Health insurance for millions in peril -- Nov. 5, 2020 column

By MARSHA MERCER

With the future of health care in limbo during the prolonged presidential election, the Supreme Court next week will take up a case that could yank health insurance from 23 million Americans during a pandemic.

On Tuesday, the court will hear oral arguments in California v. Texas, which questions whether the Affordable Care Act, a.k.a. Obamacare, is constitutional. What the court ultimately decides could affect nearly every American family, not just those who buy their insurance through Obamacare.

Republicans have long argued Congress overstepped its authority when it imposed the individual mandate, requiring most Americans to buy health insurance or pay a penalty.

In 2012, the court upheld Obamacare 5 to 4. Chief Justice John Roberts, siding with the more liberal justices, wrote that since the penalty was collected by the IRS, it could be considered a tax and Congress has the power of taxation.

In 2017, Congress zeroed out the penalty. A group of red states challenged Obamacare, arguing a zero penalty means there is no tax and the law is unconstitutional. The Trump administration backs the red states.

After rounds in federal courts, a group of blue states supporting the law asked the Supreme Court to review the issues. The House is also defending the law, which remains in effect.

This time, conservative justices hold a 6 to 3 advantage. In a sign of the significance of the case, the court has lengthened arguments from the usual 30 minutes to 40 minutes for each side side.

Tuesday’s arguments may give us a glimpse into the mind of Justice Amy Coney Barrett, who said at her confirmation hearing, “I am not hostile to the ACA,” although as a law professor she wrote an article criticizing Roberts’s reasoning in the 2012 decision.

The current case raises the doctrine of severability -- whether a law can still stand if part of it is struck down. Barrett said she has not talked or written about severability.

The highest court could let Obamacare stand, abolish it entirely or do something in between. A ruling is expected by summer.

No one argues Obamacare is perfect. Many Americans bristled at being told they had to buy insurance, at paying a penalty if they failed to do so and at the cost.

But. Under Obamacare, insurance companies may no longer deny coverage to people with preexisting conditions like cancer, diabetes or sleep apnea; charge them higher premiums, subject them to long waiting periods or cap their benefits.

About 54 million Americans under 65 – or 27% -- have a preexisting condition that, before Obamacare, insurance companies could use to decline coverage on the individual market, an analysis by the Kaiser Family Foundation found. In Virginia, about 1.3 million people under 65 – or 26% -- have such conditions, the report said.

Besides protecting those with preexisting conditions, Obamacare also prevents insurers from charging women more than men, permits children to stay on their parents’ insurance policies until age 26 and offers subsidies to some customers to help pay premiums.

Most Americans get their insurance through their employers or a government program like Medicare or Medicaid, but no one knows when a job loss, divorce or other life event may require buying insurance on the individual or non-group market.

The pandemic and economic downturn prompted an additional 3 million Americans to seek help, raising the number covered under Obamacare to 23 million, according to the liberal-leaning Center for American Progress.

In the absence of Obamacare, COVID-19 could be considered a preexisting condition, and survivors could be denied health insurance.

President Donald Trump has promised since 2016 to repeal and replace Obamacare with something better and cheaper but has never presented a replacement plan.

He issued an executive order on preexisting conditions in September that experts said was symbolic and had no practical effect.

Obamacare has withstood more than 70 Republican attempts at repeal in the House and many judicial challenges.

Before the election, when it appeared the Senate and White House might flip blue, both Democratic presidential nominee Joe Biden and House Speaker Nancy Pelosi said they would work to strengthen Obamacare.

A Republican Senate led by Mitch McConnell makes meaningful change more difficult and raises the stakes for what the court decides.

Republicans and Democrats need to work together to write a law that works and people will accept. America will be healthier for it.

©2020 Marsha Mercer. All rights reserved.

 

 

 

 

 

Trump, GOP will own shutdown, if it happens -- April 20, 2017 column

By MARSHA MERCER

President Donald Trump took credit for a Democrat’s failure to win a special election outright in Georgia’s 6^th Congressional District, forcing a run-off in June. 

“Glad to be of help!” he tweeted Tuesday night.

But if you want a true gauge of presidential clout, watch Congress as it wrestles with the prospect of yet another government shutdown. 

Americans have learned not to count on Congress to do much, but keeping the government open is a modest expectation. That goal, however, challenges Trump’s and congressional spending priorities.

Democrats have said no to Trump’s $1.4 billion request to build a border wall. They’re also fighting his proposed $18 billion in cuts to domestic programs to offset huge increases in defense spending.

Conservative Republicans still want to cut funding to Planned Parenthood, but saving it is a Democratic priority.

All this matters because Republicans likely will have to work with Democrats to avoid another government shutdown. Trump should help make a deal, but, as we know, he’s unpredictable.  

We’re here because Congress was unable to get its act together last December and passed a continuing resolution or temporary spending measure to avert a government shutdown. That spending authority expires Friday, the day before Trump’s 100^th day in office, which he’d rather spend talking up his accomplishments than explaining why national parks are closed.

Congress went on a two-week spring break without dealing with the spending issue. The Senate returns to Washington Monday and the House on Tuesday, leaving a few days to negotiate. 

The last government shutdown, in October 2013, dragged on for 16 full days, and the one before that lasted 21 full days before it ended in January 1996. Each cost taxpayers billions of dollars and caused major disruptions in services.

“There’s not going to be a shutdown,” Senate Majority Whip John Cornyn, R-Texas, assured reporters the other day. These are the same people who promised to repeal and replace the Affordable Care Act on Day One.

Congress could punt again and pass another temporary extension for a week, pushing the crisis into May, Politico reported.

Meanwhile, Republicans and Democrats are preemptively blaming each other.      

“Our Republican colleagues know that since they control the House, the Senate, and the White House that a shutdown would fall on their shoulders, and they don’t want it,” said Senate Minority Leader Charles Schumer, D-New York.

Republicans need eight Democratic votes to overcome a Senate filibuster, so Democrats are trying to use their leverage to stop Trump’s agenda.

“I think Chuck Schumer and the Democrats want a shutdown,” Sen. Ted Cruz, R-Texas and architect of the last shutdown, told constituents in Texas the other day, the Texas Tribune reported.

This is rich coming from Cruz, who kept the Senate floor for 21 hours in 2013 in a vain attempt to kill the Affordable Care Act, a stunt that led to a budget standoff and then to the last shutdown.

Cruz’s antics demonstrated a truth about budget brinksmanship and government shutdowns: They don’t work. An omnibus spending bill passed, the ACA still stands, and Congress’ approval rating is a dismal 20 percent.

The cost of paying furloughed federal workers for not working during the 2013 shutdown was $2 billion, according to the Office of Management and Budget, which also cited such additional indirect costs as uncollected fees, halted IRS enforcement measures and additional interest on payments that were late, due to the shutdown.

No matter how they spin it, Republicans would suffer political fallout of a shutdown. The stars haven’t misaligned to bring on a funding gap under single-party rule since the troubled presidency of Jimmy Carter.

Even if Congress manages to keep the government open this time, another crisis looms in the fall, when the debt ceiling is reached.

The potential shutdown is a test. Trump could demonstrate he cares more about governing than electioneering and support a compromise. Congressional Republicans could show they have more aptitude for governing than squabbling.

It shouldn’t be a big ask to keep the government’s lights on.

©2017 Marsha Mercer. All rights reserved.

Capital in confusion over Obamacare RX -- Feb. 16, 2017 column

By MARSHA MERCER

President Donald Trump turned to House Speaker Paul Ryan the other day and said: “He’s working on Obamacare. It’s going to be very soon -- right?”

“Yes,” Ryan replied, as cameras rolled in the Oval Office.

More than a nudge from the president, Ryan could use some Lyndon Johnson-style arm twisting to make good on the Republicans’ long-term promise to repeal and replace the Affordable Care Act.   

Trump has left details of reforming health insurance to Ryan and other Republicans in Congress, but they are floundering in a sea of options.  

Trump still sounds like he’s an outsider on the campaign trail. When Humana became the latest major insurer to say it will stop selling coverage on Obamacare exchanges in 2018, Trump tweeted: “Obamacare continues to fail. Will repeal, replace and save health care for ALL Americans.”

Yet he has presented no plan of his own and the goal of replacement seems to be slipping farther into the future.

As a House member, Tom Price, the new Health and Human Services secretary, offered a plan, one of many. None of the other plans has galvanized widespread support even within the GOP, let alone with Democrats. It’s unclear what Senate Republicans will accept.  

Ryan went door-to-door, trying to build a consensus around his “Better Way” plan, but Republicans even disagree on timing -- repeal and replace at the same time or repeal first and take time on a replacement.

Trump has said repeal and replace will be “essentially simultaneous.”

But Ryan told reporters this week that reform “affects every person and every family in America,” and a deliberate, “step-by-step approach” is needed for stability.

House Republicans received plan options at a party caucus before they headed home for the week-long Presidents Day break.

Meanwhile, the House Freedom Caucus, a group of about 35 to 40 of the most conservative Republicans, wants to repeal the law now and is backing a plan by Sen. Rand Paul of Kentucky.

Paul’s plan would undo most of the Obamacare rules, rely on expanded health savings accounts, allow people to buy insurance across state lines and join associations to increase purchasing power.  

Paul would also jettison the Medicaid expansion that was a state option under the Affordable Care Act. That’s a sticking point. It’s always easier to give people a benefit than take one away.

Before he left office, President Barack Obama urged Democrats not to “rescue” Republicans in their efforts to replace Obamacare. House Republicans voted scores of times to repeal Obamacare since the law was enacted in 2010 without a single Republican vote.

Despite the years of controversy over Obama’s signature law, it appears many Americans remain surprisingly uninformed. More than one in three either thought the Affordable Care Act and Obamacare are different programs or didn’t know whether they are the same or different, a poll by Morning Consult reported last month.

The Trump administration is taking actions that actually could make the law more palatable to critics. 

The Internal Revenue Service is relaxing a key enforcement mechanism scheduled to take effect this year. The IRS was to withhold tax refunds from people who failed to comply with the mandate to purchase health insurance or pay a tax penalty. Instead, IRS will process returns and refunds as usual.

In addition, HHS just proposed new rules aimed at stabilizing the exchanges to encourage insurers to keep offering coverage and customers more plan choices.     

Obama promised Americans if they liked their doctors or their health insurance plans, they could keep them. The claim turned out to be false and was a source of anger that motivated many voters.

Trump promised to get rid of Obamacare and put something better in its place while retaining the law’s popular provisions. 

People hate paying higher insurance premiums – which they blame on Obamacare even though premiums were rising before the law. But they like keeping children under 26 on their insurance plans and not being denied, or priced out of, coverage because of pre-existing medical conditions.

It’s a curious turn that, for the time being anyway, Republican dithering on Capitol Hill means Trump is keeping Obamacare alive.  

©2017 Marsha Mercer. All rights reserved.

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Out with Obamacare, in with . . . Trumpcare -- Dec. 8, 2016 column

By MARSHA MERCER

You’d think they’d be ready by now.

For nearly seven years, congressional Republicans have promised to “repeal and replace” Obamacare with something better and more affordable.

Repeal is easy. Since President Barack Obama got the Affordable Care Act through Congress in 2010 without a single Republican vote, the House has voted more than 60 times to repeal all or part of it.

On the campaign trail, Donald Trump called the law “a total disaster” and vowed to repeal and replace it on Day One.  

Senate Majority Leader Mitch McConnell said Tuesday repeal will be the first item of business in the New Year when the Senate returns Jan. 3.

Replace is hard. Republicans have yet to agree on a path forward for what inevitably will be known as Trumpcare. 

Even Trump now wants to keep two popular provisions of the health law. After he met with Obama in the Oval Office, the president-elect said he favors allowing children under 26 to stay on their parents’ health insurance plans and requiring coverage of people with existing medical conditions.

Trump’s a big-picture guy, so replacement details will fall to Congress, where, until the election, many were more interested in politics than policy. I know you’re surprised.

Only on Dec. 2 did House Majority Leader Kevin McCarthy send a letter to governors and state insurance commissioners asking for their ideas about health care reform.That way, if Trumpcare goes bad, state officials can share the blame.

McCarthy said the two-step repeal and replace process could take much of next year and beyond. House Speaker Paul Ryan also lowered expectations of speedy action.

“Clearly there will be a transition and a bridge so that no one is left out in the cold, so that no one is worse off,” Ryan said Monday in an interview with Craig Gilbert of the Milwaukee Journal Sentinel.

Ryan would not hazard a guess about how long the transition might take.

“It will clearly take time. It took them about six years to stand up Obamacare. It’s not going to be replaced come next football season,” he said.

One possibility is for Republicans to resurrect the repeal bill Obama vetoed last January. It called for a two-year delay in the effective date of replacement. Some Republicans say six months is enough.

Republican leaders invited Democrats to work with them, even though Republicans refused to cooperate with Obama. Senate Democratic leader Chuck Schumer derided Republicans as “the dog who caught the bus,” saying, “They don’t know what to do.”

Repeal without replacement will cause “huge calamity from one end of America to the other,” Schumer said. “Bring it on.”

In a letter to Trump, the American Hospital Association and the Federation of American Hospitals urged him and Congress not repeal Obamacare without a replacement. If that happens, Congress should restore funding to hospitals that was cut by Obamacare, the groups said, so hospitals can defray some of their costs.

The nonpartisan but left-leaning Urban Institute warned in an analysis this week that repeal without a clear replacement could throw into chaos the private health insurance market. Millions of Americans buy insurance directly rather than through an employer.

The number of uninsured could rise to 59 million by 2019, the study said. That’s far more than the 41 million who lacked insurance in 2014 when major provisions of Obamacare went into effect. About 28.5 million remained uninsured last year, according to the Kaiser Family Foundation.

Trump’s pick to lead Health and Human Services, House Budget Chairman Tom Price, wants to replace Obamacare with modest tax credits pegged to age, not income, to help people buy insurance on the private market.

Price’s proposed Empower Patients First Act also calls for grants to help states create “high-risk” insurance pools and expands health savings accounts.  

Republicans have not rushed to embrace the plan. Critics say it’s woefully underfunded and millions of Americans would lose coverage.

Taking time is not necessarily bad. Rushing could be worse.

But if members of Congress are going to blow up Obama’s signature legislation, they should be held to their promises and do no harm to the more than 20 million people who have insurance because of Obamacare.

To do anything less is to risk disappointing and disillusioning more Americans at a time when trust in government and politicians is badly frayed.  

©2016 Marsha Mercer. All rights reserved.

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We all pay for shutdown in dollars and trust -- Oct. 17, 2013 column

By MARSHA MERCER

President Barack Obama says there were no political winners in the crisis over the federal government shutdown and debt limit. Most Americans, regardless of their political persuasion, probably agree.

In Washington, though, every moment has a winner and a loser. Once the latest financial calamity was averted, most political analysts thought the president was a winner because he showed some spine, gave up nothing and kept his signature health care legislation intact.

Conservative Republicans, on the other hand, were losers because they totally misread the political landscape. Their ill-conceived attempt to defund Obamacare shut down the government, idled 800,000 workers for 16 days and hurt the economy – but it yielded only a minor tweak in the health care law. People who seek subsidies to buy insurance on the exchanges will have to provide income verification.

Some tea party Republicans cling to the fig leaf notion that their failed fight over the shutdown actually awakened the nation to the evils of the Affordable Care Act and support will blossom.  Really?  

Meanwhile, every Democrat, Republican and independent coast to coast will pay the cost of the federal shutdown in dollars -- and also in the incalculable currency of trust.

The pricetag of the latest shutdown hasn’t been released, but two shutdowns lasting a total of 26 days in 1995-96 cost more than $1.4 billion, the Congressional Research Service reported. That’s $2.1 billion in current dollars. Most of the money went for back pay for furloughed federal workers.

The dollar waste is unnecessary and maddening. Trust in our institutions and government is in short supply.  

To squander the people’s trust hurts our political system and is heartbreaking.  

“The American people are completely fed up with Washington,” Obama said Thursday.  He’s right, of course, but it would be nice if he or anyone else could say that Washington has learned from its misadventure and will work to rebuild the trust it has squandered. There are only glimmers that some in Congress have learned lessons.   

In reaching the deal, members of Congress did what they should have done months ago. They did their jobs. 

The bipartisan agreement reopened the government and raised the debt limit, allowing the United States to pay the bills it racked up with two unfunded wars and an unfunded Medicare drug benefit. It’s merely a reprieve that postpones the fight. In two months or so, we may face another fiscal crisis. 

The plan Obama signed Thursday funds the government through Jan. 15 and raises the debt ceiling through Feb. 7. On the way there, a bipartisan, bicameral budget conference is supposed to come up with a long-term plan on tax and spending policies by Dec. 13. The two Republicans on the conference committee voted against the bill ending the crisis, and the two Democrats voted for it. That’s hardly a promising sign.

A glimmer of hope is the 14 centrist senators led by Sen. Susan Collins, Republican of Maine, who worked together on an agreement that served as a point of departure for the final deal. The centrists were disappointed their plan didn’t prevail, but they pledge to keep working together.   

The next round of negotiations could take place in an even  more acidic political atmosphere because of the calendar.  

Obama chided Republicans on Thursday, saying, “You don’t like a particular policy or a particular president, then argue for your position. Go out there and win an election. Push to change it. But don’t break…what our predecessors spent over two centuries building.”

Some analysts say the looming 2014 congressional elections could have a sobering effect on conservatives in the House. In most congressional districts, though, a Republican incumbent fears a challenger from his right more than a Democratic one. For most House members, compromise in Washington can be a terrible career move.

Traditionally, people hate Congress but like their own member of Congress. That may be changing. About three in four people said they want to see most members of Congress defeated next year. And about four in 10 said they’d like to retire their own member of Congress, a new Pew Research Center survey found.

It’s very possible that we’ll  lurch once again from one financial crisis to the next. That not only would be a shame but would be a drain on what’s left of trust in government.

© 2013 Marsha Mercer. All rights reserved.

30

History says Obamacare may yet thrive -- Oct. 10, 2013 column

By MARSHA MERCER

The new health benefit got off to a rocky start. Complaints about long wait times were flying, and politicians wanted to ditch the law.  

“Any time Washington passes a new law, sometimes the transition period can be interesting,” the president said.

“That,” The New York Times reported dryly, “was something of an understatement.” 

But it wasn’t President Barack Obama, responding last week to complaints about overwhelmed servers and long waits to access the new online marketplaces to buy health insurance under the Affordable Care Act.

It was President George W. Bush in March 2006, trying to defuse anger over a new prescription drug benefit for seniors, known as Medicare Part D. Democrats and seniors hated it.

“This is lousy legislation,” then-Sen. Tom Daschle, D-S.D., declared when Bush signed the major new entitlement in December 2003. “We may spend the rest of our careers repairing the flaws of this bill.”

Sen. Ted Kennedy, D-Mass, thundered at a rally against the drug benefit:  “Who do you trust? The H.M.O.-coddling, drug-company-loving, Medicare-destroying, Social Security-hating Bush administration? Or do you trust Democrats, who created Medicare and will fight with you to defend it – every day of every week of every year?”

The week Bush signed the prescription benefit, only one in four seniors approved.  Republicans and Democrats were – surprise! -- polarized. Forty-nine percent of Republicans approved and 52 percent of Democrats disapproved, according to an ABC News-Washington Post poll. 

Nearly 10 years later, you’d hardly know anyone ever objected to the prescription benefit.

It’s optional, but nine in 10 seniors choose it. Of these, 90 percent say they’re satisfied with their drug coverage and 60 percent are very satisfied, according to a survey commissioned by Medicare Today, an industry group.

So what does all this say about today’s political flashpoint – Obamacare? It likely is on more solid ground than you might think, despite House Republicans’ dozens of votes to repeal it and multiple proposals to defund or delay it.   

Only about one in three people has a favorable opinion of the health law – far from a ringing endorsement. But when you think that only one in four seniors approved of the drug benefit, one in three is not so shabby.

Plus, while those who think Obamacare goes too far make the most fuss, about 7 percent of those who disapprove of the health law think it didn’t go far enough. There’s still support for a single-payer system.

   

Even its most devoted critics concede that once people actually see the Affordable Care Act in action, they’ll really like it.  

In July, Sen. Ted Cruz, R-Tex., told Fox News, “What the administration desperately wants is to get to January, to get the exchanges in place…they want people hooked on Obamacare so it can never be unwound. If we’re going to repeal it, we’ve got to do so now or it will remain with us forever.”

Cruz persuaded his House colleagues to shut down the federal government in the erroneous belief that Obama would cave on Obamacare. Republicans succeeded in shutting down the government, but funding was already in place for the rollout of Obamacare. Open enrollment began as scheduled Oct. 1.

Republicans have backed off repealing and defunding Obamacare, although they’d still like to delay it.

Obama insists that one day his signature health law will be as beloved as the Medicare drug benefit. As even Cruz indicated, it’s hard to see how Congress can take back health insurance after millions of Americans with pre-existing conditions get coverage starting Jan. 1.

Ironically, the government shutdown Cruz and others orchestrated has given the exchanges breathing room. The shutdown is more newsworthy than computer problems plaguing the rollout.

The glitches don’t get the media scrutiny they would if the marketplaces were the big news story in town. 

The Obama administration talks about the millions who have gone on the marketplaces, but it has not said how many people have been able to close the deal and buy insurance so far. Open enrollment continues through March 31.  

As another president once said, “Any time Washington passes a new law, sometimes the transition period can be interesting.”

© 2013 Marsha Mercer. All rights reserved.

RX for states: Expand Medicaid -- June 13, 2013 column

By MARSHA MERCER 

“Americans can always be counted on to do the right thing – after they have exhausted all other possibilities,” Winston Churchill supposedly said.

Whether the remark reflected Churchill’s or someone else’s wit, we again are seeing Americans struggle over the right thing. This time the right thing is for every state to expand Medicaid, the joint federal-state health insurance program for the poor.  

Medicaid currently provides health care to about 59 million low-income people – mostly young children and their parents and pregnant women. It pays for long-term care for seniors in nursing homes and people with disabilities. Some states, like Massachusetts, expanded Medicaid coverage on their own.

In March 2010, President Barack Obama signed the Affordable Care Act – a.k.a. Obamacare – which aims to bring affordable health care to most Americans no matter where they live.

The law is making significant changes. Next year, insurance companies can no longer discriminate against people with pre-existing health conditions, and almost every American will have to have health insurance or pay a tax penalty. The law also required every state to expand Medicaid to cover people with incomes up to 133 percent of the federal poverty level, about $26,000 for a family of three in 2013. The Congressional Budget Office said the Medicaid expansion would provide 16 million Americans with reliable health care.   

Republican state officials challenged the law in the courts. Last June, the Supreme Court upheld the law but said expanding Medicaid was a state option. Today 22 states and the District of Columbia are moving forward with the Medicaid expansion, according to the Kaiser Family Foundation. These include California, Minnesota, New Jersey and New York.

About 20 states have rejected the expansion – at least for now. Among them are Alabama, Florida, North Carolina, Oklahoma, Texas and Virginia. Eight other states around the country are still fighting it out.

In five Deep South states that have opted out – Alabama, Georgia, Mississippi, Louisiana and South Carolina – 62 percent of residents support the Medicaid expansion, a poll in March and April by the Joint Center for Political and Economic Studies found. The center is a public policy research group that focuses on African Americans.

Virginians were almost evenly split in March with 45 percent favoring expansion and 43 percent opposed, a Quinnipiac University poll reported.    

States that have rejected the expansion have some of the nation’s worst health records. America’s Health Rankings, an annual report by United Health Foundation, ranked Mississippi and Louisiana 49^{th,  --} the least healthy states. Alabama is 45^th and Virginia 21^st.

The states are forgoing “free” money. The federal government will foot 100 percent of Medicaid expansion costs from 2014 to 2016. Repayment will drop  to 90 percent in 2020 and level off after that. That’s a much better match than states currently have for Medicaid. The federal share ranges from 50 percent to 83 percent, with poorer states getting higher amounts per capita.   

Critics of expansion say they worry about unspecified costs down the road, and yet people without health insurance get health care every day in more costly hospital emergency rooms.    

A new Rand study of the first 14 states whose governors declared they would not expand Medicaid, including Alabama, found those states together would spend $1 billion more on uncompensated health care in 2016 than if they expanded Medicaid. The 14 states would give up $8.4 billion annually in federal payments, Rand said.

An analysis of state health data by the Los Angeles Times indicates that the states could use the help. Colon cancer deaths in states that oppose the Medicaid expansion are, on average, 16 percent higher than in states that support expansion, and deaths from breast cancer are 8 percent higher on average in states that oppose the expansion.

“Medicaid by itself may not close those gaps, which also reflect income and education disparities,” the paper reported, noting that conservatives argue that poor people would be helped more by alternative strategies that encourage people to take responsibility for their own health care.

States that don’t expand Medicaid still face other higher costs. Nationwide, only about two-thirds of people eligible have signed up for Medicaid, and the new health law includes a major outreach effort.

The fight over Medicaid is far from over. There’s no deadline for expansion, and supporters say they’ll be back in statehouses for the next legislative session. As they say in baseball, there’s always next year.

For now, though, it appears many states are determined to ignore the proverb and be “penny wise and pound foolish.”   

©2013 Marsha Mercer. All rights reserved.

At it again: Congress plays politics and favorites with health law -- May 2, 2013 column

 By MARSHA MERCER

Two things people detest about Washington: when members of Congress play politics and when they play favorites, especially favoring themselves.

 

Well, pull up a chair and get your mad on. Both sides of the aisle are guilty in the flap over the Affordable Care Act’s health insurance exchanges.

Exchanges are the online marketplaces where people will compare and buy insurance starting in January. One of the selling points for the public is that members of Congress will participate. This is less because Congress wanted to do the right thing than because Sen. Chuck Grassley, R-Iowa, added a requirement that Congress and staff enter the exchanges.

Members of Congress are notorious for making rules for the rest of us while exempting themselves, and Grassley has the novel notion that Congress ought not do that. He was also gigging Democrats and didn’t expect his amendment to survive. But Democrats surprised him and agreed to it.

With the online exchanges scheduled to open for enrollment in October, House Speaker John Boehner, R-Ohio, and Senate Majority Leader Harry Reid, D-Nev., reportedly were secretly negotiating a way to exempt lawmakers and Capitol Hill staffers. When the news broke, the twitterverse lit up with outrage.

The congressional leaders denied they wanted to exempt themselves. They wanted only to fix it so the federal government could continue contributing its employer share to workers’ insurance premiums, they said. Maybe so, but the damage was done.

Now comes Rep. Dave Camp, R-Mich., chairman of the House Ways and Means Committee. He upped the ante by proposing that all federal employees – from the president to groundskeepers – buy their health insurance on exchanges. He would exempt active-duty military and postal workers.

“If the Obamacare exchanges are good enough for the hard-working Americans and small businesses the law claims to help, then they should be good enough for the president, vice president, Congress and federal employees,” a Camp spokeswoman said.

President Barack Obama has said he will buy insurance through an exchange, although he has medical staff at his elbow in the White House.

Camp’s bill brought speedy condemnation from Democratic leader Nancy Pelosi and the unions that represent federal workers.

“There is no need to kick over 2 million federal employees off their insurance plans in order to satisfy the cynical political urges of House Republicans, who have voted to repeal this law over 30 times,” a spokesman for Pelosi said.

Camp’s proposal is an over-correction, and federal workers are already political footballs under sequestration’s automatic spending cuts and furloughs. But his proposal does raise an interesting point. Should the government continue to subsidize federal employees’ health care the way private employers do?

If so, a mechanism for employer subsidies needs to be built into the exchanges. As currently envisioned, the exchanges are for people whose employers don’t offer insurance and for people who can’t afford the coverage that is offered.

The kerfuffle over congressional participation in exchanges came as most Americans seem to be hazy, at best, about the law. Four in 10 American adults don’t even know that the Affordable Care Act is still the law of the land, the Kaiser Health Tracking Poll reported.

Obama says the law is working fine, even if people don’t know it. He still believes that people will come to understand the benefits in time, although he also concedes there will be “glitches and bumps” along the way. Only 35 percent of Americans have a positive view of the law, Kaiser says.  

People are unlikely to embrace the law as long as Congress appears to disdain it. Sen. Max Baucus, D-Mont., made news last month when he worried aloud that the rollout of the exchanges could be “a huge train wreck.” He’s retiring but other Democrats are worried that the exchanges will hurt them in the 2014 elections.

It’s evidently too much to ask Congress to show leadership on an issue that affects every American.   

For now, Democrats and Republicans have returned to their corners. But we’re likely to see more mischief making on the health law and more reasons to detest Washington.

© 2013 Marsha Mercer. All rights reserved.

30

A boomlet of Bush popularity -- April 25, 2013 column

By MARSHA MERCER

Americans are notoriously fickle. Three separate times while he was president, George W. Bush’s approval rating plummeted to 25 percent. This, of course, was the same president whose approval rating soared to 90 percent after the 9/11 attacks.

As Bush’s helicopter lifted off the U.S. Capitol grounds for his return to Texas after Barack Obama’s presidential inauguration in January 2009, the jubilant crowd sang-sneered:  “Nah, nah, nah, nah, hey, hey, goodbye!” At that point, only about one in three Americans approved of his performance as president.

Bush claims he never worries about polls or the judgment of history. When journalist Bob Woodward asked him in 2003 how history would judge the Iraq war, Bush declined to take the bait. “History. We don’t know. We’ll all be dead,” he said.

As they often do with polarizing politicians, people have mellowed toward Bush. Nearly half of adults now approve of the way he handled his job as president. While about three in four Democrats still disapprove, that’s down from the nine in 10 Democrats who disapproved in 2008 of the way he did his job.

Bush’s approval rating overall equals Obama’s, the latest Washington Post-ABC News poll reported Tuesday.  Such are the power of silence and absence.

   

In our ego-driven world, the idea of someone stepping off the national stage more or less voluntarily has definite appeal. Even his critics admired the way Bush picked up his paint brushes and went about his new life in Dallas, refusing to be drawn into the political fray.

He didn’t respond when Barack Obama and other Democrats blamed him for the mess he left. He skipped the 2008 Republican National Convention to stay in Washington after Hurricane Gustav, showing he did learn something from the disastrously slow response to Katrina. He declined an invitation to join Obama at Ground Zero after Osama bin Laden was killed in 2011. Bush also stayed away from the Republican National Convention last year.

The 43^rd president, in interviews surrounding the dedication Thursday of his presidential library, began to give his side of his eight White House years. For example, he vigorously defended the Medicare prescription drug benefit he expanded, despite Republican criticism that it was too big and costly.

“We were modernizing an antiquated system” already in place, he told the Dallas Morning News.

He regrets being unable to get an immigration bill through Congress, and he called for a “benevolent spirit” in the debate.

His brand of “compassionate conservatism” may yet get a second look from his party. After losing the popular vote in five of the last six presidential elections, the Republican National Committee finally conceded that the perception that the GOP doesn’t care hurts Republican candidates. Imagine that. 

It’s worth remembering how Bush cast his compassionate conservatism. “Big government is not the answer. But the alternative to bureaucracy is not indifference,” he said in 2000. “We will give low-income Americans tax credits to buy the private health insurance they need and deserve,” he said.

Democrats typically denounced Bush’s compassion as phony, and conservatives saw his conservatism as squishy. Interestingly, tax credits are what the Affordable Care Act – Obamacare – will give low-income people in January to buy health insurance through exchanges.

   

House Republicans have voted repeatedly to repeal Obamacare. This week House Majority Leader Eric Cantor, R-Va., tried a different approach. The felicitously titled “Helping Sick Americans Now Act” would redirect $300 million from the health law’s Prevention and Public Health Fund to a temporary health insurance fund for people with pre-existing medical conditions.

   

The idea was to show that while they hate Obamacare, Republicans do care about the sick. Not so fast.

Democrats opposed the measure for draining the public health fund, and the White House threatened a veto. But it was the ire of GOP conservatives that forced Cantor to pull the bill before a floor vote. Tea party Republicans and other conservatives refused to vote for anything short of repealing Obamacare.

Cantor says he isn’t giving up. Can he win the compassion argument among Republicans that Bush could not? Stay tuned.

   

 © 2013 Marsha Mercer. All rights reserved.

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Why House GOP is wrong on Obamacare -- March 21, 2013 column

By MARSHA MERCER

Mitt Romney promised during his presidential campaign to repeal the health law on his first day in office. 

Big mistake, he says now.  

“I think Obamacare attractiveness…was something we underestimated, particularly among lower incomes,” Romney said in an interview March 3 on “Fox News Sunday,” adding, “Obamacare was very attractive, particularly to those without health insurance.”

Leaving aside the reference to people as “lower incomes,” this is like Romney’s saying he underestimated how attractive food is to someone who’s starving.

A hungry person chooses a meal over a sermon on the virtues of eating less. Who knew?

And yet it didn’t dawn on Romney until too late that when 49 million people are uninsured, that’s a lot of votes for someone else who’s trying to make their lives better. President Barack Obama got 65 million votes last November.

If the enlightened Romney was trying to warn Republicans to back off their war on Obamacare, it didn’t work. House Republicans are in denial about the Affordable Care Act – even though the Supreme Court upheld it, Obama got four more years and the Senate stayed in Democratic hands.

House Republicans keep fighting. They may be encouraged by the tepid approval that Americans have in polls for the Affordable Care Act.

When President Obama signed the health law March 23, 2010, in a festive White House ceremony, 46 percent of people approved of the law and 40 percent disapproved, according to a Kaiser Family Foundation poll.

An optimistic Obama declared, “The bill I’m signing will set in motion reforms that generations of Americans have fought for and marched for and hungered to see.”

In fact, the signing set in motion non-stop barrage of opposition. 

House Speaker John Boehner called it a “somber” day for the American people, and House Republicans haven’t stopped bashing since.

Although Obama won the 2012 election, Republicans think they’re winning the marketing war. So, although they look foolish when they insist on voting year after year to repeal a law that has been upheld, they continue to tarnish the law. Yes, many of them support some of the law’s provisions.

Support of the health law nationally has dropped to 37 percent. Forty percent view the law unfavorably and the rest declined to answer, a poll by the Kaiser Family Foundation reported Wednesday.

The law was designed so that popular provisions went into effect first. It allows young people under 26 to stay on their parents’ insurance, abolishes lifetime caps on benefits, prohibits insurers from refusing to cover children with pre-existing conditions, provides free preventive services and begins closing the donut hole for seniors’ prescription drugs.

Health and Human Services Secretary Kathleen Sebelius says 3 million young people now have health insurance through their parents, 100,000 very sick people are receiving insurance through high-risk pools, and Medicare costs are actually dropping.

This is good news, but… Most people – 62 percent – haven’t seen any effects of the law, and only 17 percent say they’ve seen benefits like lower costs or greater access to care, according to Kaiser. A larger share, 22 percent, say they or their family have been negatively affected by higher costs or cuts in benefits.

And that’s a problem for Obama. With carrots first, people were supposed to accept sticks later. In January, mandates kick in requiring that individuals have health insurance and businesses with 50 full-time employees offer insurance -- or pay penalties.

Republicans now are trying to kill funding, just as the government is creating insurance marketplaces or exchanges where individuals and small businesses will shop for insurance.

With many details yet to be worked out, small-business owners worry. They want to help their employees, comply with the law and stay in business. Those goals should be compatible. 

Romney realized belatedly that the uninsured matter. It’s time Obama recognizes that small businesses matter. Senate Democrats need to make sure that the administration has the money to make the law a success.  

© 2013 Marsha Mercer. All rights reserved.

Supremely kicking the uninsured -- July 19, 2012 column

By MARSHA MERCER

When the U.S. Supreme Court upheld almost all the Affordable Care Act last month, analysts gushed that it was a stunning victory for President Barack Obama.

It’s becoming clear, though, that the court’s ruling on the Medicaid provision may be a bitter disappointment for low-income workers who are uninsured, especially in the South.

A central promise of the Affordable Care Act is that it will relieve the anxiety and financial insecurity of having to live without health insurance. Most of the uninsured have jobs or live in a household with someone who does, but their employers don’t offer health insurance, they aren’t eligible because they work part-time or they can’t afford the premiums.

Obamacare, as the law is known, provides carrots and sticks for people to obtain affordable health insurance. That’s where Medicaid, the nation’s largest health program in terms of participants, comes in. About 60 million Americans receive health care through Medicaid. About three-fourths are poor children and families and one fourth are elderly or disabled. Seven in 10 nursing home patients are on Medicaid.

The idea was to bring coverage to about 16 million more Americans by 2019 by adding a new category of Medicaid eligibility: adults without children who are under 65, not disabled, and whose income is near the poverty line.

The law presented states with an offer they couldn’t refuse: Expand Medicaid in 2014 to people whose incomes are within 138 percent of the federal poverty level -- $26,344 for a family of three in 2012 -- or forgo all existing federal Medicaid funding.

But Chief Justice John G. Roberts Jr., writing for the majority, said such “economic dragooning” left states no real choice but to participate in the expansion. The court struck down the funding restriction, and states now have the option of rejecting the expansion and sticking with their current Medicaid program without penalty.

Sadly, that means health coverage now depends on geography, with many low-income Americans who can’t afford insurance in limbo and at the whim of their governors.

So far, only a handful of governors will definitely implement the expansion. About a dozen governors, many in the South, have said they may or will reject expansion.Republicans Rick Perry of Texas and Rick Scott of Florida will reject. Those leaning against expansion include Alabama Gov. Robert Bentley and Virginia Gov. Robert F. McDonnell, both Republicans. Tennessee Gov. Bill Haslam, a Republican, is mulling whether to ask for a block grant to run his state’s program. A lump sum payment would come with fewer strings as to how the program operates.

The governors say their main worry is cost, and yet the federal government will pay for expanding Medicaid at first. Uncle Sam will pay 100 percent of the costs for new enrollees for the first three years. After that, states would begin sharing in the new costs, up to 10 percent.

Turn down free money? Highly unlikely, the Obama administration thought. Some veteran political watchers still predict balky states won’t turn down the money come the 2014 election cycle.

The court has left the decision up to each state at a time when the fiscal and political forecast is stormy. A new report on states’ fiscal health by respected economists predicted financial woes that will last long after the economy finally rebounds.

Complicating the matter is a provision in the health law that says those who don’t qualify for Medicaid will be able to get insurance through new marketplaces called exchanges. Those who can’t afford the premiums will be eligible for subsidies.

States are expected to set up the exchanges, but many states have been slow to get started. As with the Medicaid expansion, some may pass. If a state won’t set up an exchange for its residents, the federal government will step in. But there’s yet another catch.

The law says that the uninsured can get subsidies for premiums on state-run exchanges. It doesn’t say subsidies will be available for premiums on federally run exchanges.

That glitch too can be worked out – if there’s a will.

For now, millions of working Americans who lack insurance are still pawns on the great political chess board. And that’s a shame. We can and should do better.

© 2012 Marsha Mercer. All rights reserved.

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Scariest words in politics: If the court... -- May 17, 2012 column

By MARSHA MERCER

For a politician, nothing is worse than yanking away someone’s benefits in an election year.

It’s always easier to give than to take away, even if the budget is strained or the goodies are part of a health care reform law many Americans love to hate. It’s fine to hate a law as long as it’s in place, however tenuously.

With the Supreme Court expected to rule on the Affordable Care Act, known as Obamacare, by the end of June, the scariest word in politics is If.

If the court overturns the law, what then?

The court has many options, and the consequences are uncertain. It could blow up the entire law, although most analysts think not. It could scrap the “individual mandate,” which requires almost all Americans to have medical insurance by 2014 or pay a financial penalty, and leave the rest of the law intact. It could strike the mandate and other provisions as well. It could let the law stand, as is.

Americans by substantial margins say they favor repeal, mostly because of the hated mandate. No matter that only 7 percent of Americans actually would be required to buy insurance and 93 percent would be covered through employer-sponsored plans and other exemptions, according to a study the Urban Institute released in March. The idea that Congress can compel the purchase goes against some grains.

At the same time, people love allowing children under 26 to stay on their parents’ insurance plans, closing the “donut hole” that requires some seniors on Medicare to pay more for their medications, and ensuring that people with pre-existing medical conditions get coverage.

The White House’s official position is that the court will uphold the law, so it’s making no contingency plans. Congressional Republicans have managed so far to play to both sides.

The Republican majority in the House has voted 29 times to repeal the law, knowing that the votes are all theater because the Senate would never go along. The Republicans insist they intend to “replace” the law but never explain which provisions they’ll keep beyond the most popular, including children under 26.

How the court’s ruling may affect health care is anybody’s guess, but the politics are clear. Come November, no one running for office wants to explain to the parents of a jobless college grad that their son is going to lose his health insurance.

No politician wants to tell Grandma she has to dig a little deeper for her meds or that her grandchild with a pre-existing condition may lose coverage because insurance companies can again deny coverage.

No one wants to tell some 32 million people near the poverty line who were in line for coverage under Medicaid that they won’t be covered after all.

The court could leave all this up to Congress to sort out. And that would put House Speaker John Boehner in a ticklish spot, trying to win House seats while appeasing the Tea Party set.

News reports say Boehner is quietly making plans for the Republicans’ next step, post-Supreme Court. He told the House Republican Conference behind closed doors Wednesday, “When the court rules, we’ll be ready,” Politico reported, relying on tidbits gleaned from those in attendance.

“If all or part of the law is struck down, we are not going to repeat the Democrats’ mistakes,” Boehner told his party, according to Politico. “We have better ideas on health care – lots of them. We have solutions, of course, for patients with pre-existing conditions and other challenges.”

Really? Let us see the solutions.

Ah, but that was in private. A day later, for public consumption on his House speaker blog, Boehner declared, “Anything Short of Full ObamaCare Repeal is Unacceptable.”

Once the court rules, Boehner said, the House will “work on step-by-step, common-sense legislation that will help lower health care costs for families and small businesses, and protect American jobs.”

It was a familiar refrain. He didn’t say what any of those steps might be.

It’s spring, and politicians tremble for what may come this summer. If the court overturns…

© 2012 Marsha Mercer. All rights reserved.

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