
    By Charles P. Pierce at 3:45PM

    No. Stop it. Seri­ously. You’re killing me here.

    A senior House aide said Repub­li­cans are con­sid­er­ing leg­is­la­tion to cre­ate a new panel to find deficit reduc­tions sim­i­lar to a failed 2011 “super­com­mit­tee” of Repub­li­cans and Democ­rats from the House and Sen­ate that was asked to find tril­lions of new bud­get savings.

    I have lived through a num­ber of instances in which the prob­lems of actual democ­racy were seen as being so intractable and icky that they were beyond the strength of mor­tal men to solve. On these occa­sions, the peo­ple actu­ally elected to make democ­racy worked called upon gath­er­ings of wise men — men of lead­er­ship, of vision, of con­sid­er­able expense accounts — to lead the nation out of dark­ness and into the light of their innate genius. And you know what? Almost all of them sucked.

    The War­ren Com­mis­sion? A fic­tion. Sucked.

    The Tower Com­mis­sion on Iran-Contra? A white­wash. Sucked.

    The Gramm-Rudman Bud­get com­pro­mise? A delu­sion. Sucked.

    The pre­vi­ous Super­Com­mit­tee? Sucked. Made me agree with N. Leroy Gin­grich. Double-sucked.

    Simpson-Bowles? Don’t even get me started. Feed­ers of Vaal. Sucked.

    And now, this. The insti­tu­tions of self-government have been sab­o­taged by a col­lec­tion of van­dals and so, now, it’s time to give Bob Rubin or some­one another chance to min­gle the finan­cial ser­vices indus­try with the oper­a­tions of gov­ern­ment because that always has worked out so well for the rest of us. First of all, we shouldn’t be talk­ing about Teh Deficit now — or later, but that’s another gin fizz entirely — and the Democ­rats at last seem to have become aware of this sim­ple fact, although they still talk very much as though they’d like to get the cur­rent unpleas­ant­ness out of the way so they can get back to being “seri­ous” about Teh Deficit, thereby con­tin­u­ing to ignore the blog’s First Law Of Eco­nom­ics, and act­ing as though the Repub­li­cans are going to be any more rea­son­able after the pos­si­bly apoc­a­lyp­tic denoue­ment of the cur­rent unpleas­ant­ness as they were before. Steve King, I am sure, is des­per­ate to get back to san­ity again.

    But what makes me truly angry about pro­pos­als like this is that they bespeak a cer­tain lack of faith in the polit­i­cal insti­tu­tions through which we’re sup­posed to work all of these things out. If Con­gress is bro­ken, then, dammit, let Con­gress — and the peo­ple who elect it — fix itself.

    It’s an implicit rejec­tion of self-government, and this is only one of the man­i­fes­ta­tions of that rejec­tion that afflicts our polit­i­cal class. Craven politi­cians love that stuff. The courtier press hungers for this kind of ad hoc parade of ambu­la­tory resumes. (Save us, Lawrence Eagle­burger, you’re our only hope.) It is a val­i­da­tion of their own well-tailored belief that the only wis­dom in the coun­try can be found within the Belt­way, and that the entire appa­ra­tus of self-government exists only to power and to feed a com­pany town. It also com­forts them because, in all of the cases cited above, the gath­er­ing of elders pro­duced a report or answers that soothed the ner­vous sys­tems of the polit­i­cal elite, the mem­bers of which worry night and day that actual polit­i­cal energy might break out beyond the far shores of the Potomac. My dear young peo­ple, that sim­ply is not done.

    Part of what’s mak­ing this lat­est round of act­ing out by the GOP so dis­turb­ing is the num­ber of notable peo­ple that seem more than will­ing to just sud­denly pub­licly endorse the notion that selec­tively not pay­ing inter­est to US cred­i­tors wouldn’t be dam­ag­ing to the US credit and cred­i­bil­ity at all. In fact, the argu­ment goes, global com­mu­nity might be even more con­fi­dent in the US because we would have engaged in pre­emp­tive eurozone-style aus­ter­ity to demon­strate to the world how respon­si­ble we are as a nation. Plus, the argu­ment goes, if we don’t imme­di­ately make rad­i­cal com­mit­ments to dra­mat­i­cally scal­ing back the safety-net for gen­er­a­tions to come, the US will soon suf­fer a cri­sis of global con­fi­dence and fall into hyper-inflation and the Weimar 2.0.

    That’s the grow­ing meme and sure, the “hyper­in­fla­tion! Too much debt!” argu­ments have been a reg­u­lar part of US pol­i­tics for decades, but are we now wit­ness­ing the intro­duc­tion of “hey, there’s no such thing as default...just help­ful aus­ter­ity!” as part of the new New Nor­mal? A new Amero­zone Tru­ism? Now, appar­ently, the world gets to know that every time one of the US’s polit­i­cal par­ties decides an uncross­able bud­getary line has been crossed, the gov­ern­ment shuts down until a Super Com­mit­tee is cre­ated to over­haul the social safety-net? Can’ just being sorry be enough? Are cabals of bil­lion­aires that take things into their own hands and smash them really nec­es­sary? And...Yes, such cabals are appar­ently nec­es­sary.

    And just today, we have reports of a respected Har­vard econ­o­mist dis­miss­ing con­cerns about a default and mak­ing the exact same claim that a selec­tive default would be just fine. It raises the ques­tion: Is the debt-bug up everyone’s ass of the brain-eating vari­ety? Because that sounds like a pub­lic health con­cern that calls for expanded health­care coverage.

    Oh wait, never mind. That respected Har­vard econ­o­mist was Mar­tin Feld­stein. Par­a­sites ate his brain years ago. So it may not be a brain-eating par­a­site infes­ta­tion, although it still leaves open the ques­tion of what’s caus­ing the uptick in mass-insanity lev­els. Body­Thetans? Maybe?

    Posted by Pterrafractyl | October 8, 2013, 9:13 pm
  21. Just because a band of homo­ci­dal pup­pets go on a ram­page doesn’t mean you can auto­mat­i­cally blame the Pup­pet Mas­ter. Maybe the Pup­pet Mas­ter has a per­fectly good excuse for the ram­page. Or not. Either way, you can’t blame the Pup­pet Mas­ter:

    The New York Times
    Kochs Deny Push­ing for Shut­down Over Health Law
    Sheryl Gay Stol­berg, 11:15 am

    WASHINGTON – Koch Indus­tries, whose co-founders, Charles and David Koch, are major donors to Tea Party-inspired con­ser­v­a­tive causes, accused Harry Reid, the Sen­ate major­ity leader, on Wednes­day of spread­ing “false infor­ma­tion” about the broth­ers by sug­gest­ing they are behind the move to end financ­ing for Pres­i­dent Obama’s health­care law and the par­tial shut­down of the fed­eral gov­ern­ment.

    “Koch believes that Oba­macare will increase deficits, lead to an over­all low­er­ing of the stan­dard of health care and raise taxes,’’ Philip Ellen­der, the company’s chief spokesman, wrote in a let­ter to sen­a­tors. “How­ever, Koch has not taken a posi­tion on the leg­isla­tive tac­tic of tying the con­tin­u­ing res­o­lu­tion to defund­ing Oba­macare, nor have we lob­bied on leg­isla­tive pro­grams defund­ing Obamacare.’’

    The Koch broth­ers have long worked against the health law, and have con­tributed to orga­ni­za­tions, like Her­itage Action for Amer­ica, that are press­ing law­mak­ers to end financ­ing for it.

    Other Koch-backed groups, like Amer­i­cans for Pros­per­ity and a new group, Gen­er­a­tion Oppor­tu­nity, which is aimed at young peo­ple, are work­ing to sow doubts about the health law and to under­mine it in other ways, includ­ing by per­suad­ing Amer­i­cans not to enroll for health insur­ance and press­ing state law­mak­ers not to expand Med­ic­aid under the law. Amer­i­cans for Pros­per­ity alone has run $5.5 mil­lion in tele­vi­sion adver­tis­ing against the law over the past three months.
    ...

    So if we can’t blame the Pup­pet Mas­ters when their pup­pets go on a ram­page maybe we could at least require that they get some­thing like lia­bil­ity insur­ance for the pup­pets? Would that be accept­able? Ah, that would prob­a­bly be a ‘no’.

    Posted by Pterrafractyl | October 9, 2013, 9:29 am
  22. A some­what sur­pris­ing twist in the recent hostage-taking pivot by the GOP — from demand­ing an end to Oba­macare to demand­ing major reforms to social secu­rity and Medicare — is that it seemed to be a pivot towards a pol­icy posi­tion that explic­itly attacks America’s youth in a such a way that the GOP gets vir­tu­ally all of the blame. When it was just a fight about defund­ing Oba­macare at least the GOP could pos­ture in a way that seemed to say “hey unin­sured young peo­ple, we’re stop­ping Oba­macare in order to save you from the hor­rors of health insur­ance”. But now, thanks to the new demands that the US now sud­denly imple­ment long-term enti­tle­ment cuts, it’s going to be a lot harder for the GOP to walk away from this sit­u­a­tion with­out look­ing like a cabal that hijacked the nor­mal demo­c­ra­tic process in order to wage a long-term attack on young people’s retire­ments. It’s a high-risk response to the much feared “demo­graphic Win­ter” for the US far-right. You can’t have your pre­ferred brand of mind­less trib­al­ism dom­i­nate the future polit­i­cal land­scape when your tribe is sys­tem­at­i­cally alien­at­ing the future mem­bers of the tribe. And now the grand hostage-taking strat­egy being advo­cated by thought-leaders like Grover Norquist is to take atten­tion com­pletely away from the Oba­macare fight. Instead, they’ll refo­cus on offer­ing the Democ­rats a short-term lift­ing of the debt-ceiling in exchange for par­tial imple­men­ta­tion of the Ryan Plan to be phased in over decades. That appears to be the offer Grover is now push­ing as ‘Plan B’:

    A GOP plan B: a deal to get a win-win from shut­down and debt ceil­ing crises

    Ted Cruz’s strat­egy failed Repub­li­cans, but nei­ther Obama nor Democ­rats are ahead. Yet we all gain by a sequester cuts trade

    Grover Norquist
    theguardian.com, Tues­day 8 Octo­ber 2013 10.12 EDT

    OK. Plan A didn’t quite work as advertised.

    Texas Sen­a­tor Ted Cruz said that if the House Repub­li­can major­ity attached a “defund­ing” of Oba­macare to the con­tin­u­ing res­o­lu­tion (CR) bud­get, he and his allies would force the Demo­c­ra­tic major­ity in the Sen­ate to pass same and coerce Pres­i­dent Obama into sign­ing the repeal of his sig­na­ture leg­is­la­tion. The Democ­rats failed to co-operate in this effort.

    So now what?

    Pres­i­dent Obama is insist­ing that Repub­li­cans pass the “clean” con­tin­u­ing res­o­lu­tion – an agree­ment to keep the present bud­get going with­out changes – and the upcom­ing debt ceil­ing increase with­out attach­ing any bud­get reforms or changes to Obamacare.

    Repub­li­cans in the House walked away from Cruz’s “every­thing or noth­ing” non-negotiable demand and have offered a series of com­pro­mise deals: a one-year delay in Oba­macare, a one-year delay in the man­date to buy health insur­ance, the repeal of the tax on med­ical devices, and a law over­turn­ing Obama’s Office of Per­son­nel Man­age­ment rul­ing that con­gres­sional staff would not have to live under Obamacare.

    With no agree­ment, the pre­vi­ous con­tin­u­ing res­o­lu­tion lapsed. The gov­ern­ment shut­down, which means that Pres­i­dent Obama largely chooses what to fund and what to not fund – sub­ject to rules estab­lished (and there­fore change­able) by the exec­u­tive branch: read, the president’s appointees.

    What does each party want? What do they fear? What is their lever­age against the other?

    ..

    There is lever­age in the sequester, the 2011 law that caps the growth of domes­tic dis­cre­tionary and mil­i­tary spend­ing. Many Democ­rats find those caps smoth­er­ing. They want them lifted. Repub­li­cans fear the unfunded lia­bil­i­ties of the pay-as-you-go enti­tle­ment spend­ing that, unchanged, will bring fed­eral spend­ing to 40% of GDP (from 20%) by 2050.

    Here, there is a pos­si­ble trade: a tem­po­rary and lim­ited lift­ing of the sequester to allow some more spend­ing now, in return for reduc­ing some of the $64tn (in present value) of the unfunded lia­bil­i­ties in the future. That future over­spend­ing is not sus­tain­able. It will have to be culled back some­day. Why not get some­thing here and now in exchange?

    The sequester, like Oba­macare, is the law of the land. Repub­li­cans might trade some more spend­ing today for much less far into the future. Enti­tle­ment laws can be changed – as Rea­gan and the Democ­rats did to delay the retire­ment age for social secu­rity from 65 to 67, over 24 years. The tra­di­tional, and wholly ratio­nal, fear that promised spend­ing cuts would evap­o­rate is reduced or even elim­i­nated when cuts are gained through such changes in enti­tle­ment law.

    Deal?

    What a deal! Who wouldn’t be tempted by “tem­po­rary and lim­ited lift­ing of the sequester to allow some more spend­ing now, in return for reduc­ing some of the $64tn (in present value) of the unfunded lia­bil­i­ties in the future”? It’s an espe­cially tempt­ing offer com­ing from the guy that recently sug­gested the Ryan Plan was going to be imple­mented no mat­ter what, it’s just a mat­ter of time. Oh goodie!

    It’s still unclear, though, how America’s youth is going to appre­ci­ate the Ryaniza­tion of their finan­cial futures as the pay­out for the whole hostage-taking thing since it seems to involve hand­ing their futures over to Wall Street. Sure, that kind of fully Ryan-compliant grand bar­gain is unlikely to hap­pen in this first sec­ond pass, but as Grover promised, it’s com­ing. It’s just a mat­ter of time. Bit by bit, the finan­cial secu­rity if today’s youth gets traded away for decades to come in exchange for those awe­some Norquist rev­enue increases. And lots of future debt-ceiling fights.

    Since this is all just a taste of future safety-net fights to come, it raises the ques­tion of just how far the GOP is inter­ested in going in terms of pri­va­tiz­ing the future enti­tle­ment sys­tem of the youth because any short-term agree­ment is implic­itly a long-term agree­ment to repeated hostage-taking ses­sions. The long-term visions is pretty impor­tant for at least the short-to-medium-term because the US is appar­ently going to be forced into some sort of New Koch and Tea Deal via leg­isla­tive capit­u­la­tion or the US is going to be forced into insol­vency. So what are the long-term terms of the deal being offered to the US? Espe­cially the youth? Do any of us get to know? Is there at least a fixed crazy-rate that young adults to rely on in their far-right thought lead­ers while these lead­ers are plan­ning the youth’s retire­ments or is it one of those fancier loans that just fol­lows the crazy-market? Because the crazy-market looks scary.

    Posted by Pterrafractyl | October 9, 2013, 11:57 pm
  23. I read today that Kasich may use an Exec­u­tive Order to accept Med­ic­aid expansion.

    Posted by Kathleen | October 10, 2013, 12:50 pm
  24. @Kathleen: Yep, and now the next step, if Kasich chooses to go through with the exec­u­tive order, would be to seek the approval of a seven-member GOP-dominated Con­trol Board. And, accord­ing to Ohio’s Sen­ate Pres­i­dent Keith Faber, if the board rejects Kasich’s order he can either reverse the exec­u­tive order or Ohio’s entire Med­ic­aid sys­tem will go bank­rupt. ‘Tis the Sea­son New Cli­mate of End­less Shut­down Show­downs and Happy Health­care Hol­i­days! At least in Ohio:

    The Colum­bus Dis­patch
    Kasich Medicaid-expansion plan puts heat on GOP leg­is­la­tors
    By Jim Siegel

    The Colum­bus Dis­patch Wednes­day Octo­ber 9, 2013 6:15 AM

    If Gov. John Kasich moves ahead with Med­ic­aid expan­sion via an exec­u­tive order, leg­is­la­tors could be pressed to approve the fund­ing or face bank­rupt­ing the mas­sive health-care sys­tem in Ohio.

    Spec­u­la­tion is ram­pant that on Oct. 21, Kasich will ask the seven-member legislative-spending over­sight panel to give him the author­ity to spend fed­eral money to cover an esti­mated 275,000 low-income Ohioans under Med­ic­aid. The expan­sion, made pos­si­ble under Oba­macare, would be 100 per­cent fed­er­ally funded for the first three years and bring in an esti­mated $13 bil­lion in fed­eral money over seven years.

    “The gov­er­nor, I think, has the author­ity to do that,” said Sen­ate Pres­i­dent Keith Faber, R-Celina. “It’s cer­tainly within his pre­rog­a­tive. I’m a defender of leg­isla­tive rights, and I would think the bet­ter solu­tion would be a leg­isla­tive option, but the gov­er­nor does have that authority.”

    Faber noted that the gov­er­nor could do the expan­sion by exec­u­tive order and then seek Con­trol­ling Board author­ity to spend the money. He then described what could hap­pen if the board denies the request.

    “If you don’t do that, Med­ic­aid ... goes bank­rupt,” Faber said. “It’s pre­ma­ture to dis­cuss what would hap­pen or not hap­pen, but I don’t think any­one wants a bank­rupt exist­ing Med­ic­aid program.”

    So if the gov­er­nor pushes ahead, could GOP leg­isla­tive lead­ers who have thus far resisted expan­sion argue that they are being forced to go along — or else bank­rupt a sys­tem that serves 2.4 mil­lion Ohioans?

    Some con­ser­v­a­tives argue that Kasich could sim­ply reverse his exec­u­tive order if the board rejects the request.

    The Con­trol­ling Board is made up of one governor’s appointee and six leg­is­la­tors — two Repub­li­cans and one Demo­c­rat from each cham­ber. The appointee and the Democ­rats would likely vote for expan­sion, and at least one Repub­li­can must join them. But who?

    Faber said he has no inten­tion of replac­ing either of his mem­bers on the board — Sens. Bill Coley and Chris Widener. No one thinks Coley would vote for the expan­sion. Widener, the No. 2 Sen­ate leader, has not indi­cated support.

    The dynam­ics are inter­est­ing on the House side of the board. Reps. Ron Amstutz and Cliff Rosen­berger are the GOP mem­bers — and con­sid­ered the top two con­tenders to replace Speaker William G. Batchelder when he is term lim­ited at the end of 2014. It’s hard to imag­ine a sce­nario where one takes the heat for a “yes” vote while let­ting the other skate.

    ...

    Posted by Pterrafractyl | October 10, 2013, 8:20 pm
  25. Paul Ryan, the GOP’s offi­cial “adult in the room”, just dropped the mask a lit­tle more. In addi­tion to hold­ing on to their dreams of repeal­ing Oba­macare, he’s encour­ag­ing the GOP to “com­pletely rethink government’s role in help­ing the most vul­ner­a­ble” and “com­pletely rethink government’s role in our lives”. Con­sid­er­ing that rad­i­cally over­haul­ing and pri­va­tiz­ing the gov­ern­ment has been a GOP OCD fetish for decades, you have to won­der if there’s any­thing new that Paul thinks we should rethink...

    TPM Livewire
    Paul Ryan: GOP Shouldn’t Give Up On ‘Repeal­ing And Replac­ing’ Oba­macare
    Igor Bobic – Octo­ber 11, 2013, 2:31 PM EDT

    Address­ing a con­ser­v­a­tive con­fab in Wash­ing­ton on Fri­day, Rep. Paul Ryan (R-WI) reprised a famil­iar Repub­li­can refrain — made pop­u­lar by his and Mitt Romney’s pres­i­den­tial ticket in 2012 — to “repeal and replace” Oba­macare with a viable alter­na­tive that would extend health insur­ance to mil­lions of poor Americans.

    “The way I see it, our job is to pre­serve our val­ues in the 21st cen­tury,” the rank­ing mem­ber on the House Bud­get Com­mit­tee said in a video address at Val­ues Voter Sum­mit. “We need to apply our prin­ci­ples to the chal­lenges of today. And that means we need to com­pletely rethink government’s role in our lives.

    “We need to com­pletely rethink government’s role in help­ing the most vul­ner­a­ble,” Ryan added. “We need to com­pletely rethink government’s role in health care. That means we can never give up on repeal­ing and replac­ing Obamacare.”

    The refrain is largely a blast from the past because the Repub­li­can Party, led by a group of con­ser­v­a­tive sen­a­tors and House rep­re­sen­ta­tives, largely ditched the lat­ter in favor of a quixotic effort to defund Oba­macare in exchange for fund­ing the gov­ern­ment — with nary a men­tion about alter­na­tive proposals.

    ...

    Hmmm...something tells me this “com­plete rethink­ing” called for by Paul Ryan involves a lot of old thoughts:

    The New York Times
    Repub­li­cans and Medicare

    By PAUL KRUGMAN
    Pub­lished: Feb­ru­ary 11, 2010

    “Don’t cut Medicare. The reform bills passed by the House and Sen­ate cut Medicare by approx­i­mately $500 bil­lion. This is wrong.” So declared Newt Gin­grich, the for­mer speaker of the House, in a recent op-ed arti­cle writ­ten with John Good­man, the pres­i­dent of the National Cen­ter for Pol­icy Analysis.

    And irony died.

    Now, Mr. Gin­grich was just repeat­ing the cur­rent party line. Furi­ous denun­ci­a­tions of any effort to seek cost sav­ings in Medicare — death pan­els! — have been cen­tral to Repub­li­can efforts to demo­nize health reform. What’s amaz­ing, how­ever, is that they’re get­ting away with it.

    Why is this amaz­ing? It’s not just the fact that Repub­li­cans are now pos­ing as staunch defend­ers of a pro­gram they have hated ever since the days when Ronald Rea­gan warned that Medicare would destroy America’s free­dom. Nor is it even the fact that, as House speaker, Mr. Gin­grich per­son­ally tried to ram through deep cuts in Medicare — and, in 1995, went so far as to shut down the fed­eral gov­ern­ment in an attempt to bully Bill Clin­ton into accept­ing those cuts.

    After all, you could explain this about-face by sup­pos­ing that Repub­li­cans have had a change of heart, that they have finally real­ized just how much good Medicare does. And if you believe that, I’ve got some mortgage-backed secu­ri­ties you might want to buy.

    No, what’s truly mind-boggling is this: Even as Repub­li­cans denounce mod­est pro­pos­als to rein in Medicare’s ris­ing costs, they are, them­selves, seek­ing to dis­man­tle the whole pro­gram. And the process of dis­man­tling would begin with spend­ing cuts of about $650 bil­lion over the next decade. Math is hard, but I do believe that’s more than the roughly $400 bil­lion (not $500 bil­lion) in Medicare sav­ings pro­jected for the Demo­c­ra­tic health bills.

    What I’m talk­ing about here is the “Roadmap for America’s Future,” the bud­get plan recently released by Rep­re­sen­ta­tive Paul Ryan, the rank­ing Repub­li­can mem­ber of the House Bud­get Com­mit­tee. Other lead­ing Repub­li­cans have been bob­bing and weav­ing on the offi­cial sta­tus of this pro­posal, but it’s pretty clear that Mr. Ryan’s vision does, in fact, rep­re­sent what the G.O.P. would try to do if it returns to power.

    The broad pic­ture that emerges from the “roadmap” is of an eco­nomic agenda that hasn’t changed one iota in response to the eco­nomic fail­ures of the Bush years. In par­tic­u­lar, Mr. Ryan offers a plan for Social Secu­rity pri­va­ti­za­tion that is basi­cally iden­ti­cal to the Bush pro­pos­als of five years ago.

    ...

    The bot­tom line, then, is that the cru­sade against health reform has relied, cru­cially, on utter hypocrisy: Repub­li­cans who hate Medicare, tried to slash Medicare in the past, and still aim to dis­man­tle the pro­gram over time, have been scor­ing polit­i­cal points by denounc­ing pro­pos­als for mod­est cost sav­ings — sav­ings that are sub­stan­tially smaller than the spend­ing cuts buried in their own proposals.

    And if Democ­rats don’t get their act together and push the almost-completed reform across the goal line, this breath­tak­ing act of stag­ger­ing hypocrisy will succeed.

    In related news, now might be a good time to start rethink­ing your per­sonal moral par­a­digm. It’ll ease the exis­ten­tial angst in the event of a thought­less future.

    Posted by Pterrafractyl | October 11, 2013, 12:46 pm
  26. Hi, Pter­rafractyl: Here is the lat­est on Kasich/Medicaid (from 10–12 edi­tion of Cincin­nati Enquirer)It’s inter­st­ing to me that Right to Life and Cham­ber of Com­merce sup­port the expansion:

    COLUMBUS — Gov. John Kasich’s plan to use a seven-member board to expand Med­ic­aid has drawn praise from Democ­rats, while infu­ri­at­ing tea party Repub­li­cans, who say Kasich has aban­doned the base that elected him – vot­ers he may need in 2014.

    After fail­ing to win sup­port from Repub­li­cans in the full Gen­eral Assem­bly, the Kasich admin­is­tra­tion on Fri­day asked Ohio’s Con­trol­ling Board to let the state accept fed­eral money to expand Med­ic­aid to as many as 366,000 new Ohioans. On Oct. 21, a Kasich appointee and six state leg­is­la­tors – four Repub­li­cans and two Democ­rats – will vote on the administration’s proposal.

    “At this point, I’m pretty much good with what­ever real­izes Med­ic­aid expan­sion for the state of Ohio,” House Minor­ity Leader Tracy Heard, D-Columbus, said this week, sum­ming up Democ­rats’ reac­tion. A spokesman for Kasich’s pre­sump­tive 2014 guber­na­to­r­ial oppo­nent, Cuya­hoga County Exec­u­tive Ed FitzGer­ald, called Kasich out for his inabil­ity to get a bill through the Leg­is­la­ture, but said get­ting health care cov­er­age for low-income Ohioans was “what ulti­mately matters.”

    Kasich’s for­mer Repub­li­can sup­port­ers, tea partiers such as Union Township’s Ted Stevenot, accused Kasich of bypass­ing the Leg­is­la­ture and ignor­ing vot­ers who elected him.

    “How can he cam­paign over and over again that he’s against Oba­macare and then turn around and do this?” said Stevenot, who is pres­i­dent of the Ohio Lib­erty Coali­tion. “At a cer­tain point, enough is enough.”

    What is the Con­trol­ling Board?

    Take our poll: Should Gov. John Kasich use the Con­trol­ling Board to expand Medicaid?

    Tell Kasich where you stand using the Enquirer’s “Talk to Your Gov­ern­ment” tool.

    What you’re telling Kasich about using the Con­trol­ling Board to expand Medicaid

    The dis­agree­ment between pro-Medicaid Repub­li­cans such as Kasich and anti-Medicaid con­ser­v­a­tives is a chal­lenge for GOP lead­ers try­ing to keep the party together. Matt Borges, chair of the Ohio Repub­li­can Party, on Fri­day released a state­ment that sought to embrace both sides and focus on the “shared mis­sions” of over­com­ing Demo­c­ra­tic opponents.

    “Con­ser­v­a­tives all oppose Oba­macare,” Borges said. “On the sep­a­rate mat­ter of Med­ic­aid, good con­ser­v­a­tives have worked to make the pro­gram better.”

    Let­ting the full Leg­is­la­ture make the deci­sion on Med­ic­aid expan­sion would have been ideal, Med­ic­aid sup­port­ers and oppo­nents agree. But fed­eral money becomes avail­able Jan. 1, and Kasich’s admin­is­tra­tion has decided it can’t wait any longer.

    “From the begin­ning, we viewed this as a part­ner­ship with the Leg­is­la­ture,” said Greg Moody, who has over­seen Kasich’s Med­ic­aid expan­sion efforts. “The vehi­cle of the leg­isla­tive Con­trol­ling Board seemed the most direct route to get this done on time.”

    The move is legal, sup­port­ers say: One of the Con­trol­ling Board’s rou­tine func­tions is to approve increases in fed­eral money, includ­ing requests from the state Med­ic­aid Department.

    But it’s unusual to use the board for what is essen­tially a pol­icy change: expand­ing Med­ic­aid to adults who earn less than 138 per­cent of the fed­eral poverty level – cur­rently less than $32,500 for a fam­ily of four. Any Con­trol­ling Board approval is expected to invite a court chal­lenge, and Kasich’s action might be enough to push a con­ser­v­a­tive Repub­li­can into a pri­mary to chal­lenge his 2014 re-election bid, Stevenot said.

    The sev­en­Con­trol­ling Board mem­bers, con­tacted by The Enquirer this week, were gen­er­ally coy about how they would vote. Kasich needs four “yes” votes. With the approval of his appointee and, pre­sum­ably, the two pro-Medicaid Demo­c­ra­tic leg­is­la­tors on the board, he would need only one of the four Repub­li­can lawmakers.

    While none of the GOP law­mak­ers on the board are vocal Med­ic­aid sup­port­ers, House Speaker Bill Batchelder, R-Medina, is expected to replace at least one of the House Repub­li­cans before Oct. 21. That will likely get Kasich the votes he needs.

    A group of Repub­li­cans, plus orga­ni­za­tions such as Ohio Right to Life and the pro-free-market Cincin­nati USA Cham­ber of Com­merce, sup­port Kasich on Med­ic­aid expansion.

    Subs for the Con­trol­ling Board may come from term-limited House mem­bers who are mem­bers of that group: Rep. Ross McGre­gor, R-Springfield, openly sup­ports expan­sion, and Rep. Lynn Wacht­mann, R-Napoleon, this week told The Enquirer he was open to extend­ing Med­ic­aid ben­e­fits to the addi­tional group of Ohioans. Rep. Ger­ald Ste­bel­ton, R-Lancaster, is also thought to be will­ing to con­sider expand­ing Med­ic­aid; The Enquirer was unable to reach him Friday.

    The Kasich request asks for 18 months of fed­eral Med­ic­aid money, worth $2.5 bil­lion. That’s because the board’s author­ity is lim­ited to each two-year spend­ing cycle, said Moody, Kasich’s Medicaid-expansion point per­son. Unless the Gen­eral Assem­bly passes a bill expand­ing Med­ic­aid for the long-term, the governor’s admin­is­tra­tion would have to renew its request with the Con­trol­ling Board when the state spend­ing cycle resets in June 2015.

    Many Repub­li­cans have been wary of Med­ic­aid expan­sion because they’re wor­ried the fed­eral gov­ern­ment could back out on its com­mit­ment to pay for 100 per­cent of the new Med­ic­aid mem­bers’ care through 2016, phas­ing down to 90 per­cent after that. The Kasich request includes a line that affirms the Con­trol­ling Board would only be accept­ing the fed­eral money, not agree­ing to use state money if fed­eral funds disappeared.

    “If that finan­cial sit­u­a­tion some­how changes,” Moody said, “state funds will not be used to sup­plant the cov­er­age of this group.”

    Here’s the link to the story: http://news.cincinnati.com/apps/pbcs.dll/artikkel?NoCache=1&Dato=20131012&Kategori=NEWS010801&Lopenr=310110079&Ref=AR■

    Posted by Kathleen | October 12, 2013, 10:51 am
  27. @Kathleen: It looks like Ohio Right to Life’s sup­port for Med­ic­aid expan­sion is the excep­tion to the rule. One rea­son the Cham­ber of Commerce’s sup­port for the Med­ic­aid expan­sion might not be entirely unex­pected (although still unex­pected) is that, unlike groups like the Club for Growth, the Cham­ber of Com­merce has so many local chap­ters that have to at least pre­tend to have the inter­ests of local busi­nesses in mind that reject­ing the Med­ic­aid expan­sion is like say­ing “please go die” to many local health­care economies. Local peo­ple too.

    Posted by Pterrafractyl | October 12, 2013, 11:15 pm
  28. @Pterrafractyl: I was sur­prised, too, by Ohio Right To Life sup­port. We’ll see what hap­pens. I was ini­tially told by ACA hot line that I would qual­ify for Med­ic­aid, so I have a stake in the expan­sion being accepted.

    Posted by Kathleen | October 13, 2013, 6:07 am
  29. @Kathleen: For­tu­nately, based on today’s reports, it sounds like Ohio’s Med­ic­aid expan­sion is expected to pass the seven mem­ber Con­trol­ling Board. Let’s hope that’s right, because as Sen­ate Pres­i­dent Keith Faber reit­er­ated today, if the board doesn’t pass the expan­sion Ohio’s Med­ic­aid sys­tem goes broke. So it sounds like the sit­u­a­tion is that either folks like your­self will become eli­gi­ble for Med­ic­aid or Med­ic­aid in Ohio acquires a nasty case of Tea-Party-shutdown-itis and no one gets Med­ic­aid because Tea-Party-shutdown-itis is poten­tially fatal:

    The Colum­bus Dis­patch
    Med­ic­aid expan­sion expected to pass Con­trol­ling Board

    By Jim Siegel

    The Colum­bus Dis­patch Tues­day Octo­ber 15, 2013 2:13 PM

    Sen­ate Pres­i­dent Keith Faber said today that he expects the Con­trol­ling Board will approve the spend­ing needed for Gov. John Kasich to move ahead with expand­ing Med­ic­aid in Ohio.

    The Celina Repub­li­can did not say which GOP mem­ber of the board would pro­vide the needed vote on Mon­day, but he reit­er­ated that fail­ure to approve the spend­ing could cause the entire sys­tem to go bank­rupt. The expan­sion would cover an esti­mated 275,000 low-income Ohioans.

    “On this issue, the leg­is­la­ture gave the gov­er­nor author­ity a num­ber of years ago,” Faber said. “We tried to take that author­ity away in the bud­get and the gov­er­nor used his line-item veto to keep his authority.”

    Faber stressed that the board would not specif­i­cally approve Med­ic­aid expan­sion – the gov­er­nor would do that via exec­u­tive order – but rather would autho­rize the spending.

    “If we don’t move the money...Medicaid goes bank­rupt,” Faber said. If it’s not approved, “ that money from the expan­sion will be spent down and cur­rent Med­ic­aid recip­i­ents, kids and moms, would not have ser­vices. I don’t think that’s nec­es­sar­ily a good result.”

    ...

    And be sure to send the fol­low­ing arti­cle to your friends and fam­ily that may not under­stand how impor­tant the Med­ic­aid expan­sion and Obamacare/ACA is to Ohio’s hos­pi­tals. It does a great job of lay­ing out why it is that the Med­ic­aid expan­sion isn’t just required to save lives and pre­vent medical-related bank­rupt­cies. It’s needed to save the jobs that the GOP and Tea Party claim to care so deeply about. It also explains how an addi­tional $95 bil­lion in Medicare cuts on top of those already in the ACA (includ­ing an $11 bil­lion cut in Medicare fees to hos­pi­tals due to the sequester) has been impact­ing health­care providers across the nation. The refusal to accept the Med­ic­aid expan­sion has been a major fac­tor in forc­ing cuts to hos­pi­tals’ staffs and ser­vices but it’s far from the only fac­tor:

    The Plain Dealer
    Is Oba­macare really to blame for cuts at the Cleve­land Clinic and other hos­pi­tals?
    By Stephen Koff, Plain Dealer Wash­ing­ton Bureau Chief
    Fol­low on Twit­ter
    on Octo­ber 11, 2013 at 6:06 PM, updated Octo­ber 13, 2013 at 7:44 AM

    WASHINGTON, D.C. – The Cleve­land Clinic’s recent news that it would soon cut staff, seek­ing to save $330 mil­lion, brought imme­di­ate reac­tion: This is what hap­pens under Obamacare.

    This was the sen­ti­ment in Ten­nessee, too, when Van­der­bilt University’s med­ical cen­ter announced cuts.

    And cer­tain ele­ments were true, say health care and hos­pi­tal ana­lysts who note how changes in the way hos­pi­tal get paid under the Afford­able Care Act will affect their bot­tom line. But they say the crit­i­cism, voiced by com­men­ta­tors and scores of other crit­ics of health-care reform, lacked con­text or failed to explain how other forces – includ­ing a U.S. Supreme Court rul­ing and deci­sions made in Wash­ing­ton, Colum­bus and other state cap­i­tals since the act passed – are play­ing a direct role in the hos­pi­tals’ wor­ries. It so hap­pens that all of these forces are com­ing together now, they say.

    The Plain Dealer asked the Cleve­land Clinic and health care pol­icy ana­lysts to break down the parts of the act that affect hos­pi­tal rev­enues in order to bet­ter under­stand the fac­tors at play. Those parts are:

    MEDICARE REIMBURSEMENTS: Medicare is the fed­eral health insur­ance pro­gram that pays for peo­ple age 65 and older. It was passed in 1965 and retirees signed up start­ing the next year. Money comes from pre­mi­ums that retirees pay, and from pay­roll taxes that most work­ing Amer­i­cans pay. Con­cern about the program’s finan­cial via­bil­ity arises reg­u­larly because the elderly pop­u­la­tion is ris­ing and the cost of med­ical care gen­er­ally out­paces infla­tion and wage growth.

    ...

    The Afford­able Care Act, or ACA, cham­pi­oned by Pres­i­dent Barack Obama and passed by con­gres­sional Democ­rats in 2010, demanded new cuts: $716 bil­lion over ten years. Some of these were tied to pre­mi­ums that CMS paid to pri­vate insur­ers man­ag­ing what was effec­tively a Medicare pri­va­ti­za­tion project, called Medicare Advan­tage. But other Medicare cuts in the ACA were specif­i­cally for hospitals.

    These included fed­eral pay­ments linked to hos­pi­tals’ per­for­mance. Under the ACA, hos­pi­tals with an exces­sive num­ber of pre­ventable patient read­mis­sions were to be penal­ized. Those penal­ties were up to 1 per­cent of hos­pi­tals’ Medicare pay­ments in 2013, and will be 2 per­cent this year and 3 per­cent in 2014.

    The effect on the Cleve­land Clinic has not been that severe, thanks to its lower read­mis­sion rate. It lost over $1 mil­lion last year – 0.74 per­cent of its Medicare total – but only 0.33 per­cent this year, cut­ting the losses in half, accord­ing to a Plain Dealer review in August.

    But the ACA also cut what are known as Medicare’s Dis­pro­por­tion­ate Share Pay­ments, or DSH, start­ing in 2014. These are pay­ments given to hos­pi­tals that treat a high num­ber of unin­sured patients, or what is known as char­ity care. Hos­pi­tal asso­ci­a­tions accepted the cuts because they believed the ACA would expand insur­ance cov­er­age to non-elderly patients.

    “All of a sud­den you’d have mil­lions of peo­ple with an insurer behind them pay­ing their bills, so they would recoup some of their losses from reduced pay­ment rates through the fact that a lot of their pre­vi­ously uncom­pen­sated care patients were now insured,” said John Graves, an assis­tant pro­fes­sor spe­cial­iz­ing in health eco­nom­ics and pol­icy at Van­der­bilt University’s School of Medicine.

    The DSH cuts nation­wide came to $22 bil­lion over ten years, accord­ing to the Amer­i­can Asso­ci­a­tion of Med­ical Col­leges and the Com­mon­wealth Fund.

    From the White House per­spec­tive, the ACA-related cuts actu­ally helped Medicare. Through cost-cutting and the elim­i­na­tion of waste, fraud and abuse, the Medicare Trust Fund – the account that holds the taxes and pre­mi­ums before pay­ing providers – gained 12 years of sol­vency, CMS pro­jected ini­tially. Medicare trustees later pared that back to eight years.

    And, the White House says, seniors already see more of their pre­scrip­tion drug costs and pre­ven­tive exams cov­ered, thanks to other por­tions of the ACA.

    Eileen Sheil, the Cleve­land Clinic’s exec­u­tive direc­tor of cor­po­rate com­mu­ni­ca­tions, did not have spe­cific fig­ures avail­able for the Clinic’s loss of DSH money. But she said the loss was among the fac­tors in the deci­sion to cut costs and pare staff through attrition.

    The Ohio Hos­pi­tal Asso­ci­a­tion esti­mates that statewide, the Medicare and Med­ic­aid reduc­tions will come to $7.4 bil­lion over ten years.

    If the ACA’s decade-long Medicare DSH cuts nation­ally seem severe, the Amer­i­can Hos­pi­tal Asso­ci­a­tion says it might help to note: Con­gress has done a lot more cut­ting since the ACA passed. And there has been lit­tle if any polit­i­cal outcry.

    “There have been about $95 bil­lion of other Medicare cuts enacted since the ACA, the most recent being the sequester, that have caused a hit to hos­pi­tal finances,” said Car­o­line Stein­berg, vice pres­i­dent for trends analy­sis at the Amer­i­can Hos­pi­tal Association.

    Bud­get seques­tra­tion, or auto­matic cuts that started this year under a bipar­ti­san agree­ment by Con­gress in 2011, took away $45 bil­lion, she said. That’s more than dou­ble the ACA’s DSH cuts.

    And a bud­get deal that Con­gress made last New Year’s Eve will cut another $35.3 bil­lion, the asso­ci­a­tion said.

    The cuts “just keep com­ing,” Stein­berg said.

    MEDICAID: The major thrust behind health reform was the desire for mil­lions more Amer­i­cans to gain bet­ter access to med­ical care. Doc­tors’ offices and hos­pi­tals would see their paying-patient ros­ters grow. They would not have to write off as much bad debt from patients who could not pay their bills. And patients would not have to worry about bank­ruptcy, or sim­ply avoid get­ting care, if they got injured or sick.

    One way this was sup­posed to occur, start­ing in 2014, was through expanded insur­ance cov­er­age for those now unin­sured. They could buy poli­cies on the new insur­ance exchanges that are now enrolling peo­ple – with widely reported tech­ni­cal glitches so far — for Jan­u­ary cov­er­age, and many could get gov­ern­ment sub­si­dies to help cover pre­mi­ums, depend­ing on their incomes.

    Many of the poor­est Amer­i­cans, par­tic­u­larly women with minor chil­dren at home, could already qual­ify for Med­ic­aid, a joint federal-state pro­gram that shares the cost of cov­er­ing peo­ple with low incomes. Med­ic­aid had its lim­its, but the Afford­able Care Act was sup­posed to expand them.

    That is, the ACA would open Med­ic­aid to peo­ple with slightly higher incomes, up to 138 per­cent of the poverty level. Those earn­ing more would be directed to the insur­ance exchanges and might qual­ify for sub­si­dies if their fam­ily incomes were less than 400 per­cent of the poverty rate.

    States nor­mally share the costs of Med­ic­aid. They wor­ried about the added expense if they expanded enroll­ment. So under the ACA, the fed­eral gov­ern­ment agreed to pay all the new Med­ic­aid costs through 2016, and 90 per­cent thereafter.

    This was a pow­er­ful incen­tive for hos­pi­tals. They could get more pay­ing patients (with the gov­ern­ment as the payer). It was a big part of the logic behind accept­ing lower Medicare DSH payments.

    And it was the rea­son the ACA cut a par­al­lel DSH pro­gram under Med­ic­aid, whose DSH money flows first to states before redis­tri­b­u­tion to hos­pi­tals. The Med­ic­aid DSH cuts are sup­posed to total $18 bil­lion from 2014 to 2020. Some $500 mil­lion of that will be cut in 2014 and $600 mil­lion in 2015, accord­ing to a final rule CMS announced Sept. 13.

    To ACA sup­port­ers, this and the Medicare DSH cuts sounded like a fair trade­off: Less money for uncom­pen­sated care in exchange for more patients whose bills would actu­ally be paid.

    But the U.S. Supreme Court in 2012 threw water on those plans. While the court upheld the ACA’s pro­vi­sion requir­ing most Amer­i­cans to get insur­ance or face a fine (a tax, as Chief Jus­tice John Roberts put it), it also held that states were not oblig­ated to expand their Med­ic­aid programs.

    State law­mak­ers in places with Repub­li­can leg­isla­tive majori­ties, such as Ohio and Ten­nessee, said they wor­ried that the fed­eral gov­ern­ment would some­day shirk its oblig­a­tion and make the states pay a big­ger share for the expanded Med­ic­aid pro­grams. They said their states could not afford that.

    So they have refused to expand Medicaid.

    And for many hos­pi­tals includ­ing the Cleve­land Clinic, that poses a prob­lem. Ohio will have an esti­mated 275,000 fewer res­i­dents on Med­ic­aid than pro­jected, the Cleve­land Clinic’s Sheil noted.

    “Most of the prob­lems that we have been see­ing do relate to the Med­ic­aid expan­sion that has not panned out as planned,” said Stein­berg, of the Amer­i­can Hos­pi­tal Association.

    Put sim­ply, the trade­off — more patients who would go on Med­ic­aid and stop qual­i­fy­ing as char­ity care or bad-debt cases, and less money needed (and pro­vided) for that lat­ter care — is not hap­pen­ing in Ohio and other states that refuse to expand Med­ic­aid. Because of reluc­tant state leg­is­la­tures, Med­ic­aid will not grow as the ACA anticipated.

    “The impor­tant thing to remem­ber is the reac­tion the hos­pi­tals are hav­ing in par­tic­u­lar has to do with uncom­pen­sated care, and that’s inter­act­ing a bit with the Supreme Court deci­sion on Med­ic­aid expan­sion,” said Vanderbilt’s Graves.

    Hos­pi­tals expected to gain thou­sands of new pay­ing patients – through newly enrolled exchange clients and expanded Med­ic­aid – to make up for the Med­ic­aid and Medicare DSH cuts. Roughly 20 to 30 per­cent of their uncom­pen­sated care money is being cut, Graves said.

    “Which is a sig­nif­i­cant amount, par­tic­u­larly for safety net hos­pi­tals,” Graves said. “Hos­pi­tals across the coun­try, in par­tic­u­lar in non-expansion states, are going to have to make that up some­how. That’s what we’re see­ing at the Cleve­land Clinic and elsewhere.”

    ...

    UNPAID BILLS: Amer­i­cans who decide to buy their insur­ance on the exchanges have a num­ber of choices, just as they do when they buy insur­ance through a bro­ker. They can­not be turned down for pre­ex­ist­ing con­di­tions and their out-of-pocket costs are capped in even the lowest-cost or stingi­est poli­cies at around $6,000.

    But whether they buy such a pol­icy or go with a more deluxe plan that has bet­ter cov­er­age is up to them and their finances.

    There are four tiers of cov­er­age, and the fed­eral sub­si­dies are pegged to costs in the second-lowest tier (a “sil­ver” plan, in the color-coded, met­al­lur­gi­cal lingo of the exchanges). In prac­ti­cal terms, that means one buyer might choose the lowest-level plan (bronze), with higher co-payments or deductibles and sub­se­quently lower pre­mi­ums. Or a buyer might choose a gold or plat­inum plan, with exten­sive cov­er­age but higher pre­mi­ums. Each buyer must make his or her own cal­cu­la­tion and decide what is or isn’t afford­able after sub­si­dies are fac­tored in.

    This poses a chal­lenge for hos­pi­tals: What if most peo­ple choose plans that still leave them oblig­ated for sev­eral thou­sand dol­lars in co-payments and deductibles?

    That is already the trend in the employer-provided insur­ance mar­ket, with ris­ing deductibles fairly com­mon, accord­ing to sur­veys by the Kaiser Fam­ily Foun­da­tion. Data from the Ohio Hos­pi­tal Association’s most recently avail­able sur­vey on this shows hos­pi­tals in the state report­ing a col­lec­tive $645 mil­lion in bad debt in 2010. They reported pro­vid­ing another $1.1 bil­lion that year in char­ity care.
    ...

    Asked about the fear that bad debt will expand even though more patients will be insured, Megan Neuburger, a senior direc­tor at Fitch Rat­ings who ana­lyzes the indus­try, said, “That makes a lot of sense.”

    “I think typ­i­cally a third of a hospital’s bad debt is made up of peo­ple who have some level of insur­ance,” Neuburger said. “It’s been a grow­ing issue with the growth of these high-deductible health plans, which has been a trend in the last cou­ple years.”

    Nei­ther the Obama admin­is­tra­tion nor ana­lysts who study health care say they know how many or what per­cent­age of buy­ers will pur­chase exchange plans with thousand-or-more-dollar out-of-pocket require­ments. But ana­lysts say they think it will be high, since many of these buy­ers do not cur­rently have insur­ance and afford­abil­ity has often been a factor.

    “That cer­tainly is a trend that pre-dated the ACA, but if any­thing I would say the ACA jumps on that trend, in that the exchange plans have pretty sub­stan­tial cost shar­ing,” said Graves.

    ...

    Note that the last sec­tion of the arti­cle — the part about the prob­lems of unpaid bills poten­tially grow­ing and impact­ing hos­pi­tals even more under the ACA/Obamacare because you’ll have more peo­ple sign­ing up for insur­ance with deductibles that they can’t afford — has an unspo­ken but pretty clear impli­ca­tion: For the Afford­able Care Act to work, we kind of need an econ­omy that pays work­ers enough to actu­ally save the thou­sands of dol­lars needed to pay their deductibles. In other words, in con­trast to the fevered con­cerns about Oba­macare cre­at­ing a nation of poor peo­ple depen­dent on the gov­ern­ment, the real­ity is that the ACA/Obamacare sim­ply can’t work in a bro­ken econ­omy that doesn’t pay grow­ing num­bers of low-income work­ers enough to save for that even­tual expen­sive health­care cost. It might take a decade or more of ongo­ing trends of low US sav­ings and wage stag­na­tion — with the result­ing impacts of lower Medicare and pri­vate reim­burse­ments due to an inabil­ity to pay the deductibles and starv­ing hos­pi­tals — before the ties between the cost of health­care and gross inequal­ity and long-term eco­nomic hope­less­ness for peo­ple left out the New Econ­omy becomes part of the national conversation.

    So, on a pos­i­tive note, it’s pos­si­ble that one of the lessons the US even­tu­ally takes away from this whole expe­ri­ence is that liv­ing wages are required for the sus­tain­abil­ity of the US’s health­care sys­tem if the US decides to avoid a single-payer solu­tion and con­tinue push­ing most indi­vid­u­als towards pri­vate insur­ance plans. It also means that the eco­nomic pain inflicted by crazy politi­cians is sys­tem­at­i­cally poised to trickle down to the hos­pi­tals (sequesters, reduced Med­ic­aid cov­er­age, etc) but also bub­ble up to the hos­pi­tals as the eco­nomic con­se­quences of mass insan­ity per­co­lates through the economy.

    Will valu­able lessons be learned about the rela­tion­ship between pay­ing a liv­ing wage and liv­ing in a decent econ­omy that can main­tain a viable health­care sec­tor? Prob­a­bly not, but some­thing is prob­a­bly going to be learned from this Oba­macare default-debacle. Maybe it’ll be a pos­i­tive les­son although it’s quite pos­si­ble it’ll be neg­a­tive. A con­fused mish­mash of pos­i­tive and neg­a­tive lessons that in no way lead to coher­ent solu­tions for the chal­lenges of the day is also very pos­si­ble so we’ll just have to wait and see.

    Return­ing to the topic of Ohio’s Med­ic­aid expan­sion: Good luck Kath­leen. And good health too. With the way things are going good luck and/or good health may be a require­ment for decent health­care so such salu­ta­tions that include “and good health” may become oblig­a­tory. The new econ­omy, like the old econ­omy, still sucks. It may or may not become a cost­lier and dead­lier econ­omy. That will depend heav­ily on things like whether or not a state accepts the Med­ic­aid expan­sion and gen­er­ally coop­er­ate and cre­at­ing a viable future.

    Or maybe these state-based bat­tles over health­care and the social con­tract will become moot because the GOP in the House pre­emp­tively tanks economy...

    ....

    Good luck and good health Kathleen!

    Posted by Pterrafractyl | October 15, 2013, 11:10 pm
  30. Well, now that this flick this flick has finally ended, it’s on to the next obvi­ous ques­tion: When’s the sequel?! Because that flick was sweet! I haven’t been that trans­fixed with hor­ri­fied befud­dle­ment since Mul­hol­land Drive.

    So when is all the bick­er­ing, bom­bast and betrayal return­ing to the big screen?

    What’s that?? The next shut­down debt ceil­ing breach could be as soon as Feb­ru­ary 7th? Wow, that’s a pretty ambi­tious sched­ule. Are they film­ing these sequels all at once? Because that sounds expen­sive. And if the GOP hasn’t been plan­ning a sequel, then who are they going to find to direct a Feb­ru­ary sequel on such short order? It would take some­one with Peter Jackson’s fan­tas­ti­cal vision and David Lynch’s flair for oth­er­worldly tor­ment. That isn’t a direc­to­r­ial posi­tion eas­ily filled, espe­cially when some of the top tal­ent in mod­ern Amer­i­can hor­ror recently expressed dis­in­ter­est.

    Hmm...who could it be that could fill such shoes on such short notice....?

    Hmmm...

    Oh man, this sequel could be awe­some.

    Posted by Pterrafractyl | October 16, 2013, 11:26 pm
  31. Now that a sequel to the Great Shut­down Default is look­ing increas­ingly pos­si­ble in 2014, one of the big ques­tions for all the Alt Hist Hor­ror fan­boys is going to be whether or not the sequel will include a new vil­lain. Espe­cially a vil­lain with a weapon just as pow­er­ful as Oba­macare. Maybe Bane with a new secret weapon? How about Scare­crow makes some sort of pro-public-health anti-Gay gas? Just think of the pos­si­bil­i­ties. So many pos­si­bil­i­ties.

    Biz­zarObam­care is com­ing for you in 2014.

    Posted by Pterrafractyl | October 18, 2013, 12:43 pm
  32. Pter­rafractyl: Thanks so much for the good wishes and addi­tional infor­ma­tion. As a side note, a friend of mine who is in the med­ical field (she trains hos­pi­tal per­son­nel in the new med­ical records soft­ware required for Medicare reimbursements)said that many peo­ple are con­flat­ing doc­tors’ resis­tance to the new soft­ware with resis­tance to ACA imple­men­ta­tion. The two events are not related. Some doc­tors have closed their prac­tices because they didn’t want to use the soft­ware for record keep­ing. Right wing email chains are claim­ing they’re clos­ing prac­tices because of ACA. Thanks again!

    Posted by Kathleen | October 18, 2013, 4:28 pm
  33. @Kathleen: Well, accord­ing to one of the GOP’s top 2016 pres­i­den­tial can­di­dates that hap­pens to be a doc­tor, spread­ing mis­in­for­ma­tion amongst your fel­low cit­i­zens can be totally accept­able behav­ior. And that appar­ently includes mis­in­for­ma­tion about health­care poli­cies:

    National Jour­nal
    The Truthi­ness of Rand Paul
    The junior sen­a­tor from Ken­tucky could trans­form the GOP—if the facts don’t get in his way.
    Jill Lawrence
    By Jill Lawrence

    Octo­ber 17, 2013

    LOUISVILLE, Ky.—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.”

    Paul’s lit­tle riff had the stu­dents laugh­ing hard. And it was amusing—but also amaz­ing. Why would he set him­self up with an anec­dote like that? He knew reporters were in the lec­ture hall. He’s also well aware that watch– dogs are com­pil­ing a grow­ing file of evi­dence that he plays loose with the facts. He had offered a few exam­ples to the stu­dents that very afternoon.

    “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.

    ...

    Spread­ing mis­in­for­ma­tion is what good patri­ots do!

    Posted by Pterrafractyl | October 19, 2013, 6:19 pm
  34. Get ready for the next man­i­fes­ta­tion of the GOP’s plans for health­care reform:

    TPM Livewire
    Ron Paul Calls For ‘Nul­li­fi­ca­tion’ Of Oba­macare: ‘Pretty Soon ... We’re Just Going To Ignore The Feds’
    Tom Kludt – Novem­ber 5, 2013, 7:36 AM EST

    Stump­ing on behalf of Vir­ginia guber­na­to­r­ial hope­ful Ken Cuc­cinelli on Mon­day, for­mer con­gress­man and pres­i­den­tial can­di­date Ron Paul pre­dicted that states will soon “ignore the feds” and nul­lify the Afford­able Care Act.

    “Jef­fer­son obvi­ously was a clear leader on the prin­ci­ple of nul­li­fi­ca­tion,” Paul said at a rally in Rich­mond, Va., accord­ing to Politico.

    “I’ve been work­ing on the assump­tion that nul­li­fi­ca­tion is going to come. It’s going to be a de facto nul­li­fi­ca­tion. It’s ugly, but pretty soon things are going to get so bad that we’re just going to ignore the feds and live our own lives in our own states.”

    As Politico noted, Paul was invok­ing a term with deep roots in the Civil War era while speak­ing in a for­mer cap­i­tal of the con­fed­er­acy. He also decried the taxes asso­ci­ated with the health care law.

    “The taxes involved there, they’re evil,” Paul said. “They’re going to cre­ate class war­fare, gen­er­a­tional warfare.”

    ...

    Posted by Pterrafractyl | November 5, 2013, 8:58 am
  35. Here’s an impor­tant update regard­ing the impact on the health­care sys­tems in states that refuse to accept the Med­ic­aid expan­sion: Noth­ing has changed. Hos­pi­tals and patients in those states are still extra-screwed and it’s get­ting worse:

    The New York Times
    Cuts in Hos­pi­tal Sub­si­dies Threaten Safety-Net Care

    By SABRINA TAVERNISE
    Pub­lished: Novem­ber 8, 2013

    SAVANNAH, Ga. — The unin­sured pour into Memo­r­ial Health hos­pi­tal here: the wait­ress with can­cer in her voice box who for two years assumed she just had a sore throat. The unem­ployed dia­betic with a wound stretch­ing the length of her shin. The con­struc­tion worker who could no longer breathe on his own after weeks of untreated asthma attacks and had to be put on a respirator.

    Many of these patients were expected to gain health cov­er­age under the Afford­able Care Act through a major expan­sion of Med­ic­aid, the med­ical insur­ance pro­gram for the poor. But after the Supreme Court in 2012 gave states the right to opt out, Geor­gia, like about half the states, almost all of them Republican-led, refused to broaden the program.

    Now, in a per­verse twist, many of the poor peo­ple who rely on safety-net hos­pi­tals like Memo­r­ial will be dou­bly unlucky. A gov­ern­ment sub­sidy, lit­tle known out­side health pol­icy cir­cles but crit­i­cal to the hos­pi­tals’ sur­vival, is being sharply reduced under the new health law.

    The sub­sidy, which for years has helped defray the cost of uncom­pen­sated and under­com­pen­sated care, was cut sub­stan­tially on the assump­tion that the hos­pi­tals would replace much of the lost income with pay­ments for patients newly cov­ered by Med­ic­aid or pri­vate insur­ance. But now the hos­pi­tals in states like Geor­gia will get nei­ther the new Med­ic­aid patients nor most of the old sub­si­dies, which many say are cru­cial to the mis­sion of care for the poor.

    “We were so thrilled when the law passed, but it has back­fired,” said Lind­say Caulfield, senior vice pres­i­dent for plan­ning and mar­ket­ing at Grady Health in Atlanta, the largest safety-net hos­pi­tal in Georgia.

    It is now fac­ing the loss of nearly half of its roughly $100 mil­lion in annual sub­si­dies known as dis­pro­por­tion­ate share hos­pi­tal payments.

    Memo­r­ial is also fac­ing steep reduc­tions in the sub­si­dies. Can­cer care may be among the ser­vices reduced, admin­is­tra­tors here said. Memo­r­ial is now one of only a few hos­pi­tals in the state with a tumor clinic that accepts poor patients with­out insur­ance. Many show up cough­ing blood or hav­ing trou­ble breath­ing because their can­cers have gone untreated for so long.

    ...

    Patients with chronic con­di­tions like hers often go in and out of emer­gency rooms for years with­out treat­ment because doc­tors are only required to treat imme­di­ately life-threatening con­di­tions. Dr. Christo­pher Senkowski, a sur­geon at Memo­r­ial, recalled exam­in­ing a farmer with pan­cre­atic can­cer that had spread through­out his body after months of refer­rals to spe­cial­ists that he could not afford.

    The cuts in sub­si­dies for safety-net hos­pi­tals like Memo­r­ial — those that deliver a sig­nif­i­cant amount of care to poor, unin­sured or oth­er­wise vul­ner­a­ble patients — are set to total at least $18 bil­lion through 2020. The gov­ern­ment has pro­jected that as much as $22 bil­lion more in Medicare sub­si­dies could be cut by 2019, depend­ing partly on the change in the num­bers of unin­sured nation­ally.

    The cuts are just one of the reduc­tions in gov­ern­ment reim­burse­ments that are squeez­ing hos­pi­tals across the coun­try. Some have already announced lay­offs. In Geor­gia, three rural hos­pi­tals have closed this year.

    Med­ic­aid expan­sion may not have replaced all of the lost sub­si­dies, but it would have helped, hos­pi­tal admin­is­tra­tors said.

    “I under­stand that the state needs to bal­ance its bud­get, and con­trol the run­away costs of Med­ic­aid, but to turn a blind eye and say, ‘Let the chips fall where they may,’ you’ll end up with a gut­ted health care sys­tem,” said Mag­gie M. Gill, chief exec­u­tive at Memo­r­ial Health.

    Tra­di­tion­ally, safety-net hos­pi­tals have played a spe­cial role in car­ing for poor peo­ple. They make up just 2 per­cent of acute care hos­pi­tals in the coun­try, but pro­vide about a fifth of all uncom­pen­sated care, accord­ing to Dr. Arthur Keller­man, dean of the F. Edward Hébert School of Med­i­cine in Bethesda, Md. The sub­sidy was cre­ated in the 1980s to help hos­pi­tals with large shares of patients who were unin­sured or had gov­ern­ment insur­ance that did not pay very much. Many hos­pi­tals came to depend on it.

    A full third of Grady’s patients have no insur­ance, and, if that does not change, the hos­pi­tal will have no choice but to cut ser­vices, said John M. Hau­pert, Grady’s chief exec­u­tive. The hospital’s large out­pa­tient men­tal health pro­gram, which han­dles 58,000 vis­its a year and is crit­i­cal to keep­ing poor patients with behav­ioral prob­lems from seek­ing treat­ment in the emer­gency room, would most likely be hit, Mr. Hau­pert said.

    Some experts say the cuts in hos­pi­tal sub­si­dies are part of a larger prob­lem: gov­ern­ment pro­grams like Med­ic­aid do not pay enough to cover the actual costs of care. The cheap­est pri­vate insur­ance on the new health care exchanges, the Bronze Plan, cov­ers just 60 per­cent of costs, leav­ing low-income peo­ple who buy it with a lot of out-of-pocket costs that hos­pi­tals worry the patients will not be able to pay.

    ...

    Yep, if peo­ple can’t afford to pay their out-of-pocket expenses, hos­pi­tals will be increas­ingly on the hook for the costs. And if the econ­omy sucks, it’s even worse for the health of the health­care sys­tem (and peo­ple) because more and more peo­ple are either going to be pushed into the Medicaid-Gap No-Man’s Land, or they just be dri­ven into finan­cial dis­tress from the crappy econ­omy and unable to cover their deductibles. It’s a reminder that that any real long-term reform of the US health­care sys­tem is going to require an end to the larger prob­lem of socioe­co­nomic can­ni­bal­ism.

    Until then...

    Posted by Pterrafractyl | November 10, 2013, 12:33 am
  36. Well, now we know a lit­tle more about the GOP’s alter­na­tive to Oba­macare: Free Keg­gers with that Creepy Uncle Sam. Hope­fully you won’t have much more than a sore mus­cle, though, because he appears to mostly just offer mas­sage ther­apy:

    Pol­icy Mic
    The Repub­li­can Alter­na­tive to Oba­macare is a Sweet Keg­ger
    By Tom McKay Novem­ber 12, 2013

    Remem­ber that series of insanely creepy anti-Obamacare ads fea­tur­ing a dis­turb­ing, smil­ing Uncle Sam play­ing doc­tor with var­i­ous young people’s pri­vate parts? Pro­duced by Gen­er­a­tion Oppor­tu­nity — a Virginia-based, Koch-brothers-funded advo­cacy group that’s try­ing to con­vince young peo­ple to throw cau­tion to the wind, chug a cold one, and say “Screw you, Nobama!” to pur­chas­ing health insur­ance — these ads had some­thing impor­tant to say about flag-wearing dudes in giant plas­tic masks and your mil­len­nial gen­i­tals (millennitals?).

    ...

    Some­thing you might not have noticed about those ads: the young peo­ple in them were receiv­ing sub­si­dized health care. Dou­ble eww, if you’re a Republican!

    Well, now sleazy Uncle Sam (whose slo­gan has pre­sum­ably changed from ‘Uncle Sam wants you!’ to ‘Uncle Sam wants you’) is tak­ing his opt-out-of-Obamacare mes­sage to another sub­set of young peo­ple: Florida frat bros.

    A tail­gate party at the Uni­ver­sity of Miami-Virginia Tech foot­ball game at UM on Sat­ur­day had a DJ, this much free beer, hard liquor, pizza, and a per­sonal visit from the man him­self, who took the time to get some ter­ri­fy­ing mugshots with some hard-drinking soror­ity girls:
    [see pics]
    So, there you have it: one lead­ing anti-Obamacare organization’s alter­na­tive to Oba­macare is not get­ting health insur­ance while get­ting wicked trashed with your bros, while a creepy dude in a mask stares at you.

    ...

    If this seems like the kind of health­care option you’re look­ing for but you missed the event don’t die too soon because it sounds like we can look for­ward to a more free “Free­dom School” expe­ri­ences in the future. From sea to shin­ing sea.

    Posted by Pterrafractyl | November 15, 2013, 1:27 pm
  37. Remem­ber this threat from Sen­ate minor­ity leader Mitch McConnell back in July? If the Democ­rats remove the fil­i­buster of pend­ing judi­cial and cab­i­net nom­i­nees the repub­li­cans will remove the fil­i­buster for every­thing once they regain con­trol:

    Talk­ing Points Memo
    McConnell To Reid: If You Go Nuclear On Nom­i­na­tions, I’ll Go Nuclear On Every­thing When I’m Major­ity Leader

    Sahil Kapur – June 18, 2013, 3:00 PM EDT

    Sen­ate Minor­ity Leader Mitch McConnell (R-KY) on Tues­day starkly warned Major­ity Leader Harry Reid (D-NV) not to elim­i­nate the fil­i­buster on pres­i­den­tial nom­i­na­tions, threat­en­ing to end the 60-vote thresh­old for every­thing, includ­ing bills, if he becomes the major­ity leader.

    “There not a doubt in my mind that if the major­ity breaks the rules of the Sen­ate to change the rules of the Sen­ate with regard to nom­i­na­tions, the next major­ity will do it for every­thing,” McConnell said on the floor.

    With at least half a dozen key judi­cial and cab­i­net nom­i­nees pend­ing, all of whom Repub­li­cans have prob­lems with, Reid has threat­ened to invoke the so-called nuclear option to change the rules of the Sen­ate and elim­i­nate the fil­i­buster on nom­i­na­tions — but not any­thing else.

    Backed up by Sen. Lamar Alexan­der (R-TN), who echoed his warn­ings in a floor col­lo­quy Tues­day, McConnell said his hypo­thet­i­cal major­ity would take it a step further.

    “I wouldn’t be able to argue, a year and a half from now if I were the major­ity leader, to my col­leagues that we shouldn’t enact our leg­isla­tive agenda with a sim­ple 51 votes, hav­ing seen what the pre­vi­ous major­ity just did,” he said. “I mean there would be no ratio­nal basis for that.”

    The minor­ity leader sketched out what a Republican-led Sen­ate would do with 51 votes. Job No. 1, he said, would be to repeal Oba­macare. He also men­tioned lift­ing the ban on oil drilling in the Arc­tic National Wildlife Refuge, approv­ing the Key­stone XL pipeline and repeal­ing the estate tax (which he called the “death tax”).

    “These are the kinds of pri­or­i­ties that our mem­bers feel strongly about, and I think I would be hard pressed,” McConnell said, “to argue that we should restrain our­selves from tak­ing full advan­tage of this new Senate.”

    ...

    So if the fil­i­buster was repealed for judi­cial and cab­i­net nom­i­nees, would the GOP really pledge to repeal Oba­macare and every­thing else they could in the Sen­ate using a sim­ple major­ity if they retake the Sen­ate in 2014? The pres­i­dent could still veto such a bill, but if the GOP takes the White house and a sim­ple major­ity in 2016...bye bye Oba­macare (and hello Norquist­care). And bye bye to just about any other social pro­gram (it’s all part of the Norquist­care package).

    So the stakes for upcom­ing elec­tions would poten­tially go a lot higher if the GOP actu­ally took that pledge to go global in their nuclear response. But would they actu­ally make that pledge as part of the GOP brand if the Democ­rats decide to ‘go nuclear’ and end the fil­i­buster for judi­cial and cab­i­net nom­i­nees? We just might find out:

    McClatchy DC
    Harry Reid goes nuclear, Sen­ate changes fil­i­buster rules for some nominees

    Posted by William Dou­glas on Novem­ber 21, 2013 Updated 2 hours ago

    Frus­trated by what he con­sid­ers Repub­li­can obstruc­tion, Sen­ate Major­ity Leader Harry Reid Thurs­day imple­mented the so-called “nuclear option” to alter cham­ber rules to restrict the fil­i­buster of judi­cial and exec­u­tive branch nom­i­nees. Reid’s vote was the 51st, pass­ing a change to procedures.

    “It’s time to change the Sen­ate before this insti­tu­tion become obso­lete,” Reid said on the Sen­ate floor as sen­a­tors sat at their desks lis­ten­ing attentively.

    Reid, D-Nev., said a string of blocked pres­i­den­tial and judi­cial nom­i­na­tions high­lighted the need to change the Senate’s long-standing rules on nom­i­na­tions from a 60-vote thresh­old to a majority-rules system.

    In recent weeks, Sen­ate Democ­rats have been unable to over­come fil­i­busters on the nom­i­na­tions of Rep. Mel Watt, D-N.C., to head the Fed­eral Hous­ing Finance Agency — the first time a sit­ting mem­ber of Con­gress was blocked since 1843 — and three nom­i­nees to the pres­ti­gious U.S. Court of Appeals for the Dis­trict of Columbia.

    Reid railed against Repub­li­can fil­i­busters against the nom­i­na­tions of for­mer Rep. Chuck Hagel, R-Neb., for defense sec­re­tary. Hagel was even­tu­ally confirmed.

    “It’s a trou­bling trend that Repub­li­cans are will­ing to block exec­u­tive branch nom­i­na­tions even when they have no objec­tion to the qual­i­fi­ca­tion of the nom­i­nee,” Reid said. “Instead they block qual­i­fied exec­u­tive branch nom­i­nees to cir­cum­vent the leg­isla­tive process.”

    Sen­ate Minor­ity Leader Mitch McConnell, R-Ky., blasted Reid’s move, call­ing it a Demo­c­ra­tic power grab in order to imple­ment Pres­i­dent Barack Obama’s agenda. Reid and McConnell accused each other of vio­lat­ing an agree­ment they reached last July to avert a “nuclear option” move.

    ...

    Could a com­plete repeal of the Sen­ate fil­i­buster now be an implicit com­po­nent of every GOP Sen­ate can­di­date: vote for me, and we’ll get rid of all the fil­i­busters and then nom­i­nate the most con­ser­v­a­tive Supreme Court jus­tices we can pos­si­bly find. That type of elec­toral strat­egy could play well with the GOP pri­mary vot­ers and in ger­ry­man­dered House races, but will this new brand­ing that make the GOP even more unre­strained work well for the part in the state-wide Sen­ate races? It’s going to be really inter­est­ing to see how this impacts the GOP’s ‘brand’ because the fil­i­buster is one of those things that’s given the GOP in the Sen­ate an excuse to be slightly less crazy than their House coun­ter­parts. Are pledges to appoint more far-right Supreme Court jus­tices really going to help the brand? Maybe:

    TPM Livewire
    Norm Orn­stein: Repub­li­cans Forced Reid’s Hand On The Nuclear Option
    Sahil Kapur – Novem­ber 21, 2013, 1:02 PM EST

    Norm Orn­stein, a con­gres­sional scholar at the con­ser­v­a­tive Amer­i­can Enter­prise Insti­tute, told TPM that Repub­li­cans forced Harry Reid to “go nuclear” after his Demo­c­ra­tic major­ity took the his­toric step Thurs­day and ended the fil­i­buster for exec­u­tive nom­i­nees and non-Supreme Court judi­cial nominees.

    For what­ever rea­son, the Repub­li­cans decided to go nuclear first, with this utterly unnec­es­sary vio­la­tion of their own agree­ment and open deci­sion to block the pres­i­dent from fill­ing vacan­cies for his entire term, no mat­ter how well qual­i­fied the nom­i­nees,” Orn­stein told TPM in an email. “It was a set of actions beg­ging for a return nuclear response.”

    He also spec­u­lated that Sen­ate Minor­ity Leader Mitch McConnell (R-KY) secretly wanted Democ­rats to go nuclear so he could use the same tac­tic to end the fil­i­buster entirely if and when Repub­li­cans takes the majority.

    “McConnell’s threat, it seems to me, makes clear the strat­egy: let Dems take the first step, and we will then bear no blame when we entirely blow up the Senate’s rules after we take all the reins of power,” he said. “That other Repub­li­cans like Corker, McCain, Alexan­der, Murkowski and so on, went along, shows how much the rad­i­cals and anti-institutionalists now dom­i­nate the Repub­li­can Party. Which is sad indeed.”

    Then again, maybe going full-scale nuclear won’t actu­ally be part of the strat­egy. A quiet nuclear war might be their pre­ferred option:

    McCain: Dems Will Pay ‘Heavy, Heavy Price’ For Chang­ing Fil­i­buster
    Dylan Scott – Novem­ber 21, 2013, 12:44 PM EST

    Sen. John McCain (R-AZ) said that Democ­rats would “pay a heavy, heavy price” for chang­ing the Sen­ate rules for judi­cial and exec­u­tive nominees.

    “They’re gov­erned by the newer mem­bers... who have never been in a minor­ity, who are pri­mar­ily dri­ving this issue,” McCain told reporters after the vote. “They suc­ceeded and they will pay a very, very heavy price for it.”

    McCain said moments later, though, that he did not believe it would be a major elec­tion issue. “I don’t think Amer­i­cans under­stand it very well,” he said.

    Hmmm...the emerg­ing theme appears to be, “Vote for us and we’ll com­pletely unleash the GOP Kraken! But don’t spend too much time think­ing about, you sim­ple­tons”. It’s hard to say how this will play out in the cam­paigns, espe­cially in 2016. But, from a purely polit­i­cal stand­point, it’s prob­a­bly an improve­ment.

    Posted by Pterrafractyl | November 21, 2013, 12:28 pm
  38. It turns out you don’t need a com­puter to con­duct a denial of ser­vice attack against Oba­macare. A phone will do:

    Talk­ing Points Memo
    Boehner Fails to Fail on Oba­macare
    Josh Mar­shall – Novem­ber 23, 2013, 4:00 PM EST

    Late last week Speaker John Boehner (R-OH) made a big show of try­ing but fail­ing to sign up for Oba­macare because of the noto­ri­ously buggy web­site. (Actu­ally he appears to have been using the DC exchange site.) He even did a spe­cial tweet not­ing his hope­less sit­u­a­tion. Not ter­ri­bly sur­pris­ing given the frus­trat­ing expe­ri­ences so many have had.

    Actu­ally, it turns out he had suc­cess­fully enrolled and got a call con­firm­ing that about an hour after his tweet. But it gets better.

    Accord­ing to Scott Mac­Far­lane, a reporter for the local NBC affil­i­ate in Wash­ing­ton, eports that a DC Health Care exchange rep­re­sen­ta­tive actu­ally tried to con­tact Boehner by phone dur­ing the enroll­ment process but was put on hold for 35 min­utes, after which time the rep­re­sen­ta­tive finally hung up.

    It also tursn out that you don’t need a com­puter or phone to con­duct a denial of ser­vice attack against Oba­macare:

    GOP seeks a groundswell of oppo­si­tion to Oba­macare
    By Tom Cohen, CNN
    updated 12:23 PM EST, Thu Novem­ber 21, 2013

    Wash­ing­ton (CNN) — Use any metaphor you like — preda­tors smelling blood, invaders storm­ing the cas­tle, a snow­ball grow­ing in size and momen­tum as it rolls downhill.

    All describe efforts by oppo­nents of Pres­i­dent Barack Obama’s sig­na­ture health care reforms to kill the 2010 law after the botched launch of the HealthCare.gov web­site pro­vided a new open­ing for attack.

    Crit­ics led by con­ser­v­a­tive Repub­li­cans tar­get the Afford­able Care Act itself, not just the web­site woes, in hopes of cre­at­ing a pub­lic groundswell of opposition.

    “Oba­macare is much more than a bad web­site; it’s a bad law,” says a House Repub­li­can play­book for GOP mem­bers to fol­low in the campaign.

    The doc­u­ment obtained from a Repub­li­can source Thurs­day by CNN lays out a strat­egy of talk­ing points, videos, op-eds and social media out­reach intended to spread as neg­a­tive a per­cep­tion of the health care reforms as far and wide as possible.

    ...

    For Repub­li­cans, the goal is to bol­ster GOP prospects in next year’s con­gres­sional elec­tions by vil­i­fy­ing the health care reforms and mak­ing them the main cam­paign issue.

    Hold­ing their House major­ity and win­ning back the Sen­ate from Demo­c­ra­tic con­trol next year would increase lever­age for weak­en­ing and per­haps even dis­man­tling the reforms they despise as gov­ern­ment over­reach run amok.
    ...

    Huh, so the GOP is bas­ing its elec­toral strat­egy for 2014 on the fail­ure of Oba­macare. At least accord­ing to the “play­book” memo. That sure sounds like the kind of polit­i­cal strat­egy that could ben­e­fit from some more denial of ser­vice attacks.

    Posted by Pterrafractyl | November 24, 2013, 1:03 am
  39. The mil­lions of the still-uninsured must be really thank­ful that they aren’t being ‘placed on the Titanic’. That sounds awful:

    TPM
    Amer­i­cans Dis­cover They’re Trapped In GOP’s Med­ic­aid Expan­sion Gap
    Dylan Scott – Decem­ber 9, 2013, 6:00 AM EST

    With HealthCare.gov work­ing bet­ter and the first dead­line to sign up for health cov­er­age that starts in Jan­u­ary approach­ing, Obamacare’s so-called nav­i­ga­tors — the peo­ple and orga­ni­za­tions receiv­ing fed­eral funds to help peo­ple enroll — are see­ing more and more peo­ple come through the doors and out to their events.

    Nav­i­ga­tors are com­mu­nity orga­ni­za­tions, higher edu­ca­tion insti­tu­tions and gov­ern­ment agen­cies. They keep offices and phone hot lines open and go out to com­mu­nity events, hand­ing out fly­ers and giv­ing pre­sen­ta­tions so peo­ple know how they can get insur­ance under the health care reform law. If some­body needs help nav­i­gat­ing the insur­ance web­sites, they pro­vide it. And with HealthCare.gov finally func­tion­ing, this has been their busiest time since the Oct. 1 launch.

    But in 25 states, that robust inter­est has a down­side: Nav­i­ga­tors are forced to tell more and more peo­ple that they prob­a­bly won’t be able to get cov­ered because their states, all of which had a GOP-controlled leg­isla­tive cham­ber or gov­er­nor, have refused to expand Med­ic­aid. Lynne Thorp, who is over­see­ing the Uni­ver­sity of South Florida’s nav­i­ga­tor pro­gram in that state, told TPM that about one in four peo­ple who con­tact her team fall into that Med­ic­aid gap.

    “Those are hard­est phone calls because it doesn’t make any sense to them,” Thorp said. “We have to explain that they fall into this gap where this pro­gram can’t assist them.”

    It makes sense if you look at the num­bers. Accord­ing to the Kaiser Fam­ily Foun­da­tion, 38 per­cent of the U.S. unin­sured have an income that’s below the poverty line — the pop­u­la­tion that won’t qual­ify for either Med­ic­aid expan­sion or any finan­cial help to pur­chase pri­vate cov­er­age through the law in non-expanding states. About 5 mil­lion peo­ple fall in that gap in those states.

    But these peo­ple prob­a­bly don’t know that when they walk into a navigator’s office or attend an out­reach event. They just want to find out what options are avail­able to them — though it turns out the answer is not many.

    So how are the nav­i­ga­tors han­dling it?

    Well, offi­cially, they’re asked to let those peo­ple that they can still apply to pur­chase insur­ance through the Oba­macare mar­ket­places. There’s always the pos­si­bil­ity that the state will expand Med­ic­aid at a later date, and this way, their infor­ma­tion is already on file. The nav­i­ga­tors also direct them to free clin­ics and other non-government assis­tance that can help them get care.

    But with­out Med­ic­aid or any tax help, actual insur­ance is likely to be too expen­sive for them to afford. These are the peo­ple with the low­est incomes. For them, Oba­macare isn’t going to make much dif­fer­ence at all.

    In some cases, those being left out seem to under­stand, hav­ing been left out of the health insur­ance com­plex for a while, said Cyn­thia Rah­ming, who is head­ing the Hous­ton, Texas, nav­i­ga­tor pro­gram. She did agree, though, that her team is “often” com­ing across peo­ple who are part of the Med­ic­aid gap in that state.

    “They were excited. They were try­ing to see what’s avail­able to them,” she said. “But they’re still okay. They know it’s just a chance.”

    But Thorp described angry and con­fused peo­ple who didn’t under­stand why they wouldn’t be able to get cov­er­age under Oba­macare. Like Rahming’s group in Texas, her team refers peo­ple to free health clin­ics. But she acknowl­edged that they’ve started to become “desen­si­tized” to those expe­ri­ences, focus­ing instead on those they can help.

    ...

    “It’s awful,” one nav­i­ga­tor in a non-expanding state said. “It’s basi­cally: ‘Here are the really great options, and you can’t have them.’”

    In other news, extend­ing unem­ploy­ment insur­ance for the long-term unem­ployed is sort of like buy­ing them a ticket for the Hindenburg...

    Posted by Pterrafractyl | December 9, 2013, 1:28 pm
  40. Increas­ingly rad­i­cal­ized far-right move­ments can be quite a prob­lem, but it’s espe­cially prob­lem­atic for the groups try­ing to har­ness that rad­i­cal­ism when the move­ment is lit­er­ally dying:

    Salon
    The real prob­lem with the Amer­i­can right: Aging, white rad­i­cals
    Every­one knows the GOP has been unable to mod­er­ate its image or agenda. But less under­stood is the true rea­son why

    Brian Beut­ler
    Wednes­day, Jan 22, 2014 06:44 AM CST

    The Repub­li­can Party’s total fail­ure to make even cos­metic changes to its image and pol­icy agenda last year has at this point become the kind of cliché-cum-running joke that often attaches itself to accepted tru­isms in Amer­i­can pol­i­tics. Like chuck­ing about Bill Clinton’s inabil­ity to con­tain him­self in the com­pany of women, or not­ing that Dick Cheney actu­ally ran the show dur­ing George W. Bush’s first term, observ­ing that Repub­li­cans have failed to mod­er­ate or rein­vent them­selves after los­ing badly in 2012 is the kind of thing even sym­pa­thetic polit­i­cal wise men can say to sig­nal that they get it. That in what was a tough year for Pres­i­dent Obama, Repub­li­cans screwed up too.

    But the obser­va­tion of these symp­toms is less cru­cial than the diag­no­sis. Why are Repub­li­cans so stuck?

    When it became clear about a year ago that Repub­li­can lead­ers would have a much harder time advanc­ing immi­gra­tion reform than they real­ized — that GOP activists and con­ser­v­a­tives were livid about the idea that Repub­li­cans were going to help ille­gal immi­grants gain cit­i­zen­ship — it started to look like the party had an insol­u­ble prob­lem on its hands. Watch­ing Repub­li­cans attempt to broaden their appeal to grow­ing, tra­di­tion­ally Demo­c­ra­tic con­stituen­cies has been like watch­ing some­one try to cover a bed­room floor with a poorly cut car­pet, fas­ten­ing it into one cor­ner but pulling it out of the oth­ers in the process.

    They can’t con­nect with tra­di­tion­ally Demo­c­ra­tic con­stituen­cies with­out break­ing con­nec­tion with their reli­able sup­port­ers. They can tug in every pos­si­ble direc­tion, but at some point they need to acknowl­edge that the carpet’s too small.

    For a long time now, peo­ple have argued that the solu­tion to the GOP’s prob­lems will resem­ble the slow, painful, but steady mod­er­a­tion process Democ­rats went through in the 1980s and through the Clin­ton pres­i­dency. The adher­ents to this the­ory include Barack Obama him­self, as he told the New Yorker’s David Rem­nick dur­ing an inter­view for a new pro­file:

    “There were times in our his­tory where Democ­rats didn’t seem to be pay­ing enough atten­tion to the con­cerns of middle-class folks or working-class folks, black or white. And this was one of the great gifts of Bill Clin­ton to the Party—to say, you know what, it’s entirely legit­i­mate for folks to be con­cerned about get­ting mugged, and you can’t just talk about police abuse. How about folks not feel­ing safe out­side their homes? It’s all fine and good for you to want to do some­thing about poverty, but if the only mech­a­nism you have is rais­ing taxes on folks who are already feel­ing strapped, then maybe you need to widen your lens a lit­tle bit. And I think that the Demo­c­ra­tic Party is bet­ter for it. But that was a process. And I am con­fi­dent that the Repub­li­cans will go through that same process.”

    If the the­ory were cor­rect, you’d think repeated elec­tion defeats would have set the process in motion already. Maybe a third defeat, in 2016, will cat­alyze a more rapid tran­si­tion. But over time, I think the impor­tant dif­fer­ences between the Democ­rats’ old chal­lenge and the chal­lenge Repub­li­cans now face have started to show.

    Democ­rats didn’t have an easy go of it, exactly, but they were able to mod­ify their posi­tions across a range of issues with­out, for instance, cre­at­ing a left-wing-primary per­pet­ual motion machine, or giv­ing rise to a per­ma­nent pop­u­la­tion of resent­ful protest vot­ers. Maybe Repub­li­cans can do the same. But the 2013 expe­ri­ence sug­gests they are so in hock to aging, white, con­ser­v­a­tive reac­tionar­ies that tak­ing on new debts with minori­ties, gay peo­ple, sin­gle women and so on entails the risk of default­ing on the old ones.

    Another way of say­ing this is that Repub­li­cans have depleted most of their crossover poten­tial. And that’s a pretty novel prob­lem for a mod­ern Amer­i­can polit­i­cal party. It’s man­i­fest in the GOP establishment’s pusil­lan­i­mous rela­tion­ship with con­ser­v­a­tives. They didn’t cry “Hal­lelu­jah” when “Duck Dynasty’s” Phil Robert­son preached a big­oted ser­mon about gay peo­ple and the Jim Crow South, but they also notably didn’t treat his remarks as an oppor­tu­nity to insti­gate a Sis­ter Souljah-style con­fronta­tion with the right. To the con­trary, they ral­lied to Robertson’s defense and to a defense of con­ser­v­a­tive revan­chism in gen­eral. And when they have mus­tered the courage to con­front the extreme ele­ments in their party, it’s been over tac­tics, money, cam­paigns, rhetoric and other shades of win­dow dress­ing. John Boehner and Mitch McConnell will (finally!) crit­i­cize mon­eyed pres­sure groups for mis­lead­ing vot­ers and attack­ing Repub­li­cans, and they’ll dump on unre­pen­tant hard-liners when they say insen­si­tive but reveal­ing things about gay peo­ple, poor peo­ple and eth­nic minori­ties. But they haven’t cut the Gor­dian knot by admit­ting that these people’s moti­vat­ing beliefs have failed or been rejected by the pub­lic. It’s a consultant-class con­flict, not the deeper tur­bu­lence that would accom­pany an ide­o­log­i­cal course correction.

    ...

    Mean­while tax increases and new social spend­ing are com­pletely out of the ques­tion. House Repub­li­cans have basi­cally admit­ted they won’t hold a vote on Senate-passed leg­is­la­tion to pro­hibit work­place dis­crim­i­na­tion against gay peo­ple. And as for women?

    A fac­tion of con­ser­v­a­tives will intro­duce a res­o­lu­tion at this week’s meet­ing of the Repub­li­can National Com­mit­tee urg­ing GOP can­di­dates to speak up about abor­tion and respond force­fully against Demo­c­ra­tic efforts to paint them as anti-woman extrem­ists,CNN reported Tues­day.

    ...

    Hmmm...well, maybe the GOP’s resolve to ‘speak up about abor­tion and respond force­fully against Demo­c­ra­tic efforts to paint them as anti-woman extrem­ists’ will make inroads with the youth vote and solve this pesky “aging, white rad­i­cals” prob­lem. If not, there’s still no rea­son for a GOP freak out. They can always just retool Plan A again:

    Salon
    GOP’s apoc­a­lyp­tic new debt limit strat­egy: One enor­mous lie
    With Oba­macare repeal impos­si­ble, con­ser­v­a­tives need a new vil­lain to attack. Intro­duc­ing: The “Oba­macare bailout”

    Brian Beut­ler
    Thurs­day, Jan 23, 2014 06:44 AM CST

    Back in Decem­ber, just two months after the pre­vi­ous debt limit dead­line forced Repub­li­cans to end their gov­ern­ment shut­down with­out extract­ing any unrec­i­p­ro­cated con­ces­sions from Democ­rats Rep. Paul Ryan, R-Wis., and Sen­ate Minor­ity Leader Mitch McConnell became the first two lead­ing Repub­li­cans to pre­dict that the GOP will stage yet another debt limit hostage drama.

    ...

    I’m pretty con­fi­dent the pat­tern will hold this time around, too — but with one very impor­tant dif­fer­ence. Last time around Repub­li­cans entered the com­bined shut­down and debt limit fights com­pletely clue­less about what they hoped to extort, other than that they knew it should come out of the hides of Obama and his sup­port­ers. They floated a laugh­ably com­pre­hen­sive list of demands — the entire ros­ter of Obama accom­plish­ments in exchange for a tem­po­rary increase in bor­row­ing author­ity — but then let it dwin­dle and dwin­dle until it dis­ap­peared altogether.

    This time around, a shut­down is off the table — the gov­ern­ment is funded through Sep­tem­ber. Which means the fight will be cen­tered entirely around the much more dan­ger­ous, but much less polit­i­cally black-and-white debt limit dead­line. And this time, I think Repub­li­cans will have a sin­gle, con­crete ran­som demand.

    When Oba­macare first launched and Healthcare.gov’s ini­tial fail­ure delayed mil­lions of enroll­ments, con­ser­v­a­tives cel­e­brated, because they believed worse-than-expected enroll­ment to be syn­ony­mous with an actu­ar­ial “death spi­ral” and the law’s rapid col­lapse. Not so fast, the law’s sup­port­ers cau­tioned. First, don’t for­get that the open enroll­ment period is six months. But then keep in mind that the law out­fits the exchanges with shock absorbers — known as rein­sur­ance, and risk cor­ri­dors — so that if first– and second-year enroll­ments lag behind expec­ta­tions, insur­ers will be insu­lated from unex­pected losses and the need to jack up premiums.

    This came as a tremen­dous dis­ap­point­ment to con­ser­v­a­tives, most of whom had never heard of rein­sur­ance and risk cor­ri­dors — and who, worse, had blithely con­vinced them­selves that Oba­macare was already col­laps­ing because its authors had been too inept to back­stop their own creation.

    But they regrouped quickly. The right’s basic approach to fight­ing Oba­macare is pretty sim­ple: Since full repeal is impos­si­ble con­ser­v­a­tives take aim at the embed­ded pro­vi­sions that make the law viable. This explains their obses­sion with delay­ing the indi­vid­ual man­date. And it explains their new obses­sion with repeal­ing the risk cor­ri­dors. But the indi­vid­ual man­date is and always has been unpop­u­lar, whereas nobody’s ever heard of risk cor­ri­dors. So to make the risk cor­ri­dors just as unpop­u­lar as the man­date, con­ser­v­a­tives agreed, in an unusu­ally brazen and pub­lic way, that they would lie about that pro­vi­sion and dub it an “Oba­macare bailout.” Link­ing the word “Oba­macare” to the word “bailout” serves approx­i­mately the same role in build­ing sup­port for the fight against Oba­macare as the insin­u­a­tion of an alliance between Sad­dam Hus­sein and Osama bin Laden served in build­ing sup­port for the Iraq War. And it’s only slightly less dishonest.

    Risk cor­ri­dors are a bit com­pli­cated in design, but essen­tially reflect an agree­ment between the gov­ern­ment and insur­ance com­pa­nies par­tic­i­pat­ing in the exchanges that the gov­ern­ment will share in unex­pect­edly large losses, but that the gov­ern­ment will also recoup large insur­ance com­pany wind­falls. It is for that rea­son an induce­ment against insur­ers set­ting pre­mi­ums too high or too low and against cherry-picking healthy cus­tomers. In a very bad year for all insur­ers — if Healthcare.gov had failed entirely, or if a plague sweeps the coun­try this spring — the gov­ern­ment would be on the hook for a fair amount of money. Under nor­mal con­di­tions, risk cor­ri­dors func­tion as a trans­fer from car­ri­ers with health­ier clients to car­ri­ers with sicker clients. But in an unex­pect­edly good year for insur­ers, the gov­ern­ment would recoup its losses. Gov­ern­ment ana­lysts thus expect the risk cor­ri­dor pro­gram to be bud­get neu­tral over its three-year lifespan.

    It’s thus only a bailout in the same way that pos­sess­ing a bot­tle of Advil is a cat­a­strophic drug over­dose. But that hasn’t stopped con­ser­v­a­tives from plot­ting in broad day­light to frame it as a bailout any­how, in a cyn­i­cal cam­paign to build sup­port for its repeal and, as Ramesh Pon­nuru wrote, in mustache-twiddling prose, “raise pre­mi­ums [mak­ing insur­ance] plans even more unat­trac­tive than they already are … Oba­macare would, in other words, become even less likely to suc­ceed than it already is.”

    He might as well have said con­ser­v­a­tives won’t aban­don their Oba­macare sab­o­tage cam­paign unless George Soros gives them one zil­lion, fafil­lion dollars.

    But Ponnuru’s rel­a­tively late to the party. This idea really mor­phed from a secret plot to wreck Oba­macare into a Bond vil­lain audi­tion on Jan. 2, when, after finally dis­cov­er­ing these dreaded risk cor­ri­dors, Charles Krautham­mer advised: “Attach the anti-bailout bill to the debt ceil­ing. That and noth­ing else. Dare the pres­i­dent to stand up and say: ‘I’m will­ing to let the coun­try default in order to pre­serve a mas­sive bailout for insur­ance companies.’”

    Which is exactly what I think Repub­li­cans will do. Trea­sury Sec­re­tary Jack Lew announced on Wednes­day that Con­gress will need to increase the debt limit before the end of Feb­ru­ary, weeks ear­lier than expected. House Speaker John Boehner, who declined to demand any debt limit ran­soms just last week, sent his spokesman Michael Steel out to announce in response to Lew that “a ‘clean’ debt limit increase sim­ply won’t pass in the House.”

    So it’s pretty clear where Repub­li­cans are headed. Sen. Marco Rubio, R-Fla., even authored a “bailout” repeal bill last year. And they’ll prob­a­bly get their talk­ing point. But for any­one read­ing who isn’t in the busi­ness of lay­ing fraud­u­lent intel­lec­tual ground­work for par­ti­san cam­paign­ers, you can be absolutely secure in the con­clu­sion that this is a huge scam — indeed that almost every­one who crashed the bailout rhetoric party knows they’re lying.

    Why? Because they’ve since learned that Medicare Part D has a risk cor­ri­dor pro­gram as well! And it’s dawn­ing on them that they must now square their apoc­a­lyp­tic bailout rhetoric with the fact that some of them helped design that very enti­tle­ment a decade ago.

    And if another Obamacare-shutdown doesn’t mes­mer­ize the pop­u­lace and expand the base, the GOP could always try to con­vince young vot­ers that it actu­ally cares about their civil lib­er­ties and futures. It’s a long shot, but it just might work:

    Slate
    The New, Snowden-Loving Repub­li­can Party

    By David Weigel
    Jan. 24 2014 3:58 PM

    Benjy Sar­lin has a nice read on the other news emerg­ing from the RNC meet­ing. Sup­port­ers of Ron Paul, chiefly Nevada’s Diana Orrock, were able to sell the whole com­mit­tee on a res­o­lu­tion “renounc­ing” the NSA’s data col­lec­tion pro­grams. As of today, the RNC “encour­ages Repub­li­can law mak­ers to call for a spe­cial com­mit­tee to inves­ti­gate, report, and reveal to the pub­lic the extent of this domes­tic spy­ing” and “calls upon Repub­li­can law­mak­ers to imme­di­ately take action to halt cur­rent uncon­sti­tu­tional sur­veil­lance pro­grams and pro­vide a full pub­lic account­ing of the NSA’s data col­lec­tion pro­grams.” It basi­cally endorses Rep. Justin Amash’s leg­is­la­tion in the House.

    Andrew Kaczyn­ski com­mem­o­rates the occa­sion with a flash­back to the August 2006 RNC attack on the “lib­eral judge” who ruled against another NSA pro­gram, and was “praised by Dems.” Not long after that, one of the party’s endan­gered mod­er­ates, Con­necti­cut Rep. Nancy John­son, attacked her Demo­c­ra­tic oppo­nent for dar­ing to oppose the program.

    So it’s taken seven-odd years for the GOP to come fully around and real­ize the groovy pol­i­tics of civil lib­er­ties, but that should have been obvi­ous even before Snowden.

    Could we see a new young, hip, civil-liberties-loving GOP sweep the nation off its feet in 2014? We’ll see!

    But either way, the GOP clearly has to make a pivot away from its socially con­ser­v­a­tive base and embrace its Lib­er­tar­ian future some­day and right now might be as good an oppor­tu­nity as the GOP will ever get to rebrand the party not as the last refuge of aging, white rad­i­cals but as the party of youth­ful rev­o­lu­tion­ary spirit...a sort of stopped clock for the future. So we should prob­a­bly expect a lot more youth-friendly embraces of the Ron Paul/Rand Paul Lib­er­tar­ian wing of the party, espe­cially if the upcom­ing “Obamacare-bailout shut­down” doesn’t go well. And who knows, we might even see a few more rebrand­ing attempts by the Lib­er­tar­i­ans them­selves as this trend progresses.

    Still, the GOP should def­i­nitely avoid embrac­ing its inner Lib­er­tar­ian too aggres­sively dur­ing this rebrand­ing phase. That might solve the GOP’s “aging, white rad­i­cals” prob­lem a lit­tle too soon.

    Posted by Pterrafractyl | January 25, 2014, 5:35 pm
  41. Con­grats GOP: Mis­sion accom­plished! Mis­sion accom­plished!

    TPM Livewire
    Study: Thou­sands Of Peo­ple Will Die In States That Don’t Expand Medicaid

    Updated 11:45 AM EST, Fri Jan 31 2014

    Dylan Scott – Jan­u­ary 31, 2014, 11:00 AM EST

    As many as 17,000 Amer­i­cans will die directly as a result of states decid­ing not to expand Med­ic­aid under Oba­macare, accord­ing to a new study.

    Researchers from Har­vard Uni­ver­sity and City Uni­ver­sity of New York have esti­mated that between 7,115 and 17,104 deaths will be “attrib­ut­able to the lack of Med­ic­aid expan­sion in opt-out states” in a study pub­lished in Health Affairs.

    “The results were sober­ing,” Samuel Dick­man, one of the authors, said, accord­ing to the Morn­ing Call. “Polit­i­cal deci­sions have con­se­quences, some of them lethal.”

    They pro­jected that 423,000 fewer dia­bet­ics would receive med­ica­tion to treat their dis­ease. If opt-out states had expanded Med­ic­aid, 659,000 women who are in need of mam­mo­grams and 3.1 mil­lion women who should receive reg­u­lar pap smears would have become insured, the study found.

    “Low-income adults in states that have opted out of Med­ic­aid expan­sion will forego gains in access to care, finan­cial well-being, phys­i­cal and men­tal health, and longevity that would be expected with expanded Med­ic­aid cov­er­age,” the authors wrote.

    In terms of health cov­er­age, expand­ing states will expe­ri­ence a 48.9 per­cent decrease in their unin­sured pop­u­la­tion com­pared to a 18.1 per­cent decrease in non-expanding states. Eight mil­lion peo­ple will remain unin­sured because their states didn’t expand Med­ic­aid, accord­ing to the study.

    ...

    Posted by Pterrafractyl | January 31, 2014, 9:23 am
  42. It’s only fool’s gold if folks find out:

    TPM DC
    The GOP Has It Wrong: Oba­macare Won’t ‘Cost’ 2 Mil­lion Jobs

    Dylan Scott – Feb­ru­ary 4, 2014, 2:28 PM EST

    Repub­li­cans thought they found a gold mine when the Con­gres­sional Bud­get Office released its lat­est report Tues­day on the fed­eral bud­get and Oba­macare. They seized on one line in particular:

    The reduc­tion in CBO’s pro­jec­tions of hours worked rep­re­sents a decline in the num­ber of full-time-equivalent work­ers of about 2.0 mil­lion in 2017, ris­ing to about 2.5 mil­lion in 2024

    They had a new talk­ing point: Pres­i­dent Obama’s hated health care reform law would cost more than 2 mil­lion Amer­i­can jobs.

    “Oba­macare To Print Even More Pink Slips,” read the sub­ject of the Sen­ate Repub­li­can con­fer­ence email blasted out after the report’s release.

    “Oba­macare will cost our nation about 2.5 mil­lion jobs,” tweeted Sen. Lind­sey Gra­ham (R-SC):
    ...

    “For years, Repub­li­cans have said that the president’s health care law cre­ates uncer­tainty for small busi­nesses, hurts take-home pay, and makes it harder to invest in new work­ers,” Speaker John Boehner (R-OH) said in a state­ment. “The mid­dle class is get­ting squeezed in this econ­omy, and this CBO report con­firms that Oba­maCare is mak­ing it worse.”

    The New York Times summed it up by claim­ing that the CBO report is “pro­vid­ing Repub­li­can oppo­nents of the law a pow­er­ful polit­i­cal weapon lead­ing up to this year’s midterm elections.”

    But is that what the CBO actu­ally said or meant? No.

    What the CBO really found was that the num­bers of hours worked would decrease under Oba­macare, by roughly 1.5 per­cent to 2 per­cent between 2017 and 2024. The report then trans­lated those lost hours into the equiv­a­lent of 2.5 mil­lion jobs. But that doesn’t mean 2.5 mil­lion jobs are going to dis­ap­pear from the U.S. economy.

    The CBO report, in fact, specif­i­cally under­mines that claim. Those lost hours will “almost entirely” be the result of peo­ple choos­ing to work fewer hours because of Oba­macare — not because they lost their jobs or can’t find a full-time job.

    The esti­mated reduc­tion stems almost entirely from a net decline in the amount of labor that work­ers choose to sup­ply, rather than from a net drop in busi­nesses’ demand for labor, so it will appear almost entirely as a reduc­tion in labor force par­tic­i­pa­tion and in hours worked rel­a­tive to what would have occurred oth­er­wise rather than as an increase in unem­ploy­ment (that is, more work­ers seek­ing but not find­ing jobs) or under­em­ploy­ment (such as part-time work­ers who would pre­fer to work more hours per week).

    The report explic­itly says that Oba­macare isn’t going to force busi­nesses to cut jobs on any grand scale. What it is going to do is change how much Amer­i­cans work.

    “I think it’s impor­tant to dis­tin­guish between peo­ple choos­ing to work less and jobs being lost,” Larry Levitt, vice pres­i­dent at the non-partisan Kaiser Famiy Foun­da­tion, told TPM. “That is some­thing impor­tant to keep an eye on, since you don’t want to dis­cour­age work. But, it’s not in all cases a bad thing.”

    “For exam­ple, some peo­ple in their late 50s and early 60s would like to retire because they have health issues but have kept work­ing for the health ben­e­fits. Some of them can now retire because they can’t be dis­crim­i­nated against for hav­ing a pre-existing con­di­tion and may get help pay­ing their premiums.”

    ...

    So how exactly will the law influ­ence Amer­i­cans? It is, of course, complicated.

    The main take­away is: Oba­macare will affect how much Amer­i­cans decide to work. Why? Ben­e­fits like tax sub­si­dies to pur­chase pri­vate health cov­er­age and expanded Med­ic­aid are based on income. The more money you make, the fewer ben­e­fits you receive. In gen­eral, the law’s added finan­cial secu­rity will likely give Amer­i­cans a lit­tle less incen­tive to work.

    Some Amer­i­cans will there­fore decide to work less. That could man­i­fest in dif­fer­ent ways: some peo­ple might chose to tran­si­tion to part-time work; oth­ers might wait longer between jobs. One pop­u­la­tion — those near­ing retire­ment age — might opt to retire early because the law allows them to con­tinue receiv­ing health cov­er­age even if they don’t work.

    But the ulti­mate impact of those deci­sions is the same: Amer­i­cans will be work­ing less. But not because there will be so many fewer jobs, as Kaiser’s Levitt explained to TPM.

    “If you guar­an­tee peo­ple insur­ance even if they don’t get it on the job and you give them help based on their income, that’s likely to lead to peo­ple work­ing some­what less,” he said. “That’s going to be true of any means tested pro­gram. The only way around it is not to give peo­ple the help.”

    ...

    *gasp* You mean poor peo­ple aren’t going to have to work quite as many hours in order to keep their health­care? Well, there goes another great Amer­i­can tra­di­tion.

    But don’t worry GOP, thanks to the brave actions of the state leg­is­la­tures around the coun­try that refused to expand Med­ic­aid the great Amer­i­can tra­di­tion of work­ing until you die in a ditch is being kept alive. And because the hos­pi­tals in those states aren’t get­ting the Med­ic­aid patients they were expect­ing, hos­pi­tal jobs are also being lost which can then be blamed on Oba­macare! And these job losses are invol­un­tary, just like they should be...none of that wussy Obamacare-“I don’t want to work so much because I’m old and need health­care” nonsense.

    Refus­ing to help: it’s the gift that keeps on giv­ing:

    news-leader.com
    Med­ic­aid expan­sion: Hos­pi­tals feel pinch as Mis­souri, other states debate
    Feb. 3, 2014

    Writ­ten by
    Sarah Okeson

    HOUSTON — For­mer Pres­i­dent Harry Tru­man spoke in 1958 at the ded­i­ca­tion of the Texas County Memo­r­ial Hos­pi­tal in Hous­ton, located in the mid­dle of the county so res­i­dents in com­mu­ni­ties such as Elk Creek and Clara wouldn’t have to drive far.

    Tru­man had unsuc­cess­fully pushed for Con­gress to approve uni­ver­sal health insur­ance, but he was able to get the Hill-Burton Act passed in 1946, which helped build rural hos­pi­tals such as the Texas County Memo­r­ial Hos­pi­tal. The law of the land now man­dates uni­ver­sal health care cov­er­age, but the way that law is being imple­mented in Mis­souri could even­tu­ally con­tribute to some of the state’s most finan­cially pre­car­i­ous hos­pi­tals clos­ing or merg­ing with other hospitals.

    “I think all rural hos­pi­tals are at risk of los­ing ground or los­ing jobs or los­ing ser­vices,” said Wes Mur­ray, the CEO of the hos­pi­tal, who vol­un­tar­ily took a 5 per­cent pay cut in 2013. “More peo­ple would have to travel else­where either for a job or for their care.”

    The Hous­ton hos­pi­tal lost about $700,000 that year, accord­ing to its unau­dited finan­cial statements.

    Hos­pi­tals had counted on the expan­sion of Med­ic­aid to help off­set cuts in pay­ments to hos­pi­tals that are part of the fed­eral health care reform law. But Missouri’s con­ser­v­a­tive leg­is­la­tors have balked at expand­ing Med­ic­aid after a deci­sion by the U.S. Supreme Court allowed states to opt out.

    Missouri’s deci­sion not to expand also left an esti­mated 193,420 unin­sured adults who could have been cov­ered by Med­ic­aid in the lurch. They make too lit­tle to qual­ify for fed­eral sub­si­dies to help pay for insur­ance under the Afford­able Care Act, but they make too much to be able to get Medicaid.

    ...

    For­mer Mis­souri sen­a­tor Kit Bond said that if Med­ic­aid isn’t expanded, peo­ple “with lim­ited resources will either wind up going with­out health care or go to hos­pi­tal emer­gency rooms and none of those are acceptable.”

    Researchers from Har­vard Uni­ver­sity and the City Uni­ver­sity of New York recently pro­jected that Missouri’s deci­sion to reject Med­ic­aid expan­sion could lead to more than 200 deaths statewide. The study esti­mated that 12,947 dia­bet­ics won’t get their med­ica­tions, 7,770 peo­ple will have cat­a­strophic med­ical expenses and 21,816 peo­ple won’t get their depres­sion rec­og­nized and treated.

    “The Mis­souri leg­is­la­ture needs to act now and draw down fed­eral funds in order to expand health care access for all Mis­souri­ans,” said Michelle Tru­pi­ano, the direc­tor of the Mis­souri Med­ic­aid Coalition.

    The state’s hos­pi­tals are just start­ing to feel the finan­cial impact of not expand­ing Med­ic­aid, accord­ing to the Mis­souri Hos­pi­tal Asso­ci­a­tion. The hos­pi­tals face an esti­mated $700 mil­lion reduc­tion in Med­ic­aid pay­ments from 2014 to 2019 and a $3.3 bil­lion reduc­tion in Medicare pay­ments from 2013 to 2019 that are par­tially con­nected to the health care law, accord­ing to association.

    The asso­ci­a­tion looked at the finances of the state’s 142 hos­pi­tals. The analy­sis found that over­all, the hos­pi­tals made less than two cents before inter­est for every $1 in sales in 2012.

    Herb Kuhn, the pres­i­dent and CEO of the Mis­souri Hos­pi­tal Asso­ci­a­tion, said hos­pi­tals have laid off or not filled about 1,000 jobs.

    “We’re really start­ing to fill the pinch,” Kuhn said.

    In Spring­field, Mercy Hos­pi­tal Spring­field isn’t hir­ing employ­ees who don’t care for patients.

    Dr. Robert Steele, the pres­i­dent and CEO of Mercy Hos­pi­tal Spring­field, said Mercy is expected to lose about $16.6 mil­lion in fed­eral pay­ments in 2014. But Steele said Mercy is health­ier than rural hos­pi­tals, which tend to have a larger share of patients on Med­ic­aid and Medicare.

    “I have very seri­ous con­cerns about our sur­round­ing rural hos­pi­tals,” Steele said. “They were already under dif­fi­cult chal­lenges any­way. At best, I believe that what you’ll see is that hos­pi­tals have strug­gled so much that they get acquired by some­one else.”

    In West Plains, Ozarks Med­ical Cen­ter laid off 32 employ­ees in June. The 114-bed hos­pi­tal is pro­jected to face about $41 mil­lion in cuts in fed­eral pay­ments from 2013 to 2019.

    Jean­nie Looper, the interim pres­i­dent and CEO of Ozarks Med­ical Cen­ter, is try­ing to grow ser­vices such as ortho­pe­dic surgery, oncol­ogy and car­diac care.

    “We can­not cut our way out of that reduc­tion, as you can imag­ine,” Looper said.

    ...

    Now you know why Arkansas’s GOP leg­is­la­tors are all excited.

    Posted by Pterrafractyl | February 4, 2014, 2:37 pm
  43. A snap­shot of our con­tem­po­rary din:
    Altru­ism. Is it bad or good?

    If ongo­ing debates over the mer­its of altru­ism leave you feel­ing stressed out and con­cerned for the future, don’t let the stress get to you too much. Stress induced by an observed lack of empa­thy in oth­ers can be a self-reinforcing prob­lem. Instead, find ways to de-stress as many other peo­ple as pos­si­ble. How might we accom­plish that? What should be avoided at all cost?

    Posted by Pterrafractyl | March 25, 2014, 1:41 pm
  44. Posted by Pterrafractyl | March 28, 2014, 10:07 am
  45. “The GOP’s Most Cyn­i­cal Anti-Obamacare Attack Yet?” That’s a pretty high bar. Let’s see how this one does:

    The New Repub­lic
    The GOP’s Most Cyn­i­cal Anti-Obamacare Attack Yet

    BY NOAM SCHEIBER @noamscheiber

    My col­league Jonathan Cohn has done heroic work cat­a­logu­ing and rebut­ting some of the most non­sen­si­cal right-wing attacks on Oba­macare as the enroll­ment dead­line looms. But I fear he may have missed a lead­ing can­di­date for the top spot: Ten­nessee con­gress­woman Mar­sha Blackburn.

    Appear­ing on MSNBC this morn­ing, Black­burn was asked whether she dis­puted poll num­bers show­ing the per­cent­age of unin­sured Amer­i­cans to be steadily falling. Here’s how Black­burn responded:

    Well, I think what we, there again, have to do is look at what you find in those num­bers. And I would direct you to the 2012 Kaiser report that said 33% of all physi­cians are not see­ing new Medicare enrollees. Now, if we have a lot of Med­ic­aid enrollees—excuse me, I mean Med­ic­aid enrollees. They’re not expand­ing their Med­ic­aid pop­u­la­tion in their patient base.

    At which point anchor Chris Jans­ing rightly pointed out that Ten­nessee, along with sev­eral other Repub­li­can states, has refused to sign on to the very Med­ic­aid expan­sion Black­burn says isn’t hap­pen­ing. “But you didn’t offer that in Ten­nessee, cor­rect?” Jans­ing said.

    Back to you Rep. Blackburn:

    Let me fin­ish my thought here, then we’ll talk about Ten­nessee. What we are doing, if we are giv­ing an insur­ance card to those indi­vid­u­als who do not have access to the doc­tor. Basi­cally, it’s a false promise, because you say, “You have insur­ance to the queue, not to the physician.”

    Now the rea­son there was not a Med­ic­aid expan­sion in Ten­nessee is because we have been to this dance before. It was in the mid-‘90s, the test case for Hillarycare. It was an abysmal fail­ure. We have Sec­re­tary Sebe­lius, who has called the roll­out of Oba­macare a deba­cle. That is exactly what hap­pened in Ten­nessee. A deba­cle. The leg­is­la­ture has cho­sen not to expand Med­ic­aid in Ten­nessee, and with good rea­son. They know it’s not an afford­able premise. And they are very con­cerned about the impact that would have on the access to health care within our state.

    So, to review: Black­burn says Oba­macare is a fail­ure because the promised Med­ic­aid expan­sion isn’t hap­pen­ing. Jour­nal­ist points out that Blackburn’s own state has blocked Med­ic­aid expan­sion from hap­pen­ing. In response to which Black­burn says, Damn right! No way would we ever let Med­ic­aid expand!

    ...

    OK, it’s def­i­nitely a dou­ble.

    Posted by Pterrafractyl | March 31, 2014, 5:56 pm
  46. Just imag­ine how awe­some health­care could be in the US with­out the ‘awe­some evil­ness’:

    Wash­ing­ton Monthly
    April 09, 2014 9:40 AM
    “Almost Awe­some in its Evil­ness.” Jon Gru­ber on States’ Rejec­tion of Med­ic­aid Expansion

    By Harold Pollack

    Over at healthinsurance.org, I inter­viewed MIT econ­o­mist Jon Gru­ber on the state of ACA. We dis­cussed a huge range of things, rang­ing from the case for the “Cadil­lac tax” to lessons of the botched roll­out. It was a pretty upbeat con­ver­sa­tion. But Jon was char­ac­ter­is­ti­cally blunt regard­ing states that have declined ACA’s Med­ic­aid expansion:

    Jon: I think, Harold, the sin­gle thing we prob­a­bly need to keep the most focus on is the tragedy of the lack of Med­ic­aid expan­sions. I know you’ve writ­ten about this. You know about this, but I think we can­not talk enough about the absolute tragedy that’s taken place. Really, a life-costing tragedy has taken place in Amer­ica as a result of that Supreme Court deci­sion. You know, half the states in Amer­ica are deny­ing their poor­est cit­i­zens health insur­ance paid for by the fed­eral government.

    So to my mind, I’m offended on two lev­els here. I’m offended because I believe we can help poor peo­ple get health insur­ance, but I’m almost more offended there’s a prin­ci­ple of polit­i­cal econ­omy that basi­cally, if you’d told me, when the Supreme Court deci­sion came down, I said, “It’s not a big deal. What state would turn down free money from the fed­eral gov­ern­ment to cover their poor­est cit­i­zens?” The fact that half the states are is such a mas­sive rejec­tion of any sen­si­ble model of polit­i­cal econ­omy, it’s sort of offen­sive to me as an aca­d­e­mic. And I think it’s noth­ing short of polit­i­cal mal­prac­tice that we are see­ing in these states and we’ve got to empha­size that.

    Harold: One of the things that’s really strik­ing to me is there’s a pol­i­tics of impunity towards poor peo­ple, par­tic­u­larly non-white poor peo­ple that is almost a fea­ture rather than a bug in the inter­nal pol­i­tics in some of these states, not to cover peo­ple under Med­ic­aid, even if it’s finan­cially very advan­ta­geous to do so. I think there’s a really impor­tant prin­ci­ple to defeat this polit­i­cally, not just because Med­ic­aid is impor­tant for peo­ple, but because it’s such a toxic polit­i­cal per­spec­tive that has to be … It has to be shown that that approach to pol­i­tics doesn’t work because oth­er­wise, we will really be stuck with some very unjust poli­cies that will be pur­sued with com­plete impunity in some of these places.

    Jon: That’s a great way to put it. There are larger prin­ci­ples at stake here. When these states are turn­ing — not just turn­ing down cov­er­ing the poor peo­ple — but turn­ing down the fed­eral stim­u­lus that would come with that.

    […]

    They are not just not inter­ested in cov­er­ing poor peo­ple, they are will­ing to sac­ri­fice bil­lions of dol­lars of injec­tions into their econ­omy in order to pun­ish poor peo­ple. It really is just almost awe­some in its evil­ness.

    More here.

    Well at least we don’t have to worry about states act­ing with com­plete impunity. It’s still a democ­racy under the rule of one man one vote and politi­cians that use the poor as a polit­i­cal effigy can still be voted out, espe­cially by the peo­ple get­ting tar­geted by awe­some evil­ness. Right? Maybe?

    Posted by Pterrafractyl | April 11, 2014, 8:19 am
  47. The National Repub­li­can Con­gres­sional Com­mit­tee just issued a pub­lic cry for help over its inabil­ity to stop fix­at­ing on Oba­macare. For­tu­nately, help is on the way! Iron­i­cally.

    Posted by Pterrafractyl | April 17, 2014, 2:45 pm

Post a comment