Opinion

Reihan Salam

GOP: Beyond repealing to reforming

Reihan Salam
Feb 17, 2014 20:46 UTC

The last time the federal government approached its statutory debt limit, Republicans in the House of Representatives fought tooth and nail to attach tough conditions to any increase. On Tuesday, House Speaker John Boehner (R-Ohio) shepherded a “clean” debt limit increase through that barely raised an eyebrow.

This increase didn’t even set a dollar amount. It simply suspended the debt limit until next March. I can almost hear the conversation: “So, where should we set the new debt limit?” “Ah, you know, whatever!”

One clue as to why House Republicans went along with Boehner’s clean debt limit increase is the vote total. The bill was backed by 193 Democrats and only 28 Republicans. You could say that Democratic lawmakers rescued their Republican counterparts from having to take responsibility for increasing the debt limit.

Yet, after loudly demanding a clean debt limit increase time and again, it’s not as though Democrats could reject the offer without looking like fools. With little fanfare, Boehner steered the congressional GOP away from another destructive crisis, in which bickering Republicans face off against a president who gets to look decisive by insisting that the debt limit be raised.

So does this mean that the GOP “fever” has broken? President Barack Obama, during a June, 2012 campaign appearance, famously told reporters that if he won re-election, “the fever may break” among Republicans. That after steadily refusing to cooperate with him on efforts to expand government’s size and influence in his first term, the president suggested, his re-election might lead Republicans to see the wisdom of moving to the center if not the left.

Where is the GOP heading on immigration reform?

Reihan Salam
Jan 17, 2014 16:38 UTC

After falling off the radar for months, immigration reform is back. Late last year, Speaker John Boehner hired Rebecca Tallent — a veteran of Arizona Sen. John McCain’s efforts to offer a path to citizenship to large numbers of unauthorized immigrants — as one of his senior staffers. That decision strongly suggested that the GOP was on the verge of making a big immigration push. Laura Meckler and Kristina Peterson of the Wall Street Journal report that the Republican leadership is gravitating towards granting unauthorized immigrants provisional legal status that will give them the right to live and work in the United States, and that immigrants granted provisional status will eventually be allowed to apply for a green card.

This approach is not dramatically different from what has come before, and it is not at all clear why Boehner and his allies believe that conservative opponents of earlier proposals will now come on board. One possibility is that leading Republicans fear that Democrats will use the immigration issue as a weapon against them in the 2014 midterm elections, and that anything that takes the issue off the table is a win. Perhaps they believe that Republican lawmakers will fall into line to spare themselves a barrage of attack ads. Yet GOP critics of the bipartisan Gang of Eight senators, who’ve been the most aggressive advocates of immigration reform, are reluctant to grant the Obama administration wide discretion on immigration policy, particularly in light of the various creative ways the president has used his discretion to implement Obamacare.

The deeper disagreement among conservatives is over how immigration reform will interact with the welfare state. Immigration advocates insist that today’s immigrants are indistinguishable from the millions of immigrants who streamed into America’s farms and factories in earlier eras, and they often imply that the real reason immigration skeptics claim otherwise is simple xenophobia. The idea that less-skilled immigrants might become dependent on social programs in a fast-changing economy that prizes education more than the economy of the 1900s is, in this telling, highly offensive.

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.

How to fix the GOP’s discipline problem

Reihan Salam
Oct 4, 2013 20:28 UTC

As the government shutdown grinds on, the Republican leadership in the House is struggling to unite GOP lawmakers around a fiscal deal that Senate Democrats and the Obama administration would be willing to accept. Speaker John Boehner has reportedly said that he is willing to rely on Democratic votes if necessary to pass an increase in the debt ceiling. Yet he also insists that he will fight for spending cuts and entitlement reform in any debt ceiling bill, in a nod to conservative members who are convinced that he is eager to sell them out.

Whether or not Boehner succeeds, it is increasingly difficult to deny that the Republican negotiating position is being constrained if not dictated by a small minority of 30 or so members from safe seats who seem largely indifferent to leadership demands, or rather leadership requests. The result is that the much-derided Republican establishment is in a state of panic, sensing that GOP intransigence will lead the party to squander the political opportunity created by the president’s declining fortunes and the persistent unpopularity of Obamacare. How has party discipline broken down to this extent, and what, if anything, can Republicans do to restore it?

First, it is important to recognize that this chaotic confrontation wasn’t supposed to happen. At the start of the year, congressional Republicans seemed eager to return to regular order, in which, essentially, the House majority brokers with the Senate majority to pass legislation, which the president can then sign or veto. Yuval Levin, writing for National Review Online, argued that for the right, the central political problem with the endless succession of fiscal showdowns is that they inevitably made the president, as a unitary figure, look better than the often-fractious House Republican conference. Regular order, in contrast, would demand that Senate Democrats put up or shut up by codifying their commitments, not all of which are popular in hotly-contested states, in real legislation. House Republicans and Senate Democrats would be on a relatively level playing field, while the president would be relegated to the sidelines. But the regular order strategy didn’t come to fruition, both because Senate Democrats were reluctant to play along and because a determined minority of House Republicans couldn’t reconcile themselves to the fact that the ordinary legislative process left them with very little leverage.

Obamacare’s threat to healthcare innovation

Reihan Salam
Sep 27, 2013 20:14 UTC

Next week, the new state-based health insurance exchanges established under the Affordable Care Act, better known as Obamacare, will be open for business. Or rather — some of them will be sort of open for business, as the exchanges have been plagued by a series of technical glitches and delays. The Obama administration is now characterizing October 1st as the beginning of a “soft launch,” during which federal and state officials will work out various kinks. And though this might sound like just another bureaucratic foul-up, the success of the exchanges in these first few months will have enormous implications for the ultimate success of Obamacare.

The exchanges are online marketplaces that will allow individuals and small firms to compare the coverage options and pricing of various health insurance plans. They are also the platform through which people will apply for income-based subsidies for purchasing health insurance. One of the biggest challenges facing the officials setting up the exchanges is that applications for subsidies are meant to be processed in real time, to make the experience as easy and accessible as possible. This is much easier said than done. In Massachusetts, which has been operating an exchange of its own since 2007, applying for subsidies is a time-consuming process that involves filling out a 15-page form and providing proof that one is eligible for subsidies in the first place, and then waiting for state officials to get back to you. While Massachusetts’ approach is slow-moving, it has the advantage of being tried and true, as it is very similar to the way the states have been determining Medicaid eligibility for years. Real-time verification, in contrast, represents a break with established practice, and it would be a miracle if it didn’t involve major hiccups.

If the exchanges work smoothly, they have a decent shot at enrolling large numbers of the young, healthy Americans the Obama administration is counting on to make its new coverage expansion effort economically viable. If the exchanges don’t work smoothly, however, they might deter all but the sickest, most vulnerable healthcare consumers from enrolling, and this in turn would make the new insurance pools far more expensive to cover.

Obamacare’s sliding scales and slippery slopes

Reihan Salam
Jul 8, 2013 18:14 UTC

Last week as Americans celebrated Independence Day, the Obama administration made a pair of big announcements about the Affordable Care Act (ACA), the crown jewel of the president’s domestic policy efforts: two of the ACA’s key enforcement provisions—income verification and a mandate for employers to provide healthcare—are being delayed until 2015. The exchanges will still open and subsidies will flow in 2014, but efforts to ferret out fraud, or for that matter honest mistakes, will be put on hold. Reading between the lines, it seems as though the White House was acknowledging that the health system created by the ACA is unworkable in its current form.

As Eugene Steuerle, a fellow at the Urban Institute, has explained, the ACA establishes a “four-part, nearly-universal, health care system” built around Medicare, Medicaid, employer-sponsored insurance, and the new state-based insurance exchanges. The really confusing thing about our new four-part health system is that the federal subsidies available to households earning the same income can vary dramatically, depending on which part of the health system you find yourself in. As long as you are old or disabled, Medicare treats all comers roughly equally. The federal contribution to Medicaid varies from state to state, but the level of coverage tends to be pretty similar across recipients. Subsidies for employer-sponsored insurance, meanwhile, are much higher for households earning high incomes, and thus paying high taxes, than for less affluent households, while subsidies for the new exchange policies are generous for low-earners and phase out for high-earners. The upshot is that subsidies for many low- and middle-income households are far more generous on the exchanges than they are for employer-sponsored insurance.

Given that the subsidies on the exchanges are more generous than the subsidies for employer-sponsored insurance, the ACA took various steps to contain spending. One of the most important was its employer mandate, which imposed a fine on mid-sized and large employers that failed to provide full-time employees with affordable insurance options. The idea was that the fine would nudge employers to offer affordable insurance options, underwritten by the relatively stingy tax subsidy for employer-sponsored insurance, thus containing the growth of exchange subsidies.

For states, Washington’s budgetary seduction proves too hard to resist

Reihan Salam
Feb 6, 2013 14:22 UTC

Federalism’s days appear to be numbered. The reason isn’t so much that the power of the federal government has increased, though that’s part of it. Instead, the slow-motion death of federalism flows from the fact that a wide array of federal programs have seduced state governments into playing Washington’s tune.

This week, for example, Ohio Governor John Kasich, a conservative who first came to prominence as one of the foot soldiers of the 1994 Republican Revolution, announced that he supports the federal expansion of Medicaid, one of the central pillars of President Barack Obama’s Affordable Care Act (ACA). Opposition to ACA, and to the enormously expensive Medicaid expansion, had until recently been considered a conservative litmus test.

Kasich is the fifth Republican governor to embrace the Medicaid expansion, alongside Arizona’s Jan Brewer, Nevada’s Brian Sandoval, New Mexico’s Susana Martinez, and North Dakota’s Jack Dalrymple. And he almost certainly won’t be the last. Florida Governor Rick Scott, a former healthcare executive who strongly opposed to the Obama administration’s health reform effort in his 2010 campaign, is widely expected to do the same.

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