Republicans Quietly Make an Important Fix To Obamacare That Democrats Wanted

[babylonsister]

http://www.politicususa.com/2014/04/06/republicans-quietly-important-fix-obamacare-democrats-wanted.html

Republicans Quietly Make an Important Fix To Obamacare That Democrats Wanted
By: Jason Easley more from Jason Easley
Sunday, April, 6th, 2014, 10:48 am


While they publicly scream for the law’s repeal, House Republicans have made another quiet fix to the ACA that Democrats wanted.

The AP reported:

At the prodding of business organizations, House Republicans quietly secured a recent change in President Barack Obama’s health law to expand coverage choices, a striking, one-of-a-kind departure from dozens of high-decibel attempts to repeal or dismember it.

Democrats describe the change involving small-business coverage options as a straightforward improvement of the type they are eager to make, and Obama signed it into law. Republicans are loath to agree, given the strong sentiment among the rank and file that the only fix the law deserves is a burial.

….

No member of the House GOP leadership has publicly hailed the fix, which was tucked, at Republicans’ request, into legislation preventing a cut in payments to doctors who treat Medicare patients.

Reps. John Boehner (R-OH) and Eric Cantor (R-VA) did such a good job of hiding the fix in the bill that many House Republicans might have had no idea that they were voting on this Obamacare fix. Last month, House Republican leaders introduced three fixes to the ACA while their party was distracted by CPAC.

It is obvious that House Republican leaders intend to fix the unintended consequences of the law, as they simultaneously campaign on destroying Obamacare. Republican voters are being lied to by their own leaders. The Republican led House seems to have no intention of getting rid of the ACA. If they were serious about getting rid of it, why would they pass improvements?

House Republicans have a political interest in keeping the ACA on the books. If Republicans repealed the law, they couldn’t campaign against it anymore. Republicans believe that Obamacare is one of the few issues that will get their voters to the polls, so their actions will continue to not match their words.

There is no bigger sign of totality of the GOP defeat on the ACA than these quiet fixes that House Republican leaders continue to pass.

[arcane1]

1. Haha! That's rich. I hope the dems are smart enough to talk about this to voters!

[pangaia]

2. I seriously doubt it, unfortunately.

[canoeist52]

3. Any hint on what the three changes are?

Can't find anything even after two clicks deep.

[babylonsister]

5. The 3 fixes are here...

http://www.dailykos.com/story/2014/03/10/1283594/-Don-t-tell-Ted-Cruz-but-House-Republicans-have-three-Obamacare-fix-votes-this-nbsp-week#

[monmouth3]

14. Here they are...

One bill would allow a religious exemption from purchasing health insurance, one would exempt employers from having to provide insurance to veterans who have health care from the VA, and the third will clarify that volunteer firefighters don't have to be offered insurance from fire departments.

[progree]

15. 4 clicks later ... the details

# the Equitable Access to Care and Health (EACH) Act, H.R. 1814.
The legislation would create a new exemption under ObamaCare that lets people avoid buying health insurance if they have a religious reason for doing so. The bill would require these people to file an affidavit as part of their tax returns saying their beliefs keep them from buying insurance that meets federal standards.

# Protecting Volunteer Firefighters and Emergency Responders Act, H.R. 3979. This bill would ensure that volunteer emergency responders are not required to be offered health insurance under the law.

# Hire More Heroes Act, H.R. 3474. It would create an incentive for companies to hire veterans, since veteran workers already covered by the federal veterans health program would not have to be counted as a full-time employee for the purposes of ObamaCare. That exemption could help companies avoid the employer mandate, or the requirement to offer health plans once they have 50 or more employees.

Source: http://thehill.com/blogs/ballot-box/200316-gop-hoping-dems-help-expand-obamacare-exemptions (3/10/14)

Actually I'm not so thrilled about the first one, the religious exemption. On the face of it, it sounds like potentially an excuse almost anybody can use to opt out of the individual mandate. If the individual mandate is effectively eroded or abolished, will enough of the young and healthy sign up to keep premiums from going up into a death spiral? (Supposedly that's why we have the individual mandate in the first place). I'd have to see the details on that particular one before I cheer too loudly.

I love the names of the bills, though!

[mucifer]

16. So for the religious exemption, can the employer just say they have religious reasons

and their employees won't get covered? I'm confused.

[progree]

19. About all's I know is that it allows an INDIVIDUAL to opt out of the ACA

it has nothing to do with employers choosing to cover or not cover employees.

There's this Wikipedia article that I quickly read, and its as clear as mud (or frankly doesn't say) how stringent if anything

http://en.wikipedia.org/wiki/Equitable_Access_to_Care_and_Health_Act_(H.R._1814;_113th_Congress)

here's some gobble-de-goop from the above

This summary is based largely on the summary provided by the Congressional Research Service, a public domain source.[1]

The Equitable Access to Care and Health Act or the EACH Act would amend the Internal Revenue Code, with respect to minimum essential health care coverage requirements added by the Patient Protection and Affordable Care Act, to allow an additional religious exemption from such requirements for individuals whose sincerely held religious beliefs would cause them to object to medical health care provided under such coverage.[1]

The bill would define "medical health care" to mean voluntary health treatment by or supervised by a medical doctor that would be covered under minimum essential coverage that: (1) includes voluntary acute care treatment at hospital emergency rooms, walk-in clinics, or similar facilities; and (2) excludes treatment not administered or supervised by a medical doctor, physical examinations or treatment required by law or third parties, and vaccinations.[1]

The article links to a American Humanist Association alert. The only thing it says as far as the content of the bill:

The EACH Act contains a provision that would allow anyone with “sincerely held religious beliefs” to be exempt from the mandate in the Affordable Care Act to buy health insurance.

http://action.americanhumanist.org/p/dia/action/public/?action_KEY=15259

Well, here is the text (its mercifully short): https://www.govtrack.us/congress/bills/113/hr1814/text

Seems like anyone willing to make some bullshit statement about their sincere religious belief in writing, and file it with their tax return, can opt out of the ACA. I wonder if it applies to me, a devout member of The Church Of The Flying Spaghetti Monster.

Probably the only reason 78 House Democrats supported it was because they didn't want to risk being seen as anti-religious or against "religious freedom". (To jurors: Forgive Forgive).

I notice this from the OP's excerpt:

Democrats describe the change involving small-business coverage options as a straightforward improvement of the type they are eager to make, and Obama signed it into law. Republicans are loath to agree, given the strong sentiment among the rank and file that the only fix the law deserves is a burial.

So the Dems are not praising the religious exemption for individuals bill (as it has nothing to do with small-business coverage, unlike the other two bills). May it fail in the Senate. It is not a fix to the ACA but an erosion of it.

[IronLionZion]

26. Quite frankly, being able to afford it but choosing to remain uninsured

is its own punishment. The penalties were more to help offset the cost more than to force insurance upon the unwilling. If someone is willing to jump through hoops to avoid insurance and the penalty, and still take the risks, then they must be committed. Time will tell how many actually go this route.

"Obama is forcing you to buy something you don't want or need" is largely GOP propaganda designed to appeal to those with a rebellious mindset.

[progree]

33. "The penalties were more to help offset the cost more than to force insurance upon the unwilling" BS

I sure the heck hope not. For $4 billion / year in extra revenue (0.1% of the Federal budget)? Sounds like a right-wing meme to me -

"you know that the Kenyan Socialist Obama is grabbing your hard earned money to support socialized medicine. He's willing to impose a mandate on everyone just to raise an extra 0.1% of revenue"

Do you REALLY THINK THE MANDATE WAS A REVENUE GRAB FOR SUCH A TRIVIAL SUM?

I don't think so. Adverse selection (google it) is not a RW talking point, it is reality. Something the administration has argued time and again, including at the Supreme Court, http://thefederalist.com/2013/10/21/obamacare-cant-quit-individual-mandate/

The penalty is estimated to bring in about $4 billion/year : http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/113xx/doc11379/individual_mandate_penalties-04-30.pdf

[IronLionZion]

36. I have a different perspective and disagree

since GOP is constantly harping on how "the Kenyan socialist is forcing you to buy something you don't want". "Government is controlling your health and life! "

Do you think a trivial sum is going to force someone to buy something they don't want which is much more expensive? GOP laughs at that thought. It won't have much effect on those who don't file taxes or don't get refunds, since they wouldn't pay any penalties.

People who want coverage will get it. People who don't, won't.

There's a mix of revenue sources that go towards the subsidies. This includes employers who don't offer benefits, medical devices, tanning, expensive plans, etc. Individual penalties are just one of many sources.

[progree]

37. Obama broke his campaign promise and imposed a mandate just for $4 billion/yr? Incredible

Last edited Fri Apr 11, 2014, 03:19 AM - Edit history (1)

[font color = brown]>> Progree 15. "If the individual mandate is effectively eroded or abolished, will enough of the young and healthy sign up to keep premiums from going up into a death spiral? (Supposedly that's why we have the individual mandate in the first place)."[/font]

[font color = blue]>>ILZ 33. "The penalties were more to help offset the cost more than to force insurance upon the unwilling" <<[/font]

Again, sounds like you are spewing a rightie talking point (the mandate is a money grab by a greedy black man from Chicago threatening harsh sanctions, rather than something necessary to avoid an adverse selection premium death spiral).

And he broke his campaign promise not to impose the mandate on adults for such a trivial sum? ($4 billion/yr) (In noticeable contrast to Hillary Clinton. Obama argued in the 2008 campaign that covering the uninsured by imposing a mandate to buy health insurance made as much sense as ending homelessness by mandating everyone buy a house. Clever, huh?).

And from a revenue standpoint, the $4 billion / year wasn't even necessary. At the time of the bill's passage in March 2010, the projected revenue and savings elsewhere more than paid for the cost of the ACA program over 10 years by $143 billion, according to the CBO {1}, p. 173.

Again, for an estimated $4 billion / year, do you really think Obama broke a campaign promise and imposed a mandate and penalty? That's not what the Administration argued before the Supreme Court ( http://www.justice.gov/osg/briefs/2011/3mer/2mer/2011-0393.mer.aa.pdf )

(p. 11) ... the minimum coverage provision {i.e., the individual mandate} is essential to ensuring that the Act’s 2014 guaranteed-issue and community-rating reforms advance Congress’s goals. As Congress expressly found (and as experience in the States confirmed), those provisions would create an adverse selection cascade without a minimum coverage provision, because healthy individuals would defer obtaining insurance until they needed health care, leaving an insurance pool skewed toward the unhealthy. Premiums would increase significantly under that scenario, and the availability of insurance would decline—exactly the opposite of what Congress intended in enacting the Affordable Care Act. The guaranteed-issue and community-rating provisions are therefore inseverable from the minimum coverage provision.

(p. 46) ... healthy individuals have an incentive to stay out until their need for insurance arises while, at the same time, those with the most serious immediate health care needs have a strong incentive to obtain coverage. Premiums would therefore go up, further impeding entry into the market by those currently without acute medical needs, risking a “marketwide adverse-selection death spiral,”

Note, it's not just the Obama administration that believes in adverse selection (the old and sick more likely to buy insurance than the young and healthy). Here is the progressive Center For Budget and Policy Priorities citing the CBO (
http://www.cbpp.org/cms/?fa=view&id=4012 )

Earlier CBO estimates indicated that permanently repealing the mandate would raise average health insurance premiums in the individual market — inside and outside the new health insurance exchanges — by 15 percent to 20 percent, amounting to hundreds or thousands of dollars a year in higher premium charges for large numbers of individuals and families. Without the individual mandate, the exchanges may well not be viable over the long run; the higher premiums would discourage many healthier people from enrolling, sending premiums up still more.

So you can make the point that the insurance death spiral is a right-wing talking point all you want. I don't think that's true, but anyway, you need to also acknowledge that it is an administration and progressive talking point too. I can assure you that no Democrat in Congress voted for the individual mandate just for $4 billion a year extra revenue, or a little over 0.1% of the budget.

Actually, it’s the righties that argue that no mandate is necessary, and have voted again and again in the House to repeal the mandate. And they burble on and on how great the health system was pre-Obama -- all without a mandate. Where kings and potentates from around the world came (pre-Obama) for the best medical care in the world yada. Since you seem to follow GOP propaganda 24/7 (see your #35), you have surely heard that RW talking point.

If the mandate isn't necessary, and raises so little money, why does the administration and Democrats cling to something that polls so poorly and is so regressive?

I also experienced the health insurance death spiral. Back until the mid-1990s or so, there was an excellent health insurance plan for electrical engineers through the IEEE (Institute for Electrical and Electronic Engineers). However, premiums went up and up as the average age of people in the program went up. Then it got to the point where the younger and healthier left the program in large numbers and finally the premium death spiral grew to the point where they ended the program.

From the Landmark book {1} p. 87.

"But in today's individual insurance market where people without employer-provided coverage buy plans, the spreading of risk does not function so well. About one-third of people age 20 to 29 go without coverage, double the rate for those age 30 to 64.... as a result, rates in the individual market are high, and that, in a kind of vicious cycle, makes it even less likely that younger or healthier people will decide to buy coverage."

[font color = blue]>>ILZ 36. Do you think a trivial sum is going to force someone to buy something they don't want which is much more expensive? <<[/font]

Apparently the administration and the Democrats in the 2010 Congress thought so. Do you really think they put the penalties in for shits and giggles? (Or with the hope of raising a measly $4 billion / yr in revenue?)

Anyway, we shall see. There was quite a surge in enrollments in March (the deadline to sign up without paying a penalty). How do you explain that, compared to the low enrollments in say January and February?

And it's not trivial to the people paying the penalty. For a household of 4 (2 adults and 2 children) making a modest $40,000, the annual penalty for not having insurance in 2014 is the maximum of $285 or 1% of income ($400), whichever is greater, namely $400. That's also the penalty a single individual earning $40,000 would pay.

I don't know how many threads I've seen in DU by people saying they are only paying $0 or $20 or $40/month after subsidies (though often for multi-thousand-dollar deductibles and out-of-pocket maximums), so at least in terms of initial outlays -- the premiums -- the penalty is some cases is the same or more. (As you know, it’s a DU talking point that ACA insurance is easily affordable, and woe be to anyone who dares suggest otherwise).

In 2016, the annual penalty on such a $40,000 4-person household rises to $2,085 or 2.5% of income ($1000), whichever is greater, namely $2,085. (A single individual earning $40,000 would pay $1,000).

It’s a fair kick-in-the-butt to quit procrastinating and do what one knows one should do.

Another reason for procrastinating: a lot of people just don't trust private for-profit insurance companies. Ever seen the movie Sicko? The first 10 minutes was about the uninsured. The rest of the movie was about the plight of the insured.

==============================================================

{1} p. 173, Landmark, The Inside Story of American's New Health-Care Law And What It Means For Us All, by the staff of the Washington Post, 2010.

[jeff47]

24. It's individuals, not corps. It lets Christian Scientists opt-out. (nt)

[progree]

30. Christian Science and practically anybody else. I don't see anything in the law that

limits this to a few sects.

[jeff47]

31. Theoretically, lying about it is tax fraud.

Which should be a deterrent.....but I doubt they'd prosecute anyone for a very long time to avoid the negative publicity.

As for naming sects, that's a huge problem. Given the First Amendment, the government can't decree "this sect can opt-out, this one can't". So the law would have to be updated constantly. And if it isn't updated constantly and in a timely manner, it's a lovely target for the SCOTUS to rule against the mandate in its entirety. That knocks out one of the three legs of the stool that makes the ACA work, and the law falls apart. And since Congress can't pass shit, "law falls apart" results in going back to the old way of doing things.

[progree]

32. I still don't see anything in the law that prevents me from saying that it is God's will that

I don't buy into or support a program that also provides contraceptives and abortificants (what some call the morning after pill -- "a death sentence to innocent human life" (preventing implantation of a fertilized egg) .

On the First Amendment Establishment Clause -- by providing a religious opt out (but no such opt-out for the non-religious or "wrong"-religious) it is my very strong opinion that the proposed law violates the Establishment Clause, even as written (without naming sects). But I doubt that 5 Supreme Court justices will see it that way.

[Arkana]

22. The first one is bullshit, and I'm not wild about the second one

unless it's proven that the volunteers have insurance elsewhere.

[IronLionZion]

25. Small towns with limited budgets

would reduce their volunteer firefighters or close down firehouses due to cost. I think the intent of this change is to avoid that scenario. They don't get paid for their service, and many of them do have regular jobs too.

[IronLionZion]

23. "young and healthy don't want insurance" is largely a GOP myth

Of course anyone who has any sense of responsibility and education would want at least catastrophic insurance. You can't really "mandate" young people to do anything. They do it because they want to. Some of them don't even file taxes or get refunds, so they wouldn't be fined anyway. The GOP spin machine is the one trying to discourage them.

[Epiphany4z]

27. the young and healthy are over 26 yrs old

kids can stay on parents policy until 26. Many are starting families around that age. A great reason to want to be insured. I think most want insurance at that age. 27 is not all that young and invincible anyway. I know my bp started creeping up at that age. I was getting more muscle strains and pulls I was also on baby number 3.

[IronLionZion]

29. There is no possible way to know how many people are "healthy" for statistics

since that data isn't collected during insurance signups. So statisticians used age as a stand in for "healthy" in measuring the diversity of the risk pool. This info has been deliberately spun out of control by the GOP so much that many of them have even started to believe the propaganda.

When more accurate data comes out in a few months on who actually has insurance, GOP is never going to believe the numbers.

[progree]

34. Don't think anyone said that, nice straw man argument though :)

[IronLionZion]

35. GOP opponents say it 24/7 nt

[progree]

38. I don't know, I don't listen to GOP 24/7. I think they say the mandate isn't necessary

[font color = brown]Progree>> 15. .. Actually I'm not so thrilled about the first one, the religious exemption. On the face of it, it sounds like potentially an excuse almost anybody can use to opt out of the individual mandate. If the individual mandate is effectively eroded or abolished, will enough of the young and healthy sign up to keep premiums from going up into a death spiral? (Supposedly that's why we have the individual mandate in the first place). <<[/font]

[font color = blue]ILZ>> 23. "young and healthy don't want insurance" is largely a GOP myth <<[/font]

[font color = brown]Progree>> 34. Don't think anyone said that, nice straw man argument though <<[/font]

[font color = blue]ILZ>> 35. GOP opponents say it 24/7 nt <<[/font]

In #23, you replied to my #15 by putting "young and healthy don't want insurance" in quotes in the title line as if it was something I said. I did not say that. That's why I called it a straw man argument -- imply that I said something this categorically extreme and stupid and then ridicule it. That is the essence of the straw man debating technique.

As for what GOP says, frankly I don't immerse myself in right-wing propaganda, let alone 24/7, so I will have to take your word for it (although I'm quite dubious about it), since its you who are repeating right-wing memes (suggesting in #26 that Obama imposed the individual mandate and penalty mostly to grab $4 billion a year -- sure doesn't sound progressive to me. And politically idiotic. I can't imagine a progressive seriously making the argument that Obama administration would mandate hundreds of millions be forced to buy insurance from private for-profit companies just to collect $4 billion a year.)

As for who makes the arguments that the mandates are necessary, and who makes the argument that they are not, please see http://www.democraticunderground.com/10024787880#post37 .

[BlindTiresias]

4. Ok

It doesn't match their rhetoric as that is something they have to be uncompromising on, but how is this some kind of victory? Of course they are going to make refinements to it the core of the policy itself save for the medicare expansion was from their policy guys. As far as the more intellectually rigorous Republicans are concerned this is a massive victory as 1.) They get the policy they have wanted that leaves insurance companies intact if not stronger 2.) They get to use the policy they want as a cudgel against Democrats and 3.) They get to blame Democrats for any failure and if the policy becomes unpopular they can always revise it as they like and appear to be a hero.

[Martin Eden]

6. Today's GOP: when they do something positive they have to hide it from their base

Their own propaganda has made actual governance a liability to them politically.

[louis-t]

7. Jeez, House repug leaders can pass anything as long as

they keep telling their members they're voting to repeal Obamacare.

[Spacemom]

8. Still no fix for the "family glitch"

Which is leaving many without coverage.

[progressoid]

13. But there is a religious exemption from purchasing health insurance

Got to have our priorities!

[Solly Mack]

9. Cowards, as usual.

K&R

[UTUSN]

10. R#8 & K for, bwah-hah for all the laugh lines in this reporting:

The quiet fixes. The prodding from business. BONER and CANTOR hiding the fixes (from their own ilk). Rethugs not knowing what they were voting for. Doing it while all the wingnuts were “distracted” at CPAC. “the totality of the GOP defeat”.

Well, I’m never one to gloat, always wary of Wingnuts around the next corner. All that CASH coming. Jeb Crow Shrub. Although the inevitable downfall of Ted Carnival CRUZ will be delicious, no matter how long it takes.

[Iliyah]

11. Shows you are dumb the house & senate GOPers are

They refuse to read a damn thing including the Constitution.

[Brown Coat]

12. They just had to pass it to see what's in it

[UTUSN]

17. Let's kick this one more time. n/t

[Zambero]

18. Knowing Republicans' penchant for obliterating the truth

I would not be surprised to see one of them come forward and state that this particular Obamacare fix was necessary in order to dismantle those pesky "death panels". So, putting on my devil's advocate hat for a moment, how might this sound for a bit of false equivalency...? : "We took a vote, it passed, and now Obamacare death panels do not exist". Perfectly true in a literal sense, but then again they never did exist. Anyway, when questioned as to why they caved and voted to improve (and not repeal for the 52nd time) a law that wingnuts are conditioned to despise, some sort of excuse will be forthcoming.

[IronLionZion]

20. It eliminates the cap on high deductible plans for small businesses

For those who were wondering what the fix was.

"The provision itself was relatively minor. It eliminated a cap on deductibles for small group policies offered inside the law's health care exchanges as well as outside; the cap was set at $2,000 for individuals and $4,000 for families."

http://bigstory.ap.org/article/gop-seeks-coverage-choices-health-law-they-hate


High deductible plans are better than a big heaping pile of nothing, which can ruin people. A few thousand bucks in medical bills isn't perfect but it won't ruin people's lives. And its great for healthy people who can build up an HSA, which can be a lifesaver when you least expect it.


Talking out of both sides of their mouth is what politicians do, and republicans in particular. But I hope they continue these quiet fixes so the law can be more effective. This particular provision was put in to bribe Olympia Snowe, and it didn't work since she voted against the PPACA anyway. There are more provisions like this designed to win a vote from just one legislator and can be updated.

[mstinamotorcity2]

21. I bet they had to sneak it in!!

Or we would still be having Tea!!!

[ProSense]

28. Boehner scrambles to appear less constructive

Boehner scrambles to appear less constructive
http://www.msnbc.com/rachel-maddow-show/boehner-scrambles-appear-less-constructive

Team Boehner Frantically Reassures Drudge That GOP Really Is Repealing Obamacare
http://talkingpointsmemo.com/livewire/boehner-obamacare-change-drudge

[joshcryer]

39. Midterms are upon us. It's a repeat of 2010.

Republicans were calling the Democrats out for trying to "destroy Medicare" and liberals were claiming the Democrats were creating catfood commissions.