The President’s Political Death Has Been Greatly Exaggerated

Official White House photo courtesy of Pete Souza

Official White House photo courtesy of Pete Souza

Despite what some called “Obama’s worst year ever” and what everyone agreed was terrible, horrible, no good, very bad Obamacare rollout, Barack Obama’s job approval rating has bounced back out of the 30s and into the mid-40s—not great, but neither the inexorable slide into oblivion that many predicted. Once again, the reports of Obama’s political death have been greatly exaggerated, begging the question as to why pundits seem so eager to pronounce his last rites.

On ABC’s This Week With George Stephanopoulos, Matthew Dowd was the latest to eulogize the Obama presidency.

“A year ago today he was winning a 50 percent-plus victory, first person since Eisenhower to win two terms over 50 percent, everything seemed so great,” said Dowd. “Ever since the start of the second administration, it’s all gone downhill. His presidency, in my view, and the credibility of his presidency and the relevancy of his presidency is dramatically in question today, and I think he can’t recover from it.”

Dowd, whom I worked for briefly almost two decades ago when he was a Democrat, wasn’t making a partisan attack. Despite him later becoming a Republican who helped elect and re-elect George W. Bush, my disagreement with him here is neither personal nor partisan. I like Matthew but suspect he could be wrong.

Without ever earning a cool nickname like “the Comeback Kid” or a reputation for resiliency, Obama has made a habit of bouncing back. We turned our backs without checking for a pulse after Hillary Clinton won in New Hampshire, when Rev. Jeremy Wright god-damned America, and when Obama said “The private sector is doing fine” amid 9% unemployment. Pundits called him a dead man walking after his last “worst year ever” in 2011 when he tried to negotiate with congressional Republicans. We asked ourselves whether he could recover from his first debate with Mitt Romney, forgetting that Obama has rebounded more times that Dennis Rodman.

Yet here he stands, the president who plays his best when he has backed himself into a corner but who never gets the reputation as a clutch performer. We should respect someone who is always proving the naysayers wrong and repeatedly beats the odds. But here’s the thing with Obama—and the reason why I suspect the insiders always seem eager to attend his political funeral: Winning has never felt worse.

Obama has the bad luck to be a serious man in trivial times (Birthers, and truthers, and deniers! Oh, my!), to seek common ground with a party devoted to trench warfare, and to preside over an era of disruption that never feels like peacetime or wartime. He passed landmark laws to reform Wall Street, to make student loans cheaper, to create a new G.I. Bill, and to save the U.S. auto industry. He ended wars, torture, and Osama bin Laden‘s life. He recapitalized banks, repealed Don’t Ask Don’t Tell, and nearly doubled fuel efficiency standards. But instead of ticker-tape parades we feel cheated of both justice and satisfaction.

When Obama won in 2008 by putting red states such as Indiana, North Carolina, and Virginia into his column, he dangled the possibility of a post-racial, post-partisan peace. Instead, he has had to defend the White House against a political war of attrition. We thought we were getting a Democratic Ronald Reagan and a long spell of feel-good transformation. Instead, we got the black Lyndon Johnson, leaving behind an impressive list of achievements as well as a country exhausted from tension, obstruction, and fighting.

We only feel good when he explains the world to us, but by now we’ve become conditioned to the disappointment that inevitably follows one of his speeches. He hasn’t lost his gifts. It’s just that we know they won’t change our lives.

Instead, those who make a living watch this White House swing wildly from Obama’s political victories (“everything seemed so great”) to congressional obstruction. An improving economy is likely to continue Obama’s recovery, but bad things will happen, both real (Benghazi) and manufactured (BENGHAZI!!). And the grand marshals of the Beltway parade will ask each other whether Obama could possibly recover, ignoring the fact that he always has.

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Jason Stanford

Jason StanfordJason Stanford is a Democratic political consultant and opposition researcher based in Austin. He served as 2006 Democratic gubernatorial candidate Chris Bell's campaign manager and chief spokesman. As the head of Stanford Research, he leads opposition research for various candidates and interest groups across the region.

Stanford moved to Texas in 1994 to work as a Deputy Press Secretary for the Ann Richards Committee. Jason and a former colleague founded Stanford Ryan Research & Communications, Inc. in January 1997. The firm became Stanford Research in 1999.

He’s the co-author of “Adios, Mofo: Why Rick Perry Will Make America Miss George W. Bush”, and has a degree in Russian from Lewis & Clark College.

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Last Week, In Case You Missed It: December 29, 2013

tagxedo-123113The last week in 2013 was a busy one at Oak Ridge Now, as it probably was for you and yours. As such, may may not have caught everything we published. Here’s a quick recap of what went on.

Our Lady War Eagles blew out one of their nemeses, the Lady Cavaliers of College Park, 66-43 to score their first district win of the season. Big congratulations were in order for them.

In our Texas news, there was a lot that changed in public education in 2013. We brought your the complex and wrenching story of an Iraq veteran from Texas now on death row. We looked at how hunters in Texas are donating extra meat to food pantries around the state, which is especially good given the recent cuts in food stamp benefits. And our beloved Senator Ted Cruz has no regrets and is offering no apologies for his actions during his first year in Congress.

We published two studies from our friends at Pew Research this week: the first explores the public’s sentiments in the wake of December’s bi-partisan budget agreement in Congress. It seems most folks would prefer not to cut back on aid to the poor or entitlements such as Social Security and Medicare. So that leaves…? The second study looks at how we think about Christmas now compared to how we thought about it in our childhood. Yes, this one probably belongs in the “things that are fascinating only to me” category, but I really think it is an interesting read.

My favorite piece of the week is where Robin O’Bryant confesses how really difficult it can be to keep smiling amidst bouts of depression during the holiday season:

I keep it breezy on Facebook and say things like,  “Have a great turkey day! May all your food dreams come true! Happy Holidays! Fa la la la laaaa!!!”

Because it’s easier than saying, “Hey, I realize today may be really hard for you because it’s not what you thought it was going to be 5 years ago, or 3 months ago or 2 minutes ago. But I hope it’s bearable. I hope it’s good. I hope you make it through this day with a smile. I hope you are kind to yourself today. I hope you breathe and notice something beautiful. Maybe it’s not what you thought it was going to be. But maybe you’ve been adopted into something that is lovely and beautiful and full of light.”

We published three movie reviews this week, for Leonardo DiCaprio’s Wolf of Wall Street, River Phoenix falling in love with a computerized voice in Her, and of course, Will Ferrell’s triumphant return in Anchorman 2: The Legend Continues. Sweet Lincoln’s mullet!

Our other features included Peter Funt looking at the lives of a number of people we lost in 2013 that didn’t make the cover of US magazine or the Today Show. Dave Ramsey advised a couple to catch up on their student loans, and we profiled six soldiers who lost their lives when their Black Hawk helicopter crashed in Afghanistan.

justine-saccoOur Opinions section included our take on the Duck Dynasty uproar and on President Obama’s overlooked income equality speech. Joe Gandelman then compares the Phil Robertson saga with the treatment Justine Sacco had when she tweeted the gem on the right.

Will Durst released his belated 2013 Christmas Gift Wish List and his frustration with password complexity.Bill O’Reilly rants on, guess what, The War on Christmas.  Jason Stanford believes it is high time Texas investigates the contract of it’s $462 million stanadardized testing vendor, and Tom Purcell believes the key to keeping New Year’s resolutions, is, you know, resolve. Agreed. Resolve is difficult, especially when you come home to the smell of chocolate chip cookies just out of the oven. Resolve tends to go out the window.

All that and our terrific editorial cartoons, last week on Oak Ridge Now.

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Chuck Briese, Oak Ridge Now

Chuck Briese, Oak Ridge Now Chuck Briese has been a resident of South Montgomery County since 1988. He and his lovely and patient wife, Leslie, have six sons, with only one left to finish high school. Chuck has been a Cub Scout leader, a Little League baseball coach, a church youth leader, and a general troublemaker over the course of the past 25 years. He is obsessed with his lawn, and likes restaurants that serve food that fills up the plate. He has a tendency to tilt at windmills, which may explain why he started Oak Ridge Now.

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The Health Law Takes Effect: A Consumer’s Guide

Photo courtesy of iStock

Photo courtesy of iStock

Starting Jan. 1, central provisions of the Affordable Care Act kick in, allowing many uninsured Americans to afford health insurance. But the landmark law still faces heavy opposition from Republicans and from a public that remains skeptical the law can improve health care coverage while lowering its cost.

The law has already altered the health care industry and established a number of consumer benefits. It will have sweeping ramifications for consumers, state officials, employers and health care providers, including hospitals and doctors.

However, healthcare.gov, the federal website that is managing enrollment in 36 states, has been plagued by electronic problems that botched the Oct. 1 rollout of the health law’s online marketplaces, or exchanges. The problems frustrated potential enrollees and gave Republicans new fodder for their argument that the law was doomed to fail. After hundreds of hardware and software fixes, federal officials have said that the site works for the “vast majority of users,” but some problems remain.

Here’s a primer on where the law stands now and how it might change.

I don’t have health insurance. Under the law, will I have to buy it and what happens if I don’t?

You have until March 31 to enroll in health insurance before you are subject to the law’s tax penalty for not having coverage. For individuals, the penalty would start at $95 or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016. For families this year the penalty is $285 or 1 percent of income. That will grow in 2016 to $2,085 or 2.5 percent of household income, whichever is greater. The requirement to have coverage can be waived for several reasons, including financial hardship or religious beliefs.

Last month the administration decided to waive the individual mandate penalty for 2014 for some people in the individual insurance market whose plans were being canceled.  Under the law’s “hardship exemption,” these consumers are also eligible to buy “catastrophic” coverage policies, which have lower premiums and higher deductibles than other plans that comply with the law.

I get my health coverage at work and want to keep my current plan. Will I be able to do that? How will my plan be affected by the health law?

If you get insurance through your job, it is likely to stay that way. But, just as before the law was passed, your employer is not obligated to keep your current plan and may change premiums, deductibles, co-pays and network coverage.

The law has already made several changes to employer-sponsored insurance. For example, plans generally now ban lifetime coverage limits and include a guarantee that an adult child up to age 26 can stay on her parents’ health plan. More than 3 million young adults have been able to stay on their parents’ plan due to this provision, according to administration figures.

What other parts of the law are now in place?

Starting Jan. 1, insurers will not be allowed to deny you coverage based on a pre-existing medical condition or place annual limits on medical coverage of essential health benefits, which include prescription drugs and hospitalization.

You are likely to be eligible for some preventive services such as breast cancer screenings and cholesterol tests, with no out-of-pocket costs.

Health plans can’t cancel  your coverage once you get sick – a practice known as “rescission“ – unless you committed fraud when you applied for coverage.

The law earlier barred insurers from denying coverage to children with pre-existing conditions.

Insurers have to provide rebates to consumers if the companies spend less than 80 to 85 percent of premium dollars on medical care.

Some existing plans, if they haven’t changed significantly since passage of the law, do not have to abide by certain parts of the law. For example, these “grandfathered” planscan still charge beneficiaries part of the cost of preventive services.

If you’re currently in one of these plans, and your employer makes significant changes, such as raising your out-of-pocket costs, the plan would then lose its grandfathered status and have to abide by all aspects of the health law.

I want health insurance but I can’t afford it. What will I do?

Depending on your income, you might be eligible for Medicaid. Before the health law, in most states nonelderly adults without minor children didn’t qualify for Medicaid. But now, the federal government is offering to pay the cost of an expansion in the programs so that anyone with an income at or lower than 138 percent of the federal poverty level, (about $16,000 for an individual or $32,500 for a family of four based on current guidelines) will be eligible for Medicaid.

The Supreme Court, however, ruled in June 2012 that states cannot be forced to make that change. As of last month, 25 states and the District of Columbia have chosen toexpand Medicaid.

kaiser-health-newsWhat if I make too much money for Medicaid but still can’t afford to buy insurance?

You might be eligible for government subsidies to help you pay for private insurance sold in the state-based insurance marketplaces, also called exchanges.

These premium subsidies will be available for individuals and families with incomes between 100 percent and 400 percent of the poverty level, or about $11,490 to $45,960 for individuals and $23,550 to $94,200 for a family of four (based on current guidelines).

If you earn less than 100 percent of the poverty level and live in a state that does not expand the Medicaid program, you generally cannot qualify for a subsidy to purchase coverage. However, you are also exempted from the penalties for not having insurance.

Will it be easier for me to get coverage even if I have health problems?

Insurers are now barred from rejecting applicants based on health status.

I own a small business. Will I have to buy health insurance for my workers?

No employer is required to provide insurance. But starting in 2015 – a one-year delay from the previous date of 2014 – businesses with 50 or more employees that don’t provide health care coverage and have at least one full-time worker who receives subsidized coverage in the health insurance exchange will have to pay a fee of $2,000 per full-time employee. The firm’s first 30 workers would be excluded from the fee.

However, firms with fewer than 50 people won’t face any penalties.

In addition, if you own a small business, the health law offers a tax credit to help cover the cost. Employers with fewer than 25 full-time workers who earn an average yearly salary of $50,000 or less can get tax credits of up to 50 percent this year.

Citing technical difficulties, in late November the Obama administration announced aone-year delay in the debut of the online marketplace for small businesses, called the Small Business Health Option, or SHOP. Until the SHOP exchange is fully operational in November 2014, small business owners can apply for coverage through the mail, over the phone or with a broker or insurance agent.

I’m over 65. How does the legislation affect seniors?

There is no need for you to enroll in the health law’s exchanges. Medicare is not part of those exchanges.

But the law does make other changes to Medicare.It is narrowing a gap in the Medicare Part D prescription drug plan known as the “doughnut hole.” That’s when seniors who have paid a certain initial amount in prescription costs have to pay for all of their drug costs until they spend a total of $4,550 for the year. Then the plan coverage begins again.

That coverage gap will be closed entirely by 2020. Seniors will still be responsible for 25 percent of their prescription drug costs. As of late November, more than 7.3 million seniors and people with disabilities who hit the doughnut hole have saved $8.9 billion on their prescription drugs, according to the Centers for Medicare & Medicaid Services.

The law also expanded Medicare’s coverage of preventive services, such as screenings for colon, prostate and breast cancer, which are now free to beneficiaries. Medicare will also pay for an annual wellness visit to develop or update a plan to prevent disease or disability.

According to CMS, in 2012 an estimated 34.1 million beneficiaries took advantage of Medicare’s coverage of preventive services with no cost-sharing.

The health law reduced the federal government’s payments to Medicare Advantage plans, run by private insurers as an alternative to the traditional Medicare. Medicare Advantage costs more per beneficiary than traditional Medicare. Critics of those payment cuts say that could mean the private plans may not offer many extra benefits, such as free eyeglasses, hearing aids and gym memberships, that they now provide.

Will I have to pay more for my health care because of the law?

It depends. Younger people who often paid less for health insurance before the health law may pay more for coverage. Older people may pay less because there are tighter rules governing how much more insurers can charge based on age. People who could not afford insurance before may now be eligible for subsidies to cover the cost of premiums – and possibly out-of-pocket costs as well.  Individuals who purchased insurance before may pay more because the law’s “essential health benefits” require that more services be covered.

Opponents say the law’s additional coverage requirements will make health insurance more expensive for individuals and for the government. Even supporters of the law acknowledge its steps to control health costs, such as incentives to coordinate care better, may take a while to show significant savings.

There are also some new taxes and fees. For example, starting last year, individuals with earnings above $200,000 and married couples making more than $250,000 paid a Medicare payroll tax of 2.35 percent, up from 1.45 percent, on income over those thresholds. In addition, higher-income people faced a 3.8 percent tax on unearned income, such as dividends and interest.

Starting in 2018, the law also will impose a 40 percent excise tax on the portion of most employer-sponsored health coverage (excluding dental and vision) that exceeds $10,200 a year and $27,500 for families. The tax has been dubbed a “Cadillac” tax because it hits the most generous plans.

In addition, the law also imposes taxes and fees on several major health industries. Last year, medical device manufacturers and importers began paying a 2.3 percent tax on the sale of any taxable medical device to raise $29 billion over 10 years. An annual fee for health insurers is expected to raise more than $100 billion over 10 years, while a fee for brand name drugs will bring in another $34 billion.

Those fees will likely be passed onto consumers in the form of higher premiums.

Has the law hit some bumps in the road?

Yes. The Oct. 1 launch of healthcare.gov was marred by technical problems that frustrated millions of consumers and gave Republicans on Capitol Hill fresh material for another round of hearings and charges criticizing President Barack Obama’s signature domestic policy achievement. Some Democrats have urged the administration to delaythe law’s individual mandate, citing the website’s woes. After a series of repairs, officials have said that the website is working for the “vast majority of users.”

When millions of Americans who buy coverage on the individual market began to learnthat their current health plans would not be offered in 2014 because they did not  comply with the health law’s new requirements, Obama had to apologize for his oft-repeated statement “if you like your health plan you can keep it.”

With some Americans still having difficulty in late December trying to sign up for coverage that starts Jan. 1, administration officials asked insurers to give people more time to pay for coverage beginning Jan. 1.  Insurers said that people who enroll by Dec. 24 can pay as late as Jan. 10.

Problems with healthcare.gov have helped keep early enrollment well below government estimates, but administration officials have said they expect sign-ups to continue to intensify before open enrollment closes March 31.

Are there more changes ahead for the law?

Republicans are expected to continue their efforts to defund or repeal the health law and convene additional oversight hearings to highlight the law’s problems as Congress gears up for the 2014 midterm elections.

It’s also possible that some of the taxes on the health care industry, which help pay for the new benefits in the health law, could be rolled back due to pressure from affected groups. A repeal of the tax on medical devices was part of last fall’s debate over funding the federal government and raising the federal debt ceiling but was not included in the final deal. Medicare’s actuary has predicted that the law’s payment reductions to hospitals and other providers may not withstand heavy political lobbying on Capitol Hill.

Meanwhile, the Independent Payment Advisory Board (IPAB), one of the most contentious provisions of the health law, is also under continued attack by lawmakers. IPAB is a 15-member panel charged with making recommendations to reduce Medicare spending if the amount the government spends grows beyond a target rate. If Congress chooses not to accept the recommendations, lawmakers must pass alternative cuts of the same size.

Some Republicans argue that the board amounts to health care rationing and some Democrats have said that they think the panel would transfer power that belongs on Capitol Hill to the executive branch. In March, the House voted to repeal IPAB. The Senate did not consider the measure.

This article was republished from kaiserhealthnews.org with permission from the Henry J. Kaiser Family FoundationKaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Mary Agnes Carey, Kaiser Health News

Mary Agnes Carey, Kaiser Health NewsMary Agnes Carey has covered health reform and federal health policy for more than 15 years as an editor at CQ HealthBeat, as Capitol Hill Bureau Chief for Congressional Quarterly and at Dow Jones Newswires. A frequent radio and television commentator, recently featured on the Nightly Business Report, the PBS NewsHour and on NPR affiliates nationwide, Mary Agnes has a thorough understanding of both the policy and politics of health reform. She worked for newspapers in Connecticut and Pennsylvania, and has a master's degree in journalism from Columbia University.

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Will Durst’s Belated 2013 Christmas Gift Wish List

Photo courtesy of Marshall Astor / Flickr

Photo courtesy of Marshall Astor / Flickr

It’s the most wonderful time of the year. And finally over. Thank the maker. Because if The Little Drummer Boy was played within my immediate vicinity one more time, somebody was going to have a bacon-flavored candy cane crammed into an orifice that doesn’t naturally accommodate candy canes. Bacon or otherwise.

Merchants are whining that more money could have been spent celebrating the anniversary of the birth of the Baby Jesus, but perhaps Christian consumers got hip to their little mark-down games and are poised for the post-holiday sales, which in the tradition of modern retailing creep were being pushed before Santa flew south. Thinking five years is the over/under before the sanctity of Christmas performs the same dark death-dive Thanksgiving took this year.

But to insure that some traditions don’t get inadvertently tossed out with the ribbons, wrapping paper and littlest nephew, let me offer up my annual scathingly incisive yet curiously refreshing, WILL DUR$T’$ XMA$ GIFT WI$H LI$T FOR 2013 for people who maybe didn’t find the presents they truly deserved under the tree.

For Chris Christie: the cape and tights necessary to save the Republican Party from itself.

For Dennis Rodman: some sort of force field that prevents Kim Jong Un from referring to him as “my favorite uncle.”

For medical science to study: Dick Cheney’s heart. George Bush’s brain. And Barack Obama’s spine.

For the City of Toronto: a handshake with Lorne Michaels to star Mayor Rob Ford in “The Chris Farley Story.”

For former Secretary of State Hillary Clinton: a testosterone reduction.

For Vice President Joe Biden: the vial containing Hillary Clinton’s excess testosterone. Or 5-gallon drum.

For the Vatican: another Pope. What the hell? Look at all the positive publicity they’ve produced with two.

For the Republic of South Sudan: the discovery that there is no oil.

For Anthony Weiner: a one-way ticket to a deserted South Sea island populated solely by poisonous snakes and sword grasses.

For Vladimir Putin: a pogo stick for when he bounces around the truth.

For Amazon CEO Jeff Bezos: a deal with the U.S. Postal Service to deliver the mail by drones. Eat that, FedEx.

For Fox News: a cuddly little mascot named Ben Gazee.

For Liz Cheney (whose political ambition caused her to throw her sister under the bus): a round trip ticket on the clue train.

For the NSA: a tracking chip in every American citizen. For our security.

For Republican moderates: a remote control muzzle for Ted Cruz.

For Jay Leno: another network late-night show that will crush NBC in the ratings.

For Edward Snowden: a palate to appreciate borscht and vodka.

For Kanye West: one of those new gold iPhones with all the top divorce lawyers across the country preset into the contacts list.

For Miley Cyrus: an extreme make-over by the Mormon Tabernacle Choir.

For the NRA: enough .357 Magnums with armor-piercing explosive bullets to hand out to every school teacher in the country.

For American school children: Kevlar uniforms.

For Justin Bieber: well-deserved obscurity.

For President Barack Obama: Harry S Truman‘s desk sign — “The buck stops here.”

For the people of Texas: a state-wide time out; to stop and think before executing people with IQs of 62. And stop electing them governor.

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Will Durst

Will Durst is a political comedian who has performed around the world. He is a familiar pundit on television and radio. E-mail Will at durst@caglecartoons.com. Check out willandwillie.com for the latest podcast. Will Durst’s book, “The All American Sport of Bipartisan Bashing,” is available from Amazon and better bookstores all over this great land of ours. Don’t forget to check out his rooftop comedy minutes at: http://www.rooftopcomedy.com/shows/BurstOfDurst.

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Texas Senator Ted Cruz Ends Year as He Began It: No Apologies

 Photo courtesy of Gage Skidmore

Photo courtesy of Gage Skidmore

Ted Cruz wasn’t the only politician who promised to shake up Washington when he was sworn in earlier this year.

But he delivered like no other.

By the time the brash Houston lawyer and Republican firebrand completes his first year in the U.S. Senate on Jan. 3, he will arguably have become the most recognizable face of the GOP’s unapologetic far right — not bad for a guy with no previous experience in elective office.

Loathed by Democrats, feared by many moderate Republicans and practically worshiped by Tea Party activists, Cruz took the U.S. Senate by storm almost from the minute his hand came off the Bible.

His harsh questioning of (and opposition to) Defense Secretary Chuck Hagel during the confirmation process sparked comparisons to red-baiting Sen. Joe McCarthy. He helped lead the successful fight against a bipartisan bill aimed at introducing mandatory background checks for people who buy firearms over the internet or at gun shows. And, unlike fellow conservative senators such as Marco Rubio of Florida and Rand Paul of Kentucky, he fiercely criticized and helped derail a comprehensive immigration bill whose future is now uncertain at best.

Perhaps most significantly, Cruz was a chief architect of the budgetary confrontation that sparked a partial shutdown of the government earlier this year — all in an effort to repeal Obamacare.

In the process, he became the star of a hot-selling coloring book, sparked endless speculation about a run for president in 2016 and even prompted an addition to the political lexicon — “Cruz Control” — generally used by people opposed to his confrontational, uncompromising style.

If there was any doubt about his mark on U.S. politics, a recent poll by Rasmussen seems to clear it up. Eleven percent of the Americans surveyed in it ranked him as the most influential person of 2013 — in the world. He came in third, behind Pope Francis and President Obama.

So what does Cruz have to say for himself as he nears the one-year mark?

Sorry? You’re welcome?

In a lengthy interview with The Texas Tribune on Wednesday, Cruz made it clear that he has no regrets to ponder or apologies to make. When it comes to the government shutdown, for example, Cruz said the fight helped crystallize the failures of the Affordable Care Act while strengthening his resolve to repeal it.

“The proof is in the pudding,” he said. “As a consequence of that fight, we elevated the national debate over the harms Obamacare is causing, and today President Obama has the lowest approval rating he has ever had, and the American public has turned strongly against Obamacare. The reason is simple. This thing isn’t working.”

Democrats don’t see it that way, of course. Texas Democratic Party spokesman Manny Garcia said Cruz pushed people away from the GOP and insulted hard-working Texans.

“Ted Cruz did a great job for Texas Democrats last year,” Garcia said. “As he drove the Republican Party off the ideological cliff, every day Texans turned to Democrats for responsible leadership.” Garcia gave Cruz an “F” for his efforts to kill Obamacare while representing a state that has the highest percentage of uninsured people.

But don’t expect Cruz to back down one iota. He said he will continue to seek the repeal of Obamacare, an idea that in his view has gone from the fringes to “a common-sense, middle-of-the-road” proposal given all of the woes of the new law, such as the botched website rollout and the cancellation of existing policies.

“I intend to do everything possible to stop Obamacare because it isn’t working and it is hurting millions of Americans,” he said. “The path to repealing Obamacare is going to be continuing to energize and mobilize the American people. The answers are not going to come from Washington.”

In the wide-ranging discussion, Cruz made a variety of other observations about his first year in office, his own future and other Texas Republican heavyweights. Among the highlights of the exchange:

  • Cruz said his concerns about Hagel as defense secretary were “rendered all the more relevant by the terrible deal the Obama administration has brokered with the nation of Iran.” He added: “In that confirmation hearing my focus was consistently on his record, on his disclosures and on his past statements, all of which raised substantial reason to doubt that he was an appropriate nominee for that position.”
  • In similar fashion, Cruz defended his questioning of Sen. Dianne Feinstein during a March debate over gun restrictions, when she angrily told him she didn’t need a “lecture” as if she were “a sixth-grader.” Cruz said he merely wanted to know why Feinstein didn’t see the proposal as a violation of the Second Amendment. “It was treated as a ridiculous question outside the bounds of reasonable discussion,” Cruz said in the interview. “That’s part of the reason why we have an out-of-control federal government with a $17 trillion national debt, because there is far too little focus on the Constitution and the Bill of Rights.”
  • Cruz was perhaps the least talkative when asked about the U.S. Senate race, which pits Sen. John Cornyn against U.S. Rep. Steve Stockman and others. Reminded that Stockman was citing Cornyn’s opposition to Cruz’s tactics during the shutdown as a key reason he got in the race, Cruz said, “I like John Cornyn,” and “I like Steve Stockman.” He also noted that he and the senior U.S. senator have “stood side by side on a great many issues” but Cruz steadfastly refused to pick sides. “I’ve never liked it when Washington insiders try to pick winners and losers in Republican primaries,” Cruz said. “I think primaries should be decided by the grassroots in each state. … I’m going to leave it to the voters of Texas to make that decision.” 
  • Cruz, who was born in Canada, said he is living up to his promise to give up his claim to citizenship there but that it’s taking time. “I have retained counsel, and this is in process, but that has not been completed yet,” Cruz said. “My understanding is it should be completed sometime next year, but I don’t have an exact time frame.”
  • On the topic of his failure to disclose an investment in a Jamaican private equity firm, Cruz said his amended forms ended the matter as far as he is concerned. “To the best of my knowledge, that matter is fully resolved,” Cruz said. “We simply filed an amended filing because I realize I inadvertently omitted something I should have disclosed.”
  • As for a potential run for president, Cruz wouldn’t go there: “100 percent of my focus is on the U.S. Senate,” he said. “The Senate is the battlefield right now.” Cruz didn’t care to speculate about a potential 2016 presidential primary matchup with Gov. Rick Perry, either, though he had some kind words for the longest-serving governor in Texas history. “I think he’s been a good governor. He’s a friend, I respect him, and the economic growth and jobs in Texas over the last two decades have been extraordinary, and Gov. Perry deserves credit for helping create, helping maintain, an environment in which small businesses can prosper and thrive,” Cruz said. “I think more states should follow the model of what has worked in Texas.”

This article originally appeared in The Texas Tribune at http://www.texastribune.org/2013/12/19/ted-cruz-ends-year-he-began-it-no-apologies/. Texas Tribune donors or members may be quoted or mentioned in our stories, or may be the subject of them. For a complete list of contributors, click here.

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Jay Root, The Texas Tribune

Jay Root, The Texas TribuneJay Root is a native of Liberty, Texas. He never knew any reporters growing up, and he has never taken a journalism class in his life. But somehow he got hooked on the news business.

It all started when Root walked into the offices of The Daily Texan, his college newspaper, during his last year at the University of Texas in 1987. He couldn't the resist the draw: it was the biggest collection of misfits ever assembled. After graduating, he took a job at a Houston chemical company and soon realized it wasn't for him. Root applied for an unpaid internship at the Houston Post in 1990, and it turned into a full-time job that same year. He has been a reporter ever since.

Root has covered natural disasters, live music and Texas politics — not necessarily in that order. He was Austin bureau chief of the Fort Worth Star-Telegram for a dozen years, most of them good. He also covered politics and the Legislature for The Associated Press before joining the staff of the Texas Tribune.

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Polling Center: Obama Weighs Heavily on Texas Democrats

esident Barack Obama meets with National Economic Council Director Gene Sperling in the Oval Office, Dec. 4, 2013. (Official White House Photo by Pete Souza)

President Barack Obama meets with National Economic Council Director Gene Sperling in the Oval Office, Dec. 4, 2013. (Official White House Photo by Pete Souza)

It takes Lt. Gov. David Dewhurst all of three seconds to mention President Obama in his recent campaign ad. That is faster than the 17 seconds it took him in a previous spot; maybe the lieutenant governor was feeling the heat from one of his rivals in his re-election campaign, state Sen. Dan Patrick, R-Houston, who trumpets his efforts “FIGHTING OBAMA” five seconds into the ad he released in early October.

These are just a few of the many examples one should expect in the Republican primary: The constant invocation of a candidate’s anti-Obama bona fides is a familiar refrain for preaching to the Republican primary choir, and a tried-and-true strategy heading into a mid-term election year that is sure to see lower Democratic turnout than in the last two presidential election years with Obama at the top of the ticket.

Results from five years of University of Texas/Texas Tribune polling of Texans’ approval of Obama suggest that constant criticism of the president is unlikely to trigger much backlash among moderates and even Democrats. GOP candidates have lots of latitude when piling on the president, implications of a public opinion landscape that is bad news for the Texas Democrats who recently have been so flush with optimism.

Obama lost Texas resoundingly in both of his reelection campaigns — to John McCain by 11 percentage points in 2008 and to Mitt Romney by 16 points in 2012 — and it’s not surprising that his approval numbers in Texas have never been stellar. This is a red state, and except for a singular instance in our February 2009 UT/TT poll — right after Obama assumed office —Texans’ disapproval of his job performance has outweighed approval in the remaining 15 polls between then and October 2013.

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Public opinion toward the president favors the Republicans and hurts the Democrats heading into 2014. In the UT/TT Poll, we somewhat uniquely ask respondents whether they only “somewhat” or “strongly” approve or disapprove of the job performance of a particular officeholder. This is in contrast with most pollsters, who just ask a straight approve/disapprove question. The advantage of our format is that we can measure intensity of opinion — and changes in that intensity over time.

Texas Republicans have long held Obama in low regard, with at least 80 percent of GOP identifiers strongly disapproving of the his job performance since May 2010. The Obamas hadn’t quite finished redecorating the White House when Texas GOP candidates up and down the ballot started running against him as much as their opponents. By the time the 2010 general election rolled around, Gov. Rick Perry was doing everything he could to saddle Democratic challenger Bill White with Obama, and even Republican state legislative candidates were using the president in their ads. (For a reminder of what this was like, review this classic spot, which Republican Patrick McGuinness used — unsuccessfully — to gain ground against Democratic incumbent Mark Strama, D-Austin.) Obama’s unpopularity was no surprise at the time and is surely part of the reason so many Republican hopefuls still deride Obama as proof of their conservative credentials.

The repetitive pounding on Obama is partially enabled by the fact that the president doesn’t enjoy symmetrical support among his own partisans. Strong approval among Democrats has slid throughout his presidency — not an unusual occurrence when early hope and promise hit cold, hard political realities (just ask George W. Bush) — with slight upticks during his successful re-election campaign and after the killing of Osama bin Laden. Obama’s strong approval among Democrats now rests at a near low of 36 percent.

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In addition to this lack of intensity among his supporters here in Texas, it’s also the case that in October 2013, nearly a quarter of Democrats indicated either a neutral view of the president (that is, neither approval nor disapproval), or a negative perception — a low-water mark for his presidency. But maybe most importantly when looking ahead to the 2014 races, 42 percent of Texas moderates held a negative opinion of his job performance in October 2013, the largest share holding a negative opinion during his time in office. Democrats and moderates have been consistently kind to the president; more than 50 percent expressed approval of his job performance in 11 of the 16 UT/TT polls since February 2009. If moderates have soured on the president, there is little disincentive for GOP candidates to continue with their primary season Obama bashing during the fall. That includes anchoring an ascendant state Sen. Wendy Davis, the Fort Worth Democrat running for governor, to a sinking president.

Democratic hopes of capturing any statewide office in 2014 rest in no small part on bucking the trend of the president’s party losing ground in midterm elections. The magnitude of that lost ground tends to be foreshadowed by presidential approval numbers. Obama is still the figurehead of his party, a fact that no Republican officeholder, or potential officeholder, is likely to let the electorate forget.

Amid all the speculation about whether Democrats can turn the tide, Obama’s approval numbers are creating a rip current likely to push Democratic hopes farther out to sea — while back on shore, the lifeguards all seem to have disappeared.

Joshua Blank co-authored this story.

This article originally appeared in The Texas Tribune at http://www.texastribune.org/2013/12/05/polling-center-obama-weighs-heavily-texas-democrat/. Texas Tribune donors or members may be quoted or mentioned in our stories, or may be the subject of them. For a complete list of contributors, click here.

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Jim Henson, The Texas Tribune

Jim Henson, The Texas TribuneJim Henson directs the Texas Politics project and teaches in the Department of Government at The University of Texas, where he also received a doctorate. He helped design public interest multimedia for the Benton Foundation in Washington, D.C., in the late 1990s and has written about politics in general-interest and academic publications. He also serves as associate director of the College of Liberal Arts Instructional Technology Services unit at UT, where he has helped produce several award-winning instructional media projects. In 2008, he and Daron Shaw, a fellow UT government professor, established the first statewide, publicly available internet survey of public opinion in Texas using matched random sampling. He lives in Austin, where he also serves as a member of the City of Austin Ethics Review Commission.

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The Top 10 Comedic News Stories of 2013

green-eggs-and-hamBe still, your beating hearts. As we exultantly find ourselves in this festive place once again. The most wonderful time of the year. When squealing children race home from school to check and recheck their favorite news websites. Husbands and wives fight for possession of the living room tablet. Grandparents double up on their meds. Relax, everybody. It’s finally here. Yes, you may consider the Top 10 Comedic News Stories of 2013 officially released.

Some years make it darn near impossible from which to strain a few meager laughs. As amusing as a broken crutch on the edge of a toxic waste dump. But enough about Detroit. Because in terms of funny comedy humor, this year was lush and fecund like a tropical rain forest. Horsemeat discovered to be a major component of IKEA’s meatballs. And the teachable moment here could be not to look to Swedish furniture manufacturers for our nutritional needs.

It is pivotal to understand that the Top 10 Comedic News Stories of 2013 are in no way to be confused with the Top 10 Legitimate News Stories of 2013. No. No. No. They are as different as soy beans and lug nuts. Bluetooth and dental floss. Palm fronds and those weird, cone-shaped collars that dogs wear to keep from chewing their butts.

These are the stories and events of the year thus far, that most lent themselves to mocking and scoffing and taunting, as determined by the executive council of the Comics, Clowns, Jesters & Satirists Union. Which, as you probably have already guessed, is… me.

10. The president becomes a lame duck four months into his second term. Beyond lame duck. More of a quadriplegic platypus. Barack Obama Leadership Skills. Like saying Fukushima sushi. Paula Deen at the Apollo.

9. Former New York Congressman Anthony Weiner attempts a comeback. And he proves once again that his name is also the source of most of his problems.

8. Pope Francis turns out to be a liberal Democrat while Pope Benedict stays busy updating his Christian Mingle profile.

7. To escape government persecution, world class leaker Edward Snowden runs first to China and then to Russia. Which is like joining the army because “you’re tired of people telling you what to do.”

6. Ted Cruz rallies fellow Tea Partiers by reading “Green Eggs and Ham” on the floor of the Senate, then misinterprets the moral of a book aimed at kindergarteners.

5. Toronto Mayor Rob Ford admits using crack during one of his “drunken stupors.” Yes, plural. Subsequently sees his approval rating shoot up 5 points. Not saying Obama should replicate this strategy, but if the big, fat shoe fits…

4. Spying revelations shock America. Turns out the only way to keep the NSA from following our every move is by becoming one of their employees.

3. Dennis Rodman becomes a roving ambassador. Ambassador Worm. What’s next? Mike Tyson, Poet Laureate. Kim Kardashian, Molecular Chemistry Consultant. Tim Tebow, NFL QB.

2. Government shutdown. America comes excruciatingly close to defaulting. Again. And you know what happens then. We have to move back in with Britain.

1. Affordable Care Act website debacle. Most people decide it would be easier to let the NSA handle the whole thing. After all, they have all our information and probably know which plan best fits.

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Will Durst

Will Durst is a political comedian who has performed around the world. He is a familiar pundit on television and radio. E-mail Will at durst@caglecartoons.com. Check out willandwillie.com for the latest podcast. Will Durst’s book, “The All American Sport of Bipartisan Bashing,” is available from Amazon and better bookstores all over this great land of ours. Don’t forget to check out his rooftop comedy minutes at: http://www.rooftopcomedy.com/shows/BurstOfDurst.

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Medicare Seeks To Curb Spending On Post-Hospital Care

Photo couretsy of Paul Vinten / Fotolia

Photo couretsy of Paul Vinten / Fotolia

After years of trying to clamp down on hospital spending, the federal government wants to get control over what Medicare spends on nursing homes, home health services and other medical care typically provided to patients after they have left the hospital.

Researchers have discovered huge discrepancies in how much is spent on these services in different areas around the country. In Connecticut, Medicare beneficiaries are more than twice as likely to end up in a nursing home as they are in Arizona. Medicare spends $8,800 on each Louisiana patient getting home health care, $5,000 more than it spends on the average New Jersey senior. In Chicago, one out of four Medicare beneficiaries receives additional services after leaving the hospital—three times the rate in Phoenix.

Medicare per capita spending on these services, collectively known as post-acute or post-hospital care, has grown at 5 percent a year or faster in 34 of the nation’s 50 most populous hospital markets in recent years, according to an analysis health care economist Chapin White conducted for Kaiser Health News.

Last year $62 billion — one out of every six dollars Medicare spent in the traditional fee-for-service program — went to nursing and therapy for patients in rehabilitation facilities, nursing homes, long-term care hospitals and in their own homes, according to a congressional advisory panel.

Most of them got those services after coming out of the hospital. Some of these providers earn double-digit profits from Medicare through a hodgepodge of payment methods that health experts say encourages unnecessary and disjointed care, wastes taxpayer money and makes fraud easier. More than a quarter of Medicare spending in Louisiana, Texas, Mississippi, Oklahoma and Massachusetts was for post-acute care in 2011, Medicare records show.

kaiser-health-newsHospitals are often the gatekeepers to this world. But analysts say they do not take costs—or sometimes patients’ best interests—into account when discharging patients. “They have not had to think remotely about costs or quality or anything except where’s a bed available,” said Anne Tumlinson, a consultant at Avalere Health in Washington. “Often doctors have very little to do with the discharge decision. Largely it has to do with the supply of providers and type of providers in the area.”

Now, Medicare is experimenting with new payment methods in which hospitals and post-acute providers would be given a lump sum to take care of a patient, forcing them to become more efficient if they want to make money. In addition, President Barack Obama has proposed reducing payments for some conditions to post-acute providers and beginning to pay the same rates for similar patients.

Stephen Parente, a health care economist at the University of Minnesota, says the changes are likely to upend much of the industry. “It’s going to be a fairly ugly transition to get to a more efficient, streamlined system,” Parente said. “It’s going to be a consultant’s bonanza.”

Many Options For Care

Ironically, the growth of the post-hospital industry can be traced back to actions Medicare took in the 1980s to clamp down on long inpatient hospital stays. Medicare started paying hospitals set sums for each patient stay, giving them a financial impetus to discharge patients as soon as possible. New services sprung up in response around the country to take these patients, often with business models that sought to maximize the money they could earn from Medicare.

The vagueness of the term “post-acute” reflects the wide array of ways Medicare patients can be treated after they leave the hospital. Those robust enough to return home can receive intermittent visits from nurses, physical therapists and aides who monitor their condition and assist in basic tasks. These services are known as home health. Patients needing closer oversight can end up in nursing homes or the more intense inpatient rehabilitation facilities, where people suffering strokes, major joint replacements and fractures often end up. The sickest patients, such as those who need ventilators to breathe for weeks, may be admitted to long-term care hospitals, where the average stay is 26 days.

Medicare pays each type of facility different rates — even when they are treating the same kinds of patients. Medicare’s cost for treating stroke patients, including time in the hospital and three months of subsequent care, averages $40,000 if the patient is discharged to an inpatient rehabilitation facility, according to an analysis by Congress’s Medicare Payment Advisory Commission (MedPAC). Medicare’s cost averages $33,000 for stroke patients discharged instead to a nursing home, and only $13,000 for those cared for at home with the assistance of health aides, the analysis found.

These varying payment rates were created under the assumption that many sicker patients would need to be in facilities that could provide more intensive care. But researchers have found evidence that the same types of patients can end up in different types of facilities for no apparent medical reason.

Jim Prister, president of RLM Specialty Hospital in Chicago and Hinsdale, Ill., said that his long-term care hospitals turn down about half the patients hospitals refer because they do not meet Medicare’s criteria. “We don’t rely on what the [hospital's] care coordinator says,” Prister said. “We have a pretty large team of RNs that go out and see every patient.”

An Institute of Medicine study released in July concluded that post-hospital services are the primary reason that Medicare spends much more in some parts of the nation than elsewhere. Uneven spending on post-acute care around the country accounts for 73 percent of the variation in Medicare spending. White’s analysis of Medicare records for Kaiser Health News found that home health spending in 2011 accounted for a quarter of the reason that some areas were more costly than others.

In McAllen, Texas, doctors and hospitals have received most of the criticism for the region’s high Medicare spending, which is greater than in any other part of the country except Miami. Medicare records, however, show inpatient hospital use and spending in 2011 was around the national average, and outpatient care was significantly below average. McAllen’s post-acute spending was the true outlier. McAllen beneficiaries were more than 2 1/2 times as likely to use home health services, long-term care hospitals and rehab facilities than were the average Medicare beneficiary in 2011. As a result, Medicare spent $4,752 per capita on post-acute services, while the national per capita spending average was $1,894.

Much post-hospital use is determined by which facilities are around. A third of all home health care cases took place in Florida, Louisiana, Mississippi, Oklahoma and Texas even though only 17 percent of Medicare beneficiaries live in those states, says MedPAC.

Aggressive marketing plays a role in where patients get sent, said Jared Landis, a consultant at The Advisory Board, a consulting company for health care providers. “Anecdotally, it is a market where post-acute discharge is heavily affected by personal relationships, traditional sales and marketing—just building those personal relationships around those small gifts, those cookies,” he said.

Substantial Profits

For many companies, these patients translate into substantial profits. Nursing homes are expected to earn between 12 and 14 percent this year on their Medicare patients,MedPAC estimates. Home health margins are expected to average 12 percent, and intensive rehabilitation facilities margins are around 8.5 percent, MedPAC estimates. Long-term care hospitals, the laggard of the post-acute groups in profits, are earning almost 6 percent.

The post-acute care industry has defended these profit margins by saying that they counterbalance the losses their facilities receive from lower Medicaid payments in many states. “If you start targeting the one healthy aspect of skilled nursing that pays for the services provided, that’s going to pose real jeopardy to the entire profession,” said Greg Crist, a spokesman for the American Health Care Association, which represents nursing homes.

Policy experts say providers tailor their approaches to wring the most money out of Medicare’s payment methods. Nursing homes, for instance, are paid per day, encouraging homes to keep patients for as long as possible up to the 100-day limit Medicare set. Medicare picks up the entire tab for the first 20 days.
MedPAC calculates that even including money-losing Medicaid patients, nursing homes earned profits between 4 to 6 percent in 2011, the most recent year for which they have data.

Home health agencies are paid set sums for 60 days with no regard for how many nursing and aide visits are made. The number of visits in the average 60-day period dropped from 32 in 1998 to 19 in 2011, while the number of patients being enrolled in home health soared, with the majority no longer coming straight from the hospital, according to MedPAC.

“The incentive is to sign up patients who need hardly anything and sign them up for as long as you can get them,” said Judy Feder, a professor at the Georgetown Public Policy Institute.

At times, efforts to game Medicare have veered into outright fraud, particularly in home health.  The Centers for Medicare & Medicaid Services this summer placed a temporary moratorium on new home health agencies in Miami and Chicago. In testimony before a congressional budget writing panel in June, CMS deputy administrator Jonathan Blum said agency auditors had discovered nursing homes billing for services that were never provided and home health agencies billing for people who were well enough to leave their homes. “Some of these improper billing practices point to potential overtreatment of Medicare beneficiaries, with patients receiving more intensive care than is medically warranted,” Blum testified.

Even though the transition out of hospitals can be one of the most perilous times for patients, many hospitals have not forged close relationships with post-acute facilities. Avalere’s Tumlinson analyzed where patients from 10 different Chicago hospitals in 2010 went after discharge. She found that on average the hospitals sent patients to 130 different nursing homes. She said, “How on earth can a hospital ever get a handle on this and have a relationship with the patient post discharge if they’re dealing with this many different skilled nursing facilities?”

Bundling Payments

Experiments authorized by the federal health law and now being conducted by the Center for Medicare & Medicaid Innovation aim to alter the financial calculus for both hospitals and post-acute providers. The center has received proposals for 178 “bundled payment” experiments in which hospitals and post-acute providers will work together to treat Medicare patients for a fixed sum, instead of being paid separately. Another 157 experiments involving only the post-acute providers have also been created, many by private companies that have recruited medical providers.

One company is NaviHealth, created by former CMS administrator Tom Scully. NaviHealth evaluates hospitalized patients to determine where they should be discharged afterward, and then birddogs their care along the way. NaviHealth has proposed Medicare bundled payment experiments with hospitals in Tennessee, Oklahoma, New Mexico and New Jersey.

“We catch patients in their second day in the hospital and come up with a very detailed evaluation of their functional status,” Scully said. “Maybe you should be in the rehab hospital for 14 days, or nursing home for 10 days instead of 20 days,” which is the most days before Medicare starts charging patients a co-payment. Otherwise, he said, “the nursing home will keep you for the maximum days they can. It’s nobody’s fault, it’s just the incentives.”

NaviHealth is already managing the post-acute treatment for patients in private Medicare Advantage plans and Medicare supplemental plans. After John Alzapiedi, an 85-year-old retired technical service representative from Clinton, Mass., fractured his ankle, NaviHealth oversaw his care last summer as he moved to a nursing home to recover from surgery and a subsequent infection.

“Once I got home, there were four of them who started visiting, one for physical therapy,” Alzapiedi said. The others were a nurse, a case manager and a coach to help him with his medication. “I’d say overall things are going pretty good,” he said.

Companies such as NaviHealth are betting that similar services will be in high demand. Obama wants to cut payments for post-acute providers, pay rehabilitation facilities and nursing homes the same rates, and penalize nursing homes when their patients end up back in the hospital. He also has proposed making paying lump sums for a patient’s post hospital care, just as Medicare does with hospitals.

But just as the hospital lump payment system led to the explosion in post-acute care, some experts are warning that the ideas now being touted as improvements for this sector could have unintended consequences. “The incentive is to avoid the sick and skimp on services,” Feder said.

This article, produced in collaboration with The Washington Post, was republished from kaiserhealthnews.org with permission from the Henry J. Kaiser Family FoundationKaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Jordan Rau, Kaiser Health News

Jordan Rau has covered government and health care politics and policy in three state capitols, most recently in Sacramento at the Los Angeles Times. At Newsday, he covered Albany and at the Concord Monitor, he covered the New Hampshire State House. His stories for KHN have been printed in the Washington Post, Los Angeles Times, Philadelphia Inquirer, Star-Ledger of Newark and other newspapers, and published on npr.org, msnbc.com and other online news sites

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An Evolution Away From History and Toward Peace

President Barack Obama talks with Secretary of State John Kerry in the Oval Office, Nov. 1, 2013. (Official White House Photo by Pete Souza)

President Barack Obama talks with Secretary of State John Kerry in the Oval Office, Nov. 1, 2013. (Official White House Photo by Pete Souza)

Four years ago Dec. 10, President Barack Obama traveled to Oslo, Norway, to accept a Nobel Peace Prize he’d done very little to earn except for not being George W. Bush, which was good enough for the prize committee.

Four years on, Mr. Obama has burnished his peacemaker’s credentials in ways that might not be Nobel-worthy, but surely have made the world a safer place.

— In 2010, his administration negotiated a replacement for the Strategic Arms Limitation Treaty with Russia. Each nation agreed to limit its nuclear stockpiles to 1,550 over seven years, a 30 percent reduction. Each nation will reduce long-range missiles and launchers to 700.

— He finally extricated U.S. forces from Iraq and began the long — too long, in our view — process of bringing U.S. troops home from Afghanistan. All except a residual force were scheduled be home a year from now, but Afghanistan’s President Hamid Karzai may want to accelerate the schedule.

— Taking advantage of Secretary of State John Kerry‘s slip of the tongue in September, Mr. Obama seized an opening from Russian President Vladimir Putin that has resulted in the ongoing destruction, under U.N. auspices, of Syria’s chemical weapons stockpiles.

— Mr. Obama saw another opening in March, created by the approach of Iran’s presidential election. The volatile Mahmoud Ahmadinejad was on his way out, and Hassan Rouhani, a relative moderate, was on his way in. A back-channel diplomatic effort was opened, followed by a public channel after the election in June. The efforts culminated Sunday with the signing of a six-month stand-down of Iran’s nuclear program.

Does Mr. Obama deserve all the credit for these initiatives? Of course not. But it’s clear that his willingness to recognize an opportunity when it presents itself was important to all of them.

The key to the Syria deal was Mr. Putin, who has long been the enabler of Syrian President Bashar Assad. The key to the Iranian deal was Mr. Rouhani, who had the tacit support of Iran’s Supreme Leader, the Ayatollah Ali Khamenei. Both men’s hands were forced by ongoing international sanctions of Iran.

Mr. Obama appears to understand the adage that there’s no limit to what someone can accomplish if he doesn’t care who gets the credit. It was he who appointed Mr. Kerry as secretary of state, understanding that an iron will and a willingness to talk at great length sometimes are useful assets.

The agreement signed with Iran and other states last Sunday in Geneva will not halt the Iranian nuclear program. But it buys six months to reach a broader agreement even as it allows Iran access to assets and banking networks frozen by Western nations.

The deal introduced the world to a new term, “dash-time.” That’s defined as how long it would take a nation to extend the peaceful development of nuclear capabilities to military capabilities. Iran’s dash-time is now longer, and that can be nothing but good.

Naturally there were critics. We’ve noted before that Mr. Obama couldn’t announce a cure for cancer without someone whining, “What about heart disease?”

This time the prize for stupidest criticism went to Sen. John Cornyn, R-Texas, who tweeted”Amazing what WH (White House) will do to distract attention from O-care (Obamacare).”

Peace in the Middle East a distraction? Bringing what Mr. Bush called a “rogue state”back to reasonable discourse? Learning to talk with a nation whose fingerprints are all over Syria, Egypt, Afghanistan and Iraq? This is a distraction? Republicans like Mr. Cornyn are bidding fair to make their entire party a distraction.

Then there was Sen. Charles Schumer, D-N.Y., who for domestic political reasons felt compelled to suggest that further sanctions might be needed.

As always there was the redoubtable Benjamin Netanyahu, Israel’s hawkish prime minister, who called the Iran deal a “historic mistake.” Mr. Netanyahu, for obvious reasons, had been left out of the private discussions, being presented with a done deal that he felt obliged to hate.

In the light of history, Israel’s misgivings are understandable. But if the world is to get past its history, it must look forward.

“(W)e cannot close the door on diplomacy, and we cannot rule out peaceful solutions to the world’s problems,” Mr. Obama said Monday. In words that could have been directed at Mssrs. Cornyn, Schumer and Netanyahu, he added, “Tough talk and bluster may be the easy thing to do politically, but it’s not the right thing for our security.”

It sounds odd, but among Mr. Obama’s other peace-keeping achievements has been his willingness to use or threaten force — in air-support over Libya, in arming and training Syrian rebels and in prosecuting the war on al-Qaida. We have reservations about tactics — the CIA’s too-broad targeting policies for drone warfare, the NSA’s too-broad electronic surveillance of American citizens — but they too have made America more secure.

In Oslo four years ago, Mr. Obama made the case for war in accepting his premature prize for peace. But he quoted President John F. Kennedy on the necessity of allowing for the possibility of change.

In his June 1963 address at American University in Washington, D.C., perhaps the most important but least-known of his speeches, Mr. Kennedy said, “Let us focus on a more practical, more attainable peace, based not on a sudden revolution in human nature but on a gradual evolution in human institutions.”

Mr. Obama echoed that last line, “A gradual evolution in human institutions,” he said. This is evolution we can all believe in.

Republished from the St. Louis Post-Dispatch. Distributed by Creators.com.

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Report: Canceled Health Plans Should Be Kept in Perspective

Photo illustration courtesy of Todd Wiseman, The Texas Tribune

Photo illustration courtesy of Todd Wiseman, The Texas Tribune

Critics of the Affordable Care Act have lambasted President Obama’s signature legislation as it struggles with technical glitches and as thousands of people nationally report the cancellation of their existing health insurance plans. But a report released Thursday by Families USA, a national health consumer organization, attempts to put the numbers in perspective.

“Although President Obama was right to express his concern about and to propose interim corrective action for the people at risk of losing health coverage due to the Affordable Care Act,” said Ron Pollack, executive director of Families USA, “it is important to keep a perspective about the small portion of the population that may be adversely affected.”

The Affordable Care Act, also known as Obamacare, requires most people to carry health insurance in 2014 or pay a tax penalty. Texas political leaders strongly oppose the law, and lawmakers chose not to create a state-run health insurance marketplace to offer health plans and tax subsidies or to expand Medicaid, the state-federal program that offers health coverage to poor children and people with disabilities. Instead, Texans seeking coverage must use the federal health insurance marketplace, healthcare.gov, which has been plagued with technical problems that have obstructed people from finding out whether they qualify for tax subsidies and from purchasing health plans.

Meanwhile, health insurers have also been forced to terminate millions of health plans that don’t comply with the law. More than 113,000 Texans who don’t qualify for tax subsidies to purchase a new plan have received notices that their health plans will be canceled as a result of the Affordable Care Act, according to the Families USA report. The ACA set new standards for health insurance policies offered in 2014: They must cover essential health benefits, and health insurers cannot deny coverage for people with pre-existing conditions, charge discriminatory premiums based on health status or gender, or set annual or lifetime caps on payouts. Obama has pushed to change federal rules to allow insurance carriers to renew customers’ existing policies, even if they don’t meet the new regulations, but many fear it may be too late to keep Texans from losing health coverage.

“The Obama administration knew that millions of Americans would lose the health care plan they had — and liked — but chose to misrepresent the law,” John Davidson, a health policy analyst at the conservative Texas Public Policy Foundation, said in a statement. “It is disingenuous for those responsible for this harmful legislation to claim that a quick administrative fix is now needed. What is needed is an entirely new approach.”

But Pollack argued that it’s important to keep the number of people who will lose coverage under the law in perspective. Millions of uninsured Americans will gain coverage in states that chose to expand Medicaid, millions whose coverage is terminated will qualify for tax subsidies to purchase more expansive coverage, and those with pre-existing conditions will no longer be denied coverage, he said.

Of the 267 million people in the U.S. who are under 65 years of age, 15.2 million people — 5.7 percent of the non-elderly population — have private coverage purchased in the individual market, according the Families USA report. More than 10.8 million of those people who have individual health coverage are in households with incomes that are less than 400 percent of the federal poverty level — $46,000 annually for an individual, or $94,200 annually for a family of four — and they would qualify for tax subsidies in the federal marketplace or for expanded Medicaid coverage, according to the report.

Texas has the highest rate of uninsured residents, about a quarter of the state’s population. Among the non-elderly, 4.2 percent of people — 953,000 of 22.7 million people under 65 — have health care coverage purchased in the individual market, according to the Families USA report. Sixty-six percent of those people would qualify for tax subsidies or expanded Medicaid coverage.

Additionally, Pollack said, the individual insurance market is extremely volatile: Only 35.5 percent of people with health plans from the individual market retained that coverage for more than a year, and the median duration for individual market coverage is eight months.

“The net result is that only a very tiny portion of the non-elderly population [nationally], less than 1 percent — by our calculation, 0.6 percent — are at risk of losing their current individual insurance market plan due to the Affordable Care Act and not becoming eligible for financial help,” said Pollack.

In Texas, the percentage is slightly smaller: 0.5 percent of those in the individual market — 113,460 Texans — who would have likely retained coverage for more than a year could have their plans terminated because of the Affordable Care Act.

In comparison, Texas’ decision not to expand Medicaid will leave more than a million residents without health insurance options in 2014.

Although the report does not specify how many of the people whose plans have been terminated would have qualified for Medicaid, Pollack said Texas’ decision not to expand Medicaid doesn’t significantly impact their analysis, because those people are often too poor to purchase health plans in the individual market.

“The people at greatest risk and harm are those people below the federal poverty level,” because they won’t have any coverage options available, said Pollack.

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

This article originally appeared in The Texas Tribune at http://www.texastribune.org/2013/11/21/report-canceled-health-plans-should-be-kept-perspe/. Texas Tribune donors or members may be quoted or mentioned in our stories, or may be the subject of them. For a complete list of contributors, click here.

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Becca Aaronson, The Texas Tribune

Becca Aaronson, The Texas Tribune Becca Aaronson reports on health care and develops data interactives for The Texas Tribune. After an internship in fall 2010, she was hired by the Tribune. Becca is a native of Austin who graduated from Scripps College in Claremont, Calif., with a bachelor's degree in cultural theory.

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