Tag: health care reform
Democrats Need To Put First Things First

Democrats Need To Put First Things First

The dichotomies of the current Democratic presidential race—revolution versus restoration, progressive versus moderate—now stand in the way of a rational assessment of what the party has to do to win, and what the times demand.

Democrats need what I’d call a “first-things-first” campaign: a campaign that emphasizes progressive responses to the historically urgent challenges we face and recognizes the difficulties—political, practical, and even philosophical—of trying to check off all at once every item on the progressive wish list.

What are those historically urgent problems? The climate emergency comes first. Candidates call it an “existential threat,” but they aren’t giving it the priority those words imply. In dealing with climate, unlike many other issues, time is of the essence: The more we delay decarbonization, the more costly and political difficult it becomes, until catastrophe will be unavoidable. The basic premise of a Green New Deal also makes political sense: Combine the task of decarbonization with an infrastructure plan that creates jobs and delivers other tangible benefits in transportation, clean water, renewable energy, and other areas.

A second imperative is to preserve democracy in the face of the threats posed by Donald Trump to constitutional norms and by Republican efforts to disenfranchise voters and rig government in their favor. That democracy agenda includes measures to protect voting rights and election security and to limit such measures as partisan gerrymandering and manipulation of the census. (Others have framed this as an “anti-corruption” first agenda.) Closely related, Democrats need to prevent the entrenchment of right-wing power in the judiciary. With one more term, Trump will consolidate control of the Supreme Court, likely turning a 5-4 into a 7-2 Court and enabling an emboldened conservative majority to undertake a wholesale assault on longstanding liberal precedents and principles.

Finally, Democrats need an economic-security agenda that reflects the generational changes in gender roles and family life and addresses the difficulties of young families in affording child care, housing, and other necessities.

There is no equivalence today between the political situations of the Republican and Democratic parties. Republicans are on the verge of consolidating power in ways that Democrats will find difficult to reverse for a long time to come. A second Trump term will give Republicans that long-term advantage. Unlike Democrats, they don’t need legislative majorities in both houses of Congress to accomplish what are essentially negative objectives—stopping Democratic initiatives, declaring liberal policies unconstitutional.

But while one more term for Trump will entrench right-wing power, Democrats are unlikely to make comparable gains from winning the presidency in 2020. They can stop Trump, but they can’t move things as far to the left as Republicans can move them to the right. Unlike Republicans, Democrats do need legislative majorities to accomplish their aims, but there is no chance they will have sufficient majorities in 2021 to enact an across-the-board, New Deal–style agenda.

Here’s the ugly reality. The Senate overrepresents predominantly white, rural states. If Democrats somehow win a Senate majority in 2020, they will win it only by a few votes and depend on the likes of Joe Manchin of West Virginia and other moderates to pass legislation. The House also presents problems. The Democrats won control in 2018 only because of the seats that moderates picked up in affluent suburban districts, and they need to hold those seats in 2020.

It’s not just Congress that looms as an obstacle. Even if Democrats could pass radical legislation, it would be in danger of being struck down by the conservative majority on the Supreme Court.

The historical moment demands bold measures, for sure. A “restoration” is not what we need. I am no fan of “moderation”; I don’t warm to pleas for the middle ground. But, given the political constraints, Democrats have to weigh priorities. While they need to energize their supporters, they also need to persuade skeptics that they’ve got a grip on reality. They have to decide what needs doing now and what can get done now.

In other words, they need to put first things first.

So let me come to the big thing that shouldn’t come first—a comprehensive, single-payer health plan, the kind that goes by the misleading name “Medicare for All” (misleading because it is so radically different from the existing Medicare program).

A Sanders-style single-payer plan doesn’t just pose political problems because it would take away private insurance from people who don’t trust government to replace it. A single-payer plan also requires raising more than $1 trillion in revenue, about as much as is collected through the personal income tax today. There isn’t a snowball’s chance in hell that Democrats are going to be able to enact those taxes.

Moreover—and here’s the key point from the first-things-first standpoint—raising all that revenue to replace private health insurance premiums and out-of-pocket payments would make it impossible to do anything else.

The last two Democratic presidents spent their political capital on health care in their first two years. Bill Clinton failed and Barack Obama succeeded in passing health legislation, but they both lost control of Congress at the first midterm election. Democrats can’t afford to do that again; they need to build power over time, not lose it at the first opportunity.

That’s not to say that Democrats should avoid health-care reform. Attacking the prices of drugs and health care should be part of an economic-security agenda. They ought to try to make Medicare available as an option at age 50 for people otherwise uninsured. What they shouldn’t do is get caught up in another effort to overhaul the health system that will swallow up their entire agenda.

Democrats don’t just need to win in 2020; they need a successful presidency. If they wage a focused, first-things-first campaign, they have a shot at succeeding, building on that success, and earning the necessary support to move on to other progressive aims. They need to show they are a party ready to govern.

Polls: Americans Like SCOTUS’ Obamacare Ruling — But Opponents Are Stubborn

Polls: Americans Like SCOTUS’ Obamacare Ruling — But Opponents Are Stubborn

Two new polls show that Americans overwhelmingly approve of the Supreme Court’s decisive ruling last week on the Affordable Care Act.

The court ruled 6-3 in King v. Burwell that the federal government can continue to provide subsidies to help pay for insurance policies in states where it (rather than the states) has set up the exchange marketplace. The case could possibly be the last significant legal challenge to President Obama’s signature health care law.

The Kaiser Family Foundation poll released Wednesday found that 62 percent of Americans approve of this decision, against only 32 percent of respondents who disapproved.

In addition, a CNN poll released Tuesday found that Americans favored the ruling by a similar margin, with 63 percent in favor versus only 34 percent against it.

At the same time, the Kaiser poll also found that those who disapprove of the decision largely remain set in their views even if it is explained that the decision will help people. For those 32 percent who disapproved, a follow-up question was asked:

What if you heard that as a result of the decision, more than 6 million people in states using the federal marketplace will keep the financial help they have been getting to pay for health insurance? Would you still say you disapprove of the Court’s decision or would you now say you approve?

The result: Out of those 32 percent, only 4 percentage points switch to approve of the decision, 25 percent still disapprove, and the remainder are undecided.

And remember: Those 25 percent who still disapprove of universal access to health insurance will likely make up a large share of Republican primary voters.

Photo: SEIU International via Flickr

Obamacare’s Projected Costs Continue To Tumble, CBO Report Says

Obamacare’s Projected Costs Continue To Tumble, CBO Report Says

By Lisa Mascaro, Tribune Washington Bureau (TNS)

WASHINGTON — Five years after Obamacare became law, the projected costs continue to tumble, according to a nonpartisan report released Monday.

Costs of providing health care under the Affordable Care Act are projected to be almost one-third less than what had been anticipated by the Congressional Budget Office in 2010. By 2019, the costs are expected to be 33 percent less than forecast.

Continued reductions in private insurance premiums are largely responsible for the decline, the CBO said, along with a slight reduction — to 24 million, down 1 million — in the number of Americans projected to gain insurance under the program.

“The slower growth has been sufficiently broad and persistent,” the congressional agency said.

The CBO issued its revised outlook, as it typically does, during budget season in Washington.

Even since the last round of budget office estimates in January, the projected ten-year cost of providing health care under the Affordable Care Act has fallen 11 percent, from $1.3 trillion to $1.2 trillion, the CBO said. The projected cost of providing subsidies over the next decade to those who purchase insurance through Obamacare is now expected to be 20 percent lower than estimated in January.

The improving assessment comes as the embattled health care law is before the Supreme Court and continues to face partisan attacks in Congress.

The court is expected to decide this summer whether to allow a key provision of the law — which lets the government provide subsidies for lower-income Americans who buy insurance through the online Obamacare exchanges — to stand in all states, even those that have not set up their own marketplaces.

In Congress, Republicans are continuing efforts to repeal the law and have recently proposed various alternatives should the court dismantle Obamacare, though none has gained widespread political traction yet on Capitol Hill.

AFP Photo/Joe Raedle

Justice Who Once Tried To Kill Obamacare Now Potential Savior

Justice Who Once Tried To Kill Obamacare Now Potential Savior

By Greg Stohr, Bloomberg News (TNS)

WASHINGTON — U.S. Supreme Court Justice Anthony Kennedy voted to strike down Obamacare three years ago. Now, he could be the law’s savior.

Kennedy on Wednesday emerged as a pivotal vote as the court weighed whether to strip more than 7 million Americans of the federal subsidies that helped them buy health insurance.

At several points during the hearing, Kennedy said the challengers’ reading of the 2010 statute could violate states’ rights by coercing them to set up insurance marketplaces.

“There’s a serious constitutional problem if we adopt your argument,” he told the lawyer challenging the tax credits.

Kennedy’s questions suggested he was at least a potential fifth vote to back the administration’s argument that the law, President Barack Obama’s signature legislative achievement, provides the credits to purchasers in all 50 states.

“He’s definitely the justice who’s in play,” said Cory Andrews, a lawyer with the Washington Legal Foundation, which backs the challenge against Obamacare.

The nine-member court’s four Democratic appointees all indicated they agreed with the administration. Chief Justice John Roberts, who cast the decisive vote to uphold the law against a constitutional challenge in 2012, asked only a handful of questions.

The fight turns on a four-word phrase in the Affordable Care Act. The measure says people qualify for tax credits when they obtain insurance on an exchange “established by the state.”

Four Virginians say those words limit the credits to the 16 states that have set up their own online marketplaces, known as exchanges, for people to buy insurance. The other 34 states, mostly Republican-controlled, declined to do so and left the job to the federal government.

The Obama administration is urging the court to look beyond those four words to the rest of the act and its broad purpose of providing coverage to tens of millions of uninsured Americans.

Kennedy suggested several times that the challengers’ reading of the law was the more natural one. “Perhaps you will prevail on the plain words of the statute,” he told Michael Carvin, the lawyer representing the challengers.

The problem for Kennedy stemmed from what that interpretation would mean. The administration says eliminating tax subsidies would render insurance unaffordable for millions of people, leaving only the sickest and most desperate in the market and sending rates surging upward.

“If your argument is accepted, the states are being told either create your own exchange, or we’ll send your insurance market into a death spiral,” Kennedy said to Carvin.

The possible solution: interpreting the law as the administration advocates so that states wouldn’t be pressured into setting up their own exchanges.

Kennedy, 78, mentioned the legal doctrine of “constitutional avoidance.” Under that approach, the court tries to interpret statutes so as not to render them unconstitutional.

“I was encouraged by the questioning,” said Elizabeth Wydra, a lawyer with the Constitutional Accountability Center, which backs the administration in the case. It showed that Kennedy “appreciates the disastrous consequences that result from the challengers’ interpretation of the law.”

Kennedy, a 1988 appointee of Republican President Ronald Reagan who is often the court’s swing vote, also indicated he understood the burden that approach would impose on the states, Wydra said.

“Taking him at his word, he was saying that the court needs to think long and hard about the legal doctrine known as constitutional avoidance,” she said.

Some lawyers said a ruling along the lines suggested by Kennedy would require a major shift in the court’s approach toward states’ rights.

“To say it’s a serious constitutional problem is to suggest that prior laws that the Supreme Court has upheld against constitutional challenge are in fact constitutionally problematic,” said Jonathan Adler, a law professor at Case Western Reserve University in Cleveland who was one of the first to make the case against nationwide subsidies.

Kennedy himself made clear he wasn’t sold on one prong of the administration’s argument, concerning the Internal Revenue Service. The government says the court should defer to the IRS view that the tax credits apply nationwide.

“It seems to me a drastic step for us to say that the Department of Internal Revenue and its director can make this call one way or the other when there are, what, billions of dollars of subsidies involved here?” Kennedy said.

Even so, the thrust of Kennedy’s questions opened up a new path for the administration to win the case and preserve the law.

“He is the big question mark,” Andrews said. “That’s the big takeaway from today.”
With assistance from David McLaughlin in Washington.

Photo: Steve Rhodes via Flickr