Editorial January 26, 2017

TheWeekinCongress.com

Editorial

There are two sides to the debate on repealing the Affordable Care Act; one is to simply get rid of the law for all the reasons opponents state even though most are not true; its a job killer, it is crushing the economy and the less specific argument that it is a train wreck. Point is that the arguments against the bill are very weak and most not true in any detail.

From that side of the argument there has been several proposals to replace the law and more to come. Most recent are ‘universal access to health care’, allowing doctors and patients to make medical decisions, and higher quality healthcare. Of course universal access to healthcare now exists (if you can afford it), doctors and patients do make medical decisions without the government weighing in and (if you can afford it), higher quality healthcare (does that suggest that under the current insurance programs we are getting less quality care?

There is one thing common to all the replacement proposals; it will cost you more to buy insurance because there will be no subsidies to help bring premiums down. Soon to be Secretary of Health and Human Services head, Tom Price (R-GA) doesn’t want you to not be able to afford insurance so he is proposing tax credits to offset the costs. While CBO is predicting that removing the ACA will cause premiums to go up we need only look back to how things were before the ACA; people weren’t insured because they couldn’t afford the premiums. So if premiums are going to go up and there are no subsidies to help it is not likely that many can carry the freight until tax time in order to get the financial help to offset the premium costs. That, and those with low incomes are not likely to itemize and claim the credit.

On the other side of the argument are the people enrolled who want to keep it. Here from the House Minority Whip’s Office are several statements about how life will be for some people without the ACA.

  • Sen. Susan Collins (R-ME): “I think that the executive order is very confusing, we really don’t know yet what the impact will be.” [1/23/17]
  • Larry Levitt, Kaiser Family Foundation: “Potentially the biggest step implied by this order would be granting wide-scale hardship exemptions from the individual mandate, which could create significant uncertainty for insurers and chaos in the individual insurance market.” [Huffington Post, 1/20/17]
  • “Ex­perts say break­ing a [ACA] re­place­ment in­to smal­ler pieces could set up some of those pieces for fail­ure—and they could take the whole en­ter­prise down with them… Be­cause Re­pub­lic­ans don’t know what the spe­cif­ic ele­ments of their policy pro­pos­al will be, they don’t know how polit­ic­ally con­tro­ver­sial those ele­ments will be. But if cer­tain pieces of a piece­meal strategy fail, the rest might not work and in­sur­ance mar­kets could des­cend in­to a ‘death spir­al.” [National Journal, 1/23/17]
  • Repealing the ACA without a replacement plan in place would kick 18 million Americans off their health coverage in the first year, and 32 million Americans would be without health coverage by 2026. [CBO]
  • Americans with employer-based insurance would see their premiums increase at least 20 percentin the first year of repeal.
    • Premiums would double in 10 years if the Medicare expansion and marketplace subsidies are eliminated. [CBO]
  • Republican efforts to repeal the ACA and delay implementation of a replacement plan could increase premiums for young adults on average $725 in 2018. [The Century Foundation, 1/24/17]
  • Cedar Rapids, Iowa: “Sara Kissling owns The Sausage Foundry in Cedar Rapids with her husband. She has stage five kidney failure. The Affordable Care Act lets her get coverage with her pre-existing condition. It also helps her afford dialysis treatment and medical equipment…‘Without it I would have met my cap within maybe six months. I’d be dead right now anyway, because who can afford $30,000 per month in expenses.’” [KCRG, 1/15/17]Morristown, New Jersey: “More than 40 people gathered at the Morristown office of U.S. Rep. Rodney Frelinghuysen (R-11) on Friday to express their concerns with the proposed repeal of the Affordable Care Act and to urge the congressman to hold a town hall meeting on the matter. Elsa Sjunneson-Henry, who is partially blind and partially deaf, told a spokesperson from Frelinghuysen’s office she’s worried the repeal of ACA would stop her from being able to lead a regular life. ‘I have been disabled since birth,’ Sjunneson-Henry said. ‘I have literally had a pre-existing condition since before I was born…If the ACA is repealed, I’m very afraid that with the pre-existing conditions I have I could lose my insurance.’” [NJ.com, 1/20/17]Solon Springs, Wisconsin: “Susan Flemmen, a retired teacher from Lake Nebagamon, challenged [Rep. Sean] Duffy (R-WI) for his vote last Friday to repeal the Affordable Care Act, noting that nine other Republicans voted against repeal…‘What was their plan — your plan — to replace it?’ she asked. ‘Why weren’t Republicans working on replace, not just repeal?’” [Hudson Star-Observer, 1/22/17]

Hamilton on Congress

Our System Comes With No Guarantees 

By Lee H. Hamilton

Hamilton

Hamilton

There are a lot of dire predictions about our representative democracy out there. We’re just past a presidential election campaign in which candidates complained about a rigged political system. Now, commentators worry about the imminent failure of the American experiment.

I don’t agree with these predictions of calamity. Our representative democracy is not on the verge of collapse. But I do see stresses and tensions that should concern anyone who cares about our system of self-government. Our representative democracy has been remarkably stable and successful for over two hundred years, but that is no guarantee it will survive and prosper.

The mere fact that this nation is filled with so many citizens who have lost confidence in key institutions is worrisome. The Gallup organization’s ongoing polling has found declines in public confidence over the past few decades in everything from the Supreme Court and Congress to the police and even the military. It shows a pervasive drop in public regard for the institutions that under-gird American life.

The reasons stem in part from a declining willingness among the people who inhabit those institutions to observe the norms of behavior that evoke public confidence. This is notable especially on Capitol Hill and in political life, where the parties seem to have abandoned fair play and taken to using institutions to maximize partisan advantage. In the Senate, the recent refusal even to hold hearings on the President’s nominee to the Supreme Court brought the lack of comity between branches to a new low.

Politicians engage in a degree of partisanship that a few decades ago would have disqualified them in the eyes of the voting public. They attack opposing politicians’ patriotism, impugn their loyalty, accuse them of criminal activity, question the fairness of the election process itself – with virtually no evidence – and seek to undermine their effectiveness in office. Small wonder that elected officials’ legitimacy is increasingly called into question among the public at large.

If we had a media that prized both the vigilance and impartiality it displayed during its heyday, these tendencies might not run so rampant. Similarly, if politicians were willing to negotiate, compromise, and search for remedies to the nation’s challenges, then our current dysfunctional inability to get things done would be less of a hallmark of these times.

Yet too many politicians seem fine with dysfunction. They appear more interested in holding power than in using it to solve problems. They reject the norms of behavior in a civil society – for example, the New York politician who wished President Obama dead of Mad Cow Disease. They sidestep accountability and transparency: tweeting their stances rather than facing hard questions, avoiding press conferences that would give reporters a chance to hold them to account, preferring public rallies to the give and take that allows the public to examine and scrutinize their stances.

All of this poses real challenges to the system. So what might be done to restore public faith in its fairness, justness and decency?

Paul Light, a professor of public service at New York University, recently came out with a paper, “What Americans Want from Government Reform,” that reinforces the proposals many reformers have been pushing in recent years. His list of fixes that would enjoy support among ordinary Americans in both parties includes reducing the role of money in elections, boosting ethical constraints on elected officials, reducing waste and inefficiency, finding ways to increase the voices of ordinary citizens, and ensuring that civil servants and political appointees are qualified and competent.

Americans don’t expect miracles. They just want the basic features of government to work. But here’s the thing: making this happen is up to us. Politicians may be directly responsible for the problems above, but you and I as voters allow them to get away with it. We voted them into office, kept them there, and paid little attention to their shenanigans.

The problem is not just the politicians. It’s us, too. The first words of the Constitution read, “We the People,” not “We the Government.” It’s up to us to strive for a more perfect union, and to be vigilant about these adverse tendencies that threaten to undermine our representative democracy.

Lee Hamilton is a Senior Advisor for the Indiana University Center on Representative Government; a Distinguished Scholar, IU School of Global and International Studies; and a Professor of Practice, IU School of Public and Environmental Affairs. He was a member of the U.S. House of Representatives for 34 years.


Foreign Affairs

Mosul, Iraq

“The Iraqi Security Forces (ISF) pushed ISIS out of eastern Mosul on January 24, but will need to continue efforts to expel ISIS from historic support zones in Diyala and Anbar. With the support of Coalition advisors, the ISF recaptured the last ISIS-held neighborhood in eastern Mosul on January 24 and is preparing to launch operations into western Mosul.” ISW

Syria

“Russia and Turkey implemented a nationwide ‘cessation of hostilities’ agreement on December 29 in preparation for negotiations between the regime and opposition scheduled to be held in Astana, Kazakhstan on January 23. The deal will exclude all groups designated as “terror organizations” by the UN Security Council…violence continued across the country.” ISW

Yemen

“The US carried out “targeted drone strikes” in Yemen on Friday, Saturday and Sunday, killing a handful of al Qaeda militants, according to a US official and the Pentagon. The strikes were aimed at al Qaeda in the Arabian Peninsula, and were the first such strikes to take place under President Donald Trump.The strikes, which were later confirmed by the Pentagon, did not require Trump to sign off on them.” CNN


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