Editorial October 13, 2017

TheWeekinCongress.com

From the Left

How to Dismantle the Affordable Care Act

 Here’s a look at each of the ways the Trump Administration and Congressional Republicans are sabotaging the ACA:

LATEST EXECUTIVE ORDER

Today, the President signed into law an executive order that attempts to put in place policies included in TrumpCare that have already been rejected by the American people. The executive order would:

  • Undermine consumer protections and allow insurance companies to sell plans without essential health benefits, like hospitalization, meaning people may not be able to get the care they need;
  • Significantly destabilize health care markets, leaving consumers with few – if any – options for affordable health coverage;
  • Allow healthier consumers to obtain cheaper plans with few benefits that won’t cover all the care they may need, while leaving older, sicker consumers with skyrocketing costs;
  • Return us to the days when insurance companies could discriminate against Americans with pre-existing conditions.
 ACA OUTREACH AND ENROLLMENT

As open enrollment begins on November 1, the Trump Administration has taken every effort to make it harder – not easier – for Americans to sign up for coverage. The Administration:

  • Cut the open enrollment period in half, giving Americans less time to apply for affordable health care. The open enrollment period for 2018 plans will last from November 1 to December 15, compared to the open enrollment period for 2017, which was six weeks longer.
  • Slashed funding for outreach efforts that help educate Americans of the open enrollment period by 90%. This funding helps grassroots organizations participate in health fairs and walk Americans through the health care sign-up process.
  • Will shut down the Healthcare.gov website on every Sunday of open enrollment, limiting weekend opportunities for Americans to sign up for health care.
    • Stopped all outreach to the Hispanic community, the most underserved, underinsured population that has seen the largest gains in coverage since the ACA was signed into law. 
      • Pulled out of all coordination with state and local officials on events to help Americans enroll.
        • Vox highlights one example in Mississippi: “For the past three years, the US Health and Human Services Department has partnered with a health advocacy group in Mississippi on an education tour before Obamacare enrollment started. They would meet around the states with groups that sign people up for coverage — state officials, health centers, insurance brokers, and the like — to prepare for open enrollment.  Up until Monday, Roy Mitchell, executive director of the Mississippi Health Advocacy Program, thought these events were going forward… But then two days ago, he received a short message from an agency official, which Mitchell shared with Vox: HHS wouldn’t be doing any Obamacare marketplace events in the South this year. No further explanation was provided.

COST SHARING REDUCTION PAYMENTS

In addition, the Trump Administration continues to threaten to cut off payments for Cost-Sharing Reductions, which reduce out-of-pocket costs for low-income working families and ensure the continued stability of insurance markets. Refusing to make these payments would cause instability for insurers and rate increases on millions of other Americans. A Congressional Budget Office analysis says ending these payments would likely increase premiums by 20% next year and by 25% in 2020. In addition, if the Trump Administration does not make CSR payments, the individual market could collapse.

In addition to President Trump’s threats to stop these payments, Congressional Republicans filed a politically-motivated lawsuit in 2014 seeking to end cost-sharing reduction payments. Republicans continued to stoke fear and market instability by delaying the legal proceedings and denying certainty for insurers over whether the payments will be made as they set premiums for 2018. Health insurers in several states announced they are exiting the Marketplaces in 2018 as a result of the uncertainty Republicans have created.

WEAKENING THE LAW

In addition to today’s executive order, President Trump signed another executive order when he took office that instructed agencies to weaken the Affordable Care Act by not enforcing certain provisions. By signaling to insurers that the law, as written, would no longer be enforced, insurers had to factor that into their decisions about 2018 rates and whether they would participate in the marketplaces at all in this uncertain climate. The continued instability and uncertainty as to whether the Affordable Care Act will be enforced means increased premiums and fewer options for consumers in 2018.

Since the Affordable Care Act’s enactment, Congressional Republicans have taken steps to undermine risk mitigation programs that help stabilize the insurance markets. This includes inserting a provision into a 2014 government funding bill that defunded risk corridors, which were established to ensure stability in the initial years of the ACA’s implementation as millions of previously uninsured Americans constituted a new and inherently risky market. As a result, insurers received a fraction of what was owed under the ACA, amounting to billions in losses for insurers nationwide, which then led to the industry cutting back on benefits and increasing premiums.

OTHER LEGAL CHALLENGES & ATTEMPTS TO SABOTAGE

As previously noted, state Republican leaders refused to implement the ACA and pursued legal challenges in the courts, including a lawsuit challenging the constitutionality of the law filed in 2011. The following year, the Supreme Court upheld the constitutionality of the law in NFIB v. Sebelius, but it also ruled that the federal government could not compel states to expand coverage through their Medicaid programs. With 19 Republican Governors refusing to expand Medicaid to all those eligible under federal law, consumers face higher premiums in those states. The Urban Institute predicts if all states expanded Medicaid, 5 million uninsured Americans would gain coverage. According to a 2016 report by the Office of the Assistant Secretary for Planning and Evaluation, premiums are about 7% higher in states that did not expand Medicaid.

Hamilton on Congress

Election Reform Is About More Than Fraud 

By Lee H. Hamilton

Hamilton

Hamilton

A dozen years ago, the preface to a report on federal election reform began with these words: “Polls indicate that many Americans lack confidence in the electoral system, but the political parties are so divided that serious electoral reform is unlikely without a strong bipartisan voice.”

I can find no part of that sentence that’s not still true. Americans still lack confidence in the electoral system. The political parties are still divided. Serious electoral reform remains unlikely. Perhaps the only change is that the commission issuing the report was co-chaired by a Democrat and a Republican – former President Jimmy Carter and former Secretary of State James Baker – who genuinely tried to find a bipartisan approach to our election system’s problems.

Since then, we’ve careened into a pitched political battle on the issue.

At one level, I’m baffled by the lack of progress. I sat on that commission, and what seemed obvious to us then seems even more obvious today. Voting is the most basic step a representative democracy asks of us. We do three things when we vote: we select the officials we want running the government; we suggest the direction of government policy; and we reaffirm our belief and our stake in representative democracy. You can’t get more important than that. So why do we remain in an endless national standoff on how to fix our elections?

The answer, of course, is that in politically divided times, changes to elections are seen through partisan eyes.

This is disappointing, because right now there should be plenty of room for agreement. We face genuine challenges to our electoral system that even the most partisan of Democrats and Republicans could come together on: aging machines, long lines at the polls, cyber attacks by hostile entities, foreign interference, inadequately trained voting officials, voter lists that are not up to date… It’s a long list.

But where the two sides fall apart is on the most basic of questions: how readily do we give access to the voting booth? I’ll lay my cards on the table. I believe in wider access. Creating a Congress and an overall government that are more representative of the American people rests on expanding the electorate and beating back the barriers to voting.

The more people who vote, the better the chance to strengthen the political center formed by moderates and pragmatists. The lower voter turnout becomes, the more sway held by the most ideologically intense voters, who reward the most polarizing candidates, and the more likely deep resentments are created among those citizens denied the right to vote.

This is not to dismiss concerns about voter fraud. We do need to make sure that the person arriving to vote at a polling site is the same one who’s named on the voter list. And we’re headed in that direction. The number of states requiring a voter ID has increased dramatically over the last couple of decades – today about 50 percent of American voters live in states that require a voter to produce an ID before casting his or her ballot.

Yet the ambivalence many of us feel about this is understandable. We want to ensure there’s no fraud, but at the same time we are aware that stringent ID requirements disenfranchise a lot of people who may have trouble acquiring an ID: they don’t have a driver’s license, passport, or birth certificate. So the requirements can be an effective way to block minority groups or others from voting. And there’s this political reality: many of those who call the loudest for restrictive ID laws are targeting groups that they think will vote against them.

Though we want to ensure that only those people eligible to vote are actually voting, we also want to ensure that all those who are eligible to vote find it convenient to do so. There’s a lot of work to be done on that front, at every level of government. The entire system needs top-to-bottom review and strengthening. And so far, I see no evidence that we as a nation are taking this need seriously.

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.


Bill-O-the-Week

S. 585Dr. Chris Kirkpatrick Whistleblower Protection Act of 2017 This bill seeks to strengthen protections for lower-level federal whistleblowers.  It requires agency heads to propose suspensions of at least three to five days for first offenses and termination for second offenses if an agency head, administrative law judge, Merit Systems Protection Board, a federal judge, or Inspector General finds that supervisors retaliated against whistleblowers. The bill also reduces the length of notice requirement for proposed disciplinary action for thirty to fourteen days, and eliminates the option to hold hearings if supervisors contest a proposed disciplinary action.  The Office of Personnel Management (OPM) has expressed concern that this and other provisions may not withstand constitutional scrutiny if challenged in court.  In Cleveland Board of Education v. Loudermill, the Court ruled that agencies must notify employees of factors they will consider regarding the penalties and provide employees with meaningful opportunities to respond, in order to comply with Due Process protections.


Magic Mondays


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