Repeal and Replace This

Last night I ventured into Laura Ingraham’s No Spin Zone. Confined to the house by inclement weather, I chose to contribute indirectly to Prince Al-Waleed bin Talal’s News Corp. dividends and directly to Bill O’Reilly’s Olympian ego. In the race to the bottom that is cable news, Laura Ingraham’s monotonous Reaganite pabulum trumps msnbc, which is unwatchable, as well as that other thing which barely warrants mentioning.

I witnessed a truly interesting exchange between the aforementioned Ms. Ingraham and Rep. Eric Cantor, who gets to be majority leader after the bloodbath of November. The broad issue was ObamaCare but the main focus was what Ingraham perceived to be Eric Cantor’s squishiness on Republican plans to “repeal and replace” the unpopular reform law.

LAURA INGRAHAM, GUEST HOST: …You've now got to correct the record because Politico is reporting that Eric Cantor, if he's the House majority leader come -- come November, that you're going to push for a more modest approach to Obamacare, meaning defund it, not repeal it. Did Politico get it wrong?

REP. ERIC CANTOR: Laura, I'll tell you one thing: As you and I have known each other for several years and as many of my constituents are, I'm a big fan of yours. So I got several calls from constituents over the last day or so saying, "What's Laura Ingraham talking about that Eric Cantor is not for a repeal of Obamacare?" Of course I'm for a repeal of Obamacare.

As you know, Laura, I'm the Republican whip in the House, and the duty of the Republican whip was to marshal as many votes as we could against Obamacare to make sure it didn't become law. And in the end, we didn't have one Republican vote that voted for it. Unfortunately, the bill passed. So we are faced with a situation where, hopefully, this November, a conservative majority will regain position in the House. And we're going to do everything we can to repeal the bill, to delay the bill, to defund the bill, to do all of the above. I mean, these things go hand in hand, Laura.

Whenever I wade into the land of Rupert Murdoch and Glenn Beck, I’m always careful to have plenty of aspirin and a barf bag on deck. The latter very nearly came into use after watching Mr. Cantor kiss the ring of hot reactionary blonde Laura Ingraham like the dickless establishmentarian he is. But however nauseating the display may have been, there are important insights to be gleaned here.

Rather than reaping a fortuitous repeat of 1994, conservatives are exactly where progressives were in ’06. In many respects ObamaCare is to them what the war in Iraq was to us. The mainstream public’s rather late aversion to the intractable chaos and bloodshed of the Iraq adventure vindicated grassroots progressives. It was a swift reversal of fortune that came right on time after the nightmarish re-election of President Bush. Unsatisfied with handing Democrats a decent majority in the House and a slim one in the Senate, the American people marched ahead and put a charismatic “change agent” in the White House two years thereafter. And yet the war(s) go on.

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Sebelius warns insurers on denying coverage to sick kids

Health and Human Services Secretary Kathleen Sebelius wrote to the head of the insurance industry's lobbying arm yesterday warning against efforts to continue to deny coverage to children with pre-existing conditions. Excerpt from the letter, which you can download as a pdf file at Greg Sargent's blog:

Health insurance reform is designed to prevent any child from being denied coverage because he or she has a pre-existing condition. Leaders in Congress have reaffirmed this in recent days in the attached statement. To ensure that there is no ambiguity on this point, I am preparing to issue regulations in the weeks ahead ensuring that the term "pre-existing condition exclusion" applies to both a child's access to a plan and to his or her benefits once he or she is in the plan. These regulations will further confirm that beginning in September, 2010:

*Children with pre-existing conditions may not be denied access to their parents' health insurance plan;

*Insurance companies will no longer be allowed to insure a child, but exclude treatments for that child's pre-existing condition.

I urge you to share this information with your members and to help ensure that they cease any attempt to deny coverage to some of the youngest and most vulnerable Americans.

A spokesperson for House Speaker Nancy Pelosi sent Sargent the following statement:

The intent of Congress to end discrimination against children was crystal clear, and as the House chairs said last week, the fact that insurance companies would even try to deny children coverage exemplifies why the health reform legislation was so vital. Secretary Sebelius isn’t going to let insurance companies discriminate against children, and no one in the industry should think otherwise.

Let's hope this works. I wouldn't be surprised to see insurance companies challenge the new regulations in court. They were probably counting on that loophole.

Founding Father signed health insurance mandate into law

State attorneys general have filed two federal lawsuits challenging the individual mandate to purchase health insurance, which President Barack Obama signed into law last week. Those lawsuits look like pure political posturing to me, given the well-established Congressional powers to regulate interstate commerce and taxation.

It turns out that precedent for a health insurance mandate is much older than the 1930s Supreme Court rulings on the Commerce Clause. Thanks to Paul J. O'Rourke for the history lesson:

In July, 1798, Congress passed, and President John Adams signed into law “An Act for the Relief of Sick and Disabled Seamen,” authorizing the creation of a marine hospital service, and mandating privately employed sailors to purchase healthcare insurance.

This legislation also created America’s first payroll tax, as a ship’s owner was required to deduct 20 cents from each sailor’s monthly pay and forward those receipts to the service, which in turn provided injured sailors hospital care. Failure to pay or account properly was discouraged by requiring a law violating owner or ship's captain to pay a 100 dollar fine.

This historical fact demolishes claims of “unprecedented” and "The Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty...”

Perhaps these somewhat incompetent attorneys general might wish to amend their lawsuits to conform to the 1798 precedent, and demand that the mandate and fines be linked to implementing a federal single payer healthcare insurance plan.

O'Rourke posted the full text of the 1798 legislation as well.

I'm not one to claim American's "Founding Fathers" could do no wrong. After all, President Adams also signed the Sedition Act, which violated the First Amendment. But Republican "strict constructionists" say we should interpret the constitution only as 18th-century Americans would have understood it. Some claim judges should cite only 18th-century sources when interpreting the constitution. Well, Congress enacted and the president signed a health insurance mandate less than a decade after the U.S. Constitution went into effect.

I don't expect these facts to affect Republican rhetoric about health insurance reform. Thankfully, Iowa Attorney General Tom Miller is not wasting our state's money on this frivolous lawsuit. So far I haven't heard any Republicans demand his impeachment, as some GOP legislators are doing in Georgia.

The elephant in the room, real cost controls missing in healthcare bills

For anyone not interested in slogging through the debate on the 500-odd amendments to the Baucus bill, it has become increasingly and painfully apparent that the healthcare legislation soon to emerge from at least the Senate will fall far short in reigning in out of control health care costs.

That lapse is especially ironic in that "affordability" is perhaps the only goal that seems to top everyone's to do list, from President Obama to the "keep the government hands off my (government-financed) Medicare" crowd.

But as long as our policy makers refuse to throw the elephant out of the room, the insurance company pirates and their predatory pricing practices,  all their subsidies and tweaking will amount to little more than an umbrella in a hurricane.  

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A Question About Health Care Tax Credits / Clinton Plan

I was reading a brief CNN account of Clinton's health care plan, and this sentence really stuck out at me:

"It puts the consumer in the driver's seat by offering more choices and lowering costs," said Neera Tanden, Clinton's top policy adviser, according to AP. "If you like the plan you have, you keep it. If you're one of tens of millions of Americans without coverage or don't like the coverage you have, you will have a choice of plans to pick from and you'll get tax credits to help pay for it."

Can I actually ask a genuine question?  I am no expert on health care coverage, but: Why the obsession with tax credits as a form of subsidy?  This isn't a criticism of Clinton's plan exactly, since I think most other Democratic plans use the same mechanism.  But what does confuse me is the consensus forming around this option and the seeming lack of public discussion about it.

The most obvious problems are two:

1.  Wouldn't a worker only receive the subsidy after making twelve months of payments? 
If you receive your subsidy in a lump sum at the end of the year when you receive your tax rebate, wouldn't this mean that you would first be expected to pay the full twelve months of payments before receiving any form of subsidy?  

This would actually be a substantial new monthly cost that would be mandated.  Wouldn't it make more sense to have some other kind of way of distributing subsidies?  Why tax credits?

2.  Savings plans? 
By giving the subsidy essentially as a lump sum at the end of the year, aren't you relying on people saving this money in order to be able to make their payments the following year?  

For those with higher incomes and savings accounts, it might be a realistic expectation, but with all of the demands on low-income people and less of a tradition of savings, isn't it at least problematic?  Second, there's also the possibility of people, regardless of need, just being irresponsible and spending the rebate frivolously --- as most people (such as me) do with their ordinary tax refunds.

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