Health Care

Terrible Republican Idea Exposed as Even More Terrible

Flickr/adwriter
Yesterday, the Congressional Budget Office came out with a report assessing the budgetary impact of something many conservatives have supported, raising the Medicare eligibility age from 65 to 67. What they found was that the change would save far less money than had previously been assumed: only $19 billion over the next decade. The main reason is that many of the people no longer eligible for Medicare would be eligible for either Medicaid or insurance subsidies through the health exchanges, so the net effect on the federal budget would be small. But more important than that, this is an opportunity to remind ourselves that when government is doing something worthwhile, doing less of it isn't a good idea even if it saved a lot of money. And if cutting back only saves a modest amount of money, it's a really bad idea. You know what else would save a lot of money? Eliminating the United States Navy. But I'm guessing that most conservatives think having a navy is a good thing. Medicare is...

Kasich Goes Rogue on Medicaid

AP Images/Tony Dejak
AP Images/Tony Dejak W hen news broke Monday that Ohio would be the 25 th state to expand Medicaid, there were plenty of cheers on the left. After months of negotiations with lawmakers that repeatedly broke down, Republican Governor John Kasich, who has made the expansion a centerpiece of his agenda, decided to take a new tack. With the legislature out of session, Kasich, through his Medicaid director, requested a waiver from the federal government to expand the existing Medicaid program without the assembly’s approval. It was an unusual move. He got permission to spend the money from a small body, called the Controlling Board, composed of three lawmakers from the House and Senate, respectively, as well as a governor appointee. The board normally moves money between programs to adjust for shifts in spending throughout the year. This time, it approved $2.5 billion in federal funds to open up health care for nearly 300,000 Ohioans. Kasich has been one of the leading Republican voices...

No, Healthcare.gov's Problems Will Not Offer the GOP Political Deliverance

Some of the healthcare.gov contractors testifying today.
Today marks the beginning of what will surely be a series of hearings in Congress at which members will fulminate and shake their fists at various people who had responsibility for creating Healthcare.gov. It's quite something to see some congressman who's still struggling to figure out how to work the Blackberry his staff gave him asking questions about beta testing and error logs and a bunch of other stuff he doesn't begin to understand. But maybe the weirdest thing is the feeling one gets from the GOP over the last few days, which can be summarized as, "We got 'em now!" They seem to believe that the website problems are going to provide the deliverance they've been waiting for after the political disaster of the government shutdown. Here's a little prediction: Feigned Republican outrage over the ACA web site is going to be just as effective in reversing the GOP's current fortunes as feigned Republican outrage over Benghazi was in undoing Barack Obama's re-election bid. Nevertheless...

The Key to the Broffordable Care Act's Success

Flickr/CNDOZ
W hen Barack Obama made the decision to design a universal health care program based on the private insurance market, he faced one key problem. If you require insurance companies to accept anyone regardless of pre-existing conditions—as everyone wanted—you face the threat of "adverse selection," in which only those who are sick (and therefore expensive) get insurance. Just as the system of car insurance needs those who go long periods without having an accident to pay premiums so there's enough money to fix the cars of those who do have accidents, the health-insurance system needs the currently healthy to keep paying to support the currently sick. The answer was the individual mandate, which pulls people into the system and expands the risk pool. And especially critical to expanding that risk pool is getting as many young, healthy people as possible to get insured. So it may have been inevitable that young people would become targets for both the law's advocates and its opponents. A...

Popping the Pill's Bubble

AP Images/THE JONES INSTITUTE
A s the Affordable Care Act creaks into gear—and the Obama administration sends its armies of tech elves into the back end of the Healthcare.gov website to deal with the glitches—newly insured women can, for the first time, begin to start thinking about what kind of birth control they want , rather than what they can afford. Under Obamacare, all forms of female contraception will be offered without a co-pay to insured women as part of a larger package of preventive-care services. The logic behind the “contraception mandate” is so simple it’s hard to believe insurers didn’t come up with it themselves. If women can choose a form of birth control that works for them, without worrying about the cost, they’ll be less likely to get pregnant, saving insurance companies thousands of dollars in sonograms and prenatal vitamins. Obamacare has the potential to end the birth control pill’s dominance over the contraceptive market. More than 8 in 10 women will use a contraceptive pill at least once...

Before Long, We'll Forget about the Problems with Healthcare.gov

I'll confess that I was pretty surprised about the difficulties Healthcare.gov has been having. After all, despite all the complexities of creating this system, it wasn't exactly hard to foresee that the workability of the exchange website would be a very big deal. So you'd think that once a day or so for the last six months, the President would be calling the Secretary of Health and Human Services and saying, "This is going to go smooth as silk, right? Don't let me down, Kathleen." And she'd light a fire under everybody reporting to her to make damn well sure it did, so they wouldn't have to scramble like mad to fix a hundred problems once it had already launched. While the different things the site has to do certainly present technical challenges, they're hardly insurmountable. Now, you might just put it down to the fact that the whole thing was outsourced to private corporations, and we all know you can't trust the private sector to do anything without screwing it up (ha!). But...

Blurred Lines at the Border

AP Images/Matt Rourke
AP Images/Matt Rourke L ast year, during the height of the “religious freedom” fracas over the Affordable Care Act’s (ACA) contraception-coverage requirement, three Catholic laywomen made the church’s case to an audience at the Catholic Information Center (CIC) in downtown Washington, D.C. Housed in an unassuming bookstore on K Street and operated by the controversial Opus Dei order , the CIC claims to cater to the spiritual needs of Washington’s political elites with daily mass as well as lectures and panels featuring prominent conservative pundits and activists. The “Women for Freedom” panel aimed to teach lay Catholics to “convince rather than antagonize” the public about the church’s stances on divisive issues, and, in the words of one panelist, “share and show love.” “Our goal,” said Kim Daniels, then the head of the organization Catholic Voices and now the spokesperson for the president of the United States Conference of Catholic Bishops (USCCB), “is to make the church’s case in...

In Praise of Designer Babies

One day, I will rule this measly planet. (Flickr/paparutzi)
Imagine you knew that you carried a gene for a debilitating illness. But doctors could go into your egg (or your spouse's) and remove that gene, enabling you to have a baby who, whatever other problems they might encounter through their lifetime, wouldn't have to worry about the illness. Would you let them? Most people would say probably yes, provided they were sure the technique was safe and wouldn't produce some kind of two-headed mutant centaur baby. That, after all, is what people were worried about when the first baby conceived via in-vitro fertilization was born in 1978—although in that case, they were worried about cyclops babies ( seriously ). It turned out in the end that IVF is perfectly safe, and now it's a common procedure, the ethics of which is questioned only by radical anti-choice extremists. Well we may be approaching the time when doctors can fix certain kinds of inherited diseases before an egg is even fertilized. And naturally, people are worried about "designer...

No, Really, Blame John Roberts on Medicaid

The Prospect 's Paul Waldman has a terrific piece noting the terrible effects of states refusing the Medicaid expansion contained in the Affordable Care Act. Slate 's Matt Yglesias notes who should get the blame for this: John Roberts and the other conservative Republican justices who—in an unprecedented decision—ruled that making existing Medicaid money from the federal government contingent on accepting the expansion was unconstitutional. Kevin Drum of Mother Jones , however, argues that we shouldn't blame John Roberts because he was right : I think this is unfair. In fact, there were only two justices who upheld the Medicaid expansion (Ginsburg and Sotomayor). All the rest, including the liberals Breyer and Kagan, struck it down. So it wasn't even a close call. The vote against the Medicaid provision was 7-2. And as much as I dislike the result, I can't find a lot of fault with this. The basic holding was simple: given our federalist structure, states can't be forced to help fund...

The Big Donors Behind the Shutdown

The big donors behind the crisis in Washington are finally being called out by the mainstream media. Yesterday, the New York Times had a major investigative piece about how the Koch brothers and other major conservative donors pushed the Republican Party toward its current extreme strategy of trying to stop Obamacare. I have been saying the same thing for some time, citing the key role played by the Club for Growth in threatening House Republicans with electoral retaliation at primary time if they don't go all out on Obamacare. But the Times story breaks new ground by spelling out exactly how deep pocketed donors are using their clout with Republicans in Congress. These donors have made defunding Obamacare a litmus test and have directed intense fire, in the form of TV and Internet ads against Republicans seen as not falling in line behind this push. This stands in contrast to the usual narrative about the government shutdown, along with debt ceiling brinksmanship—which is that it's...

The Myth of Obamacare's Bad Sales Job

Flickr/Brent Moore
When they went forward with their plan to shut down the government in order to undo, defund, or otherwise undermine the Affordable Care Act (ACA), conservatives convinced themselves that their plan was going to work because Americans hate Obamacare. If you look at it in an extremely narrow, context-free way, that's sort of true. If you just ask people whether they approve of the ACA, you get between 35 percent and 45 percent approval. But the closer you look, the more complicated it gets. Some people disapprove of it because they feel it didn't go far enough; add them with those who say they approve, and you'll get a majority. Furthermore, and most critical for what I'd like to discuss, the actual components of the law, like giving people subsidies to buy insurance, outlawing denials for pre-existing conditions, and so on, are extremely popular (the one exception is the individual mandate). One thing's for sure, though: You can't say that the ACA as an abstract entity is...

The Cruelty of Republican States in One Chart

Click through for exciting full-size version.
Many people are talking today about this article in today's New York Times , which focuses on the particularly cruel doughnut hole created when the Supreme Court allowed states to opt out of the expansion of Medicaid in the Affordable Care Act. The problem is that if you live in a (mostly Southern) state run by Republicans, you have to be desperately poor to qualify for Medicaid under existing rules. But it isn't until you get to 133 percent of the poverty level ($31,321 in yearly income for a family of four) that you're eligible for subsidies to buy insurance on the exchanges, because when the law was written the idea was that everyone under that income would get Medicaid. When all those Southern states decided to refuse the Medicaid expansion in order to shake their fist at Barack Obama, they screwed over their own poor citizens. So millions of people will be caught in the middle: not poor enough to get Medicaid, but too poor to get subsidies on the exchanges. But when we say "not...

What Happens to Conservatism When the Obamacare War Is Over?

Flickr/Fibonacci Blue
When we look back decades from now, one of the keys to understanding this period in our political history will be the story of how a set of market-based health insurance reforms that started as a proposal from the Heritage Foundation and then were successfully implemented by a Republican governor who later became the GOP presidential nominee, ended up being viewed by virtually all conservatives as not just an abomination but the very essence of statist oppression. Liberals have often expressed wonder or exasperation about the way conservatives changed their opinions about this particular brand of reform. But now that it's driving a government shutdown (and soon a potential default on the debt), we have to acknowledge that it's more than just a policy conservatives hate. The Affordable Care Act is far, far bigger than that. It has become the most important definer of conservatism in America circa 2013. It isn't that conservatives don't still want to cut taxes for the wealthy, or slash...

Daddy's Home!

AP Images/Edmond Terakopian
AP Images/Edmond Terakopian M any mornings this year Matt Nuttall and his friend Ryan Faulkner met up in one of several neighborhood parks located between their houses in Pleasant Hill, California. While they changed diapers, dispensed snacks, and made sure their little ones didn’t fall off the playground equipment, the dads “talked to each other in adult,” as Nuttall puts it. Before too long, their children would begin to fade, and they’d head back to their respective houses to prepare lunch and oversee afternoon naps. “We didn’t do much, just sat around and kept the kids and ourselves from going crazy,” says Nuttall, who teaches ninth- and tenth-grade English at Sacred Heart Cathedral Preparatory in San Francisco. After his wife returned to her job, Nuttall took 12 weeks off from his. For half of that time, he received $945 a week through California’s Paid Family Leave program. The program, which has been in existence since 2004, offers workers up to six weeks off with maximum pay...

Obama's Opening Salvo In the War of Words

President Obama making a statement today.
Starting today, Americans are going to learn three things when they watch media coverage about the government shutdown. First, they'll see Republicans say that Obamacare totally sucks and everybody hates it, and also that President Obama is being super-mean by not giving them what they want. Second, they'll learn that their fellow citizens have a pox-on-both-their-houses view on this whole thing, because nothing says "journalism" like going out on the Mall or to the local diner and getting a few quotes from average folk saying, "They're all acting like children!" And third, they'll hear Barack Obama say that with their intransigence, Republicans are hurting regular Americans. And not just regular Americans generally, but actual, specific regular Americans. Many of these Americans will be seen standing patiently behind the President as he tells their stories. That's what he did today in his first post-shutdown statement, which combined a celebration of the opening of the health-care...

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