Monday, December 8, 2014

Persistent Obamacare Schadenfreude

No matter how much I beat it down, it keeps creeping out:

Guess who's going to Congress?  Dr. Gruber! Congressional Republicans to grill Obamacare consultant at hearing
Issa said the public deserved an explanation from Gruber at Tuesday's hearing.

"If you can't trust what he says, and what he says he'll do, to get votes and trick the American people into voting for something, then can you trust his analytics?" Issa said of Gruber.

"It is our job to see that the administration is working to run the country and that they are reporting honestly their successes and their failures,” he told Reuters.

Republicans say Gruber's comments show the administration deceived Americans as it pushed the law through Congress. Americans For Prosperity, a group backed by the billionaire Koch brothers, used Gruber's comments to attack Democrat Mary Landrieu in the runoff for the Louisiana Senate race.

Democrats have distanced themselves from Gruber. Obama referred to him as "some adviser who never worked on our staff" who "expressed an opinion that I completely disagree with."
Issa's democratic opponent on the panel promised to waste more time deflecting criticism of Obamacare:
Representative Elijah Cummings, the top Democrat on the House Oversight panel, called Gruber's comments "very unfortunate." He said he would use the hearing to talk about the benefits of Obamacare.

"To spend hours upon hours of time trying to get (Gruber) to explain himself, to me it does not insure one more person, it does not help heal anybody, and it doesn't do anybody any good. We're wasting our time," Cummings said.
Will Jonathan Gruber Topple Obamacare? The health economist’s controversial remarks could undo him and the law he worked so hard to create.
For just about everyone else who has dealt with Gruber, though—Democrats, academics, policy wonks, and the health care reporters who used to call him regularly for catchy quotes about what the latest Obamacare development really means—the videos are just head-scratchers. He’s a smart guy, everyone says, and he has been a hugely successful economist who clearly knows his health care policy. So they’re all coming back to the same question: Why the hell would he say that? Does he really believe it?

The answer, according to the people who know Gruber best, is that he has always been someone who is two seconds away from putting his foot in his mouth. Yes, he has had an astonishing rise in the world of health care policy—and it’s completely deserved, in their view, because of his groundbreaking work on predicting the cost impact of different kinds of health care legislation. Gruber is the man who developed an economic model that could basically work like a faster Congressional Budget Office—a huge help to congressional staffers as they drafted the Affordable Care Act, as well as the Massachusetts policymakers who wrote Mitt Romney’s health care reform law that preceded it.

But politically savvy? No, no, no. Gruber is a chatty, affable guy, but he’s also a man with no filter—and he knows it. It’s always when he drifts away from economics, and tries to talk about politics, that he gets into trouble, colleagues say. That’s where Gruber stepped on so many land mines in those videos—claiming there was a strategy to hide uncomfortable details from voters, as if he knew the political strategy and not just the economics, and that the “stupidity of the American voter” allowed them to get away with it.
So his appearance before Congress should be some good TV. Stay tuned!

Half of the Senators who voted for Obamacare won't be part of new Senate
To be sure, it isn’t fair to attribute all of the turnover in the chamber to Obamacare. In some cases — such as John Kerry leaving his seat to become secretary of state, or Robert Byrd passing away — Obamacare clearly had nothing to do with the departures. Additionally, some outgoing pro-Obamacare votes were replaced by new Democratic senators (although that tended to be the case in heavily Democratic states).

That having been said, many senators who voted for Obamacare lost re-election battles in which they were hit hard for their support for the law and other Democrats were forced to retire because they had no hope of getting re-elected given their support for the law. A total of 16 Senators who voted for Obamacare either failed to win reelection or declined to run for reelection and had their seats turned over to Republicans.
Lost and replaced by a Republican:

Sen. Mark Begich, D-Alaska, Sen. Mark Pryor, D-Ark., Sen. Mark Udall, D-Colo., Sen. Kay Hagan, D-N.C., Sen. Mary Landrieu, D-La., Russ Feingold, D-Wis., Blanche Lincoln, D-Ark., Arlen Specter, D-Penn.

Left Senate and replaced by a Republican:

Jay Rockefeller, D-W.V., Max Baucus, D-Mont., Tim Johnson, D-S.D., Tom Harkin, D-Iowa, Ben Nelson, D-Neb., Byron Dorgan, D-N.D., Evan Bayh, D-Ind., Roland Burris, D-Ill.
. . .As you sow, so shall you reap.

Health law impacts primary care doc shortage
A survey this year by The Physicians Foundation found that 81 percent of doctors describe themselves as either over-extended or at full capacity, and 44 percent said they planned to cut back on the number of patients they see, retire, work part-time or close their practice to new patients.

At the same time, insurance companies have routinely limited the number of doctors and providers on their plans as a way to cut costs. The result has further restricted some patients' ability to get appointments quickly.

One purpose of the new health law was connecting patients, many of whom never had insurance before, with primary care doctors to prevent them from landing in the emergency room when they are sicker and their care is more expensive. Yet nearly 1 in 5 Americans lives in a region designated as having a shortage of primary care physicians, and the number of doctors entering the field isn't expected to keep pace with demand.

The Association of American Medical Colleges projects the shortage will grow to about 66,000 in little more than a decade as fewer residency slots are available and as more medical students choose higher-paying specialty areas.
You could call this an unexpected, unintended consequence of Obamacare, except that conservatives predicted it would have this effect over and over as the law was being rammed through without their votes.

Some background on the King vs Burwell suit which may drive a stake through the liver of Obamacare. Pessimist's persistence could pay off against Obamacare
The legal argument was fleshed out early in 2011 by Jonathan Adler, a law professor at Case Western Reserve University. Asked to write a paper for a University of Kansas School of Law conference, he read the 906-page law, "which it's clear a lot of people didn't do." He concluded that tax credits were dangled as an incentive for states to create the online exchanges, which administration and congressional proponents deny.

Then Michael Cannon, a health policy economist at the libertarian Cato Institute, discovered that the Internal Revenue Service was preparing regulations that would allow tax credits in federal as well as state exchanges. That, he said, was not the letter of the law.

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