Obamacare

Why An Adverse Supreme Court 'Obamacare' Ruling Puts Republicans In A Tough Spot

Brian Beutler | May 17, 2012, 1:29PM

John Boehner

If the Supreme Court overturns part or all of President Obama's health care law, House Republicans will find themselves on the horns of a dilemma. They will be implicitly responsible not just for the demise of the individual insurance mandate and other unpopular parts of the Affordable Care Act, but also its popular provisions and the return of some of the insurance industry's harshest practices, like discriminating against people with pre-existing medical conditions.

Recent reporting by both the New York Times and Politico suggests the GOP congressional leadership might try to mitigate the political liabilities of HCR being overturned by introducing piecemeal legislation to reinstitute popular pieces of the law -- provisions banning discrimination, and allowing children to be covered by their parents' health benefits until they're 26. But that creates a host of new practical and political problems for the GOP.

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Obamacare

Top GOPer: Ban On Pre-Existing Conditions Discrimination 'A Terrible Idea'

Sahil Kapur | May 1, 2012, 1:42PM

Rep. Tom Price (R-GA), the No. 5 House Republican, says he opposes one of the Affordable Care Act's most popular provisions -- a ban on the insurance company practice of discriminating against people with pre-existing medical conditions.

"It's a terrible idea," he told Politico.

The remarks reflect a major conundrum for Republicans who, a year and a half after winning back the House, still have no idea how to replace "Obamacare" and are divided over how best to repeal it.

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Obamacare

How 'Obamacare' Is Saving Seniors Billions On Meds

Sahil Kapur | May 1, 2012, 6:16AM

In the first two years after "Obamacare" was signed, Medicare reforms in the law saved seniors a total of $3.4 billion in prescription drug costs by bridging a coverage gap, according to official figures.

Over 220,000 beneficiaries have saved an average of $837 in the first three months of 2012, the Medicare agency said Monday. That's on top of $3.2 billion in savings enjoyed by some 5.1 million seniors in 2010 and 2011 thanks to the Affordable Care Act, according to the advisory on the new figures.

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Obamacare

'Obamacare' To Yield $1.3 Billion In Rebates For Consumers

Sahil Kapur | April 26, 2012, 1:30PM

A lesser-known but important provision in "Obamacare" that regulates how health insurance companies spend their money is yielding benefits for consumers, a new study finds.

By this August, insurers are projected to send consumers a total of $1.3 billion in rebates, according to a Kaiser Family Foundation analysis released Thursday -- $541 million to large employers, $377 million to small businesses and $426 million to people with their own insurance plans.

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Medicare

How An 'Obamacare' Repeal Would Take Medicare And The Rest Of The Health Care System With It

Brian Beutler | April 24, 2012, 12:50PM

health care reform, obamacare, supreme court

If the Republican Party gets its way, it will repeal President Obama's health care law wholesale. Mitt Romney's committed to repealing it, as are the party's congressional leaders and rank-and-file members on Capitol Hill. That's the plan if they win big in November -- unless the Supreme Court beats them to the punch and overturns the entire law.

According to the Democratically-appointed public trustee of the Medicare program, that wouldn't just spell doom for "Obamacare," but for Medicare and the entirety of the country's ailing health care system.

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Health Care

Romney Hints At Radical Health Care Reform Plan To Replace 'Obamacare'

Brian Beutler | April 24, 2012, 6:00AM

Mitt Romney

Likely GOP presidential nominee Mitt Romney doesn't like to talk about the key details of his own plan for reforming the country's health care system -- the plan he'd push as a replacement to "Obamacare."

But if you string together what he has said publicly, you arrive at a plan that would be far more disruptive to the existing health care system than "Obamacare" would be if fully implemented.

That's what the Los Angeles Times did in a story that the White House missed and the Romney's campaign declined to discuss with TPM. What the Times arrived at is a plan broadly similar to the widely derided blueprint John McCain ran on in 2008.

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Barack Obama

Medicare, Social Security Reports Fuel Fight Over GOP Privatization Plan

Brian Beutler | April 23, 2012, 2:59PM

The Medicare and Social Security trustees presented mixed news for the country's two largest and most popular entitlement programs in annual reports released Monday. The analyses suggest that the 2008 economic crisis, and its lingering effects on the economy, have modestly weakened the programs' finances -- but that President Obama's health care law, if implemented as intended and matched with advancements in health care delivery, will extend the life of Medicare as expected.

The conclusions fuel an ongoing fight between the parties over the propriety of the programs, and the manner in which the federal government should act to provide sustainable retirement security for American workers. In particular, it puts the parties' vastly different views about Medicare back at the center of the 2012 election -- and will force Republicans to continue to defend their far-reaching plan to privatize that program.

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Barney Frank

Barney Frank: NRCC 'Twisting My Words' On Health Care

Sahil Kapur | April 17, 2012, 10:54AM

Rep. Barney Frank (D-MA)

Rep. Barney Frank told TPM Tuesday morning that the National Republican Congressional Committee is "twisting my words" by citing a recent interview to say Frank believes the Affordable Care Act is a "disaster."

"No, I have no issue with the subject matter or the bill itself," Frank said. "I was just commenting on the politics. And I was saying it was a mistake to have done it first." He was arguing that Democrats should have prioritized financial reform, Frank insisted -- which was more popular, and for which which Frank was the point person -- before moving on to health care.

In the interview with New York magazine, Frank said, "I think we paid a terrible price for health care. I would not have pushed it as hard. As a matter of fact, after Scott Brown won, I suggested going back. I would have started with financial reform but certainly not health care."

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Medicare

What's Really Behind The Latest Conservative Attack On 'Obamacare'

Brian Beutler | April 11, 2012, 6:05AM

A new report by a Bush administration economist has reignited the spin wars over the fiscal soundness of President Obama's health care reform law, and is being promoted by conservatives as a counterweight to official, non-partisan government estimates that the law will reduce the deficit by billions of dollars over the next 10 years.

Making it all the more provocative is the fact that the author is the Republican Medicare trustee. His paper, published by the conservative Mercatus Institute, is designed to raise doubts about the soundness of the official estimates, causing editors and reporters, typically ill-equipped to adjudicate partisan disputes, to throw up their hands in frustration and cite it as a valid alternative to the consensus view that the health care law will improve the country's budget situation. But it goes further than that, in subtle attacks on both 'Obamacare' and Medicare, intentionally obscured by abstruse budget language and doomsday graphs.

At issue is the reform law's seemingly inconsistent claim that it will take money from Medicare to subsidize the uninsured while at the same time extending the solvency of Medicare itself. It's an impossible feat, opponents of entitlements argue, and proof that the law is nothing but fiscal smoke and mirrors. In reality this core promise of the health care reform law isn't fiscally inconsistent, but it gives conservatives a subtle way to chew away at the roots of popular entitlement programs.

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Health Care

Kentucky Dem Broadsides Mitch McConnell For 'Dishonesty' On Obamacare

Brian Beutler | April 11, 2012, 6:04AM

An outspoken Kentucky Democrat is directing an unusually pointed attack at a member of his own delegation. And not just any member -- the single biggest target.

Rep. John Yarmuth (D-KY) laid in to Senate Minority Leader Mitch McConnell in a letter delivered last week for misleading their mutual constituents about the facts and benefits of President Obama's health care law.

And in a follow-up interview, Yarmuth again attacked McConnell, his former ally, for putting partisan politics before representing the people of his state.

"I've known Mitch for 40 years," said Yarmuth. "We were political allies at one point. I was a Republican 'til 1985. In recent years, as I've said publicly before, he has a considerable knack for being scrupulously accurate and rarely honest."

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HCR/SCOTUS

How John Roberts Could Uphold 'Obamacare'

Sahil Kapur | April 9, 2012, 6:05AM

In his written opinion on a recent case regarding the constitutionality of suspicionless, forced strip searches of inmates, U.S. Chief Justice John Roberts pointed at one way he could come down on the side of upholding President Obama's health care law and assuage libertarian fears of federal over-reach, some court-watchers speculate.

The constitutional questions in Florence v. Board of Chosen Freeholders of County of Burlington are different than those in the health care case. But experts see a potential connection in the broader philosophical point Roberts made in his concurring opinion.

Last week the Supreme Court held 5-4 that prisons may strip-search inmates, even those who are jailed for minor infractions, arguing that security concerns trump privacy in such an environment. Roberts wrote a short aside emphasizing that the court may later place limits to that power when necessary. The caveat suggests that Roberts is concerned about tarnishing his court's legacy by issuing opinions that reflect poorly on his tenure as chief justice in retrospect. And it highlights the fact that future courts can circumscribe federal powers -- including the one at stake in the fight over "Obamacare."

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Health Care

White House Says GOP Budget A Disaster For Women

Brian Beutler | April 6, 2012, 5:36AM

President Barack Obama and Vice President Joe Biden

The Obama administration is hoping for a Friday three-fer.

Amid a political fight over women's rights that has caused GOP support among women to collapse; a Friday jobs report expected to show that the economy continues to grow rapidly; and an election year fight over the Republican Party's controversial budget, the White House will host a forum on women and the economy -- to highlight the administration's accomplishments in the area of women's rights, particularly in contrast with the Republican Party's governing platform.

The goal is to capitalize on all three simultaneously.

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Supreme Court

DOJ: No, Obama Didn't Say Courts Can't Strike Down Laws

Brian Beutler and Sahil Kapur | April 5, 2012, 2:05PM

Attorney General Eric Holder

U.S. Attorney General Eric Holder responded Thursday to a federal appeals court's request for a letter explaining President Obama's assertion that the Affordable Care Act must be upheld, a move that even some conservatives considered a bridge too far.

Holder reminded the Fifth Circuit Court of Appeals that the president was making the point that the law jibes with longstanding precedent, but -- contrary to what the Republican-appointed judges suggested -- he wasn't challenging the judicial branch's authority to strike down laws that violate the Constitution.

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Paul Clement

How GOP's Lawyer Paul Clement Helped Defend 'Obamacare'

Sahil Kapur | April 5, 2012, 10:57AM

Paul Clement, the lawyer for the Republican-led states challenging "Obamacare," played a key role years ago, when representing the Bush White House, in expanding the same federal power that's now the constitutional basis for the health care reform law. Today his clients have different interests, and the 180-degree flip in his reasoning underscores an inconsistency in Republican views of the Constitution.

As the Bush administration's solicitor general in 2004, Clement argued before the Supreme Court in Gonzales v. Raich that Congress's power to regulate interstate commerce is broad enough to override state laws permitting medical marijuana patients to grow cannabis for personal consumption. Notably, two of the justices he won over in the the 6-3 decision were Anthony Kennedy and Antonin Scalia.

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Mitt Romney

Mitt Romney Doubles Down On Medicare Distortions

Sahil Kapur | April 5, 2012, 6:14AM

Mitt Romney

Mitt Romney made a series of claims Wednesday that distort President Obama's positions on Medicare, an indication that he's sticking with an earlier, misleading line of attack as he gets closer to winning the Republican nomination for president.

"I'd be willing to consider the president's plan, but he doesn't have one. That's right: In over three years, he has failed to enact or even propose a serious plan to solve our entitlement crisis," Romney said in a speech to the Newspaper Association of America in Washington, D.C. "Instead, he has taken a series of steps that end Medicare as we know it. He is the only president to ever cut $500 billion from Medicare. And, as a result, more than half of doctors say they will cut back on treating seniors."

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Barack Obama

Associated Press Ignores Obama On Drawing False Equivalences On Health Care

Brian Beutler | April 4, 2012, 12:23PM

President Barack Obama

One of the key moments of President Obama's Tuesday speech before an Associated Press luncheon came at the end, when he urged reporters not to cast partisan disagreements about the key issues of the day -- health care, the environment, the role of the federal government -- as a product of equal intransigence on both sides. Republicans, he noted, have abandoned their previous support for Obama initiatives -- from transportation funding, to cap and trade, to the health care reforms that comprise 'Obamacare' -- many of which emerged as conservative alternatives to more liberal policies.

His hosts weren't listening -- and as a result they've made Obama's points about Republicans and the media for him.

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John Roberts

John Roberts Faces A Legacy-Defining Predicament On 'Obamacare'

Sahil Kapur | April 4, 2012, 5:39AM

You're the chief justice of the United States, and you're presented with a choice: Either rebuke the political movement that gave you your dream job, or put your institution's reputation on the line by neutering a sitting president's signature legislation for the first time in 75 years.

This is the unenviable dilemma John Roberts faces as the Supreme Court prepares to rule on "Obamacare." Initial votes were cast by the justices last Friday, and a final decision on the law's constitutionality is expected by the end of June. And with four liberal justices considered a lock to uphold the law, Roberts is uniquely positioned to determine the law's fate, and faces considerable risks no matter what he chooses.

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Health Care

Repealing 'Obamacare' Would Explode Debt, Says Government Auditor

Brian Beutler | April 3, 2012, 6:05AM

A new report by an independent government auditor concludes that implementing President Obama's health care law as intended will make a significant dent in the long-term debt forecast.

The report comes as Supreme Court justices weigh striking some of "Obamacare's" central provisions -- and perhaps the law in its entirety -- and as the Republican Party remains committed to repealing the law if it seizes control of government in November.

"[I]f the Patient Protection and Affordable Care Act (PPACA) is implemented as intended it would have a major effect on the [fiscal] gap but would not eliminate it," the Government Accountability Office wrote in a Monday report -- a conclusion in line with its own past research and similar research conducted by other government and non-government analysts.

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Health Care

Why Overturning 'Obamacare' Could Lead To Single-Payer

Sahil Kapur | April 2, 2012, 6:06AM

If the Supreme Court strikes down "Obamacare," Republicans claim a huge short-term victory, but they may end up big losers in the long run. The future of the nation's health care system would be thrown into disarray, and conservatives may be forced to swallow a more bitter pill.

The prospect of moving toward a more liberal, government-controlled health care system is fraught with political peril, and therefore far from inevitable, but may wind up being the only way to prevent the demise of the unsustainable, existing system from leaving many more millions without access to health care. Without a mechanism like an individual mandate to cover the uninsured and tackle the free-rider problem, health care costs are set to rise at an unsustainable rate and compel potentially drastic action from Congress.

"Conservatives may find that they weren't careful about what they wished for in opposing 'Obamacare,'" Adam Winkler, a constitutional law professor at UCLA School of Law, told TPM. "The economic, social and political pressure for health care reform aren't going to just disappear. There's a reason every major industrialized country has national health care. If the Supreme Court invalidates the Affordable Care Act, we are likely to see a government takeover of health care in the next decade."

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HCR/SCOTUS

Supreme Court Kicks Off Historic Case On Health Care Law

Sahil Kapur | March 26, 2012, 5:35AM

Supreme Court of the United States

The Supreme Court begins hearing arguments Monday morning on President Obama's health care reform law, a case with sweeping political and policy implications grand enough to make it one of the most important in years.

At stake: the future of this country's badly ailing health care system and perhaps even the legacy of its first black president. The political ramifications of the ruling will be enormous, with one of the two major political parties poised to see its vision for the future of government suffer a body blow.

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HCR/SCOTUS

McConnell: GOP Weighing Legislative Response To 'Obamacare' Ruling

Brian Beutler | March 23, 2012, 1:33PM

Senate Republicans are preparing legislative strategies for the possibility that the Supreme Court ultimately rules the health care law's individual mandate unconstitutional.

At a Capitol press briefing Friday, McConnell declined to discuss the details, which, he noted, would depend on the extent of the court's decision. But his message was essentially: Stay tuned.

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HCR/SCOTUS

The Glitch That Allows The Supreme Court To Throw Out All Of Obamacare

Brian Beutler | March 22, 2012, 5:24AM

Jason Maehl/ Shutterstock

We know there's some chance the Supreme Court will decide to take a pass on President Obama's health care law for a few years -- until after its mandatory coverage mandate takes effect in 2014. And we know that if they do rule on the central challenge to the Affordable Care Act this year, precedent is on the side of upholding that piece of the law.

But what happens if they determine that the mandate is unconstitutional anyhow?

On Tuesday, the court will hear arguments about just how "severable" the ACA is. Major legislation often includes what's known as a "severability clause," to prevent courts from invalidating entire laws when they find that small sections of those laws violate the Constitution.

By dint of a small, but highly consequential legislative oversight, the ACA does not include such a clause. That means it'll be up to the justices to decide how much of the law can stand if they rule that the individual mandate violates the Constitution.

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HCR/SCOTUS

What's In A Mandate? Why SCOTUS May Take A Pass On 'Obamacare' -- For Now

Brian Beutler | March 20, 2012, 5:23AM

When the Supreme Court convenes next week to hear arguments about the constitutionality of President Obama's health care law, the first issue they will consider is the basic character of one of the law's crucial features: the requirement that uninsured Americans either purchase coverage or pay a fine to the federal government.

Better known as the individual mandate, it's the provision of the health care law at the heart of the GOP's constitutional complaint. The plaintiffs -- the 26 states suing over the law -- contend the individual mandate exceeds Congress' power to regulate interstate commerce, and the court's ruling on that issue could have the most sweeping legal impact, perhaps upending decades of Commerce Clause jurisprudence.

But before they get to the question of whether the individual mandate is an unconstitutional expansion of the Commerce Clause, the justices have agreed to consider whether they even have the power to take up this case, since the mandate does not go into effect for another two years. And that decision will ride on a fine distinction: Is the individual mandate a tax or is it a penalty?

The arguments they will hear, and the decision they ultimately reach, will determine whether the court can proceed to rule on the merits of the law, or whether they must punt on the substance until after the mandate takes effect in 2014. Either decision would place several key actors in awkward political predicaments without any easy escape routes.

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Medicare

Dems To GOP: No Cover From Us On Medicare Privatization Plan

Brian Beutler | March 19, 2012, 1:04PM

Rep. Paul Ryan (R-WI)

When House Republicans unveil their 2012 budget on Tuesday, they are expected to include a Medicare privatization plan endorsed by one Democrat -- Sen. Ron Wyden (D-OR). That, Republicans will claim, proves their controversial overhaul proposal has bipartisan support.

Leading Democrats say they won't let the GOP get away with it.

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Health Care

GOP Leaders Take Conservative Fire For Health Care Repeal Strategy

Sahil Kapur | March 19, 2012, 10:04AM

When top House Republicans advanced a bill this month aimed at repealing one of the most contentious parts of President Obama's health care law, they didn't see much downside. More bad press for health care reform, a splintered Democratic House minority and a consolidated Republican Party. They didn't look hard enough.

Not only have they managed to alienate some Democratic allies on the bill, slated for a floor vote this week, they're also facing heat from the right for targeting just the one provision of "Obamacare," instead of the law in its entirety.

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HCR/SCOTUS

Supreme Court Prepares To Determine Fate Of U.S. Health Care System

Sahil Kapur | March 19, 2012, 4:49AM

Shutterstock /stefanolunardi

In one week, the Supreme Court will hear arguments on a legacy-defining case for President Obama as it determines whether a crucial piece of his signature legislative achievement meets constitutional muster. The health care reform law's path to the high court has underscored a climate of supercharged partisan politics, and the highly anticipated decision expected this summer, in the dead heat of presidential election season, will help determine the trajectory of the nation's health care system.

The main question facing the justices is whether the law's requirement that Americans purchase insurance falls within the limits of federal power under the Constitution. They'll also hear arguments on whether, if the mandate is deemed unconstitutional, other aspects of the law such such coverage guarantee also need to be struck down. There's a chance that the court will punt the case to after 2014 under a law that says a tax may not be challenged in court until it is being collected.

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Affordable Care Act

An 'Obamacare' Cost Explosion? Hardly -- GOP Distorts CBO Report

Sahil Kapur | March 15, 2012, 2:09PM

House Speaker John Boehner (R-OH) and Houser Majority Leader Eric Cantor (R-VA)

Republicans and conservative media are cherry-picking a figure in a new Congressional Budget Office spending estimate (PDF) to assert that the cost of "Obamacare" has nearly doubled to $1.76 trillion. But the claim ignores the corresponding savings during the additional period of the spending projection, thus distorting the actual cost estimates of the law.

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Medicare

New GOP Medicare Privatization Plan: Obamacare For Seniors Only?

Brian Beutler | March 15, 2012, 12:45PM

Sen. Rand Paul (R-KY)

You're a Republican senator. How do you sell a plan to privatize Medicare?

One way is to fashion the massive overhaul as an extension of the private system members of Congress enjoy -- the Federal Employee Health Benefits Plan -- and then trumpet the merits of that system over existing Medicare.

"We have to convince [seniors] this is something better," said Sen. Jim DeMint (R-SC), flanked by Sens. Lindsey Graham (R-SC) and Rand Paul (R-KY), authors of a new Medicare privatization plan, at a Capitol press conference on Thursday. "If we thought Medicare was better, we would be on it as senators."

DeMint is 60 years old. Graham is 56. Paul is 49. Medicare eligibility age is 65.

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Mitt Romney

The Many Misleading Claims In Mitt's Monday Medicare Memo

Brian Beutler | March 12, 2012, 12:59PM

As part of an effort to reverse the public's perception of the parties' positions on Medicare, Mitt Romney's campaign is appropriating a common Democratic attack and using it against President Obama. To wit, it's Obama, not Romney and the GOP, who plans to "end Medicare as we know it."

There are multiple, and conflicting, facets to this claim, all of which are intended to obscure one fundamental fact -- the GOP broadly supports a plan that, over years, will phase out traditional Medicare, and replace it with a subsidized private (or private-public) insurance system for seniors; President Obama supports, and has signed into law, efforts to make the existing single-payer Medicare plan more cost-effective in order to avoid "ending Medicare as we know it."

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Medicare

How The Affordable Care Act Could Quash The GOP's Dream Of Medicare Privatization

Sahil Kapur | March 12, 2012, 5:40AM

President Barack Obama and Vice President Joe Biden

What if "Obamacare" not only helped save Medicare from fiscal doom, but also quashed the GOP's longstanding goal of privatizing the program? It's too early to know what will ultimately happen, but new evidence suggests that nightmare scenario for conservatives is within the realm of possibility.

In a development with potentially profound implications -- both for Medicare itself and for the broader ideological fight between the two parties over the role of government -- researchers writing in the New England Journal of Medicine believe that the growth in per patient Medicare costs has slowed, contra earlier projections that spending would soar at an unsustainable rate. More importantly, the researchers believe this trend will hold over time, thanks largely to the Affordable Care Act's sweeping cost-control policies.

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Claire McCaskill

McCaskill: Obamacare Is Like Ryancare For Non-Seniors

Sahil Kapur | March 8, 2012, 6:02AM

United States Senator Claire McCaskill (Democrat of Missouri) holds a press conference in the U.S. Capitol

Grilled about her support for the Affordable Care Act, Sen. Claire McCaskill (D-MO) told a home state radio interviewer that the law's core structure is "exactly" like the House GOP Medicare privatization plan that conservatives support and liberals detest.

"The irony of this situation is that these are private insurance companies people will shop to buy their insurance. It's not the government," she told KMOX of St. Louis on Wednesday. "It's exactly what Paul Ryan wants to do for Medicare."

"It's subsidized by the government -- premium subsidies -- which is exactly, this is the irony," continued McCaskill, who faces a tough reelection battle this fall. "You think what Paul Ryan wants to do for seniors, you think it's terrific. But when we want to provide private health insurance for people who don't have insurance with subsidies from the government, you think it's terrible."

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CLASS Act

Long-Term Care On Life Support As House GOP Passes Repeal Of CLASS Act

Sahil Kapur | February 1, 2012, 7:06PM

Shutterstock /stefanolunardi

"Where is your heart?" cried Rep. Bill Pascrell (D-NJ). "Have you no heart?"

Despite the congressman's plaintive objections during Wednesday's House debate, his Republican colleagues passed a bill 267-159 to repeal the ill-fated CLASS Act. The Community Living Assistance Services and Supports program, championed by the late Ted Kennedy, aimed to provide a long-term care insurance program. Wednesday's party-line vote deepens a partisan stalemate over how to fill that major hole in the U.S. health care system, as the legislation now goes to the Senate where it's expected to perish.

The impasse in a nutshell: The Obama administration conceded last October that it saw no viable path to implement CLASS within its statute, citing financial solvency problems. But the President and his Democratic allies oppose repealing the program and would rather repair it. Republicans, who decry CLASS as costly, unworkable and predicated on a budget gimmick, have no intention of letting that happen. They're insisting on outright repeal and say Congress must start from scratch on the long-term care problem -- although they haven't yet offered an alternative.

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Affordable Care Act

Did Health Care Reform Hurt The Private Insurance Part Of Medicare? Apparently Not

Sahil Kapur | February 1, 2012, 1:15PM

President Barack Obama

The Obama administration announced Wednesday that the Medicare Advantage program, which allows seniors to receive health coverage through a private insurer, is enjoying lower costs and more customers as a result of the health care reform law.

Medicare Advantage enrollment has risen 10 percent over the last year while average premiums have fallen by 7 percent, said Health and Human Services Secretary Kathleen Sebelius. She also pointed out that similar improvements were seen the previous year.

The figures bolster President Obama's defense of his signature achievement, and for Democrats it has the added bonus of refuting earlier Republican warnings that "Obamacare" would gravely undermine the choice provisions in Medicare.

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Barack Obama

Why A President Romney Would Find It Hard To Repeal 'Obamacare'

Brian Beutler | January 18, 2012, 5:27AM

Mitt Romney

Should he win the nomination and the presidency, then on inauguration day in 2013, after all the pageantry has subsided, Mitt Romney will face a key test: does he take aggressive action to roll back Obamacare as he and every other GOP contender has promised? Or will he accede to pragmatic realities and seek detente with Democrats on the issue that has most divided the parties over the past three years?

The amount of money, strategizing, myth-making, and political capital that Republicans have already thrown at the health care law will make it very difficult for Romney or any GOP President not to enter office with guns blazing. But many of the would-be policy makers who have made dismantling the law their top priority haven't given any real thought to how, mechanically, to unwind it. A closer look reveals that chipping away at Obamacare, or even repealing it altogether will be a daunting challenge, and even if successful will leave the Republican party holding the bag politically for the policy muddle they will create in the process.

"It would be a mess," said Donald Berwick, who led the law's implementation last year as Obama's Centers for Medicare and Medicaid Services director. "If I was given the assignment of unwinding the law, I wouldn't know how to do that. I would thoroughly disagree with it but it would be technically very difficult."

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Affordable Care Act

How To Easily End The 'Doc Fix' Problem -- And Why House GOP Is Opposed

Sahil Kapur | January 16, 2012, 5:32AM

Rep. Phil Gingrey (R-GA) And House GOP Doctors Caucus

One of the items Congress extended for two months in the December payroll tax package is current Medicare payment rates to physicians, averting a steep 27.4 percent cut. Although a yearlong "doc fix" is seen as likeliest when lawmakers return to town this week and begin negotiating pay-fors, even that would merely be punting an issue in need of a permanent fix.

Over the last few months there's been serious talk in Congress of buying out the "doc fix" issue once and for all with war savings from troop withdrawals in Iraq and Afghanistan, estimated at over half a trillion dollars.

The idea has been championed by Senate Majority Leader Harry Reid (D-NV), House Minority Leader Nancy Pelosi (D-CA), Senate Minority Whip Jon Kyl (R-AZ) and multiple other key senators including John Kerry (D-MA), Debbie Stabenow (D-MI) and Tom Harkin (D-IA).

But even though this plan could remove for free the $300-billion-and-growing albatross from the nation's neck, it faces fierce resistance from House Republicans. In fact, some of the vocal opponents are doctors in the caucus, whom Leadership tends to give the first bite at the apple on health issues.

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Obamacare

Why The 2012 Election May Be The GOP's Only Chance To Repeal Health Care Reform

Sahil Kapur | January 10, 2012, 5:23AM

President Barack Obama speaks on the economy in Shaker Heights, OH on January 4, 2012.

Before she dropped out of the GOP presidential race, Michele Bachmann waxed apocalyptic about how 2012 is the Republican Party's only chance to repeal the health reform law. "We cannot afford to have a candidate who fails to understand the complexity of Obamacare or the urgency of its repeal," the Minnesota congresswoman said in an often-repeated line. "Because, we have only have one chance for repeal, and that's 2012."

There's truth to this statement: if Republicans fail to capture the presidency this time around, repealing some or all of the law becomes far more difficult later, even if the GOP sweeps Congress in 2012 and wins the White House in 2016 with equal determination to squash it.

"The 2012 election will be the most important in the history of our health care system because it will determine whether the Affordable Care Act (ACA) is implemented or repealed," wrote Harvard health policy expert David Blumenthal in the New England Journal of Medicine. "The consequences for Americans and their health care will be huge."

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Rick Santorum

Hmmm... Santorum's Healthcare Pitch Sounds An Awful Lot Like Obamacare For The Elderly

Brian Beutler | January 9, 2012, 2:11PM

Ever since Republicans in Congress voted overwhelmingly for Paul Ryan's budget, the GOP has expected its leading Presidential candidates to back a similar Medicare privatization scheme. Most of them have followed suit. Rick Santorum is trying to have it both ways.

During Sunday morning's NBC debate, the come-from-behind winner of the Iowa caucuses talked about his Medicare pitch to voters.

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Medicaid

ObamaCare Challenge Exposes Conservative Hypocrisy On Federal Power

Brian Beutler | December 12, 2011, 1:21PM

The Supreme Court in Washington, DC

Next year policy wonks, politics junkies, and legal experts will wait with bated breath for the Supreme Court to determine the constitutionality of a key section of President Obama's health care law: the mandate that uninsured individuals purchase health care coverage.

But the court will also review another major piece of the law -- the requirement that states expand Medicaid eligibility to people with incomes of up to 133 percent of the federal poverty line. This is no small expansion. Of all the millions of people expected to become insured under the law, about half will be covered through Medicaid.

For the first several years, the federal government will pay the states for the full cost of the expansion. After 2020, the federal contribution will drop to 90 percent. States with conservative governors don't like this one bit. But Medicaid is a voluntary program -- if states don't like the terms and conditions the government sets for the program, they're free to drop out of it.

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Payroll Tax Cut

GOP's Keystone Pipeline Gambit Distracts From Other Measures

Brian Beutler | December 9, 2011, 1:28PM

House Speaker John Boehner (R-OH) and President Barack Obama

In a bid to consolidate support within their caucus -- and to flip the bird to President Obama -- House Republicans have tacked a provision on to their payroll tax cut bill that would force the administration to decide whether to allow construction of the Keystone XL pipeline within 60 days, instead of after the election next year as the administration currently plans.

Though controversial outside of Washington, the pipeline has bipartisan support in Washington, and Republicans -- itching for this fight -- are banking on the idea that some Democrats will cross the aisle and put Senate Dems and Obama in a tough spot.

And to some extent they've been successful. Obama strongly suggested he'd veto the bill over the provision, Senate Majority Leader Harry Reid has called it dead on arrival, and many in the media have painted the GOP's bill as providing Dems a choice between passing the payroll tax cut and blocking the Keystone pipeline.

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Medicare

GOP Filibuster Ends Tenure Of Health Care Cost Cutting Expert

Brian Beutler | November 23, 2011, 1:45PM

President Obama hasn't used his recess appointment power very often. But he didn't hesitate to install Donald Berwick as the administrator of the Center for Medicare and Medicaid Services without Senate confirmation over a year ago, to lead the implementation of the new health care law. Berwick's has, without a doubt, been Obama's most important recess appointment, and his most effective. But he will step down early next month -- a few weeks before his term expires -- because filibustering Republicans continue to deny him an up or down vote.

The GOP claims its opposition is rooted in Berwick's past praise of Britain's state-run National Health Service. But his powers as CMS administrator obviously stop well short of socializing the United States health care system. So what gives?

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