Thursday, November 14, 2013

Obamacare and keep-your-junk-health-insurance: a left-right alliance?

I was struck by this post on the left-leaning Firedoglake blog from Jon Walker, Obamacare Can Handle the "Keep Your Health Plan" Bill FDL dated 11/14/2013; accessed 11/13/2013. He's endorsing Michigan Republican Congressman Fred Upton's so-called Keep Your Health Plan Act to allow insurance companies to peddle substandard, junk insurance policies. "It lasts for only one year," Walker assures us. Just like other the postponements that Republicans have been demanding as part of their all-out efforts to sabotage the implementation of the ADA any way they can. Why the junk insurance policies are desirable for 2014 but not for 2015 is not clear. Gee, I wonder if some Republicans will propose another year-long extension this time next year?

I was almost done with the post when I got the news that the White House is now on board with the idea of extending the private junk insurance policies for a year. So I'm changing the tenses below to reflect that this was a political preliminary to the White House capitulation, which could in practice turn out to be fatal for the ACA as a whole. This is a delay that matters, a lot. Republicans are sure to read this as a "blood in the water" sign from the White House on the ACA.

Bill Clinton jumped on board with this idea earlier this week. This was a surprise to me. I would have thought his partisan devotion to what is, after all, a private-insurance based ACA would have held him back from doing this. And, as Sam Stein reports in Obamacare Angst Among Democrats Approaches A Tipping Point Huffington Post 11/13/2013:

On Wednesday morning, Sen. Jeff Merkley (D-Ore.) announced that he was co-sponsoring a bill to allow individuals who buy their own insurance to stay on their current health care plans indefinitely rather than be forced into better regulated plans through the newly created exchanges.

Coming from one of the Senate's most notably progressive voices, the Oregon Democrat's announcement was a particularly vivid demonstration of how nervous party members are over the state of the Affordable Care Act. The flawed website, combined with the steady stream of news of insurers forcing people to adopt more comprehensive and at times expensive plans in response to new regulations, had already persuaded five other Democrats to support the Keeping the Affordable Care Act Promise Act, introduced by Sen. Mary Landrieu (D-La.).
I suppose if you value Bipartisanship as valuable in itself, this might be an encouraging sign.

Otherwise, it's not so encouraging for a labor-progressive point of view.

The Firedoglake bloggers were generally critical, as most of the Democratic wing of the Democratic Party were, of the failure to include a public option in the ACA. I was also of a mind in 2010, looking at the specific situation as of that moment, that I wanted to see the Progressive Caucus be willing to go down to the bitter end to deep-six the plan if it didn't include a public option.

Whether that would have wound up with Obama capitulating and including the public option or not is not just another of the endless what-if questions of history. The fabled dustbin of history has a lot of those. But I do believe that the failure to take a more determined stand taught the Obama White House that the Congressional progressive could be safely ignored when push came to shove. The weight of corporate money means that no matter how small, the Blue Dog faction among the Democrats will have weight in policy fights disproportionate to their numbers. But the more specific practical lesson that the White House undoubtedly drew from the public option controversy was that if they disappointed the Progressive Caucus on even a self-described red-line issue like the public option, it wouldn't matter. The progressives would go along with the watered-down version.

The Obama White House didn't have to be afraid of the Progressive Caucus, in other words. But the smaller Blue Dog faction was willing to threaten to kill legislation that didn't meet Blue Dog minimum requirements. This is no the situation I want to see Congressional progressive be in.

But now we have the ACA, with all the flaws inherent in its private-insurance basis and the various ways in which the structure of the legislation gives the Republicans in Congress and the state level to do a great deal of mischief. If the ACA breaks down in the current environment, the Republicans and Blue Dogs will push to gut the law of all its most constructive features. But I predict they would try to leave in place the individual mandate, because that is something the insurance companies love but a lot of consumers will hate, especially if the insurance companies can go back to providing only junk insurance.

Changes to the law at this point have to go in one of two broad directions: toward removing the constructive parts, or toward fixing the problems by better regulations of the insurance companies and by expanding the opportunities for public-option features. And I think Digby is right in pointing the Medicaid expansion as a type of increased public option, even in the ACA framework. (Single payer under Obamacare? You betcha! Hullabaloo 11/11/2013) Finding away around the crassly partisan Supreme Court's ruling allowing individual states to refuse to adopt the Medicaid expansion would be a good step in the constructive direction.

So the rush of both Blue Dogs and some progressives, as well as Bill Clinton (who presumably has Hillary's political positioning also in mind), to join with Republicans on the keep-the-junk-health-insurance cause is disturbing.

Robert Reich is harsh on the latest round of corporate Dem folding in the face of criticism from rightwinger (Having the Backbone to Set Minimum Standards for Health Insurance 11/13/2013):

Democrats are showing once again they have the backbones of banana slugs.

The Affordable Care Act was meant to hold insurers to a higher standards. So it stands to reason that some insurers will have to cancel their lousy sub-standard policies.

But spineless Democrats (including my old boss Bill Clinton) are caving in to the Republican-fueled outrage that the President “misled” Americans into thinking they could keep their old lousy policies — and are now urging the White House to forget the new standards and let people keep what they had before.

Charlie Pierce was disturbed by Clinton's announcement (The Beginning of What May Be the End Esquire Politics Blog 11/13/2013):

If the Democratic party, through its elected leaders, bails on the health-care law even so far as go out of its way to let people keep their lousy insurance plans that do not come up to the Affordable Care Act's specifications, that's pretty much the ballgame. There will be barbering and compromising until hell won't have it and, eventually, the only thing left will be the Medicaid expansion, and we all know the vast influence that poor and lower middle class people have over the political process. (And, as Steve M shrewdly notes, the Democrats will get blamed for the deleterious effects of any changes now anyway.) There is far less of a downside right now to being stubborn, regardless of what the courtier press is telling nervous Democrats. Otherwise, the tracks already are cleared and you can hear the the train a-comin'.
He's right. Democrats are really losing sight of the basics of health care reform if they fold on this.

As Reich puts it:

Can we please get a grip? Whenever industry standards are lifted — a higher minimum wage, safer workplaces, non-toxic foods and drugs, safer cars — people no longer have the “freedom” to contract for the sub-standard goods and services.

But that freedom is usually a mirage because big businesses have most of the power and average people don’t have much of a choice. This has been especially the case with health insurance, which is why minimum standards here are essential.
In The Surrender Is Not Abject, So There's That 11/14/2013 after the White House announced it's capitulation, Pierce writes:

This, of course, is meant to "head off" a general stampede by the Democratic chickenshit caucus. It is also meant to show that the president is conscious of the concerns of a Republican opposition that will now proceed to demand a delay in the individual mandate, tort reform, and the removal of one of the A's in the president's surname.

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