Opinion

Reihan Salam

The death of the Obamacare individual mandate

Reihan Salam
Dec 20, 2013 19:56 UTC

Obamacare is best understood as a collection of carrots and sticks designed to expand access to insurance coverage. But what happens to Obamacare if we get rid of the sticks? It looks like we’re about to find out.

During the Obamacare debate, many conservatives, myself included, warned that once the law was in place, the sticks would prove politically impossible to enforce, the carrots would have to get more and more generous to compensate, and the end result would be a fiscal calamity. We won’t know if this dire projection will be fully borne out for some time. What we do know is that at least one of the most important Obamacare sticks, the individual mandate, is already getting watered down, and it’s not crazy to imagine that it will at some point be abandoned. Before we get to the individual mandate, though, consider the carrots and sticks that apply to state governments and employers.

In the original legislation, states that agreed to expand Medicaid were promised new federal funds to help meet the cost of doing so (the carrot) while states that refused to expand Medicaid had to forsake federal Medicaid funds altogether (the stick). This combination of carrot and stick would have made refusing to expand Medicaid a very costly decision for state governments, virtually all of which are struggling to meet the high and rising cost of providing medical insurance to those who are already on Medicaid. Last summer, however, the Supreme Court ruled that the threat of removing all federal Medicaid funds from states that refused to play ball was unconstitutionally coercive, and so a large number of states have chosen not to expand Medicaid. Eventually, the holdout states might decide that the carrot of new federal money is too tempting to resist, particularly when neighboring states cash in. But for now, the all-carrot, no-stick approach has definitely held down the number of Medicaid enrollees.

Large employers, meanwhile, were supposed to be subject to an employer mandate, the requirement that all employers with 50 or more full-time-equivalent employees either had to provide health insurance benefits or pay a stiff penalty. This was a pretty big stick without much of a carrot attached. Yet the employer mandate was very important, as it was meant to hold down the costs of coverage expansion, as the federal government was expected to subsidize low- to moderate-income workers with employer-sponsored coverage less generously than similarly situated workers on the exchanges. In July, the Obama administration announced that it would delay enforcement of the employer mandate until 2015. And so, another stick was removed from the Obamacare arsenal.

The debates over Medicaid expansion and the employer mandate have been heated. But the individual mandate debate has been the most contentious of them all.

The budget deal’s central achievement: protecting America’s military strength

Reihan Salam
Dec 13, 2013 19:47 UTC

Remember 1986? Ronald Reagan was in the White House, Dionne Warwick was topping the charts, and movie audiences swooned as Tom Cruise romanced Kelly McGillis in Top Gun. Children born in 1986 are now adults having children of their own. So it is sobering to realize that 1986 was also the last year in which a divided Congress — a Democratic House and a Republican Senate, to be precise — was able to reach a budget agreement. To the surprise of many, House Budget Committee Chairman Paul Ryan, a leading light among conservative Republicans, and Senate Budget Committee Chairman Patty Murray, a savvy Democrat with a populist streak, reached a modest budget deal at the start of this week that eased the rigid caps on discretionary spending imposed by sequestration in the short term, in exchange for more mandatory spending restraint over the long term.

Almost immediately, influential conservative lawmakers, like Florida Sen. Marco Rubio and Oklahoma Sen. Tom Coburn, declared their opposition to the deal, as did influential conservative groups like Heritage Action, FreedomWorks, and the Club for Growth. For a brief moment, it looked as though the GOP’s right flank would choose another government shutdown over what many saw as a half-hearted compromise. But instead the House passed the Bipartisan Budget Act of 2013 by a margin of 332-94, with 62 Republicans voting “no.” Assuming the Senate also passes the deal, the country will be spared a government shutdown until at least the fall of 2015.

To many rank-and-file Republican members, and in particular to those representing vulnerable House seats, this must come as a relief. In recent weeks, President Obama’s approval ratings have sharply declined. A recent Quinnipiac survey finds that only 38 percent of voters approve of the president. Moreover, they prefer Republican over Democratic House candidates by 41 percent to 38 percent, a marked improvement for the GOP. It seems that while the government shutdown damaged Republicans, a steady drumbeat of negative news coverage surrounding Obamacare implementation has given the GOP breathing room. Another government shutdown could reverse these gains and give the president and his allies the upper hand.

Mandela’s heirs face a rocky economic future

Reihan Salam
Dec 6, 2013 16:20 UTC

The death of Nelson Mandela is being mourned across the world, and for good reason. As the first president of post-apartheid South Africa, he served as a symbol of national reconciliation and as a defender of South Africa’s new and fragile liberal constitution. It is also true, however, that the movement he led, the African National Congress, has not lived up to lofty expectations, and that at least some of the responsibility lies with the great man himself.

Before we turn to what has gone wrong with post-apartheid South Africa, it is worth briefly rehearsing what has gone right, thanks in no small part to Mandela. During the apartheid era, South Africa’s Afrikaner-dominated ruling National Party warned that majority rule would bring violent reprisals against the country’s white minority, a Marxist revolution that would mean the end of private property, and an alliance with the Soviet bloc that would threaten the free world. None of that ultimately came to pass, for a variety of reasons. As the Soviet threat receded, and as anti-apartheid activists pressured governments in the U.S. and Western Europe to isolate the South African government, elements within the governing National Party sensed that the days of minority rule were numbered, and that some accommodation with the ANC was the only way to prevent a bloody denouement. And Mandela, to his great credit, proved a willing partner. Having established his moral authority within the liberation movement as a champion of armed insurrection against the apartheid government, he committed himself to a path of non-violence. One shudders to think of what might have happened had Mandela chosen differently. Mandela’s fateful decision to work with his former enemies paved the way for the ANC’s extraordinary political success.

Since 1994, when South Africa held its first authentically democratic and multiracial national elections, the ANC has won every national election by substantial margins, and there is good reason to believe that it will win the election that will be held next spring. Yet after almost two decades of ANC rule, the country suffers from shockingly high levels of poverty, unemployment, and violent crime. Hundreds of thousands of educated South Africans — white, black, and Asian — have emigrated in search of opportunity in Britain, Australia, the U.S., and elsewhere. Many middle-income countries that were in the same economic ballpark as South Africa in 1994 in terms of GDP per capita — like Poland, Malaysia, Chile, Mauritius, and neighboring Botswana — have raced ahead in the years since. When we compare South Africa to China or South Korea, the contrast is more dismal still.

When progress trumps privacy

Reihan Salam
Dec 2, 2013 14:47 UTC

In 1890, two of America’s leading legal minds, Louis Brandeis and Samuel Warren, published an article called “The Right to Privacy” in the Harvard Law Review. Scandalized by the rise of a gossip-mongering press that intruded on the lives of prominent citizens, they called upon the courts to recognize a “right to privacy.” Their fear was that new technological and commercial innovations — in this case photography and the mass-circulation gossip rag — would cause the rich and famous untold mental pain and distress. As Stewart Baker observes in his provocative book Skating on Stilts, the substance of Brandeis and Warren’s argument now seems rather quaint, as a gossipy news media has become a central part of our public life. In Baker’s telling, “the right to privacy was born as a reactionary defense of the status quo.” And even now, he argues, privacy campaigners often overreact against new technologies they fear but do not understand.

Baker’s argument has been panned in civil libertarian circles. When he suggests that societies eventually adapt to new technologies — that “the raw spot grows callous” as we grow accustomed to invasions of privacy — privacy campaigners reply that it is Baker who has grown callous to the harms in question. Baker’s central goal is to convince Americans to accept that government must use new technological tools, like the data mining programs used by the National Security Agency, to combat mass-casualty terrorism. His critics maintain that he is far too glib about the potential that government might abuse these new tools, and indeed too dismissive of the notion that it has already done so.

I’m torn on the question of whether the national security state has overstepped its bounds, and there are people I respect on both sides of the debate. Civil libertarians like Ben Wizner of the American Civil Liberties Union and Julian Sanchez of the Cato Institute see the new Leahy-Sensenbrenner USA FREEDOM Act– which would end the dragnet collection of Americans’ phone records under the PATRIOT Act, and limit other surveillance — as an important step towards reining in a bureaucracy run amok. Baker fears that it will cripple the ability of U.S. intelligence officials to prevent future terror attacks. I couldn’t tell you which side is closer to the mark.

What the filibuster’s demise means for the Supreme Court

Reihan Salam
Nov 22, 2013 21:53 UTC

Now that Senate Majority Leader Harry Reid has ended the filibuster for district and appeals court nominees and executive branch appointments, it’s only a matter of time before the filibuster goes away for Supreme Court nominations and legislation as well. Reid’s decision has been a long time coming: One of his predecessors, Republican Bill Frist, came very close to ending the filibuster in 2005.

Even so, at least some observers are troubled by what they see as Reid’s recklessness. Former Senator Olympia Snowe and former Agriculture Secretary Dan Glickman, co-chairs of the Bipartisan Policy Center’s Commission on Political Reform, of which I’m a member, released a statement criticizing the filibuster decision on the grounds that “any alterations of rules or practices should be done judiciously, after careful consideration and with a balanced approach that incorporates views from all sides.”

The problem, however, is that the filibuster has not been used judiciously, by either Democrats or Republicans. Over the past forty years, it has been transformed from a tool designed to encourage deliberation to something else entirely. Josh Chafetz, a professor at Cornell Law School, argues that the filibuster has become an implicit supermajority requirement — one that violates the Constitution. According to Chafetz, the rules governing the legislative process and the appointments process are based on the premise that a determined legislative majority will eventually prevail over the minority, not that the minority has the right to exercise an effective veto. One could argue that there is a meaningful difference between using the filibuster to block judicial nominees and executive branch appointments, and using it to stymie legislation, but it’s not at all clear that such a distinction would hold up in a constitutional challenge.

Finding new ways to make work pay

Reihan Salam
Nov 14, 2013 18:32 UTC

One of the scariest notions about America’s sluggish labor market recovery is that it doesn’t represent an aberration, but rather a new reality in which good jobs are few and far between, particularly for those with limited skills. It is certainly possible that the future will be brighter than we think, and that we will soon enter a new economic Golden Age in which people with low education levels will flourish as employers clamor for their services at ever-higher wages. But if this happy outcome does not come to pass, as the current evidence suggests, the United States and other market democracies will have to come up with a Plan B.

A number of interrelated developments, from automation to organizational innovation to off-shoring, appear to have reduced the willingness of employers to pay middle-income wages to less-skilled workers. That is, the problem is not that there is no wage at which employers will take on less-skilled workers. If this were the case, agriculture and hospitality companies wouldn’t be pressing lawmakers for an immigration overhaul that would allow for a large influx of less-skilled workers from abroad.

Rather, the problem we face is that employers are only willing to employ less-skilled workers at very low wages, including wages that the voting public considers unacceptably low. Public support for raising the federal minimum wage, now at $7.25, is overwhelming. A Gallup survey released on Monday finds that 76 percent of voters favor a $9 per hour minimum wage, and one assumes that support for an even higher minimum wage would be almost as robust.

Obama’s apology (of sorts) for his “keep your plan” promise

Reihan Salam
Nov 8, 2013 17:59 UTC

This week, President Barack Obama offered an apology (of sorts) to Americans who believed him when he repeatedly assured the public that anyone who liked their current health insurance plan could keep it under the Affordable Care Act. In an interview with Chuck Todd of NBC News, the president said, “I am sorry that they are finding themselves in this situation based on assurances they got from me.”

Up until now, the president and his allies have insisted that the “keep your plan” promise had been misinterpreted, and that the plans that were being cancelled were “junk plans” that belonged on the scrap heap, a claim that many insurance beneficiaries found objectionable. Keith Hennessey, a veteran of the Bush White House, constructed a flowchart of the “keep your plan” defenses made by the president and his allies, the complexity of which spoke to the president’s political dilemma. One of the architects of the Affordable Care Act, Ezekiel Emanuel, struggled to defend the veracity of the “keep your plan” promise in a recent episode of Fox News Sunday. So the president’s apology will surely come as a relief to those tasked with maintaining that the “keep your plan” promise wasn’t at least slightly misleading.

The president’s apology didn’t prevent him from making other misleading statements during the same interview. Once again, he insisted that the disruption of existing insurance arrangements applied only to people in the individual insurance market, which represents a relatively small share of insurance beneficiaries. But the Affordable Care Act imposes new regulations on employer-sponsored plans, which have the potential to disrupt the insurance arrangements of many more Americans, and the law’s grandfathering provisions are quite narrow. Fortunately for the president, the apology itself will draw enough attention to distract from this looming issue, which could prove far more politically potent than what some are describing, perhaps prematurely, as the slow-motion collapse of the individual market.

Why New Jersey and Virginia matter to the GOP — and its future with black voters

Reihan Salam
Nov 1, 2013 19:27 UTC

Next week’s election will be an important one for the future of the GOP. In New Jersey, Republican Gov. Chris Christie is up for re-election, and by all accounts he is set to defeat his Democratic opponent, state Sen. Barbara Buono, by a wide margin. Christie is widely considered a serious candidate for the Republican presidential nomination in 2016, and his ability to win support among independents and Democrats in his home state will be a central part of his appeal.

But in Virginia, it increasingly looks as though Terry McAuliffe, an entrepreneur and investor best known as a political ally of former President Bill Clinton, will defeat Ken Cuccinelli, a staunch conservative much admired by the Tea Party right. At least some conservative activists saw Cuccinelli, who as Virginia’s attorney general played a leading role in constitutional challenges against the Affordable Care Act and other Obama administration initiatives, as a potential presidential contender. A bruising defeat against McAuliffe will put an end to such talk.

There are many things that separate Christie from Cuccinelli. Having served as governor for the better part of the last four years, Christie is a familiar figure. He began his tenure with a series of polarizing confrontations with New Jersey’s powerful public employee unions, yet he has spent the last year on a more conciliatory note, motivated in part by a desire to help his state recover from the damage wrought by Hurricane Sandy. In a heavily Democratic state, Christie has distanced himself from congressional Republicans, and he has framed himself as a pragmatic reformer who stands above the political fray. This position is particularly valuable in light of parlous state of the GOP brand. The most recent NBC/Wall Street Journal poll finds that the Republican party now has a 22 percent positive rating and a 53 percent negative rating across the country, and it’s a safe bet that the picture is even worse in New Jersey.

After Obamacare glitches, the case for default insurance

Reihan Salam
Oct 25, 2013 20:44 UTC

The Obamacare debate is entering a new phase. The problems plaguing the insurance exchanges have raised serious questions about the viability of the president’s health reform effort. The Obama administration and its allies insist that the exchanges will soon be up and running, and that they’ve already been successful. Yet at least some liberals are starting to wonder if the exchange model should be abandoned in favor of a single-payer, Medicare-for-all approach. John Cassidy of the New Yorker, an occasional Obamacare critic from the left, is just one of many liberals who’ve touted the virtues of a single-payer system, and it is easy to imagine future Democratic presidential candidates doing the same. Conservatives, meanwhile, have tended to characterize the failure of the exchanges as a reflection of the limits of government. Patrick Ruffini, a well-regarded conservative strategist, captured the views of many on the right in a short piece titled “How Healthcare.gov Discredits Liberalism.” We’re nowhere near a consensus on whether the kludgy mess that is Obamacare ought to be replaced. But serious questions are being raised across the political spectrum.

One idea that hasn’t drawn much attention is the role that default insurance might play in a future U.S. health system. This is despite the fact that low-cost default insurance might be the most straightforward way for the U.S. to achieve universal coverage at a price all Americans can afford.

Almost everyone, including President Obama, accepts that the process of signing up for insurance on the exchanges has proven quite difficult. But it hasn’t been impossible. A decent number of determined consumers have been able to sign up for coverage after many false starts. The concern is that the most determined consumers are presumably the ones who have the most to gain from insurance coverage, which is to say consumers who expect to have high health costs. The goal of the exchanges, and specifically of the generous federal subsidies offered to low- and middle-income people seeking coverage, has been to attract as many young and healthy consumers as possible, to ease the burden of providing medical care for the old and sick. There is still time to fix the exchanges, and the experience is gradually improving. Nevertheless, the initial hiccups have led to renewed calls for delaying implementation of the individual mandate. Until recently, these calls have been limited to Republican critics of Obamacare. Now, however, Democrats like Rep. John Barrow (D-GA), Rep. Gerry Connolly (D-VA) and Sen. Mark Begich (D-AK) have joined the chorus. To be sure, these Democrats, many of whom represent Republican states, are calling for a delay if and only if problems with the exchanges persist. But the prospects for delaying the individual mandate have greatly improved. And such a delay will make it even less likely that young and healthy consumers will sign up for coverage.

Instead of a divorce, the GOP needs primary reform

Reihan Salam
Oct 18, 2013 16:15 UTC

A few days ago, an older and wiser friend of mine and I had a lengthy conversation about divorce, that most cheerful of subjects. He noted that one of the surest signs of a marriage in trouble was that both parties were convinced that they had been forgiving of various betrayals and accommodating of various foibles, yet this generosity hadn’t been reciprocated. Naturally, this brought to mind the increasingly strained relationship between Tea Party conservatives and Republican regulars. What better way to describe how Ted Cruz must feel about John Boehner, the sellout, and how John Boehner must feel about Ted Cruz, the zealot?

Molly Ball of the Atlantic recounts the quasi-mutinous musings of various conservative luminaries, like Glenn Beck of TheBlaze, Erick Erickson of RedState.com, and Sean Hannity of Fox News, among others. As recently as 2010, the notion that the Tea Party movement would bolt from the GOP to establish a party of its own would have seemed absurd. But now, in the wake of a fiscal showdown that’s proven to be an utter fiasco for congressional Republicans, the idea of a bona fide divorce is gaining credence. Among the Tea Party faithful, there is a widespread conviction that the effort to defund Obamacare would have proven successful had Speaker Boehner and his anxious allies been tougher, and more willing to risk breaching the debt ceiling. Republican regulars, meanwhile, are largely convinced that the defund Obamacare effort was a hopeless indulgence that exacted a real political cost. At least one critic of the Tea Party movement, David Frum of the Daily Beast and CNN, has argued that Republicans would benefit if “the Sarah Palins and the Ted Cruzes who have done so much harm to their hopes over the past three election cycles” were to bolt.

This isn’t the first time libertarian-minded conservatives have contemplated a formal exit from the GOP. In the 1970s, William A. Rusher, the publisher of National Review and a staunch, Rockefeller-hating Goldwaterite, frequently made the case for a new conservative party, which he hoped would be led by Ronald Reagan. After Reagan’s narrow defeat in the 1976 contest for the Republican presidential nomination, however, the former California governor stood by his moderate rival Gerald Ford, and in doing so he dashed the hopes of Rusher and other third-party enthusiasts. The Libertarian Party, established in the early 1970s, has long been divided over whether to appeal to disaffected Republicans or hippies. In the 1980 presidential election, the Libertarians achieved great success by espousing a pacifist, left-leaning brand of “low-tax liberalism,” while in 1988 the party turned to Ron Paul, the libertarian populist who would later make waves as a Republican presidential candidate in 2008 and 2012. The 2012 Libertarian presidential nominee, former New Mexico Gov. Gary Johnson, an unpretentious Republican who combined familiar Tea Party bromides with a commitment to ending the War on Drugs, had some promise as an alternative to Mitt Romney, but in the end his candidacy proved to be a footnote, in part because the septuagenarian Paul stole his thunder. The Constitution Party, first established as the U.S. Taxpayers’ Party in 1991, is a vehicle for a hard-edged Christian conservative politics that has never found much success. And in 2000, Pat Buchanan tried to transform Ross Perot’s Reform Party into a nationalist conservative party in line with his own idiosyncratic, anti-trade populism.

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