"Death panels" are back. Just in time for Congress' August recess, conservatives are resurrecting Politifact's 2009 Lie of the Year to once again rile up right-wing rage. But while the GOP lie four years ago concerned the Affordable Care Act's proposed funding for end of life counseling for those patients seeking it from their doctors, "Death Panels 2.0" slanders Medicare's Independent Payment Advisory Board (IPAB).
Leave aside for the moment that IPAB, the 15 member board tasked with controlling cost growth in Medicare, is barred by law from "rationing" health care and regardless won't be implemented until at least 2015 due to the dramatic drop-off in the rate of health care cost increases. Right-wing mythology notwithstanding, Sarah Palin was not right. The truth is that there are no death panels, only death panelists. And as it turns out, the people who would deny health insurance to millions, drop coverage when policyholders get sick, support annual and lifetime benefits caps, force Americans to pay higher premiums and actually ration Medicare find their home in the Republican Party.
Here are just some of the real death panelists. (Click a link to jump to the details for each below.)
- Private Insurance Companies
- 95 Percent of Congressional Republicans
- Paul Ryan
- Republican Governors like Rick Perry, Scott Walker and Bobby Jindal
- Republican Legislatures like Those in Florida and Ohio
- Conservative Groups like FreedomWorks
- GOP Congressmen like Jason Chaffetz and Tim Huelskamp
Private Insurance Companies. These, of course, are the original death panelists. It's bad enough that up to 50 million people in the United States have gone without health insurance. (Studies from Families USA, the Urban Institute and Harvard Medical School put the unnecessary death toll for the uninsured as high as 45,000 a year.) One recent analysis found that 22 percent of those seeking insurance in the private market nationwide were rejected. And as Ezra Klein detailed back in 2009, the industry's practice of "purging," in which "insurers rid themselves of unprofitable accounts by slapping them with 'intentionally unrealistic rate increases'" forces companies and individuals alike to drop their policies.
But the insurers' most cruel and vicious practice, one eliminated by Obamacare, is "rescission." As the Los Angeles Times documented in horrifying detail beginning in 2006 ("Sick but Insured? Think Again"), insurance companies use the rescission process to drop subscribers who become ill, often falsely claiming they suffered from a pre-existing condition or committed fraud to obtain coverage in the first place. As the Times reported, one Blue Cross employee explained that "a special department considers as many as 1,500 cases for cancellation each week in California alone." It's no wonder a consumer lawyer who saw Blue Cross' cancellation tally sheets described the department as a "rescission factory."
At a Congressional hearing on June 16, 2009, Americans got a much fuller picture of how those rescission factories actually work. As it turned out, the major insurers maintained lists of up to 2,000 conditions which they used to automatically trigger an investigation into possible grounds for rescission. As Newsweek recounted:
The commerce-committee investigation released the first public data on the practice, finding that the three companies, WellPoint, UnitedHealth, and Assurant, rescinded nearly 20,000 policies from 2003 to 2007, saving $300 million. The committee found that at WellPoint, employees were rewarded for rescinding policies based on how much money they saved the company.
As the Los Angeles Times detailed, when lawmakers asked executives from the three firms if they would stop dropping customers except where they can show "intentional fraud," all answered "no."
95 Percent of Congressional Republicans. Every single Republican Representative and Senator voted against the Affordable Care Act before President Obama signed it into law in March 2010. Since January 2011, House Republicans have voted 40 times to repeal Obamacare. Were they to succeed, the GOP wouldn't just be preventing up to 30 million more people in the U.S. from obtaining health insurance. All of the law's reforms that ended the worst practices of the insurance industry--refusing to cover those with pre-existing conditions, using "rescission" to drop coverage for those who become sick, discriminating against women, setting annual or lifetime benefits caps and more--would return to torment American patients and their families. Three and a half years after Senate Minority Leader Mitch McConnell announced that the GOP's 2010 midterm campaign slogan "will be 'repeal and replace', 'repeal and replace,'" his party has failed on both counts.
But that's not all. In 2011, 2012 and again in 2013, virtually every Republican member of the House and Senate voted for the Paul Ryan budget that would repeal Obamacare while pocketing the $1 trillion plus in new revenue partially offset the cost of another massive tax cut windfall for the wealthy. Oh, and one other thing: for three straight years, 95 percent of Republicans in Congress voted to ration Medicare for future generations of American seniors.
Which is why Mitt Romney's running mate Paul Ryan deserves a special place in the GOP death panelists hall of shame.
Paul Ryan. In February 2010, Ryan unveiled his "Roadmap for America's Future" which called for the privatization of Social Security and Medicare. But when Ezra Klein of the Washington Post pointed out to Ryan that his underfunded Medicare voucher scheme would invariably lead to rationing of care for future elderly by "the government capping its payments and moderating their growth in such a way that many seniors will not get the care they need", Ryan protested:
"Rationing happens today!" The question is who will do it? The government? Or you, your doctor and your family?"
But then as now, he omits the real culprit: private insurers who can deny coverage, jack up premiums and cherry-pick healthier customers. Three years, three budget plans and two name changes later, Paul Ryan's Medicare privatization scheme will still lead to de facto rationing.
The nonpartisan Congressional Budget Office explained why. In 2011, the CBO concluded that the value of Ryan's voucher for future seniors buying insurance in the private market would not keep up with cost increases, resulting in "a typical beneficiary would spend more for health care under the proposal." (How much more? $6,500 a year more by 2030, with the beneficiary's share of their health expenses reaching a shocking 68 percent). Even when Ryan revised his proposal in 2012 to include the traditional government-run Medicare as one option for seniors, CBO still estimated that "that new beneficiaries could pay up to $2,200 more by 2030 and up to $8,000 more by 2050."
But Paul Ryan's denial of service hardly ends there. His proposal to slash Medicaid spending by a third over the next decade and give what funding remains as block grants to the states would leave an estimated 38 million more people without health insurance. But despite repealing Obamacare, the Ryan budget keeps all of the new revenue it will generate from tax hikes and Medicare savings (yes, that same $716 billion in Medicare savings he and Republicans continue to decry) in order to give rich people more tax cuts instead. Those like Senators Ted Cruz (R-TX) and Marco Rubio (R-FL) who would shut down the government in order to defund Obamacare are doing precisely the same thing.
Republican Governors like Rick Perry, Scott Walker and Bobby Jindal. In June 2012, the Supreme Court of the United States upheld the Affordable Care Act. But the Roberts' Court ruled that states could opt-out of the ACA's expansion of Medicaid eligibility to those earning up to 133 percent of the federal poverty line. Now, 24 states have chosen to turn their backs on billions in federal funding with the result that an estimated 11.5 million of their residents will unnecessarily be denied health insurance.
A recent study the RAND Corporation found that the Medicaid expansion is a great deal for the states. After all, the federal government picks up 100 percent of the tab through 2017 and 90 percent after that. But states that opt out will be on the hook for the cost of emergency care and hospitalization of the uninsured, a cost that exceeds the price of opting-in after 2017. Nevertheless, Republican Governors and 2016 GOP White House hopefuls like Bobby Jindal (R-LA), Scott Walker (R-WI) and Rick Perry (R-TX) said no. As Perry, flanked by Republican Sens. John Cornyn and Ted Cruz and Reps. Joe Barton and Michael Burgess, put it in April:
"Texas will not be held hostage to the Obama administration's attempt to force us into this fool's errand."
As it turns out, Rick Perry's fool is staring back at him in the mirror.
The numbers are staggering. In Texas, Perry's foolishness in opting out means an extra 1.9 million Texans will needlessly go without health insurance in a state where 6 million people--24 percent of all residents and 30 percent between the ages of 18 and 64--lack coverage. Next door neighbors Minnesota and Wisconsin provide another useful case study. While Democrat Mark Dayton will be cutting the ranks of the uninsured by almost half in his state, in Madison Republican Scott Walker is leaving an estimated 182,000 folks out in the cold. Down in Bobby Jindal's Louisiana, 300,000 will be left uninsured.
Those kinds of number were not lost on Arizona Governor Jan Brewer. Despite her opposition to Obamacare, Brewer wisely decided to take Washington's offer on Medicaid and so provide coverage for 300,000 more Arizonans. As she put it, "It's pro-life, it's saving lives, it is creating jobs, it is saving hospitals." Brewer knows this from her own past experience as a GOP death panelist. When she temporarily cut Arizona's own Medicaid funding for transplants in 2010, people died.
There is no doubt about it. The Republicans' decision to turn down the Medicaid expansion as a matter of political spite will produce a body count. Almost as tragic, their decision to refuse to set up their state health care exchange will leave their residents with fewer insurance choices and higher premiums.
Republican Legislatures like Those in Florida and Ohio. In some states, Republican governors wanted to expand Medicaid, only to be blocked by their GOP-controlled state legislatures. In Florida, where the GOP legislature rebuffed Governor Rick Scott's choice to accept the windfall from Washington, roughly one million residents will be left without insurance. In Ohio, Republican Governor John Kasich continues to press his GOP legislative majority to accept the Medicaid expansion that would cover an additional 366,000 Buckeye State residents, declaring "I believe it's a matter of life and death." As Kasich warned his GOP colleagues in June:
"When you die and get to the meeting with St. Peter, he's probably not going to ask you much about what you did about keeping government small, but he's going to ask you what you did for the poor. You'd better have a good answer.
Their answer--that Republicans must oppose the Affordable Care Act because President Obama supported it--like won't be sufficient to gain them entry through the Pearly Gates.
Conservative Groups like FreedomWorks. A lot of conservative activists and political action groups will find admission difficult to come by as well. After all, the usual suspects like Americans for Prosperity and Crossroads GPS aren't just spending millions of dollars are deceptive or downright fraudulent anti-Obamacare advertising; they are actively encouraging Americans to flout the law's individual insurance mandate.
Take, for example, FreedomWorks campaign to get Americans--especially the younger and currently uninsured--to burn their "Obamacare cards." As Politico reported last month:
Never mind the fact that there are no such thing as Obamacare cards.
"It's not against the law to ignore the mandate or to buy coverage that doesn't fully conform to the law's complicated and intrusive rules," said FreedomWorks' vice president of public policy, Dean Clancy. "The FreedomWorks 'Burn Your Obamacare Card' campaign aims to resist the draft in good conscience, without risking jail time or significant fines."
The conservative group plans to train people to "beat the mandate" and resist the health law's requirements.
FreedomWorks objective is to prevent Americans ages 18 to 34--a group the Obama administration is targeting for 2.7 million newly insured to offset the cost of covering older, sicker Americans--from purchasing insurance starting in 2014. What could possibly go wrong?
Well, a September 2011 Republican presidential debate provided one answer. When Wolf Blitzer asked Ron Paul what should happen to a health 30 year-old that refused to pay for an insurance policy and then suddenly has a major health care emergency, the GOP audience provided the answer.
GOP Congressmen like Jason Chaffetz and Tim Huelskamp. Kevin Lucia, an assistant research professor with the Georgetown University Health Policy Institute's Center on Health Insurance Reforms, recently explained that tasks like providing assistance and enforcement of insurance regulations are "typically reserved for state insurance departments." But last week, Texas joined Arizona, Alabama, Missouri, Oklahoma and Wyoming in announcing its insurance watchdog agency will do no such thing for Obamacare, and instead will turn residents and their questions over to the federal Centers for Medicare and Medicaid.
To help fill the information void, groups like Enroll America are planning to supplement federal outreach in 10 critical, often recalcitrant states including Texas, Georgia and Florida. But for those expecting some constituent service in states like Utah and Kansas, don't expect any help from your GOP Congressmen. As The Hill explained, their answer is "call Obama":
Some Republicans indicated to The Hill they will not assist constituents in navigating the law and obtaining benefits. Others said they would tell people to call the Department of Health and Human Services (HHS).
"Given that we come from Kansas, it's much easier to say, 'Call your former governor,'" said Rep. Tim Huelskamp (R),
referring to HHS Secretary Kathleen Sebelius.
"You say, 'She's the one. She's responsible. She was your governor, elected twice, and now you reelected the president, but he picked her.'" Huelskamp said.
"We know how to forward a phone call," said Rep. Jason Chaffetz (R-Utah).
"I have two dedicated staff who deal with nothing, but ObamaCare and immigration problems," he added. "I'm sure there will be an uptick in that, but all we can do is pass them back to the Obama administration. The ball's in their court. They're responsible for it."
The Obama administration is responsible for trying to help Americans stay financial secure, healthy and, well, alive. As for the group of Republicans trying to stop them, there's a term for that.
(This piece also appears at Perrspectives.)