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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

52 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
  48. Ok then:

    Slate
    Fed­er­al­ist Rolling Papers
    Two states’ rights advo­cates are pur­su­ing a sil­ly law­suit to the Supreme Court that could under­mine states’ rights.
    Dec. 30 2014 11:49 AM
    By Mark Joseph Stern

    The attor­neys gen­er­al of Nebras­ka and Okla­homa have decid­ed that they should have a say over what hap­pens in the state of Col­orado. Just before the hol­i­days, the two men, Jon Brun­ing and Scott Pruitt, filed a law­suit against Col­orado for legal­iz­ing mar­i­jua­na. The suit is a long shot, but some respect­ed legal schol­ars think Brun­ing and Pruitt have a fight­ing chance. Should they suc­ceed, their case could lead to epic bat­tles among the states over reg­u­la­tion of guns and pollution—and give Con­gress unprece­dent­ed pow­er.

    Brun­ing and Pruitt’s cru­sade against Colorado’s mar­i­jua­na laws con­flicts with their osten­si­ble sup­port of states’ rights. As attor­ney gen­er­al of Nebras­ka, Brun­ing has fought Oba­macare with the fanati­cism of a zealot, argu­ing in a legal chal­lenge that the law tramped upon states’ rights. As attor­ney gen­er­al of Okla­homa, Pruitt has led the next major chal­lenge to the act, insist­ing that the fed­er­al gov­ern­ment must respect states’ deci­sions not to set up their own exchanges and to deny their cit­i­zens cheap access to good insur­ance. Both men believe their states have a right to con­trol their own health insur­ance sys­tems.

    But when anoth­er state decides to exper­i­ment with a new drug pol­i­cy, Brun­ing and Pruitt’s sup­port for state sov­er­eign­ty dries up. They are argu­ing that Congress’s pro­hi­bi­tion against mar­i­jua­na should force every state to pro­hib­it it as well. (These attor­neys gen­er­al aren’t opposed to all intox­i­cants. Their posi­tion on mar­i­jua­na might have some­thing to do with the fact that both Brun­ing and Pruitt have received sig­nif­i­cant cam­paign con­tri­bu­tions from alco­hol indus­tries.)

    This strange lit­tle law­suit against Col­orado is so aston­ish­ing­ly hyp­o­crit­i­cal, so brazen­ly antipo­dal to Brun­ing and Pruitt’s pro­fessed phi­los­o­phy, that even admir­ers of both men are aghast. Case West­ern Law’s Jonathan H. Adler, the mas­ter­mind behind the lat­est Oba­macare suit, not­ed with dis­gust that “it is as if their argu­ments about fed­er­al­ism and state auton­o­my were not argu­ments of prin­ci­ple but rather an oppor­tunis­tic effort to chal­lenge fed­er­al poli­cies they don’t like on oth­er grounds.” George­town Law’s Randy Bar­nett, who brought the first Oba­macare suit from the fringe to the main­stream, wrote that “I see no oth­er way to inter­pret Nebras­ka and Oklahoma’s law­suits than as an exam­ple of ‘fair weath­er fed­er­al­ism.’ ” (Fed­er­al­ism describes the bal­ance of pow­er between states and the cen­tral gov­ern­ment; self-described fed­er­al­ists favor increased state auton­o­my.)

    What has Adler and Bar­nett so riled up about the mar­i­jua­na law­suit isn’t just the rank hypocrisy. It’s the prece­dent. Fed­er­al­ists may have lost their argu­ment against Obamacare’s indi­vid­ual man­date at the Supreme Court, but they won the oth­er half of their suit: the claim that the fed­er­al gov­ern­ment can’t coerce states into par­tic­i­pat­ing in the law’s gen­er­ous Med­ic­aid expan­sion. (That’s why red states are still able to squab­ble over the pro­gram today.) Fed­er­al­ists have long strived to estab­lish that Con­gress can’t dra­goon states into adopt­ing cer­tain poli­cies or pro­grams. By push­ing the Supreme Court to rule that the fed­er­al gov­ern­ment can’t force states to expand Medicaid—even on Congress’s dime—federalists scored a huge win.

    If Nebras­ka and Okla­homa suc­ceed in their law­suit against Col­orado, that vic­to­ry would effec­tive­ly be reversed. The two states are argu­ing that fed­er­al law out­law­ing mar­i­jua­na doesn’t just make the use and sale of mar­i­jua­na fed­er­al crimes. Rather, they’re argu­ing that Con­gress intend­ed to force state leg­is­la­tures to crim­i­nal­ize mar­i­jua­na, and to use their states’ police pow­er to pun­ish mar­i­jua­na users. If this claim is true, then the law itself con­sti­tutes a fed­er­al infringe­ment upon state auton­o­my far, far greater than any part of Oba­macare. Brun­ing and Pruitt read Congress’s mar­i­jua­na ban to coerce every sin­gle oth­er state into enact­ing, main­tain­ing, and vig­or­ous­ly enforc­ing its own mar­i­jua­na ban.

    ...

    If Adler and Bar­nett are tru­ly shocked that these two con­ser­v­a­tive Repub­li­can attor­neys gen­er­al are fair-weath­er fed­er­al­ists, then they haven’t been pay­ing atten­tion. Pruitt joined an ami­cus brief in Unit­ed States v. Wind­sor argu­ing that the Supreme Court should uphold Congress’s ban on same-sex marriage—even though the law encroached upon state sov­er­eign­ty by lim­it­ing the states’ abil­i­ty to pro­tect a cer­tain class of cit­i­zens. Brun­ing also sup­port­ed the fed­er­al gay mar­riage ban, and is cur­rent­ly defend­ing his state’s ban in court.

    With mar­riage equal­i­ty and health insur­ance, it’s easy for Brun­ing and Pruitt to stand up for their alleged fed­er­al­ist con­vic­tions. They already despise gay rights and uni­ver­sal health care, but attack­ing gay peo­ple and poor peo­ple is a bit gauche these days—so instead, both attor­neys gen­er­al can degrade and dis­ad­van­tage their cit­i­zens under the osten­si­bly prin­ci­pled ban­ner of states’ rights. When it comes to mar­i­jua­na, how­ev­er, Brun­ing and Pruitt’s true col­ors show. For these politi­cians, fed­er­al­ism was nev­er any­thing more than oppor­tunis­tic cam­ou­flage, a façade to con­ceal their dis­crim­i­na­to­ry designs. Fair-weath­er fed­er­al­ism is too kind a term for what Brun­ing and Pruitt believe. Their vision of fed­er­al­ism was nev­er any­thing more than a sham.

    Well, at least these two attor­neys gen­er­al might acci­den­tal­ly expand access to health­care. That may not have been their intent but, hey, it’s still sort of a good deed. Sort of.

    Posted by Pterrafractyl | December 31, 2014, 2:16 pm
  49. The His­to­ry of Moth­er’s Day 101. Les­son 1: The moth­er of Moth­er’s Day was­n’t very proud of her off­spring.

    Hap­py Moth­er’s Day:

    Nation­al Geo­graph­ic
    Moth­er’s Day Turns 100: Its Sur­pris­ing­ly Dark His­to­ry
    By Bri­an Handw­erk, for Nation­al Geo­graph­ic

    PUBLISHED May 09, 2014

    As Moth­er’s Day turns 100 this year, it’s known most­ly as a time for brunch­es, gifts, cards, and gen­er­al out­pour­ings of love and appre­ci­a­tion.

    But the hol­i­day has more somber roots: It was found­ed for mourn­ing women to remem­ber fall­en sol­diers and work for peace. And when the hol­i­day went com­mer­cial, its great­est cham­pi­on, Anna Jarvis, gave every­thing to fight it, dying pen­ni­less and bro­ken in a san­i­tar­i­um.

    It all start­ed in the 1850s, when West Vir­ginia wom­en’s orga­niz­er Ann Reeves Jarvis—Anna’s moth­er—held Moth­er’s Day work clubs to improve san­i­tary con­di­tions and try to low­er infant mor­tal­i­ty by fight­ing dis­ease and curb­ing milk con­t­a­m­i­na­tion, accord­ing to his­to­ri­an Katharine Antoli­ni of West Vir­ginia Wes­leyan Col­lege. The groups also tend­ed wound­ed sol­diers from both sides dur­ing the U.S. Civ­il War from 1861 to 1865.

    In the post­war years Jarvis and oth­er women orga­nized Moth­er’s Friend­ship Day pic­nics and oth­er events as paci­fist strate­gies to unite for­mer foes. Julia Ward Howe, for one—best known as the com­pos­er of “The Bat­tle Hymn of the Republic”—issued a wide­ly read “Moth­er’s Day Procla­ma­tion” in 1870, call­ing for women to take an active polit­i­cal role in pro­mot­ing peace.

    Around the same time, Jarvis had ini­ti­at­ed a Moth­er’s Friend­ship Day for Union and Con­fed­er­ate loy­al­ists across her state. But it was her daugh­ter Anna who was most respon­si­ble for what we call Moth­er’s Day—and who would spend most of her lat­er life fight­ing what it had become.

    “Moth­er’s Day,” Not “Moth­ers’ Day”

    Anna Jarvis nev­er had chil­dren of her own, .but the 1905 death of her own moth­er inspired her to orga­nize the first Moth­er’s Day obser­vances in 1908.

    On May 10 of that year, fam­i­lies gath­ered at events in Jarvis’s home­town of Grafton, West Virginia—at a church now renamed the Inter­na­tion­al Moth­er’s Day Shrine—as well as in Philadel­phia, where Jarvis lived at the time, and in sev­er­al oth­er cities.

    Large­ly through Jarvis’s efforts, Moth­er’s Day came to be observed in a grow­ing num­ber of cities and states until U.S. Pres­i­dent Woodrow Wil­son offi­cial­ly set aside the sec­ond Sun­day in May in 1914 for the hol­i­day. (See pic­tures of ani­mal moth­ers and babies.)

    “For Jarvis it was a day where you’d go home to spend time with your moth­er and thank her for all that she did,” West Vir­ginia Wes­leyan’s Antoli­ni, who wrote “Memo­ri­al­iz­ing Moth­er­hood: Anna Jarvis and the Defense of Her Moth­er’s Day” as her Ph.D. dis­ser­ta­tion, said in a pre­vi­ous inter­view.

    “It was­n’t to cel­e­brate all moth­ers. It was to cel­e­brate the best moth­er you’ve ever known—your mother—as a son or a daugh­ter.” That’s why Jarvis stressed the sin­gu­lar “Moth­er’s Day,” rather than the plur­al “Moth­ers’ Day,” Antoli­ni explained.

    But Jarvis’s suc­cess soon turned to fail­ure, at least in her own eyes.

    Storm­ing Moth­er’s Day

    Anna Jarvis’s idea of an inti­mate Moth­er’s Day quick­ly became a com­mer­cial gold mine cen­ter­ing on the buy­ing and giv­ing of flow­ers, can­dies, and greet­ing cards—a devel­op­ment that deeply dis­turbed Jarvis. She set about ded­i­cat­ing her­self and her siz­able inher­i­tance to return­ing Moth­er’s Day to its rev­er­ent roots. (See Nation­al Geo­graph­ic’s pic­tures of moth­er­ly love.)

    Jarvis incor­po­rat­ed her­self as the Moth­er’s Day Inter­na­tion­al Asso­ci­a­tion and tried to retain some con­trol of the hol­i­day. She orga­nized boy­cotts, threat­ened law­suits, and even attacked First Lady Eleanor Roo­sevelt for using Moth­er’s Day to raise funds for char­i­ties.

    “In 1923 she crashed a con­ven­tion of con­fec­tion­ers in Philadel­phia,” Antoli­ni said.

    A sim­i­lar protest fol­lowed two years lat­er. “The Amer­i­can War Moth­ers, which still exists, used Moth­er’s Day for fund-rais­ing and sold car­na­tions every year,” Antoli­ni said. “Anna resent­ed that, so she crashed their 1925 con­ven­tion in Philadel­phia and was actu­al­ly arrest­ed for dis­turb­ing the peace.”

    Jarvis’s fer­vent attempts to reform Moth­er’s Day con­tin­ued until at least the ear­ly 1940s. In 1948 she died at 84 in Philadel­phi­a’s Mar­shall Square San­i­tar­i­um.

    “This woman, who died pen­ni­less in a san­i­tar­i­um in a state of demen­tia, was a woman who could have prof­it­ed from Moth­er’s Day if she want­ed to,” Antoli­ni said.

    “But she railed against those who did, and it cost her every­thing, finan­cial­ly and phys­i­cal­ly.”

    Moth­er’s Day Gifts Today: Brunch, Bou­quets, Bling

    Today, of course, Moth­er’s Day con­tin­ues to roll on as an engine of con­sumerism.

    Accord­ing to the Nation­al Retail Fed­er­a­tion, Amer­i­cans will spend an aver­age of $162.94 on mom this year, down from a sur­vey high of $168.94 last year. Total spend­ing is expect­ed to reach $19.9 bil­lion. The U.S. Nation­al Restau­rant Asso­ci­a­tion reports that Moth­er’s Day is the year’s most pop­u­lar hol­i­day for din­ing out.

    As for Moth­er’s Day being a hall­mark hol­i­day, there’s no deny­ing it, strict­ly speak­ing.

    Hall­mark Cards itself, which sold its first Moth­er’s Day cards in the ear­ly 1920s, reports that Moth­er’s Day is the num­ber three hol­i­day for card exchange in the Unit­ed States, behind Christ­mas and Valen­tine’s Day—another appar­ent affront to the mem­o­ry of the moth­er of Moth­er’s Day.

    About 133 mil­lion Moth­er’s Day cards are exchanged annu­al­ly, accord­ing to Hall­mark. After Christ­mas, it’s the sec­ond most pop­u­lar hol­i­day for giv­ing gifts. (See “Father’s Day at 100: How It Began, Why Dad Gets Few­er Gifts.”)

    ...

    Now you know: The sec­ond most pop­u­lar hol­i­day for giv­ing gifts was cre­at­ed in the mem­o­ry of the moth­er of its founder, Anna Jarvis, a peace activist who died pen­ni­less and bro­ken in a san­i­tar­i­um after try­ing to end the hol­i­day after see­ing it devi­ate from its roots:

    ...

    But the hol­i­day has more somber roots: It was found­ed for mourn­ing women to remem­ber fall­en sol­diers and work for peace. And when the hol­i­day went com­mer­cial, its great­est cham­pi­on, Anna Jarvis, gave every­thing to fight it, dying pen­ni­less and bro­ken in a san­i­tar­i­um.

    It all start­ed in the 1850s, when West Vir­ginia wom­en’s orga­niz­er Ann Reeves Jarvis—Anna’s moth­er—held Moth­er’s Day work clubs to improve san­i­tary con­di­tions and try to low­er infant mor­tal­i­ty by fight­ing dis­ease and curb­ing milk con­t­a­m­i­na­tion, accord­ing to his­to­ri­an Katharine Antoli­ni of West Vir­ginia Wes­leyan Col­lege. The groups also tend­ed wound­ed sol­diers from both sides dur­ing the U.S. Civ­il War from 1861 to 1865.

    In the post­war years Jarvis and oth­er women orga­nized Moth­er’s Friend­ship Day pic­nics and oth­er events as paci­fist strate­gies to unite for­mer foes. Julia Ward Howe, for one—best known as the com­pos­er of “The Bat­tle Hymn of the Republic”—issued a wide­ly read “Moth­er’s Day Procla­ma­tion” in 1870, call­ing for women to take an active polit­i­cal role in pro­mot­ing peace.

    ...

    Hap­py Moth­er’s Day.

    So in the spir­it of Moth­er’s Day, here’s a fun sto­ry about a man that used the mem­o­ry of his mom to end but then re-embraced his sense­less oppo­si­tion to an offer by the Fed­er­al gov­ern­ment to pay for the health­care of a large num­ber of unin­sured poor peo­ple that are almost poor enough to qual­i­fy for Med­ic­aid, but not quite. Hap­py Moth­er’s Day:

    MSNBC
    Rick Scott’s stun­ning health care ‘ruse’ in Flori­da
    05/08/15 04:54 PM

    By Steve Benen

    In ear­ly 2013, Flori­da Gov. Rick Scott ® sur­prised near­ly every­one by announc­ing he’d changed his mind about Med­ic­aid expan­sion through the Afford­able Care Act. The Repub­li­can gov­er­nor had long con­demned the idea, but he appar­ent­ly had a change of heart.

    “I can­not, in good con­science, deny the unin­sured access to care,” he said at the time. Scott added that Med­ic­aid expan­sion is “a com­pas­sion­ate, com­mon sense step for­ward.” The gov­er­nor even ref­er­enced the death of his moth­er when explain­ing his ratio­nale.

    “A few months ago, my moth­er passed away, and I lost one of the only con­stants in my life,” Scott said. “Los­ing some­one so close to you puts every­thing in new per­spec­tive … espe­cial­ly the big deci­sions…. As I wres­tled with this deci­sion, I thought about my Mom’s strug­gles rais­ing five kids with very lit­tle mon­ey.”

    That was Feb­ru­ary 2013. In April 2015, Scott reversed course again, announc­ing his renewed oppo­si­tion to the pol­i­cy he’d endorsed. And today, the local CBS affil­i­ate in Mia­mi reports that that the gov­er­nor offered an unex­pect­ed expla­na­tion for his pos­ture two years ago.

    Scott con­ced­ed this week that was all a ruse. He now says his sup­port for Med­ic­aid expan­sion was a cal­cu­lat­ed move designed to win sup­port from the Oba­ma admin­is­tra­tion for the state’s pro­pos­al to hand over con­trol of Med­ic­aid to pri­vate insur­ance com­pa­nies. At the time, he denied that his sup­port was tied to a deal with the fed­er­al gov­ern­ment.

    Now that he’s suc­ceed­ed in pri­va­tiz­ing Med­ic­aid, Scott is again rail­ing against Med­ic­aid expan­sion and is suing the fed­er­al gov­ern­ment for alleged­ly forc­ing it on him.

    Oh my.

    Of course, if you notice that CBS/Associated Press excerpt, you’ll notice that it’s miss­ing some­thing: a quote. The entire report appears to be a para­phrase of Scott’s com­ments, and the exact word­ing always mat­ters.

    Indeed, the governor’s office this after­noon pushed back against the AP’s report­ing, say­ing the piece “edi­to­ri­al­ized” Scott’s com­ments.

    So, which is it? On Twit­ter, Gary Fine­out, an AP reporter in Flori­da, fleshed this out in a lit­tle more detail, explain­ing the argu­ment Scott pre­sent­ed yes­ter­day. As Fine­out described it, the gov­er­nor may have claimed at the time that his mother’s death inspired him to change his per­spec­tive, but in real­i­ty – accord­ing to Scott’s com­ments yes­ter­day – the Flori­da Repub­li­can only sup­port­ed Med­ic­aid expan­sion as part of “a quid pro quo” to get a waiv­er from the Oba­ma admin­is­tra­tion for Med­ic­aid pri­va­ti­za­tion.

    Scott may have pub­licly claimed in 2013 that his posi­tion was about his “con­science” and deceased moth­er, but accord­ing to the governor’s new ver­sion of events, the rhetoric wasn’t actu­al­ly sin­cere – his pre­vi­ous posi­tion was a cal­cu­lat­ed move to gain approval for his pri­va­ti­za­tion plan.

    In oth­er words, the gov­er­nor didn’t lit­er­al­ly use the word “ruse” yes­ter­day, so much as he effec­tive­ly described a scheme in which he told the pub­lic some­thing untrue in order to get what he want­ed at the time.

    ..

    “Scott may have pub­licly claimed in 2013 that his posi­tion was about his “con­science” and deceased moth­er, but accord­ing to the governor’s new ver­sion of events, the rhetoric wasn’t actu­al­ly sin­cere – his pre­vi­ous posi­tion was a cal­cu­lat­ed move to gain approval for his pri­va­ti­za­tion plan.”

    Extra-hap­py Moth­er’s Day.

    And yes, instead of expand­ing Med­ic­aid, Rick Scott, who made his for­tune start­ing a chain of pri­vate hos­pi­tals, sud­den­ly announced that the Med­ic­aid expan­sion isn’t hap­pen­ing and his admin­is­tra­tion is now suing the Fed­er­al gov­ern­ment over charges that the Feds are was try­ing to coerce Flori­da into accept­ing the Med­ic­aid expan­sion by say­ing the “Low Income Pool” (LIP) pro­gram was sup­posed to be replaced by the Med­ic­aid expan­sion would expire as sched­uled.

    But that’s not all. It turns out that Rick Scott just con­vened a com­mis­sion to study how pub­licly fund­ed hos­pi­tals spend their mon­ey. And the entire pan­el will be select­ed by the gov­er­nor. And the last time Rick Scott con­vened a com­mis­sion like this it rec­om­mend­ed the wide­spread pri­va­ti­za­tion of Flori­da’s hos­pi­tals. Super extra-Hap­py Moth­er’s Day:

    Tam­pa Bay Times
    Gov. Rick Scott offi­cial­ly con­venes com­mis­sion on hos­pi­tal spend­ing

    Kath­leen McGro­ry, Times/Herald Tal­la­has­see Bureau

    Tues­day, May 5, 2015 11:51am

    TALLAHASSEE — Wednes­day could be an awk­ward day for Gov. Rick Scott, who is sched­uled to meet with U.S. Health and Human Ser­vices Sec­re­tary Sylvia Bur­well to talk about renew­ing a $2.2 bil­lion hos­pi­tal fund­ing pro­gram for Flori­da.

    After all, he’s suing her.

    Bur­well is named as the defen­dant in Scot­t’s suit alleg­ing that the Oba­ma Admin­is­tra­tion is try­ing to coerce Flori­da into expand­ing Med­ic­aid by end­ing the so-called Low Income Pool (LIP). The agency has not com­ment­ed direct­ly on the suit, but says Med­ic­aid expan­sion is and has always been a “state deci­sion.”

    Despite the legal tus­sle, Scott is opti­mistic about his trip to Wash­ing­ton.

    “The rea­son I’m doing this is we’ve got to get a bud­get done,” he said on his way to the air­port Tues­day. “And it’s hard to get a bud­get done not know­ing exact­ly (the feds) deci­sion.”

    Uncer­tain­ty over the future of the LIP pro­gram has par­a­lyzed state law­mak­ers tasked with build­ing the state bud­get. The pro­gram, which pro­vides sup­ple­men­tal fund­ing to safe­ty-net hos­pi­tals and coun­ty health depart­ments, is sched­uled to end on June 30 — unless the fed­er­al gov­ern­ment approves a pro­posed suc­ces­sor pro­gram. A spe­cial ses­sion will be held, but it’s unclear when law­mak­ers will return to Tal­la­has­see.

    It is not clear what role Med­ic­aid expan­sion will play in the deci­sion.

    Fed­er­al health offi­cials have said Med­ic­aid expan­sion and the con­tin­u­a­tion of the Low Income Pool are linked because they would cov­er some of the same peo­ple. But because of strong oppo­si­tion from the Flori­da House, the Leg­is­la­ture is unlike­ly to accept fed­er­al Med­ic­aid expan­sion mon­ey this year. The Sen­ate is push­ing for expan­sion and has pro­posed its own plan to do so.

    Scott, a for­mer hos­pi­tal exec­u­tive, oppos­es Med­ic­aid expan­sion. In recent weeks, he has been try­ing to dri­ve a par­al­lel con­ver­sa­tion on the issue of health care and hos­pi­tal fund­ing.

    On Tues­day, Scott signed an exec­u­tive order cre­at­ing a new com­mis­sion to explore the issue. In addi­tion to inves­ti­gat­ing out­comes at tax­pay­er-sup­port­ed hos­pi­tals, the work­ing group will exam­ine exec­u­tive com­pen­sa­tion and spend­ing on lob­by­ists, adver­tis­ing and polit­i­cal cam­paigns.

    With Med­ic­aid spend­ing account­ing for one-third of the state bud­get, Scott said the com­mis­sion makes sense.

    “We ought to know how those dol­lars are being spent,” he said. “What’s the out­come of those dol­lars? Are they being spent effi­cient­ly?”

    The exec­u­tive order did not spec­i­fy how many mem­bers would be appoint­ed to the com­mis­sion, what kind of qual­i­fi­ca­tions would be required, or when the group would begin meet­ing. It did, how­ev­er, say that all mem­bers of the com­mis­sion, its chair and its exec­u­tive direc­tor would be appoint­ed by the gov­er­nor.

    Scott said he planned to make appoint­ments “prompt­ly,” adding that the infor­ma­tion would be use­ful to law­mak­ers under pres­sure to pass a bud­get by June 30.

    Democ­rats were quick to bring up the fact that he resigned his job as the CEO of a for-prof­it hos­pi­tal chain in 1997 after fed­er­al agents went pub­lic with an inves­ti­ga­tion into the com­pa­ny. Columbia/HCA lat­er agreed to pay a record $1.7 bil­lion in gov­ern­ment penal­ties and fines.

    “Now, Rick Scott — who resigned from the health care com­pa­ny he found­ed amid fed­er­al fraud inves­ti­ga­tions — has decid­ed his time would be well spent audit­ing the books of Flori­da hos­pi­tals,” Flori­da Demo­c­ra­t­ic Par­ty Chair Alli­son Tant said in a state­ment. “How does that help resolve the grid­lock in the leg­is­la­ture? The only hos­pi­tal man­age­ment advice Rick Scott knows how to offer is train­ing exec­u­tives how to fleece the fed­er­al gov­ern­ment for bil­lions.”

    ...

    Hap­py Moth­er’s Day.

    Posted by Pterrafractyl | May 10, 2015, 11:01 pm
  50. Imag­ine that: Some pub­lic hos­pi­tals win, oth­ers lose with Oba­macare. Specif­i­cal­ly, if your state expand­ed Med­ic­aid instead of kick­ing the poors, your hos­pi­tal prob­a­bly won. Oth­er­wise...:

    Reuters
    Some pub­lic hos­pi­tals win, oth­ers lose with Oba­macare

    SAN FRANCISCO | By Robin Respaut
    Thu Jul 23, 2015 7:49am BST

    A year and a half after the Afford­able Care Act brought wide­spread reforms to the U.S. health­care sys­tem, Chicago’s Cook Coun­ty Health & Hos­pi­tals Sys­tem has made its first prof­it in 180 years.

    Sev­en hun­dred miles south, the for­tunes of Atlanta’s pri­ma­ry pub­lic hos­pi­tal, Grady Health Sys­tem, haven’t improved, and it remains as depen­dent as ever on phil­an­thropy and coun­ty fund­ing to stay afloat.

    The dis­par­i­ty between the two “safe­ty net” hos­pi­tals, both of which serve a dis­pro­por­tion­ate share of their com­mu­ni­ties’ poor­est patients, illus­trates a grow­ing divide nation­wide.

    In states like Illi­nois that have opt­ed to accept fed­er­al mon­ey to expand Med­ic­aid, some large, pub­lic hos­pi­tals are find­ing them­selves on sol­id finan­cial foot­ing for the first time in decades, and for­mer­ly unin­sured patients are now get­ting reg­u­lar care.

    But in states that did not expand the gov­ern­ment med­ical pro­gram for the poor, pri­mar­i­ly ones with con­ser­v­a­tive elec­torates opposed to Oba­macare, includ­ing Geor­gia, the impact of the Afford­able Care Act on pub­lic hos­pi­tals has been neg­li­gi­ble.

    While the pub­lic exchanges estab­lished by the fed­er­al gov­ern­ment and 14 states have brought cov­er­age to many pre­vi­ous­ly unin­sured peo­ple in all parts of the coun­try, the effect on the poor­est Amer­i­cans varies dras­ti­cal­ly from state to state.

    Near­ly four mil­lion low-income, unin­sured Amer­i­cans liv­ing in states that did­n’t expand Med­ic­aid would have qual­i­fied for cov­er­age had their states cho­sen to expand it, accord­ing to the Kaiser Fam­i­ly Foun­da­tion. And pub­lic hos­pi­tals in those states, many of which rely on bond mar­kets for fund­ing, are like­ly to feel the pinch even more acute­ly over time, experts said.

    “Providers in these states are going to be at a dis­ad­van­tage,” said Jim LeBuhn, senior direc­tor at Fitch Rat­ings. “It’s going to make it that much more chal­leng­ing for these providers to main­tain their finan­cial pro­files.”

    Since the Afford­able Care Act’s first open enroll­ment in 2013, the num­ber of Amer­i­cans cov­ered under Med­ic­aid has risen by 21 per­cent, to 71.1 mil­lion.

    Non­prof­it hos­pi­tals in the 30 states that expand­ed Med­ic­aid report­ed on aver­age 13 per­cent less bad debt from unpaid bills last year, accord­ing to Moody’s Investors Ser­vice. In con­trast, accord­ing to Moody’s, such “hos­pi­tals in non-expan­sion states saw bad debt increase through much of the year.”

    Hos­pi­tals in Med­ic­aid expan­sion states, accord­ing to Kaiser, report­ed an aver­age 32 per­cent decrease in unin­sured patients and a 40 per­cent cut in unre­im­bursed costs of care for patients with­out the abil­i­ty to pay, known in the indus­try as char­i­ty care costs. In non-expan­sion states, the num­ber of unin­sured patients declined by 4.4 per­cent and char­i­ty care costs dropped by 6.2 per­cent.

    New recip­i­ents of Med­ic­aid ben­e­fit­ed, too. After one year, adults who gained the cov­er­age were 55 per­cent more like­ly to have their own doc­tor than those who did not, Kaiser found. Med­ic­aid also increased the like­li­hood of receiv­ing pre­ven­tive care, such as mam­mo­grams and cho­les­terol checks.

    A TALE OF TWO HOSPITALS

    Both Cook Coun­ty and Grady are safe­ty-net hos­pi­tals based in urban coun­ties where the pover­ty lev­el is slight­ly high­er than the nation­al aver­age, and both have han­dled high num­bers of unin­sured clients in recent years: about half of the patients at Cook and near­ly a third at Grady.

    Since Oba­macare took effect, the num­bers at the Geor­gia hos­pi­tal have remained about the same. But things have changed dra­mat­i­cal­ly at the Illi­nois hos­pi­tal, in large part due to the area’s enroll­ment of about 170,000 of an esti­mat­ed 330,000 eli­gi­ble for the expand­ed Med­ic­aid.

    ...

    With­in two years, the per­cent of unin­sured patients at the hos­pi­tal had dropped from more than a half to about a third, almost entire­ly dri­ven by increased Med­ic­aid cov­er­age, hos­pi­tal data show. And for the first time in the hospital’s his­to­ry, a major­i­ty of the patients it treat­ed had cov­er­age.

    A third of the new Med­ic­aid enrollees treat­ed at Cook Coun­ty were patients new to the sys­tem. And, hos­pi­tal admin­is­tra­tors say, those with chron­ic dis­eases such as dia­betes, who used to be fre­quent emer­gency room vis­i­tors, now have per­son­al physi­cians to help them man­age their con­di­tions.

    In the fis­cal year end­ing in Novem­ber 2014, uncom­pen­sat­ed char­i­ty care dropped to $342 mil­lion from $500 mil­lion the year before. Fund­ing from Med­ic­aid near­ly dou­bled the health sys­tem’s oper­at­ing rev­enues, a major rea­son that, after end­ing 2013 with a net loss of $67.6 mil­lion, Cook Coun­ty Health fin­ished its most recent fis­cal year in the black.

    Now, the provider, like oth­er safe­ty-net hos­pi­tals, has a new chal­lenge: hold­ing onto old clients.

    “For the first time in our his­to­ry, we need to com­pete for our patients,” said Shan­non. “A world of improved access is also a world of choice.”

    At Grady Health Sys­tem in Atlanta, mean­while, the num­ber of patients cov­ered by insur­ance increased by less than 2 per­cent last year. Bad debt from unpaid bills has con­tin­ued to climb, to $396 mil­lion from $269 mil­lion in 2013. And the per­cent­age of patients cov­ered by Med­ic­aid didn’t change.

    “We’ve seen no dif­fer­ence from the Afford­able Care Act,” said John Hau­pert, Grady’s chief exec­u­tive. Many patients “are still com­ing to us as a safe­ty-net provider and falling under our char­i­ty care.”

    Geor­gia is one of 20 states, dis­pro­por­tion­ate­ly clus­tered in the South, that didn’t expand Med­ic­aid. About 89 per­cent of those left out of the new Med­ic­aid cov­er­age, because their states chose not to expand the pro­gram, live in the South, Kaiser Fam­i­ly Foun­da­tion found.

    Grady has a bet­ter finan­cial out­look than many hos­pi­tals in states that did­n’t expand Med­ic­aid, thanks to a phil­an­thropic cam­paign that has raised $350 mil­lion since 2008 to fund new infra­struc­ture and expand clin­i­cal ser­vices. But, unlike Cook Coun­ty, which has reduced some depen­dence on local gov­ern­ment sup­port with the help of Med­ic­aid expan­sion dol­lars, Grady remains reliant on $57 mil­lion in tax sup­port from two local coun­ties. With­out the local fund­ing, Grady would be run­ning a deficit.

    “From a glob­al per­spec­tive, it seems like the ACA is work­ing,” said Kevin Hol­lo­ran, senior direc­tor at Stan­dard & Poor’s. But in non-expan­sion states, like Geor­gia, “it’s real­ly a neu­tral. It’s just the sta­tus quo.”

    Wow! So in addi­tion to turn­ing down fed­er­al Med­ic­aid dol­lars that the states’ tax-pay­ers are legit­i­mate­ly owed, the states that refuse to expand Med­ic­aid are forced to fill the gap with local fund­ing:

    ...
    Grady has a bet­ter finan­cial out­look than many hos­pi­tals in states that did­n’t expand Med­ic­aid, thanks to a phil­an­thropic cam­paign that has raised $350 mil­lion since 2008 to fund new infra­struc­ture and expand clin­i­cal ser­vices. But, unlike Cook Coun­ty, which has reduced some depen­dence on local gov­ern­ment sup­port with the help of Med­ic­aid expan­sion dol­lars, Grady remains reliant on $57 mil­lion in tax sup­port from two local coun­ties. With­out the local fund­ing, Grady would be run­ning a deficit.
    ...

    And on top of all that, in the states that expand­ed Med­ic­aid, hos­pi­tals are now fac­ing more com­pe­ti­tion in the health­care mar­ket­place:

    ...
    A third of the new Med­ic­aid enrollees treat­ed at Cook Coun­ty were patients new to the sys­tem. And, hos­pi­tal admin­is­tra­tors say, those with chron­ic dis­eases such as dia­betes, who used to be fre­quent emer­gency room vis­i­tors, now have per­son­al physi­cians to help them man­age their con­di­tions.

    In the fis­cal year end­ing in Novem­ber 2014, uncom­pen­sat­ed char­i­ty care dropped to $342 mil­lion from $500 mil­lion the year before. Fund­ing from Med­ic­aid near­ly dou­bled the health sys­tem’s oper­at­ing rev­enues, a major rea­son that, after end­ing 2013 with a net loss of $67.6 mil­lion, Cook Coun­ty Health fin­ished its most recent fis­cal year in the black.

    Now, the provider, like oth­er safe­ty-net hos­pi­tals, has a new chal­lenge: hold­ing onto old clients.

    “For the first time in our his­to­ry, we need to com­pete for our patients,” said Shan­non. “A world of improved access is also a world of choice.”

    At Grady Health Sys­tem in Atlanta, mean­while, the num­ber of patients cov­ered by insur­ance increased by less than 2 per­cent last year. Bad debt from unpaid bills has con­tin­ued to climb, to $396 mil­lion from $269 mil­lion in 2013. And the per­cent­age of patients cov­ered by Med­ic­aid didn’t change.

    ...

    Low­er tax­es and increased com­pe­ti­tion. Head for the hills!

    Posted by Pterrafractyl | July 23, 2015, 8:58 am

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