Exchange Politics – It’s Personal

The latest Republican strategy – cutting off your nose to spite your face.

No, this is not about plastic surgery.

The phrase refers to one who attempts to do harm to another, but in so doing harms themselves

Yep, we are talking about health reform.

The Affordable Care Act as Republican policy

President Obama has rebutted criticism that his health care reform was too radical by arguing that it is modeled after successful legislation that became law in Massachusetts under then Republican Governor, Mitt Romney – and that was based on ideas originally proposed by the Heritage Foundation.

From the perspective of the ivory tower of the Heritage Foundation, or from the myopic world of Republican health care policy, there may actually be some arguable distinction.

But from the perspective of real health care reform, say single payer, it is a distinction without a difference.

The only thing that separates Obama’s Affordable Care Act from Mitt Romney’s Massachusetts imitative is the political affiliation of its author.

As soon as Obama and the Democrats signed on, Romney signed off.

The Affordable Care Act as Democratic policy

But Romney wasn’t the only one to turn and run from an idea they once embraced.

Tim Pawlenty, a Republican contender for president briefly, thought Mitt Romney was on to something in 2006, the year of the Massachusetts healthcare reform law.

He expressed openness to the concept of the individual mandate and support for the idea that everyone should be in a health care plan.

Likewise John Huntsman was an eager proponent of health reform measures that would expand coverage.  He openly supported the individual mandate until it was obviously going nowhere in Utah.  He settled for a more modest version of the insurance exchange concept that distinguished Romney’s legislation.  Utah and Massachusetts are the only working models for the other states trying to implement health care exchanges.

The pickle

Three of the current field of Republican candidates endorsed in some way, the concepts central to what is now derisively referred to as Obamacare – individual responsibility, make the markets work better, allow for profit insurance companies.  Don’t they sound like concepts that are more likely to come from the Republican side of the aisle?

But they have the name of the current President associated with them and for that reason, Republicans will not allow them to succeed.  It’s personal, you see.

State Exchanges

Take the state health insurance exchanges.  Another idea that is more likely to be associated with Republicans than Democrats – allow each state flexibility in setting up their own exchanges.  But if they don’t create their own exchanges, the federal government will do it for them.

This seems to put some Republican governors in a rather curious pickle.  If they do create an exchange for their own state, they would be adopting values traditionally associated with Republicans:  individual responsibility, the growth of a new market for insurance companies, local autonomy.  The alternative is generally not attractive to Republicans – let the federal government do it.

But there is a catch.  It is a catch that some Republican governors just cannot bring themselves to overcome.  By consenting to the creation of their own exchange they would be acquiescing to the will of President Obama.

It’s personal, you see.

Kansas Governor, Sam Brownback (R) turned down federal seed money to start its exchange.  He piously asserts that, given pressure on the federal government to reduce expenditures, states should not rely on the feds in setting up their own exchanges.  But the absence of federal funds has halted Kansas’ progress to create its own exchange, which may prompt a federal takeover.

Oklahoma Governor, Mary Fallin (R), turned down federal money to help it build its own exchange.  Sounds noble enough.  They want to do it themselves.  Or do they?  According to the Governor, she was “pleased to announce this agreement that accomplishes my goal from the very beginning: Stopping the implementation of the President’s federal health care exchange in Oklahoma.”

Florida Governor Rick Scott (R), has declined federal funds to set up an exchange in Florida, an exchange the state has yet to authorize.  Remember Rick Scott? – the guy who made his money as the head of a for profit hospital chain that pleaded guilty to defrauding the federal government and paid almost $2 billion dollars in settlements.

Texas Governor, Rick Perry, (R), presiding over the state with one of the highest rates on uninsured residents,  has vowed to oppose any effort to create an exchange in Texas as long as the legal questions around the Affordable Care Act are unresolved.  That does not mean he cannot accept the grant money handed out by the feds to create the non-existent exchange, not to mention $60 million in Early Retiree Reinsurance program grants – also a part of the Affordable Care Act.

Louisiana Governor Bobby Jindal (R), has also refused to set health care insurance exchange in his state because it would advance Obamacare regulations.

It’s personal, you see.

It doesn’t have to be rational.

Photo Credit:     FLICKR  Sara_Mc

Romney Stands by Massachusetts Health Care Reform

Mitt Romney not backing away from the health care reform law that he pushed forward in Massachusetts.

In a speech he delivered in Ann Arbor, Michigan, the state where his father had been governor, the presidential aspirant went on to say that what was right for Massachusetts is not necessarily right for the rest of the country.

He then proceeded to trot out the tired Republican formulas for health care reform:  block grants to states, selling insurance across state borders, medical liability reform, and shifting more costs onto individuals.

I would have offered a different response for Mr. Romney.

The federal law on employee benefits, ERISA, ties the hands of states who want to expand health care coverage.  It’s called the ERISA preemption.  We came up with a solution that ducks the federal preemption.  It works in Massachusetts because Massachusetts has a high rate of unionization, a high rate of income and a very low rate of uninsured.  That is not a solution that could work in states like Texas or Mississippi that have none of those. Continue reading

Support for Single Payer in MA and VT

Some recent bright spots did shine through among the depressing election results this past week.

In Massachusetts, voters and docs expressed support for a single payer solution to the continuing health care crisis.

Fall in New England

Fall in New England

Massachusetts is the state that gave us the Connector – the model for the Affordable Care Act that is now the target of the anti-incumbent horde that is invading Washington DC.

I have noted here before that the Massachusetts model might have been an acceptable state model given the restrictions that federal law imposes on the ability of states to be truly innovative with health care reform.

An individual mandate might even work in a state with a high level of income and a low rate of uninsured. Continue reading

Single payer ballot questions pass in all fourteen Massachusetts districts! – PNHP’s Official Blog

 By Benjamin Day

Massachusetts voters have, for the second straight election, overwhelmingly affirmed their support for single payer health reform by turning in majority ‘Yes’ votes in all fourteen districts where local single payer ballot questions appeared on November 2. The ballots spanned 80 different cities and towns in a state of 351 municipalities, winning in every city and town reporting results so far except two. Five of the districts backing single payer reform voted for Scott Brown in last year’s special senate election, which was largely seen as a referendum on national health reform, showing that the goal of improved and expanded Medicare for All is supported by a diverse range of communities across the state.

Single payer ballot questions pass in all fourteen Massachusetts districts! – PNHP’s Official Blog

Mass Makes Mess for Dems and Health Care Reform

Dear President Obama

You seem to think that the reason the Dems did not do well in Massachusetts has to do with jobs. Maybe, but not quite.

image006 snake and bird
It’s about how you don’t get it.  And the people in Massachusetts see that in the way you have handled health care.

Now look at the mess you created.  Your health insurance program is at risk.  The Supreme Court just handed your opponents a blank check and the likelihood of changing that court now is very much in question.

Massachusetts was a bad model for reform

ERISA ties the hands and the feet of state governments that want to solve their uninsurance problem.  The Commonwealth of Massachusetts came up with one of very few ideas left over to them.  If it works at all in Massachusetts, and people will argue that, it is because Massachusetts is a relatively high-income state with relatively few people uninsured.

To try and apply that model to states like Louisiana, Texas, or Nebraska is misguided at best.  To be blackmailed by the likes of Sen. Ben Nelson (D-NE) is insulting.  To ask the people of Massachusetts to pay for it?  Oops. Continue reading