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Are Republicans afraid of taking on the health-care law?

I want to emphasize something that Nancy-Ann DeParle pointed out in our interview: The GOP isn’t banning discrimination based on pre-existing conditions. They just want you to think they are.

When I first read over the GOP’s “repeal-and-replace” language, I figured it wouldn’t work: You can’t ban preexisting conditions without also passing an individual mandate and subsidies for people who can’t afford care. Premiums will skyrocket as the sick rush into the system and the healthy rush out. This is partially what happened in Massachusetts, and it led a Republican governor named Mitt Romney to sign a bill that looked a lot like the Affordable Care Act. And you don’t have to believe me on this one. Just ask the National Review’s Ramesh Ponnuru.

But bad policy is one thing. Deceitful policy is another. And it looks like the GOP’s language was intentionally misleading. Under the heading “we will ensure access for people with pre-existing conditions,” the document mentions high-risk pools and reinsurance programs, and then says, “We will make it illegal for an insurance company to deny coverage to someone with prior coverage on the basis of a pre-existing condition, eliminate annual and lifetime spending caps, and prevent your insurer from dropping your coverage just because you got sick.”

On first read, that seems like they lifted the language direct from the Affordable Care Act. And Republicans have been using it all day to protect against charges that they’ll repeal the bill’s many popular parts. But notice: “to someone with prior coverage.” So it’s not the case that an insurer can’t turn me away for a long history of allergies. They just can’t turn me away if I already had their insurance. Which is both unimportant and already written into federal law.

Now, you might say the language is clear enough and it’s not their job to make sure everyone reads it closely. But when Norah O’Donnell interviewed Rep. William Thornberry, he either intentionally or unintentionally blurred the difference. Asked whether the GOP would repeal the Affordable Care Act’s protection for children with preexisting conditions, he waved the question away. “It says when we repeal Obamacare, part of the replacement is protection for people with pre-existing conditions,” he replied.

That’s just not true. But it shows the difficulty the GOP is going to have when they try to move the conversation from “should we pass Obama’s health-care bill?” to “should we repeal, replace, or stop funding Obama’s health-care law?” The bill is unpopular. But the component parts are popular. And even now, when Republicans have as much momentum as they’re likely to get, they’re afraid to say that they actually oppose what the bill does and they’re just going to get rid of all of it. But though these sorts of word games might work when people are skimming your campaign pamphlet, they don’t when you’re actually writing legislation.

By Ezra Klein  | September 23, 2010; 3:47 PM ET
Categories:  Health Reform  
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Next: Reconciliation

Comments

"You can’t ban preexisting conditions without also passing an individual mandate and subsidies for people who can’t afford care. Premiums will skyrocket as the sick rush into the system and the healthy rush out."

You lie!

The Democrats did exactly this in the individual children's health insurance market.

Posted by: krazen1211 | September 23, 2010 4:11 PM | Report abuse

The GOP "plan" should be called the "Pledge to Nowhere."

Posted by: JPRS | September 23, 2010 4:17 PM | Report abuse

"You lie! The Democrats did exactly this in the individual children's health insurance market."

Damn those Democrats for trying to give sick kids access to health care.

Posted by: Lomillialor | September 23, 2010 5:03 PM | Report abuse

Ezra, problem is who on Dem side is shouting 'this reality' with a megaphone? Anybody? They need these speakers and need to keep on talking all these points, but for some unexplained reasons Dems are simply not responding.

Posted by: umesh409 | September 23, 2010 5:11 PM | Report abuse

"Damn those Democrats for trying to give sick kids access to health care."

Damn them or don't damn them. Whatever.

But at least you're more honest than Ezra.

Don't lie and claim something cannot be done when it was just done.

Posted by: krazen1211 | September 23, 2010 5:14 PM | Report abuse

I might add also, that they tried and failed.

Insurers are fleeing the individual children's market.

Whoops. Hope and change!

The reason Democrats can't shout about this reality from a megaphone is because this reality stinks for most people.

Posted by: krazen1211 | September 23, 2010 5:16 PM | Report abuse

"Now, you might say the language is clear enough and it’s not their job to make sure everyone reads it closely."

Yes, as long as you don't literally lie, it's ok to intentionally horrendously mislead people in ways that grievously harm them.

Posted by: RichardHSerlin | September 23, 2010 5:22 PM | Report abuse

Here's a scenario - insurers flee the child insurance market - they all flee (similar to hurricane insurance in Florida). What happens the Government will offer the care, and will force hospitals to provide it for the cost that the government determines.

Sounds like a good outcome to me.

Posted by: ChicagoIndependant | September 23, 2010 5:29 PM | Report abuse

First off, don't believe the insurers fleeing the children's market crap. That was one story, and after decades of immoral rescissions and pre-existing conditions, I for one no longer believe a word that comes out of the insurance companies' mouths.

Second, the children's market is different than the adult market, because, and this is a shocker, children don't buy insurance! The kid is on his parent's insurance, which makes his insurance much easier and more accessible, and while some parents would play games with their kids healthcare, most won't. That kind of logic is sustainable for a short period of time, and, voila, the situation is written for only a short period of time.

It's not an open-and-shut case from a behavioral economics standpoint, but the flipside is that sick kids get healthcare, so I'll take it for four years.

Posted by: CarlosXL | September 23, 2010 5:35 PM | Report abuse

"Here's a scenario - insurers flee the child insurance market - they all flee (similar to hurricane insurance in Florida). What happens the Government will offer the care, and will force hospitals to provide it for the cost that the government determines."

Really? When did this all happen?

Posted by: krazen1211 | September 23, 2010 5:46 PM | Report abuse

"Here's a scenario - insurers flee the child insurance market - they all flee (similar to hurricane insurance in Florida). What happens the Government will offer the care, and will force hospitals to provide it for the cost that the government determines."

Really? When did this all happen?

Posted by: krazen1211 | September 23, 2010 5:47 PM | Report abuse

"First off, don't believe the insurers fleeing the children's market crap. That was one story, and after decades of immoral rescissions and pre-existing conditions, I for one no longer believe a word that comes out of the insurance companies' mouths.

Second, the children's market is different than the adult market, because, and this is a shocker, children don't buy insurance! The kid is on his parent's insurance, which makes his insurance much easier and more accessible, and while some parents would play games with their kids healthcare, most won't. That kind of logic is sustainable for a short period of time, and, voila, the situation is written for only a short period of time."

And yet, you believe lots of words that come out of Obama's mouth......


Anyway, you obviously do not understand the issue. The market in question is the INDIVIDUAL children's market; they are NOT on their parents' insurance.

Posted by: krazen1211 | September 23, 2010 5:48 PM | Report abuse

@krazen1211:

For starters, do you know the answers to the following questions:

1. When are insurers prohibited from varying premiums by an applicant's circumstances (whether they survived cancer a few years ago, whether they contracted HIV, whether they spent time in substance abuse counseling classes, etc.)?
2. When does the individual mandate go into effect?

If you can't answer these two questions, then you have no right to comment.

Posted by: moronjim | September 23, 2010 5:51 PM | Report abuse

"You can’t ban preexisting conditions without also passing an individual mandate and subsidies for people who can’t afford care."

Sure you can. For affordability, you can offer various levels of coverage including a no frills catastrophic coverage option. And instead of a mandate, you have an open enrollment period, after which you limit or exclude coverage for preexisting conditions.

Posted by: bgmma50 | September 23, 2010 5:52 PM | Report abuse

"Yes, as long as you don't literally lie, it's ok to intentionally horrendously mislead people in ways that grievously harm them."

You mean like claiming Obamacare would reduce costs for business and families? Yeah....

"The act will make health care more affordable for Americans," DeParle said.

But the head of the nonpartisan economic unit at Medicare that produced the original cost report says the White House number "does not provide a meaningful or accurate indication" of the effect of the health care law.

"The amounts quoted in the White House blog are not meaningful and cannot be used to calculate the change in health expenditures per insured person," Richard Foster, Medicare's chief actuary, told The Associated Press.

Posted by: krazen1211 | September 23, 2010 5:53 PM | Report abuse

Lord, Kraven -- I hope they pay you plenty to parrot the GOP's talking points to protect the rich.

Posted by: AZProgressive | September 23, 2010 5:57 PM | Report abuse

"Lord, Kraven -- I hope they pay you plenty to parrot the GOP's talking points to protect the rich,"

What?

Posted by: krazen1211 | September 23, 2010 6:03 PM | Report abuse

"1. When are insurers prohibited from varying premiums by an applicant's circumstances (whether they survived cancer a few years ago, whether they contracted HIV, whether they spent time in substance abuse counseling classes, etc.)?
2. When does the individual mandate go into effect?"


1. 2010, for these children in this market.
2. 2014

Prima facia evidence that the 2 don't have to go together, according to the Democrats.

Posted by: krazen1211 | September 23, 2010 6:10 PM | Report abuse

Patriots are so afraid of taking on the Obama/Pelosi health freedom takeover that they're suing in 14 different federal Courts.

Has anyone read page 11 of the Obama/Pelosi Regime's latest brief? You know -- the one where the Obama/Pelosi Regime argues that the Constitution permits the Regime to require "persons who already do buy Chevrolets (and invariably will continue to buy them) to finance the purchase through a means that will minimize the economic burdens on others."
And then goes on to say that health care is a privilege and not a right -- that the federal government has the absolute authority to determine what health care an individual receives. [See p. 11 of the Regime's reply brief dated 22-Sep-2010, available via the federal court PACER system (https://ecf.vawd.uscourts.gov/cgi-bin/login.pl).]

You know you want a Chevy! You know you want ObamaCare! And, most of all, you know you want anything that any future regime -- Republican or otherwise -- wants you to purchase!

Posted by: rmgregory | September 23, 2010 7:03 PM | Report abuse

krazen1211,

Sorry Propagando, you exemplify my point. The AP article you cite goes on to explain that the discrepancy is that the blog figures talk about health care spending per person, that is per all Americans, those insured and those uninsured. This is as opposed to just insurance cost per each person who's fortunate enough to have health insurance. He doesn't debate that health care spending per person goes down substantially. Total health care spending goes up somewhat, but the number of uninsured plummets, so it's for a lot more people getting health care, those the cost per all persons, all Americans, drops greatly.

Readers can see the AP article for themselves at:

http://www.wtop.com/?nid=111&sid=2051239

You could also try to mislead by saying the cost of an average health insurance policy will go up. But as Ezra pointed out:

First, the bottom line of the report is simple: The CBO says premiums will go down for the vast majority of Americans, and that the same insurance policy will cost less under reform.

The confusion comes in the CBO's analysis of the individual market, which serves about a tenth of the population. CBO expects prices in the individual market to rise by 10 or 12 percent, an expectation driven entirely by predictions that individuals will purchase policies that are much more comprehensive, and thus somewhat more expensive, then the insurance they can afford now. Then the CBO turns to look at the impact of the subsidies, which will cut premium costs by a bit over 50 percent for a bit over 50 percent of the market.

But as the CBO explains on page five, part of the increase in the type of insurance being purchased is the result of "people’s decisions to purchase more extensive coverage in response to the structure of subsidies." In other words, the change is driven by the subsidies, not offset by them.

To see this more clearly, imagine that the University of Florida decided to give incoming students who receive financial aid an $800 credit to purchase a laptop computer. You'd expect that the average computer purchased by students on financial aid would become a bit more expensive. But that wouldn't be because computers had become more expensive. It would be because people now had money to buy better computers.

at: http://voices.washingtonpost.com/ezra-klein/2009/12/to_repeat_the_cbo_found_that_p.html

And with regard to misleading on health care costs per person over the long run, see:

http://voices.washingtonpost.com/ezra-klein/2010/09/does_health-care_reform_bend_t.html

They are projected to be much lower over the long run, even when the CBO estimates very conservatively.

Posted by: RichardHSerlin | September 23, 2010 9:40 PM | Report abuse

"First, the bottom line of the report is simple: The CBO says premiums will go down for the vast majority of Americans, and that the same insurance policy will cost less under reform.

The confusion comes in the CBO's analysis of the individual market, which serves about a tenth of the population. CBO expects prices in the individual market to rise by 10 or 12 percent, an expectation driven entirely by predictions that individuals will purchase policies that are much more comprehensive, and thus somewhat more expensive, then the insurance they can afford now. Then the CBO turns to look at the impact of the subsidies, which will cut premium costs by a bit over 50 percent for a bit over 50 percent of the market."

Of course, that hasn't happened either.

Businesses are saying they're paying higher premiums in 2011 due to Obamacare.

Posted by: krazen1211 | September 23, 2010 10:56 PM | Report abuse

"The confusion comes in the CBO's analysis of the individual market, which serves about a tenth of the population. CBO expects prices in the individual market to rise by 10 or 12 percent, an expectation driven entirely by predictions that individuals will purchase policies that are much more comprehensive, and thus somewhat more expensive, then the insurance they can afford now. Then the CBO turns to look at the impact of the subsidies, which will cut premium costs by a bit over 50 percent for a bit over 50 percent of the market."

And here we get to the actual point of the bill.

To pick winners and losers and transfer wealth to Obama's base.

People are going to lavishly spend when they're spending someone else's money? Who knew?

Posted by: krazen1211 | September 23, 2010 11:00 PM | Report abuse

"Total health care spending goes up somewhat, but the number of uninsured plummets, so it's for a lot more people getting health care, those the cost per all persons, all Americans, drops greatly."

Total health care costs go up.
Number of Americans are unchanged.
Health care costs per person... down?

If you increase the numerator on a fraction while holding the denominator constant, you get a bigger number.

"Then the CBO turns to look at the impact of the subsidies, which will cut premium costs by a bit over 50 percent for a bit over 50 percent of the market."

The premium costs aren't cut. Peter's premiums appear to go down because he's holding a gun to Paul's head and "asking" him to pay half of it.

Krazen is preicsely correct when he says "And here we get to the actual point of the bill. To pick winners and losers and transfer wealth to Obama's base." The losers are for the most part those that aren't getting the subsidies.

On top of the pure distributional effects, these transfers discourage earning income due to the implicit marginal tax these subsidies create, especially the gigantic cliff you go over when you break 400% of the poverty level and thousands worth of subsidies are suddenly taken away.

Posted by: justin84 | September 24, 2010 10:52 AM | Report abuse

Sorry again Propagando,

1) The health care bill hasn't come close to being fully implemented yet. Almost none of it was implemented until a few days ago, and most of it won't go into effect until 2014. The CBO projections are for when the bill goes fully into effect.

2) Health care costs go down for virtually everyone. It's largely a decrease in total costs to the tune of trillions over the long run due to economies of simplicity and scale, solutions to asymmetric information, people not waiting till things get terrible bad and then getting very expensive emergency room treatment, etc. It's why universal care countries have about as good health care or better at about half the cost or less. The wealthy may pay more in taxes, but that's largely a phenomena of insurance – when your income is high and it's easy to pay more, you pay more, but if things go bad you have the insurance of knowing your family will still have health insurance.

Propagando 2,

"Total health care costs go up.
Number of Americans are unchanged.
Health care costs per person... down?"

Number of Americans unchanged, Number of Americans with health insurance very changed, Total amount of health care provided very changed.

Posted by: RichardHSerlin | September 25, 2010 3:27 PM | Report abuse

Sorry again Propagando,

1) The health care bill hasn't come close to being fully implemented yet. Almost none of it was implemented until a few days ago, and most of it won't go into effect until 2014. The CBO projections are for when the bill goes fully into effect.

2) Health care costs go down for virtually everyone. It's largely a decrease in total costs to the tune of trillions over the long run due to economies of simplicity and scale, solutions to asymmetric information, people not waiting till things get terrible bad and then getting very expensive emergency room treatment, etc. It's why universal care countries have about as good health care or better at about half the cost or less. The wealthy may pay more in taxes, but that's largely a phenomena of insurance – when your income is high and it's easy to pay more, you pay more, but if things go bad you have the insurance of knowing your family will still have health insurance.

Propagando 2,

1) "Total health care costs go up.
Number of Americans are unchanged.
Health care costs per person... down?"

Number of Americans unchanged, Number of Americans with health insurance very changed, Total amount of health care provided very changed.

2) Due to the income and substitution effects, the wealthy tend to work harder when their taxes go up, as they have to to be able to afford their lifestyles. This is well established in economics. And over the long run there is little effect except for very very extreme rates. From an expert well versed in this literature, MIT economist Jonathan Gruber:
Changes in tax rates appear to have relatively modest effects on total gross income; the total amount of income actually generated through work or savings does not respond in a sizable way to taxation.

– "Public Finance and Public Policy", 2nd edition, 2007, page 734

Also, the subsidies phase out gradually, not off a cliff.

Posted by: RichardHSerlin | September 25, 2010 3:33 PM | Report abuse

"Number of Americans unchanged, Number of Americans with health insurance very changed, Total amount of health care provided very changed."

And total costs, up, average costs per person, up. I'm sorry but there are no free lunches. If there is any "propagando", it is the ridiculous notion that "total amount of health care provided" will be "very changed [increased]", at no incremental cost.

"Due to the income and substitution effects, the wealthy tend to work harder when their taxes go up, as they have to to be able to afford their lifestyles. This is well established in economics. And over the long run there is little effect except for very very extreme rates. From an expert well versed in this literature, MIT economist Jonathan Gruber:
Changes in tax rates appear to have relatively modest effects on total gross income; the total amount of income actually generated through work or savings does not respond in a sizable way to taxation."

Gruber? You mean this guy?

http://www.huffingtonpost.com/jane-hamsher/how-the-white-house-used_b_421549.html

Wow, a bought and paid for statist economist reaches conclusions which support statist policies. I wonder who financed this particular opinion.

And yet, the income of the wealthy always manages to soar after tax cuts, much to the chagrin of liberals who lament rising income inequality.

And yet, the incomes of the wealthy are quite modest over in high tax Europe - but they sure do get a lot of leisure time! Let's take a look at the work of another guy who hasn't been paid hundreds and thousands in 'consulting fees' by the government:

http://tinyurl.com/2cy2ymp

And yet, low tax Singapore has overtaken the United States in terms of GDP per capita.

"Also, the subsidies phase out gradually, not off a cliff."

Consider a household headed by a 50 year old, with two children on his policy in a high cost area. Try putting in $93,699 and $93,700 in this calculator. When I do this, the $11,328 tax credit goes to zero, and the out of pocket max soars.

Or take a 56 year old single person in a medium cost area. He earns $46,021, and he gets a $4,449 government tax credit for a policy with an out of pocket max of $4,167. He earns $46,022, and he gets no tax credit and his out of pocket max is now $6,250.

It's a cliff for families with (40+) near 400% of the FPL. As health care costs rise, younger and younger people - even those in low cost areas - will face the cliff.

http://healthreform.kff.org/subsidycalculator.aspx

It's only a question of how many will choose to jump the cliff, and how many will be content to stay in the dead zone.

http://mises.org/daily/3822

Posted by: justin84 | September 26, 2010 1:45 PM | Report abuse

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