The one thing about the Affordable Care Act (ACA), aka Obamacare, is if the law is as bad as the regressives make it out to be, then why to they and theirshills in the media have to keep making stuff up and lying about it? It’s because the law is proving the GOP lies about it false. And the more people begin to understand it – free well checks, near universal coverage, no more “pre-existing” conditions, and coverage for children until 26 – the more they realized it includes very good things, and they’re warming to it.
Saying he’s committed to repealing Obamacare, U.S. Rep. John Carter, R-Round Rock, told constituents: “You may not be aware of one of the most frightening provisions in the president’s healthcare plan — the creation of the Independent Payment Advisory Board.”
Carter’s July 31, 2012, letter continues: “This board, comprised of 15 unelected, unaccountable people hand-picked by the president, will have the ability to come between you and your doctor in determining the best treatment options for you!”
After readers asked us to look into Carter’s claim about the board’s intrusive powers, we emailed Carter’s office for backup information — and didn’t hear back.
[...]
With Carter’s wording in mind, we read the relevant portion of the law.
Section 3403 indeed states that the board is to include 15 members appointed by the president. Each appointee also would face Senate confirmation.
As far as we can tell, the law does not give the board the power, or permission, to regulate any individual’s treatment options.
For an August 2011 Truth-O-Meter article, PolitiFact Georgia asked four health experts about a congressman’s claim that “a bunch of bureaucrats” would “decide whether you get care.” All four said that’s incorrect.
A scholar at the Cato Institute, a libertarian think tank usually at odds with Democratic positions, said the assertion that the board would be controlling patients’ health-care decisions is “not even close to correct.” Cato scholar Michael Tanne said the board “has nothing to do with individual care at all. It’s not making decisions on individuals.”
Our ruling
Carter’s claim has no factual foundation. We rate it False.
Perrys’ picks to replace Suehs (HHS) and Scott (TEA) will likely be right wing and pro-privatization. And it’s likely, no matter how the Speaker and US Senate/Lt. Gov. races turnout, that the committee chairs will be more right wing and pro-privatization. So cuts and privatization will likely be the proposed “fixes” for these two long-beloved public programs in our democracy.
Kyle Janek’s previous record on health care is troublesome, however. As a senator in the Texas legislature, Kyle Janek’s top two contributors were both PACs relating to healthcare, one of them being the Texas Medical Association PAC and the other being the Greater Houston Anesthesiology PAC (Kyle Janek also works as an anesthesiologist). As a lobbyist in 2011, Kyle Janek was on the payroll
The Health Care Compact Alliance, an alliance headed by Leo Linbeck III (the CEO and chairman of Linbeck Corporation, a Houston-based construction company, and a member of a powerful family that donates often to libertarian causes) This 501c(4) focuses on advocating for the interstate health care compact, which would strip Texas, among other states, of federal regulations on health care. Texas would receive block grants with no federal rules attached; the state government could do what it pleases. In the worst case scenario, Texas could remove Medicaid, Medicare, CHIP and other federal programs entirely. The interstate health care compact was seen by Republicans as a way to get out of the Affordable Care Act, no matter what the Supreme Court ruling turned out to be. Kyle Janek, along with top lobbyist Mike Toomey, led the lobbying effort onbehalf of the Health Care Compact Alliance. The health care compact was included in SB7, passed last year.
Janek, who lobbied to get rid of federal programs such as CHIP and Medicaid, is now at the head of the commission that is responsible for the administration of federal programs. As a former state senator and lobbyist who is now back in government, Janek personifies the revolving door in politics. His connections to ALEC, TPPF, and the Health Care Compact Alliance suggests that he will be no friend to Texas’ most vulnerable populations.
The AAS Ed Board has hope, for now, but that likely won’t make it through the legislative session. The regressives are in government to tear it down, not build up.
Kainser Health News published an article in which they surmise that Texas Gov. Rick Perry will eventually accept the expanded Medicaid funding from the Affordable Care Act (ACA). It may be the first one that really shows why he might actually wind up accepting the expansion. The first part of this article does a really good job of explaining how our government works, Businesses Will Push Perry to Rethink Medicaid Expansion.
Texas Gov. Rick Perry says he rejects the “Obamacare power grab” and will block measures expanding health insurance to millions in his state. The country’s second-biggest health insurer is betting he won’t succeed.
The same day last week that Perry said expanding Medicaid would be like “adding a thousand people to the Titanic,” WellPoint Inc. disclosed an agreement to buy Texas’s biggest Medicaid managed care company for $4.9 billion. The purchase of Amerigroup, which operates in 12 other states besides Texas, is WellPoint’s attempt to cash in on the health act’s addition of 17 million Americans to Medicaid, the state and federal program for the poor.
The Supreme Court decision allowing states to block Medicaid growth without a penalty, however, threatens the profits of companies hoping to manage care for the new beneficiaries. Perry is one of more than half a dozen Republican governors resisting the federal Medicaid windfall set to begin in 2014.
But if there’s one thing more powerful than Republican governors’ dislike of the Affordable Care Act, many believe, it may turn out to be the business interests in their own states.[Emphasis added]
It really doesn’t get more stark then that. This offers a glimpse of how our “republic” really works now. It’s a corporatocracy. Pay no mind to the fact that millions in Texas and across the US – the people – are without health care. The real issue is how is this law going to effect the corporate bottom line. In other words Perry won’t relent because it’s the right, or moral, thing to do. He’ll relent because those who finance his campaigns will profit from the expansion.
“Once the headlines die down, every hospital in Texas is going to look at Perry and say, ‘Please tell me why we’re not taking money from the federal government to offset my uncompensated care,’” said Thomas Carroll, who follows health insurance stocks for investment firm Stifel Nicolaus. “That is a question that Rick Perry absolutely cannot answer.”
A higher portion of Texans lack coverage than residents of any other state. A Texas Medicaid expansion would generate $100 billion in federal money for the state over a decade, according to the state Health and Human Services Commission, and furnish coverage to an estimated 2 million Texans.
At the same time it would generate nearly $1 billion in annual Texas revenue for Amerigroup and WellPoint, calculates Carroll.
Quiet for now, insurers are expected to join hospitals and patient advocates to fight for Medicaid expansion and what are enormous amounts of money, even by Washington standards. Nowhere are the dollars bigger than in Perry’s state, where one in four lacks health coverage.
“Fights seem to follow the money, and there is a lot of money at stake in Texas on this,” said Phil King, a Republican state representative from outside Fort Worth who opposes the Medicaid expansion. “Maybe you need to rename this ‘The Full-Employment Act for Lobbyists.’”
With world-renowned medical institutions such as the University of Texas and a large part of its Medicaid coverage handled by private insurers such as Amerigroup, the state’s health industry is “just behind oil and gas” in size and influence, said Vivian Ho, a health economist at Rice University. “Given how much Amerigroup has to gain from a Medicaid expansion in Texas, they may be one of the most effective organizations to lobby Perry and the state legislature to fund the expansion.”
In this day and age, when corporations have their own foreign policy, and only work with nation states when it benefits their bottom line, this should not surprise anyone. Our elected leaders true constituents are not the people, but those who profit from the decision our elected leaders make.
This is why efforts to attack our elected leaders – along moral, ethical, and logical lines – seem so futile often times. They’re obviously not worried about a backlash from voters, because it never comes. Our politicians are only worried about fueling their addiction. And until that’s fixed little will change.
While it’s starting to become obvious that many of the inflated,and false, claims the regressives, (see below), made about the Affordable Care Act, they’re still trying to go negative. Case in point, Texas slashes estimate of state’s ObamaCare tab.
Suehs testified to a House budget panel that he agrees with Perry that Texas shouldn’t opt into the federal law’s expansion of Medicaid to include childless adults until after the state-federal program’s problems are fixed.
If Texas opts in, the extra $15.6 billion in state spending through 2023 would draw down $100.1 billion in additional federal dollars, Suehs said
Not the $27 billion Suehs once thought. (Here’s the link from 2010 on Suehs prior inflated projection. It does look like he’s just trying to make things right before he’s out the door.) Of course, why we should care, or trust what Suehs says anymore is beyond comprehension.
What’s being lost in this discussion is what a good deal this is for Texas. If we will spend $15.6 billion over the next 10 years and get $100.1 billion back from the federal government. And insure almost two million uninsured Texans at a cost of $1.56 billion per year to taxpayers. (If my calculations are correct that around $800/per person, per year.) That may be the best economic development money this state has spent in decades.
HHSC Commissioner Tom Suehsestimates that health care reform’s top-dollar items — Medicaid expansion to roughly 2.1 million Texans, plus heightened reimbursement rates for primary care physicians — will cost the state more than $27 billion between 2014 and 2024, up $3 billion from his most recent estimate.
But the Congressional Budget Office’s numbers are far different. Between 2010 and 2019, the agency estimates, the reform will cost Texas $1.4 billion. A letter written last month by U.S. Rep. Henry Waxman, D-California, the chairman of the House Energy and Commerce Committee, notes that Texas’ estimate is more than the $20 billion the reform is expected to cost all state governments combined in the next decade.
“I don’t know where he went to school and got his math education. But it’s not right,” Suehs said of Waxman, speaking at a joint hearing of the Senate Health and Human Services and State Affairs committees. (The answer? UCLA.) “I can’t rationalize the CBO’s budget numbers when I know that I’ve got a higher population of uninsured than most states have total population.”
Some lawmakers said they’d understand a small cost differential, but that this difference looks enormous. “Glaring,” state Sen. Robert Duncan, R-Lubbock, called it. And they said that whatever the final cost is, it’s clear it will take a major bite out of Texas’ bottom line.
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Suehs said the most obvious discrepancy between the state and federal numbers is that the federal estimate doesn’t include administrative costs. It also starts immediately, while the state estimate doesn’t begin until 2014. In the first three years of the reform program, the costs to the state are expected to be minimal, and Suehs said he wanted to give lawmakers a fleshed-out 10-year view.
“I felt I had an obligation to give a long-range [view] to the Legislature,” he said. “You need to have strategies for how you finance, how you fund it.”
But some Democratic lawmakers questioned that approach — particularly in light of staunch Republican opposition to the reform. “I don’t know of any time where I’ve had the financial years start out in 2014 and go out to 2023,” El Paso state Sen. Eliot Shapleighsaid skeptically. “We’re being presented with a sticker-shock number.”
Suehs took issue with that, and he vowed that the federal estimate will continue to rise. “In my 35 years of doing budget work, there’s never been a group of cost estimates that have had more cost analysis than our efforts on this reform bill,” he said.
There are a few things to keep in mind regarding Gov. Rick Perry’s announcement yesterday that he would turn down the federal Medicaid expansion in Texas, as a result of the Affordable Care Act (ACA). The main thing is that nothing has actually been decided yet. And that a certain amount of this is just political posturing, his attempt to stay relevant, for the November election.
If President Obama is reelected there’s not chance the ACA will be repeal. And ever hard core GOP partisans acknowledge that, no matter who is elected in November, the ACA will be very hard to repeal. Likely GOP nominee Mitt Romney stated that he wants to keep what’s in it, he just doesn’t want to pay for it. The GOP will fight this, tooth and nail, as they’ve historically done with landmark legislation. It takes time, years even, to get controversial laws like this implemented. A few excepts from a Melissa Harris Perry show from July 1st.
Now, that`s three years after the Supreme Court ordered southern states to move with quote, “all deliberate speed” to desegregate public schools. Now, the affordable care act line is more specific. States have until January 1, 2013 to demonstrate by the department of health insurance services that their exchanges, the marketplace where is customers can shop around for insurance, will be up and running next year.
The governor`s threats of delays now as they did then, have very real implications for the lives and the liberty of American people. By 1964, for example, a full ten years after brown, less than two percent of black children in the south attended desegregated schools. And the health of individual Americans and the already astronomical cost of caring for the uninsured can`t afford the cost of that kind of delay today.
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But there is a cruelty, in not just southern governors, but governors like Kasich, Walker, and the governor of Florida, Rick Scott, in turning down federal funds[...] But on this, it`s just putting lives on the balance for ideological reasons.
I also think this decision and I defer to the constitutional experts here, was crafted, the finesse, it still puts limits on the federal government and that relationship between the government and the states is still up for
grabs, though the immigration decision was interesting, because there was very clearly the federal government has the prerogative in the immigration area, so I think it`s a very fluid moment, and last point on the brown versus board, it will take movements, it will take movements, fused with court decisions, to bring about the real progress in this country. We saw it with the civil rights movement, having to push years after brown to make real the promise of that decision and I think that will be the case with this.
That’s the point, change doesn’t come easy, and this is just another step in a decades long process of making sure all Americans have health care. As FDR referred to it in his Economic Bill of Rights – The right to adequate medical care and the opportunity to achieve and enjoy good health.
What Perry and the wing nuts are screeching about it ideological, it must be kept in mind that Texans will pay, whether he takes the federal money or not, it’s just cheaper if Texas takes the federal money. Because Perry turning down the money hurts hospitals, and shifts the cost from federal and state government, to local governments, Perry’s rejection of Medicaid expansion could burden local taxpayers.
Many opponents had pinned their hopes on victory in the courts and now hope Republicans can sweep this fall’s elections and repeal the law.
“We’re just not going to be a part of … socializing health care in the state of Texas,” Perry told Fox News.
Parkland Memorial Hospital, which treats many of the North Texas region’s uninsured patients in its emergency room, said Perry’s resistance to the proposed Medicaid expansion won’t stop the flow of indigents seeking care at safety net hospitals.
“If our state is going to turn away hundreds of millions in federal funds, we are eager to see what our leaders will propose to replace them,” the Parkland Health & Hospital System said in a written statement. The system said that last year it provided $605 million in uncompensated care.
Dan Stultz, an internist who heads the Texas Hospital Association, said Medicaid offers only paltry payments to providers, but having uninsured people flock to emergency rooms for care simply shifts costs to those with insurance. It also places more burdens on the county property owners whose taxes support hospitals such as Parkland.
“With a strained state budget, it’s hard to imagine addressing the uninsured problem in Texas without leveraging federal funds, which will now go to other states that choose to expand their Medicaid program,” Stultz said.
Houston neonatologist Michael Speer, president of the Texas Medical Association, said he’s especially worried about uninsured adults under the poverty line who were intended to be added to Medicaid and may not qualify for subsidies to buy private plans.
That sets up a very good set of issues for Democrats to run on in Texas. To fight to make sure the almost 2 million uninsured Texans get insurance, and to keep the GOP from raising local property taxes, by accepting the federal Medicaid expansion.
Another issue to keep in mind is that the hospitals, the insurance corporations, and the drug corporations we’re all on board with the ACA. They know Medicaid is being expanded because it’s the least expensive way to get almost all Americans insured.
Unfortunately logical and sound fiscal arguments aren’t the most effective ways to sway enough people. But maybe the utter cruelty of rejecting health care coverage for so many that don’t have it. Especially those who need it the most.
The provision that Perry wants the state to reject would add to the state’s Medicaid rolls more than 1.5 million poor, childless adults who are currently ineligible, plus as many as 300,000 pregnant women, children and extremely poor parents who already qualify but aren’t enrolled.
Fortunately it’s not just up to Perry, but it will take many from the, “let him die!” Party to join with Democrats to keep this provision alive. The legislature can still “assert itself”, though unlikely, on this issue.
Legislators could attempt to buck Perry on the issue next year, though it’s unlikely enough other Republicans will want to do so.Either way, Medicaid — one of the largest parts of the state budget — will again be a major issue. Last year, lawmakers helped bridge a $27 billion shortfall by underfunding Medicaid between $4 billion and $5 billion of state funds. They’ll have to pay the tab in 2013, even though state finances are expected to again be tight.
Rep. Garnet Coleman, a Houston Democrat who is a leading health policy writer, said Perry “chose the policy that’s best for him politically” but ignored the plight of poor adults, many suffering from diabetes, cancer and mental illness.
“The governor said it’s better to follow his ideology and throw those folks under the bus than to provide health coverage that the state of Texas would pay zero for, at least for the first three years,” Coleman said.
House Speaker Joe Straus, R-San Antonio, said he agrees with Perry that the state could offer bare-bones health coverage more efficiently than the federal government.
However, Straus said the biggest problems in U.S. health care originate with the federal tax code. Federal income taxes encourage employer-provided coverage, which keeps consumers from having “skin in the game” and being prudent purchasers, he said.
“The Legislature will have a say in this once we know past November who is in the federal government making decisions,” the speaker said.
The reality is that it’s going to take a movement, sustained pressure, over the course of years to get all Texans the health care that is their right.
Further Reading:
Kuff has a great rundown of the timeline and reaction across Texas to Perry’s decision, No Medicaid expansion for you!
Texas will not expand Medicaid or establish a health insurance exchange, two major tenets of the federal health reform that the U.S. Supreme Court upheld last month, Gov. Rick Perry said in an early morning announcement.
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Perry’s office sent a letter to U.S. Health and Human Services Secretary Kathleen Sebelius on Monday morning asserting his opposition, both to accepting more than a hundred million federal dollars over the next several years to put more poor Texas adults onto Medicaid, and to creating an Orbitz-style online insurance marketplace for consumers.
[..]
“I look forward to implementing health care solutions that are right for the people of Texas,” Perry wrote in the letter to Sebelius. “I urge you to support me in that effort. In the meantime, [health reform's] unsound encroachments will find no foothold here.”
While the Affordable Care Act will still increase the number of insured Texans by between 2 and 2.5 million individuals, the roughly 1.8 million Texans who were eligible per HHSC guidelines to gain coverage through the Medicaid expansion now will not.
This was pretty much expected. The only difference between Perry and the other GOP class warriors, is that Perry’s announcement isn’t as knee-jerk as the others. He’s trying to make it look like he actually took his time.
Robert Draper describes the results of focus groups done a few months by Democratic groups attempting to define Mitt Romney:
Burton and his colleagues spent the early months of 2012 trying out the pitch that Romney was the most far-right presidential candidate since Barry Goldwater. It fell flat. The public did not view Romney as an extremist. For example, when Priorities informed a focus group that Romney supported the Ryan budget plan — and thus championed “ending Medicare as we know it” — while also advocating tax cuts for the wealthiest Americans, the respondents simply refused to believe any politician would do such a thing.
That’s really how bad the Ryan budget is: voters don’t believe that real politicians would actually do such a thing. The plan to gut Medicare in order to make room for tax cuts for the rich is egregious and embarrassing that groups like Politifact have to go out of their way to cover for them.
And then there’s Mitt Romney, a vulture capitalist responsible for mass layoffs and outsourcing, who supported the Ryan budget and continues to advocate for tax breaks for millionaires and austerity for everyone else. As Jonathan Chait says:
The basic theme of Romney as a super-rich guy who sees the world through the lens of his own class seems like a powerful and roughly accurate one. The attacks on Romney’s business career fit with the theme. I’m sure there will be more attacks on Romney’s secretive finances — Obama’s campaign keeps dropping the phrase “Swiss bank account” because, I would wager, focus groups find it a little suspicious.
Once they’ve established that frame for voters to understand Romney, then they have set the stage for a closing attack that focuses on the policy contrast. (Or so I have argued.)
One odd thing is that Romney has done so little to insulate himself against this line of attack. George W. Bush framed his entire campaign persona in 2000 so as to protect himself from charges of looking out for the rich — he called himself a compassionate conservative, he falsely claimed his tax cuts disproportionately benefitted the poor, he surrounded himself with cultural symbols of the middle class. Romney is a very rich man running on a platform of helping other rich people and doing almost nothing to deflect the most obvious political attack.
It’s almost as if the Republicans are planting gigantic targets on their backs, standing in the middle of the street and daring Democrats to hit them. It’s such openly flaunted evil that even the most jaded voters refuse to believe it’s actually real.
This has more to do with who would be receiving health care, then it does with the so-called federal strings that are attached. That’s just what Perry and the GOP hide behind when they don’t want to talk about the millions without health insurance in Texas. It’s extremely doubtful that this will be an issue where the , “..Legislature needs to assert itself..”. The only way this will stop is to change our elected officials.
Here’s the statement from the Texas Democratic Party:
Rick Perry’s announcement is both cruel and negligent. No person with a speck of intelligence would turn down billions in federal dollars that would be a boon to our economy and help Texans. But then again this is Rick Perry. Rick Perry could’ve brought billions in federal dollars to Texas, reduced the rate of the uninsured and improved the quality of life for Texans. Rick Perry’s Texas solution is to let Texans stay ill and uninsured. That is not a health care plan. Once again Perry is putting partisan political pandering in front of the interests of Texas.
There’s been a tremendous debate since the Supreme Court (SCOTUS) ruling on the Affordable Care ACT (ACA) last week. No matter where one comes down on how the mandate was rationalized by the court, (is it a tax?), it really doesn’t matter. It does the same thing either way, It doesn’t matter if they call it a tax or a penalty.
It’s fairly obvious what the mandate does: once the government makes health insurance affordable (in theory), people who don’t pay for it will be penalized in order to prevent moral hazard, and to prevent people from not buying insurance until the minute they feel they might have a medical problem. Call it a tax, call it a penalty, call it whatever one wants: the concept is clear enough.
While the mandate was central to allowing the law to move forward, the issue that will matter most in people’s lives is how, or if in some states, the Medicaid expansion is implemented. The discussion about the Medicaid expansion fascinating and will be the main focus going forward. The reason it is so fascinating is because the issue has so many of the elements our country has been struggling with since the beginning. Race, taxes, fairness, equality and/or inequality, wealth, and the poor just to name a few. All around the subject of health care.
To get a sense of what an incredibly, astonishingly, unbelievably good deal that is, consider this: The federal government currently pays 57 percent of Medicaid’s costs. States pay the rest. And every state thinks that a sufficiently good deal to participate.
But, somewhat perversely, the states that get the best deal under the law are states like Texas, which have stingy Medicaid programs right now, and where the federal government is thus going to pick up the bill for insuring millions and millions of people. In states like Massachusetts, where the Medicaid program is already generous and the state is shouldering much of the cost, there’s no difference for the federal government to pay.
That is to say, the less you’ve been doing on Medicaid so far, the more the federal government will pay on your behalf going forward. And that gets to an irony of the health-care law: Red states have, in general, done less than blue states to cover their residents, so they’re going to get a sweeter deal under the terms of the Affordable Care Act.
The U.S. Supreme Court’s decision to uphold the Affordable Care Act marks a giant step forward for millions of Texas children and families who can now get the healthcare coverage they need.
Because of our state’s highest-in-the-nation rates of uninsured, Texas stands to benefit from this decision more than any other state.
The nation’s health law has already improved the lives of millions of Texans. More than 7.5 million Texans, including more than 3 million children, have directly benefited from the law since 2010.
But the reality is that none of those arguments, logical and fiscally sound as they are, will likely be enough for the “Let him die!” party to just allow this to go forward. Here’s what the supposed moderate Speaker of the Texas House had to say.
“The battle to overturn the burdens this law places on American citizens by our elected leaders in Washington is not done. I will continue to urge the Texas Congressional delegation to dismantle this legislation and find real solutions to improve our health care system so Texans can have access to quality, affordable care. The Texas House will do its part during the next session by attempting to limit any negative impact the law might have on our state.”
It looks like there’s little that unifies the Texas GOP more then taking away people’s health care. One option to try and sway moderates, if there still are any in the GOP, is the moral argument.
Make the moral argument: Appeals to the Medicaid expansion being a “great deal” for states will fall flat. Conservatives won’t trust the source, and will shift the numbers in their favor. Plus there really are costs to expansion on the states, even if they’re minimal.
What cannot be elided is the idea that we have a responsibility to each other, and don’t want to see the day when our brothers and sisters die in the street for lack of medical care. I don’t expect this to reach the outer edges of the tea party right, but it should be able to sway moderates. Since 2008, the moral argument is the argument that has not really been employed. It was dropped in favor of arguments about “bending the cost curve.” But the idea that health care is an essential right and not a privilege has the ability to move people from where they are.
Conservatives and Republicans do not concede the moral imperative of universal health care — although that leaves them isolated in the entire advanced democratic world. There is no other country among our allies in Western Europe, Canada, Japan, and Australia that does not stipulate every citizen will have health insurance from birth as a matter of course. In all those countries, the center-right parties have long accepted the moral imperative, whatever initial misgivings they may once have voiced. So do the medical- industrial complexes of every nation but ours [...]
So the moral issue must be joined in the most aggressive fashion possible. Not so much by showing empathy for the uninsured—liberals are always wonderful at showing empathy. No, by belligerently challenging conservative pundits and Republican politicians at every opportunity, reminding them how lucky they are to have health care themselves.
This is especially true in the case of Medicaid, which hits a vulnerable and often invisible population. Over the years-long battle for expansion, it is incumbent to make them visible and real and unforgettable. That’s a far better campaign to “I can’t believe what a good deal these people are passing up!”
Digby and Dave Dayen have been doing a tremendous job of highlighting the ridiculous conventional wisdom that all of the GOP governors will opt in to the Medicaid expansion in ACA simply because the hospitals want them to. The CW assumes that Republican governors are driven purely by corporate greed, rather than a deep ideological commitment to the idea that the undeserving poor should be left to suffer out of a sense of Calvinist cosmic justice. For GOP governors and their base, there are two kinds of people: those who deserve to prosper and be happy and those who don’t. For them, the greatest injustice in the world is the taking of their tax dollars to assist the undeserving, and the removal of their private authority to abuse and exploit the undeserving.
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I’ve said it before: what made the New Deal so popular and effective was the fact that most of its programs benefited everyone (well, at least everyone white.) The Civil Rights Era alienated a huge number of Americans who weren’t yet prepared to see women and minorities as equally deserving human beings. For liberalism to be politically palatable for enough of the public, the benefits of liberalism cannot be seen as going overwhelmingly to people that suburban and rural whites consider to be less than fully deserving of the same empathy and basic rights that they themselves enjoy.
As the Affordable Care Act becomes increasingly associated with Medicaid, and as Republicans continue to demonize it as taking away Medicare money to give to “undeserving” people, the Affordable Care Act itself will be unpopular.
Democrats need not be shocked by Republican governors’ refusal to accept Medicaid funds, and they need not feel that the experience of the Affordable Care Act means that Americans don’t like “socialized medicine.” What Democrats need to learn from this experience is that Democrats need to avoid the welfare trap, and need to embrace the power of universal social insurance.
Universal social insurance has always been popular and will remain popular when implemented. It’s just a matter of having the courage to enact it in the first place.
There’s a long way to go in the continuing fight for a better health insurance system in our state and nation. But the fight may not happen if Barack Obama isn’t reelected. This is also a huge opportunity for Democrats, especially in Texas, to show and huge difference between them and the GOP on health care. All Democrats should campaign on saving health care for millions of Texans and guarantee to work to expand health care for millions more. Because it’s the right and moral thing to do, and because it’s obvious the GOP won’t.
In nine out of 12 categories Texas rated weak or very weak. The only area where Texas ranked good was in maternal and child health care measures. A spokeswoman for the Texas Health and Human Services Commission did not immediately reply to a request for comment.
Texas offers one of the most limited health care programs in the nation for the disabled and the poor, and more than 25 percent of Texans do not have health insurance of any kind, the highest in the nation.
The Affordable Care Act (ACA) was enacted by a Democratic President. But how, or if, certain parts of it will be available to Texans is all going to be up the the elected members of the Texas GOP. Will the health care exchange in Texas be setup and run by the state or federal government? It’s up to the GOP. Will millions of Texans now be insured because of the expansion of Medicaid? It’s up to the GOP.
By Nov. 16, the state is supposed to declare whether it intends to create its own exchange or leave it to the federal government to create one. If Mitt Romney wins the election that month and can get Republican majorities in both houses of Congress, the prospect of a federally administered insurance exchange for Texans may disappear through repeal of the law.
But there’s not much time left if Texas wants to design its own exchange rather than accept the Obama administration’s approach. And that worries insurers, benefit analysts and even some conservative health economists.
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Under Obama’s health care overhaul, each state would have an insurance exchange for individuals by 2014. (The law also creates separate exchanges for small businesses.) Most Texans could expect to continue to get their health care at work as an employee benefit. The individual exchange would offer markets to people between jobs, people who can’t get insurance because of their health or who work for firms that don’t offer comprehensive insurance.
Families making less than $88,000 a year would qualify for federal subsidies. The law limits the amount a family would be expected to spend at 9.5 percent of income; the amount drops to 3 percent for individuals making about $15,350.
Two years ago, the state’s Health and Human Services Commission told the Legislature that as many as 43 percent of an estimated 6.5 million uninsured Texans could qualify for subsidies under Obama’s individual insurance exchange.
In short, the Medicaid expansion will significantly increase coverage at a modest cost to state Medicaid programs, and it will lower state costs for providing care to the uninsured.
It’s a good deal for getting many more Texans health insurance. And keeping them out of the emergency room saves money for everyone with insurance.
To assess the fiscal impact on states of the Medicaid expansion, one must look at more than just Medicaid, because the health reform law’s coverage expansions will reduce some state and local costs. As a result of health reform, Medicaid will essentially pay for many health services now provided to people who are uninsured. Thus, the federal government will bear a substantial share of the cost of providing health care services to people whose health care costs otherwise would be borne in part by state or local governments.
In other words the ACA could be a boon for county governments. If Perry and the statewide elected GOP don’t accept the Medicaid expansion, it may save the state money, but it will almost certainly force local governments to raise taxes. Which is just more cost shifting from the state to city and county governments.
“It’s ideology,” said Bruce Buchanan, a political scientist at the University of Texas at Austin. “It’s stubbornness.”
Buchanan suggests Texas’ GOP leadership could be subjected to “moral pressure” if most other states participate in the expansion.
“They’re not going to admit it at the moment, because they are so opposed to the whole fundamental health care requirement,” he said.
Taking the money and expanding coverage would be the smart thing to do from a policy standpoint, suggested Rice University political scientist Mark Jones.
“It’s free money for a relatively long time period,” Jones said. “It sends money into the economy. But politically, it’s difficult.”
The GOP has never succumbed for “moral’ reasons and they won’t start now. But this also makes great economic sense.
But things may change.
Patricia Gray, who represented Galveston in the Texas House from 1992-2003 and now is special assistant for health policy at the University of Texas Medical Branch in Galveston and an adjunct professor at the University of Houston Law Center, said state leaders may change their minds, especially if Congress allows more flexibility.
“Texas sends more money to Washington than it gets back,” she said. “If we don’t do this, we’re subsidizing New York’s Medicaid expansion, and California’s Medicaid expansion.”
That’s one argument.
Rep. Garnet Coleman, D-Houston, will make another.
“If history tells us anything, it’s that Texas won’t do the Medicaid expansion,” he said. “But I have to argue the consequence to Texans if we don’t.”
Coleman, who served on Obama’s Working Group of State Legislators for Health Reform, estimates the expansion could bring the state $189 billion in federal funding over a decade, money spent in part to pay doctors, nurses and other health care workers.
“If we don’t do the expansion based on ideology, it has a real economic impact,” he said.
As I’ve said from the beginning, the moral heart of the ACA is the medicaid expansion (and the banning denial of pre-existing conditions.) This was the big payoff for liberals in this thing. The rest is an experiment in using “markets” to make it “more affordable” for middle class people in the private insurance market. (Like me.)Hopefully the subsidies and exchanges will work and many people will be better off. Certainly they’ll have better preventive coverage and no lifetime limits, so that’s something.
But expanding Medicaid to cover more than 10 million people, mostly working poor, who cannot afford to buy health insurance at all was the real liberal accomplishment of the Act, although some of us predicted from the beginning that it would also be the most vulnerable. (Hell, even the Obama administration has been willing to cut existing Medicaid, so it’s hard to see how this won’t be on the chopping block going forward.)
In any case, this is the one piece of the ACA that truly offends the right wingers. It actually is government paid health care, after all. I think Kilgore is right and that it’s not a given that these governors will accede to the federal law on this without a long drawn out battle.
Today the US Supreme Court upheld President Barack Obama’s signature accomplishment of his first term, the Affordable Care Act (ACA), otherwise known as “Obamacare”. Supreme Court Upholds ‘Obamacare’.
The Supreme Court has ruled 5-4 that the Affordable Care Act meets constitutional muster and can be allowed to continue its slow process of transforming the nation’s health care system.
Thursday’s historic decision, authored by Chief Justice Roberts, was by no means a fait accompli. Though the consensus among constitutional scholars has always been that the law’s insurance mandate did not exceed Congress’ Commerce Clause powers, its opponents erected a counterargument that quickly became an article of faith on the right. In the end, Roberts’ decision upheld the mandate as an exercise of Congress’ taxing power.
There’s a way to view Supreme Court decision in our day and age. I can’t remember who said it, but it wasn’t me, that the Supreme Court – who gets on and each decision – is always done in favor of corporations and big money. There were a lot of “tea party” wing nut critics of the Affordable Care Act (ACA), but the insurance corporations have not said a bad word about it. And I think that was the ace in the hole.
It had become apparent in the last few days that if this attempt to fix health care went down, all that was left was a single-payer, Medicare for all type of fix. That would have cut the insurance corporations out of health care and that’s likely why this decision happened. Like last week’s immigration decision, which was all about cheap labor for certain corporations – think Bob Perry, owner of Perry Homes.
I hate to by so cynical on such a “big” day. But that’s likely what’s really going on here.
Additionally, and this is very important in predicting where this lands, states that newly cover these low-income, uninsured folks initially get fully reimbursed for the costs by the Feds (by 2020, that match falls to 90%). Also, under the original law, states risked losing their federal Medicaid contribution if they failed to implement the expansion. (See here for more details.)
But SCOTUS reversed that part. They said states could reject the extension and Congress could not take away their existing Medicaid funding.
So, what does this mean? It has some potentially pretty weird implications.
For example, one’s first thought is that hard-core conservative governors—the type that rejected fully paid-for Recovery Act bucks when their citizens needed jobs—will surely reject the expansion, despite the fact that it’s fully funded through 2017. Lefties and advocates for the poor will squawk, but so what, right?
But the thing is, they’re not the only ones who will be pushing back on their governors. Hospitals, doctors, community health care providers, their lobbyists, and anyone else who deals with low-income, sick people will be pushing very hard to take the money.
Obviously, ideology may triumph but the coalition in support of the expansion, even in the reddest state, will be decidedly purple.
Next, because the law was written assuming that the uninsured poor would be covered by Medicaid, subsidies to purchase health insurance in the exchanges don’t kick in until higher income levels. The poor won’t have to pay the tax penalty formerly known as the mandate because of a hardship exemption in the law, but neither will they get the subsidy until their incomes go up enough.
It’s a very weird reversal of the usual means-test for government benefits. Typically, as your income rises you become ineligible for benefits. Here, you become eligible.
A couple of weeks ago it was announce that the Employees Retirement System of Texas (ERS), who administers retirement, health and other insurance benefits for current and former employees, was changing corporations that administers health insurance. From Blue Cross to United HealthCare, via the ERS web site.
On February 21, 2012, the ERS Board of Trustees agreed to enter into contract negotiations with United HealthCare Services, Inc. to serve as the third party administrator (TPA) for the self-funded HealthSelectSM of Texas health plan starting September 1, 2012. United HealthCare Services, Inc. call center and claims processing unit is located in San Antonio, Texas.
Since that time Paul Burka has been all over this story as a clear sign that “The Perry gravy train is back on the track”. This post shows how the ERS contract is sweet deal for Perry insiders, and not a good deal for state worker and retirees. Burka starts by pointing out the ties to UnitedHealthCare and Gov. Perry.
UnitedHealthCare is a client of … Mike Toomey. What a remarkable coincidence.
I went on to quote from the release:
Chris Cronn, a former Perry staffer, will become Vice-President for state affairs for UnitedHealthCare, and other former Perry staffers are on the gravy train. Their names appear below, following the text of an email that went out on Wednesday:UnitedHealthcare was selected by the Employees Retirement System of Texas (ERS) to be the third party administrator of the HealthSelect of Texas health insurance plan. As the administrator, UnitedHealthcare will process claims, provide customer service and manage the HealthSelect network starting September 1, 2012. We will be working with ERS, and the current administrator, Blue Cross and Blue Shield of Texas, to make the transition as easy as possible for all HealthSelect members.
The names that followed included Cronn (as the new vice president for state affairs for UHC); Toomey; Laura Keel; Louis Saenz, a former senior adviser for Perry; and Victoria Ford, a former Perry health care staffer.
This certainly highlights what many refer to as the “revolving door” of politics and the corporate world. Those who leave state government and use their connections in the private sector for personal gain. While there is no evidence of corruption, this certainly looks fortuitous. He then goes on to point out that this will cause “major disruptions”.
First, UnitedHealthcare’s competitors are not going to go quietly into that good night. I am told that ERS will meet tomorrow, and that representatives of the speaker’s office and the lieutenant governor’s office will be present. The switch from Blue Cross to UHC is going to have huge implications, both financial and personal. (Full disclosure: I am covered by Blue Cross through TEXAS MONTHLY’s parent company.) The UHC plan will cause major disruptions in patient care, at least in the beginning, as well as considerable cost-shifting to state employees and retirees.
And ends with this:
I don’t want to rush to judgment here. I haven’t read the contract. I don’t pretend to understand the nuances of health insurance. I haven’t seen a comparison of the two plans. But the combination of possible influence peddling by the governor and his former staffers turned lobbyists, and the potential impact of the plan on thousands of state employees, should motivate the state’s leadership (excluding Perry) to determine whether state employees are getting the best possible deal here. The integrity of TRS has already been compromised by Perry’s appointments–remember the Michael Green whistle-blowing letter–and now ERS is likely to come under scrutiny. Dewhurst and Straus should seek a thorough airing of the differences between the new UnitedHealthcare plan and the Blue Cross Blue Shield plan that is no longer in force and determine whether state employees are well served by the new contract.
And what about ERS’s lawyer — Greg Abbott? He is widely believed to be planning a race for governor. He would benefit significantly if Perry were to step aside. But would Abbott risk a fight with Perry by questioning the process that led to the awarding of a contract to Perry’s friends? Unlikely. This is really ugly, and it is going to get worse before it gets better.
What’s sad about this, especially from what I’ve read thus far, is that there doesn’t seem to be much being said, especially from the ERS board members, about how this will effect their membership. Here’s what the “Get Answers” link says regarding coverage and cost.
The new contract is expected to save the health plan money, while providing quality benefits.
[...]
You will not pay more because of this transition. The legislature and/or the ERS Board of Trustees determine the plan design and premium changes.
What that says to me is that, “quality benefits” is not “the same benefits you have now”, and that yes you will pay more in the future but we’ll blame it on something else.
But this also goes to what Lawrence Lessig has been pointing out for several years now, money buys results. Here’s the video which lays it out pretty succinctly.
You can enter any of the office buildings of Congress fairly easily. There’s a metal detector manned by guards, obviously not happy with their TSA-like shift. The search is brief, almost fake. You’re then inside a building typically with long, beautiful hallways, onto which the offices of congressmen and senators open. Often the halls are empty. Silent. Almost abandoned. Then, seemingly at random, a single person may enter a hall, or a gaggle of staffers. And sometimes, at the center, is a Member of Congress. Harried, focused, typically reading something as he or she walks, often frowning, unless you catch his or her eye. Then you’re met, whether you know the Member or not, with an “of course I remember you” smile, for a second, until light won’t bend to you, at your angle, anymore. The race then resumes, to a typically meaningless procedural vote, or to a florescent-lit cubicle in an office just next to the Capitol, where Members spend hours cold-call fundraising, the only truly required work of Members of Congress.
It is easy in this mix not to notice the basic bankruptcy that is the First Branch of the Framers’ Constitution: Congress. The obsessively hard work of the staff, the fawning of visiting constituents, the respect of uniformed officers—all that fuels an obliviousness to the basic failure of this the democratic core of our government. Public cynicism about Congress couldn’t be greater; public approval couldn’t be lower. (Rasmussen, for example,recently reported that for the first time, favorable views about the work of Congress fell to single digits—9%.) But most in Congress do their job as if the standing of Congress were simply not their concern. Members are loved locally, and that is enough. That the institution they serve is despised is irrelevant.
Nothing on the political horizon is going to change this. Bush v. Gore notwithstanding, the public still trusts and admires the Supreme Court. No matter whether Obama or McCain wins in November, the public will once again approve and admire the Presidency. But nothing will save Congress. Without fundamental change, the institution will remain despised and increasingly irrelevant. Power will continue to shift—as it has for the past fifty years—to the President and the Court. The core institution of the Framers’ democratic design, the institution that many of them were most proud of, will remain essentially bankrupt.
That’s a strong term. But it predicates well of Congress. If the credit of any public institution is trust and respect, then Congress is, as Websters would define it, “discredited, having forfeited all credit.” Not because of any particular decision, or failed vote. Most couldn’t name one thing Congress did or didn’t do that they object to. Not because anyone believes its Members (or most of its Members) are bribed, or evil people. To the contrary, Congress is filled with souls with an extraordinary commitment to the public. These are good, not evil, people.
Rather, Congress’s “credit” is “forfeit” because of a profoundly deep sense among most that the machine that Congress is is simply bent. Like a rigged slot machine at a casino, or a balance sheet by the Enron accounting department, the vast majority of Americans don’t believe that the answers Congress gives are the right answers for the right reasons. Most believe that they track something else entirely: not sense but dollars. And not the dollars of an illegal bribe (though no doubt, too many believe this too), but the dollars that fund the essential element of congressional tenure—campaign contributions.
America’s view of Congress’s behavior is not likely correct. Political scientists are almost unanimous in their judgment that there is no simple quid-pro-quo to what Congress does. If there is improper influence, it is far less direct, or obvious. Any improper influence is well hidden in the web of relationships that power attracts.
But this is one of those crucial contexts in which perception is reality. Congress is bankrupt because the people see it so. Why America sees as it does is obvious; likewise obvious is what Congress must do to change that belief. Not obvious, however, is how that change gets effected.
Because of the “revolving door” and campaign finance system, now in place, it’s impossible for us to trust our elected, or appointed in the case of ERS, leaders are doing what they believe is best for ERS members and the state of Texas.
PolitiFact Texas ?@PolitiFactTexas