A window for Obamacare -- April 11, 2019 column

By MARSHA MERCER

After nine years of fighting Obamacare, congressional Republicans and the White House have a new bogeyman.   

Look, over there, it’s a radical, socialist scheme! A nightmare that will ruin the economy! It’s Medicare for All!

When independent Sen. Bernie Sanders of Vermont Wednesday introduced his revamped proposal to transform Medicare into a universal health program, he said Americans want “a health care system that guarantees health care to all Americans as a right.”

But to White House Press Secretary Sarah Sanders, a “Self-proclaimed socialist . . . is proposing a total government takeover of healthcare that would actually hurt seniors, eliminate private health insurance for 180 million Americans, and cripple our economy and future generations with unprecedented debt.” 

The concept of Medicare for All is the latest danger du jour – and that, at last, opens a window for endangered Obamacare.

President Donald Trump has tried repeatedly to kill Obamacare by declaring it dead -- it isn’t – and Americans like it more than ever.

Fifty percent of adults surveyed last month had a favorable opinion of Obamacare while only 39 percent had an unfavorable opinion, the non-partisan Kaiser Family Foundation Health Tracking Poll reported. That’s up from 46 percent favorable in April 2010.

Similar results among registered voters came from a Morning Consult-Politico poll taken March 29 to April 1.

Without a viable plan to replace Obamacare, Senate GOP leaders have moved on to fear-mongering about Medicare for All.

“This radical scheme would be serious bad news for America’s hospital industry,” Majority Leader Mitch McConnell, R-Ky., told the American Hospital Association this week. “You should not be the guinea pigs in some far-left social experiment.”

Four Democratic presidential hopefuls have endorsed Sanders’ Medicare for All bill, but he has only 14 cosponsors this time, down from 16 last year, a sign Democrats are more wary.

People like the idea of Medicare for All, polls show, until they’re told they may pay higher taxes and wait longer for care.

House Speaker Nancy Pelosi wisely says Congress needs first to protect the Affordable Care Act – the official name for Obamacare -- before it considers any Medicare for All plan.

The requirement to buy insurance stuck in Americans’ craw, but several surviving provisions remain popular.

About 11.4 million Americans get their health insurance through the law, and 12 more million more are covered because of the law’s Medicaid expansion.

The law protects people with pre-existing conditions – about half the population under 65 – from being rejected for health insurance or paying higher insurance premiums.

Young people under 26 can stay on their parents’ health care plans. Seniors save money on preventive care and prescriptions. Caps limit how much patients must pay annually or in a lifetime.

Trump’s obsession with obliterating all things Obama means he can’t admit there’s anything worth saving in Obamacare. His Justice Department has joined a lawsuit seeking to invalidate the entire law.

A federal appeals court will hear arguments in early July, and the case could reach the Supreme Court before the election.  

Trump promises a better, cheaper health care plan to replace Obamacare by and by. Sometime. Eventually. After the election. 

Democrats believe health care helped them win back control of the House. Polls before last November’s elections on which party would do a better job on health care policy found Democrats with an 18-point advantage over Republicans.

Democrats need now not to overplay their hand. Several iterations of Medicare for All legislation are in Congress. A key sticking point is cost. Some analysts say Sanders’ proposal could cost upwards of $30 trillion over a decade.

Medicare for All excites the Democratic base, but if Democrats want more than a campaign talking point, they’ll need to work deliberately and collaboratively and study the intended -- and unintended -- consequences of universal health coverage.

Now is the time to shore up Obamacare. A group of Republican senators proposes, in case the courts do invalidate Obamacare, to preserve parts of the law, such as protecting people with pre-existing conditions.

Even in the run-up to an election, saving the best parts of Obamacare is a worthy goal for Democrats and Republicans.

©2019 Marsha Mercer. All rights reserved.

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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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Congress fiddles while doc shortage looms -- March 5, 2015 column

By MARSHA MERCER

You’re not the only one getting older. Take a look at your doctor.

One in 10 active physicians is between the ages of 65 and 75 – retirement age. More than a quarter is 55 to 64 -- likely to retire within the decade.

The graying of our doctors and ourselves is part of the larger problem of access to health care. The goal of the Affordable Care Act, or Obamacare, is to help everyone get insurance. Then what?   

If you have health insurance through your employer or a public program such as Medicare, Medicaid or the Veterans Administration – as nearly 85 percent of us do -- access depends on when you can see your doctor. That can be days, weeks or even months.

Seeing a doctor likely will get only more difficult, unless Congress acts. And even that won’t solve the problem.

By 2025, the nation will be short 46,000 to 90,000 physicians overall, the Association of American Medical Colleges warned Tuesday in its latest study, “The Complexities of Physician Supply and Demand: Projections from 2013 to 2025.”

The study, which based its findings on demographic trends and changes in health care delivery and payment policies, projected a shortage of 12,000 to 31,000 primary care physicians and 28,000 to 63,000 specialists, notably surgeons of various types.

“The doctor shortage is real – it’s significant – and it’s particularly serious for the kind of medical care that our aging population is going to need,” said Dr. Darrell G. Kirch, the association’s president and CEO, in releasing the report. The association represents 158 medical schools, 400 teaching hospitals and 51 Veterans Administration medical centers.

The physician shortage showed up last summer at VA facilities with delays in care, Kirch told reporters. He noted that the over-65 population in the United States is projected to grow 46 percent by 2025.

Older, sicker people need more medical care, but physicians already say they’re overworked. In a survey last year, 81 percent described themselves as over-extended or at full capacity, and only 19 percent said they had time to see more patients.

Forty-four percent planned to cut back on patients seen, work part time, close their practices to new patients or retire, the 2014 Physicians Foundation nationwide survey found.

By the way, if you’re inclined to blame the influx of newly insured people through Obamacare, don’t. Even though an estimated 26 million people eventually will have insurance or other health care coverage through the law, those patients now are projected to increase the demand for physician services by only 2 percent or 16,000 to 17,000 doctors, the medical colleges’ report said.

Overall shortfall projections in the medical colleges’ study are smaller than those in 2010, when its study estimated a 130,600-physician shortfall. The lower shortfall numbers reflect such changes as more physicians completing their training and lower Census projections of the population, the new report said.

Medical groups want Congress to raise the cap on the number of medical residencies from about 29,000 a year to 32,000.That would cost about $1 billion every year through 2025, Dr. Janis M. Orlowski, chief health care officer of the medical colleges association, says. Medicare pays $40,000 of the $152,000 a year it costs to train a medical resident.

The cap was set “temporarily” in 1997; attempts to lift it have languished in Congress for years. Even if Congress does find $10 billion to boost the number of residents, though, other changes will be needed, experts agree.

An Institute of Medicine report last July said that the doc shortage is mostly geographical; many doctors train in New Jersey, New York and Massachusetts – and stay there to practice. Plus, a reallocation between primary care and specialist residency slots is needed.

A bright spot is the rapid growth in the number of advanced practice nurses and nurse practitioners and their increased role in delivering care. But, says the medical colleges’ report, “even in these scenarios, physician shortages are projected to persist.”

Here’s a problem Republicans and Democrats in Congress should tackle together – and soon. They’re not getting any younger either.

©2015 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.

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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.

This August, tell Congress what you think -- Aug. 1, 2013 column

By MARSHA MERCER

With Congress on a five-week vacation, it’s your chance to give your House member and senators a piece of your mind.

An old-fashioned town hall meeting is probably coming your way. Yes, tweeting is faster, but getting in a lawmaker’s face? Priceless.

When Rep. Robert Goodlatte, R-Va., sponsored a town hall meeting in Lynchburg last month, the last person to stand and speak was Dulce Elias, 16, whose parents brought her to the United States when she was 3.

“I love it here. This is my country. I want to keep on pursuing my education and I want to serve my country. But I can’t because I am undocumented,” Elias said, choking up, the News & Advance reported. 

Please, she implored Goodlatte, help the children whose parents brought them here and have done nothing wrong.

Goodlatte, the powerful chairman of the House Judiciary Committee, strongly opposes immigration reform until the borders are secure and enforcement is tightened. He’s no fan of citizenship for all 11 million undocumented individuals, but he said he would look into the issue.

“Maybe for someone like you, it could include a pathway for citizenship,” he said.

In 2009, tea party activists hijacked town hall meetings and turned them into shouting matches over health care reform and federal spending. In 2010, many Democratic members of Congress skipped town halls to avoid a scene with constituents. Nobody loves being yelled at. This year, though, Democrats say they won’t cede the field and intend to talk about immigration reform. Republicans want to focus on, what else, the evils of “Obamacare” and big government.   

The Senate passed a bipartisan immigration bill June 27 that includes a path for citizenship for 11 million undocumented immigrants. The Republican House leadership rejects that comprehensive approach and may vote on several separate bills this fall.   

Progressives will use the summer recess to pressure the GOP. Rep. Xavier Becerra, D-Calif., had a warning for House members: “If you have a town hall or if you don’t, we’re going to find you in the grocery store because this is it. We’ve never been this close,” he said Tuesday in an interview with Bloomberg News.

Polls show public support for a path for citizenship, but House Republicans fear GOP challengers from the party’s anti-immigration wing. So Republicans in the House plan to focus on topics the party faithful can agree on.

To fight Obamacare, Heritage Action, an offshoot of the conservative Heritage Foundation, plans town hall meetings in nine cities between Aug. 19 and 29 -- Fayetteville, Ark.; Dallas, Tampa, Nashville, Birmingham, Ala., Indianapolis, Columbus, Ohio; Pittsburgh, and Wilmington, Del. – The idea is to kill the health care law by starvation.   

“We’ll make sure lawmakers understand the American people expect then to defund Obamacare in its entirety,” said Heritage’s Michael Needham.

Democrats have warned that trying to defund the health law will result in a government shutdown, and that could have disastrous consequences for the economy.

Responsible Republican members of Congress who want to keep the government open have a tough job going against the anti-government tide. Video snippets posted online of a town hall meeting Monday in Wetumpka, Ala., illustrate the problem.

Rep. Martha Roby, R-Ala., 37 and a second-term House member, met with skepticism from a tea party audience when she said shutting down the federal government was a bad idea.    

“If we shut the government down, I believe that’s exactly what Barack Obama wants us to do,” Roby said, explaining that Obama would win more seats in Congress in 2014, dooming Republican chances to repeal the health law.

“The last thing we need to do is to give this guy unfettered control for two years,” she said.

That wasn’t enough for a woman named Jody, who called Roby on the carpet for being too close to the “moderate elite establishment of the Republican Party, in particular John Boehner.” Roby tried to explain why being able to agree – and disagree -- with the House Speaker might be a good idea. No go.

Oh, the drama. I’m waiting for the reality TV folks to discover “Real Congress of Grassroots America.” Until then, check out a town hall meeting in a town or city near you this summer.

(Marsha Mercer writes from Washington. You may contact her at marsha.mercer@yahoo.com)

© 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.

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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.

Enough crust already -- it's time for Romney and Obama to roll out policy -- June 21, 2012 column

By MARSHA MERCER

Former Massachusetts Gov. Mitt Romney wrapped up a bus tour of rural America in Michigan, where he rolled out a crust for an Honest Abe cherry-apple pie. When it came to policy, though, the five-day trip offered only crumbs.

President Barack Obama flew to an international summit in Mexico that yielded moody photos of the president on the world stage along with reassuring words about progress – and little of substance.

To hear Romney talk, Obama is a job-killing big spender who wants to put America on the path to Europe. Obama contends that Romney wants to slash taxes for the wealthiest while cutting the jobs of teachers, firefighters and police. Fact checkers say both camps are stretching the truth.

For voters who are sick of the endless “trust me – not him” attacks -- and that’s most of us, right? -- there’s good news. The stars may be aligning to force Obama and Romney to show their policy hands.

The Supreme Court likely will issue blockbuster decisions this week on health care and immigration. If, as many analysts expect, the court strikes at least part of the Affordable Care Act, Obama will be called on to explain the next phase of his health reform strategy.

Publicly, the president says he believes the law will be upheld and has made no contingency plans. At fundraisers behind closed doors, however, he reportedly has said he won’t give up on reform. He needs to tell the rest of us his plans.

Romney promises to repeal “Obamacare” his first day in office, but he also promises to save the most popular parts of the law, such as parents’ insurance coverage for children up to age 26. Romney has been vague about whether he’ll ensure that people with pre-existing conditions are covered under his plan. He will be pressed on how his plan would work, absent the linchpin of the individual mandate, which requires everyone to purchase insurance, spreading the cost.

On immigration, Obama showed the power of the incumbency last week when he announced that his administration would stop deporting young people who were brought to this country illegally as children, if they meet certain conditions. Up to 1.4 million children and adults who are in the country illegally could benefit from the change, according to an analysis by the Pew Hispanic Center. Nearly two-thirds of likely voters support the change, a Bloomberg poll found.

Romney, who took a hard line during the primaries against illegal immigration, is heading for a kinder, more bipartisan stance. The immigration plan he sketched Thursday included more favorable treatment for “the best and brightest” immigrants and a path to citizenship for military veterans. Romney needs to say whether he would repeal Obama’s non-deportation rule.

Raising the stakes on immigration will be the Supreme Court’s decision on Arizona’s strict immigration law. The Obama administration challenged the 2010 law that requires police officers to ask for immigration papers if the officers believe individuals they’ve stopped are illegal immigrants. Other provisions make not carrying immigration papers and unauthorized work crimes.

Although Nov. 6 is nearly five months away, the calendar also prods Romney and Obama to focus on issues. Thirty-two states allow early voting, and the start dates vary. Voting begins in Iowa Sept. 27. That’s fewer than 100 days away.

Iowa is one of the swing states Obama won last time that Romney visited on his “Every Town Counts” bus tour. The Obama administration released a 32-page report touting its help for rural areas, and the Obama campaign promises an unprecedented ground game in the battleground state.

In a close election, analysts say, rural voters in a few swing states could determine who wins the White House, or Hispanic voters could, or African American or gay voters.

One thing does unite voters as we choose the next president, and that’s the need to look past clever slogans and symbols. Policy may not be as easy as pie, but it matters a lot more.

© 2012 Marsha Mercer. All rights reserved.

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