Tag Archives: Affordable Care Act (ACA)

Healthcare and Taxes May Prove How Big a Political Issue Taking Things Away May Become

Pamphlets advertising for the Affordable Care Act are seen at Sunshine Life and Health Advisors store setup in the Mall of Americas on November 1, 2017 in Miami, FL. Photo by Joe Raedle/Getty Images

Indianapolis  There’s a funny thing that happened to the Republicans as they tried to take away the healthcare guarantees embedded in the Affordable Care Act for all Americas: they made it more popular! The message they missed from citizens and voters is that they may have wanted improvements in the pricing, coverage, and general package, but they sure as heck didn’t want to do without the healthcare provided already in Obamacare.

Now after one ridiculous proposal after another the Republicans find themselves owning the problem, proving that you can’t beat a horse without a horse, and you certainly can’t beat a horse with a dead horse, which was the strategy they tried over the last year. A recent poll by the Wall Street Journal and NBC found that more than 50% of Americans would blame the Republicans for any rise in prices for health insurance and only 37% would fault the Democrats, according to records on their website. Voters in Maine, given the opportunity to expand Medicaid in their state after the governor had vetoed expansion proposals approved by the legislature four different times, overwhelmingly approved the measure. Other efforts to put the question on the ballot in 2018 are also now moving forward in other states that could drive voters to the polls to punish any opponents of health care protection.

When they failed to get healthcare off the table, the current administration strategy has been to starve it, especially when the enrollment period opened up for only six weeks between November 1st and December 15th. The allocations for recruitment and navigation were slashed to the bone. Other executive orders from the President attempted to cut subsidies and bleed it out with other cuts. How did the public respond? A record number, more than 600,000 people, have enrolled in the early days of enrollment, according to reports from the 39 states using the federal government’s marketplace.

There’s a powerful message in all of this, and it will dangerously imperil Republicans as they continually attempt to avoid it.

The same phenomena is likely to be repeated in the wake of the Republican’s corporate-and-rich-welfare and assistance program, which they are trying to call tax reform. Majority Leader Mitch McConnell has already been forced to admit that some middle class families will pay more to help corporations and the rich, rather than receiving a break. The Senate has already backed away from some of the House takeaways like for medical deductions and certain interest deductions. None of them had the stomach to outright deny mortgage interest deductions, but even a proposal to cap them for the rich has kicked a hornet’s nest. There is a big battle coming around the efforts to deny deductions from federal income taxes for the amounts paid in state and local taxes, with many high tax, Democratic states seeing these efforts as pure political punishment. There are other issues around childcare credits. The list is endless, and each battle prolongs the war, and it’s a war the Republicans are challenged to win. In a long game it’s hard to sell a bait-and-switch claim that this is all about the middle class when in fact the middle class loses more and more each time they look at the details, while the rich and corporations make out like bandits. Add in the current scandal of the Paradise Papers revealing how the rich, corporations, and deep pocketed institutions are avoiding taxes, because they can afford to find the loopholes to the tune of hundreds of billions, while the public is being played for suckers, and where can the Republicans find to hide from the voters?

Heck, they don’t even have the votes tight within their own caucus, so they may be saved from another disaster still by a principled few in their crew among true fiscal conservatives and even fewer moderates, but as health care is demonstrating, people are watching, and increasingly it seems there will be an accounting.


When National Healthcare is Not Mean, but Vindictive, Not Policy, but Politics

New Orleans  Healthcare is a huge part of the overall US economy and, arguably, of critical importance to every American. Regardless of the cliché, it is in fact a question of life and death. Yet we are watching a horror show spectacle of a White House that is clueless about anything but whether or not it can claim a “win,” and a Congress that is cunning and calculating without any field of vision that can see past 2018 and the midterm elections.

Meanwhile the public is treated to media coverage that, rather than focusing on the complexity of the bill and its evisceration of any semblance of public policy, treats the whole affair as if this were an extra innings baseball game and the only real issue was whether or not Majority Leader Mitch McConnell can get enough votes to pass the Senate version before the totally arbitrary deadline of July 4th. Well, perhaps not totally arbitrary, since McConnell is worried that when his caucus goes home for the recess their constituents will kick their asses so badly his whole secret legislative architecture will collapse.

Remember Kellyanne Conway, so discredited as a Trump aide that we’ve been spared her doublespeak recently. Well, she was back on this bill with the outrageous claim that no one can support, that, oh, no, there are no cuts to Medicaid in the Senate bill, which everyone knows is wrong. Good try, Kellyanne, now go hide out again, because this time there weren’t even any headlines following such an outrageous claim.

How about we look at how the Senate went from mean to downright vindictive? Their bill restored funding for what is known as “disproportionate share” money to hospitals. Pay attention in class now, friends, this is important. In places like Louisiana where I live we know a bit about “disproportionate share” payments because in their heyday they figured so prominently in statewide political scandals. Ever popular, former multi-term Governor Edwin Edwards did court and prison time on the issue of having unduly helped some friends get such money to build hospitals in poorly served and lower income areas of the state. Indeed, disproportionate share payments were designed to subsidize health care costs in lower income and ill-served areas originally in order to assure communities that these institutions could survive, because a “disproportionate share” of their patient base was poor. Obama’s Affordable Care Act flipped the script here. By assuring that everyone would have to get insurance and providing subsidies for lower income families and Medicaid expansion, disproportionate share payments would be phased out to pay for Obamacare. In fact now is the time when $43 billion would be reduced between 2018 and 2025.

What did the Senate do in their bill? They buckled to the lobbyists and restored these disproportionate share payments, but, now get this, only to states that had not expanded Medicaid coverage. This allows them to punish those states and their people by cutting the subsidies to Medicaid in their bill and rewarding the scofflaws by restoring the disproportionate share payments.

Now it’s politics that inflicts real pain and terrible consequences. Need a vote in Alaska or Maine, then sweeten the pot on opioid money even though states throughout the country are reeling under such a crisis. Take away support for mental health coverage, but throw some dollars out here and there to get a vote. Cutback money for the elderly poor on Medicaid, but kick the can down the road past 2018 so that you can keep the votes with a wink and a nod until the oldsters figure out the con.

None of this is good policy, and, frankly, I’ll be darned if I even understand how it is good politics, when all of these repeal bills are wildly unpopular in every poll of the American people. The public wants to live, not die, at the hands of government. Why isn’t that news everyone understands?