The White House definitely wants the Catfood Commission II to negotiate their grand bargain that they can tout along the lines of “getting things done” with a “bipartisan compromise.” And they believe that the automatic cuts that would be triggered if the Catfood Commission II recommendations don’t come about are so distasteful to both sides, that it will force an agreement.
Some Democrats took a look at the automatic cuts and thought they were tough, but probably better than a bad agreement that would slash the safety net and in all likelihood do little on revenues. After all, Medicaid, Social Security and programs for the poor were protected in the agreement, and Medicare would only see a provider haircut. And half of the automatic cuts would hit the Pentagon. What’s the forcing mechanism for the left?
Turns out, that would be the exchange subsidies from the Affordable Care Act:
The new health care law will make insurance more affordable by providing subsidies to people who buy insurance on their own. And these subsidies come in two forms. There are tax credits, which people can use to offset the cost of their premiums. And there are subsidies to defray cost-sharing: In other words, the government will help reduce people’s out-of-pocket costs. Under the debt ceiling deal, the tax credits are exempt from automatic reductions, because they are a tax credit and not a form of spending.
But, as both administration and congressional sources are confirming, the cost-sharing subsidies are not exempt. They will decline. And that’s worrisome because the subsidies were already pretty low. In fact, many of us were hoping that, over time, lawmakers would see fit to raise them rather than reduce them. I can’t be sure how much the subsidies would decline, as nobody I’ve contacted seems to have run the numbers yet. And I’m not even positive how reduced subsidies would translate into reduced protection, since technically the subsidies go directly to the insurers. (I don’t even want speculate about the impact until I know more. I’ll update this item when I do.)
But the point here isn’t to second-guess specific trade-offs in the automatic cuts; again, I think Obama and the Democrats did a good job of protecting the most vital programs and the most vulnerable populations. Rather, it’s a reminder about the overall structure of the deal. When you decide to reduce the deficit by $2.4 trillion over ten years, with little chance for including new revenue as part of the package, you’re going to end up cutting spending in some regrettable ways. No amount of last-minute negotiating was going to change that.
So there’s already reason to be concerned about how the exchanges will work and whether the subsidies will be affordable. Now we have this possibility that, without a Catfood Commission II agreement, the exchange subsidies would be even more meager. And they would be more meager in ways that the individuals wouldn’t see right away. Their premiums would be the same, but their co-pays and deductibles would go up. Their coverage would be less useful to them.
The exchange subsidies, which for the moment have no constituency, were always going to be a big pot of money for deficit reducers to target. They already have been, as they were clawed back to pay for the elimination of 1099 reporting, the first fix to the ACA. Why the subsidies wouldn’t be protected and exempted from automatic cuts is astonishing; after all, we’re talking about poor and middle-class people here. And this is the President’s signature bill. He’s already going to subject it to slings and arrows?
I guess this is why we’re all not clapping louder at the deal.





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There is no more “WTF” surprises with the Obama administration. It’s just ‘eh’
David,
does the pres get a veto of the tiny congress recommendations in November, or only if it passes the full Congress?
The exchange subsidies were always part of the BIG LIE. I always return to Amy Klobuchar, my faux progressive Senator, who told us that universal healthcare is unrealistic. They don’t believe in it! It’s not a value! This is the BIG CHEAT. This is dupe the dopes. This is like when they “reformed” the poverty programs. NBC was reporting tonight that 36% of the people in Alabama are on food stamps. But when was the last time you saw a Democrat in a photo with poor person?
Poor people?? Ewww!
Well this sucks. Can’t say I didn’t see it coming. Just not this fast, before the ACA even takes effect.
No one ever explained where the poor people who could not afford insurance now were going to be able to pay the premiums for the coverage BEFORE they got their tax credits back. The system was set up for failure. Lots of smoke and mirrors.
I’ve been saying this was coming since the inactment of the bill. It’s been obvious, but the believers in unicorns, tooth fairies, leprecauhns, and the like would hear nothing of it. It’s got to grow like other legislation did. Nice theory, different time, different reality.
This confirms for me that Obama only wanted to provide the Profit Protection part of the Health Insurance Reform. He’s done his job for the private health insurers by getting the mandate in place. He is a good Corporatist and political stooge.
Only thing is…if the exchange subsidies go, do the mandates go? Does the whole Obama health insurance reform fall apart?
And with Medicaid getting cuts as well…. What do poor people do?
Hurry Up and Die? (Now there’s a campaign slogan!)
I didn’t see anyone clapping except the politicians.
Also have you looked at the subsidy tables for those over 50 in the exchange.
It turns out that at around $40,000 in income if someone age 64 earns a single dollar more in income they would lose about $6000.00 in tax credits.
This needs to be fixed even before the meager cost sharing.
You can play with the Kaiser reform calculator:.
That’s the beauty of Obama’s grand bargain. The ruling class will not stop until America becomes a third-world shithole where the super rich rule from gated enclaves over the serfs who suffer and toil until they die in the gutter.
This is a small penalty. It seems large because these exchanges were used to diminish the damage of not having single payer or a public option in the health care act. There are no regulations set for the exchanges that would place any kind of control on issues like Co-pay or deductibles. There is no definition of what is contained in minimum coverage for mandated policies. Part of the reason (probably the only reason) these features don’t come online until 2014, is so no one notices the little impact that this weak health care act will have on the populace. Most of the exchange mechanics are supposed to be set up by the States. Does anyone think there is a lot of effort being expended on making this successful in Alabama or Texas? If the Super catfood commission were to strip this portion of ACA, it was just the shiny keys to distract us from the limitations from the actual bill itself.
I posted this before but on the wrong thead
was listening to randi rhodes the other day (sadly an obamabot) and she said the debt bill makes it so all revenue bills must originate in the house
if this is so, I believe they can make a valid case the obama tax cuts for the wealthy (marketed as bush tax cuts for the wealthy) cannot expire without them saying so
Wow. I just looked at the exchange/cost estimator. There is no way most people making over the cut-off at 40,000 per year will be able to afford the premiums and housing. If they raise the Medicare age to 67, people are going to die as a result.
Mind boggling.
I heard Obama say at his birthday party that when he promised change you can believe in, he did not promise it right away….makes you wonder what else is coming…..
So Harry Reid and the Democrats think equal sharing is cutting your Social Security AND raising your taxes.
Thanks.
I dont underdstand why the President would allow his ‘historic’ health care act be subject to being defunded. Why would he allow his signature plan to die because there is no reason to believe the Republicans will agree to anything except to do nothing to ensure the health care law go down in flames. This President is so weak its not even funny its really sad.
My prediction. The exchanges, due to open in 2014, will not open at all. The opposition to the individual mandate will either kill them outright or be the momentum that drives a single-payer solution. Right now, killing them outright looks most likely because no strong case is being made to the public by the advocates of single-payer. And it’s not for those advocates lack of trying; it just hasn’t reached critical mass in the public yet.
There’s no way they can think that cutting the deficit is good for America, it’s very good for the rich. Even the ‘official’ economists are beginning to admit that cutting govt spending is an economy-killer. Andrew Jackson in a article on Canadian austerity:
Friedman ‘economics’ is like Calvinist ‘theology’. The real theologians consider it bunk, but it’s very attractive to the rich.
I agree it is a small penalty.
Indeed it will not stop Vermont single premium because the financing was and will be mostly a payroll tax.
http://my.firedoglake.com/papau/2011/08/03/vermont-single-payer-detail-federal-waivers-laws-needed/
But Vermont single payer and the other states (Minnesota, Pennsylvania, and California) currently considering single payer may need a higher payroll tax that otherwise anticipated if the exchange premium subsidies available via a 2014 waiver to be used to fund the state based single payer plan are lowered.
Randi is losing it.
The Constitution has always said budget bills begin in the House.
The debt limit bill says both chambers do not do new taxes during the next 18 months – but the commission can “re-shape” the effect of the Clinton tax rates that return via current law – and that $3.5 trillion could move from higher rates on the rich to “loophole closers”. But that is not going to happen because the Tea Party knows Obama does not have the backbone to accept the Clinton tax rates returning and will therefore rush to redo the Bush tax cuts for the rich with perhaps a small increase on the top bracket for election purposes (so he can say I did not allow a tax increase on those under $250,000 and I got an increase on the rich). Even this is unlikely as Obama is talking about a drop in the tax rates on the rich as the offset to “loophole closers” – like the tax deduction on your home mortgage being more limited than under current law.
I’d take the return of the Clinton tax rates – and they return unless Obama forces a new law to stop the return – in a NY minute. That $3.5 trillion recovery is a better route to fiscal sanity than any cut to Medicare or Medicaid, or SS.
The advocates of single-payer – like myself – are looking to the exchanges and the premium subsidies they are to receive as a fund that will help lower the eventual payroll tax needed for state based single payer.
So if Hillary runs…?
If you get sick, die quickly
“getting things done” with a “bipartisan compromise.”
The real indistinction of the two parties began when the word bipartisan constantly got applied to any legislation of importance, intensified since the 2001 AUMF. The regular application of the term is a reflection of a one-party sytem. The folks in Congrees and the WH are revealing what the score is.
Obama and Baucus et al built their health insurance “reform” on sand. Now we see again how easily it shifts and we, the people, lose.
But, fancy that! The corporations and rich people still win!
Nice sleight of hand Obama…
I rue the day I volunteer for, donated to, and voted for that betrayer. Never again. No Blue Dogs, no New Democrats.
“There’s no way they can think that cutting the deficit is good for America”
They are not interested in cutting the deficit. It is a red herring. They are interested in the transfer of wealth upward. If one assumes the former, none of what they’ve been doing lately makes sense.
Great similie between Friedman and Calvin.
-200
Going back to the Clinton rates is basically a 4% tax increase accross all income lines.
I wonder if it’ll be labled “Tax Increase for the Rich”.
The subsidies were in the form of tax credits received long after paying premiums? I wasn’t certain of this detail, but I’m not at all surprised.
I too never thought the subsidies would exist. It seems all that will exist by 2014 is a mandate to purchase insurance.
The only difference between pre- and post-ACA is that with the ACA, the private health insurance companies will now be empowered to sue Vermont when they make their single payer system.
Since December 2009 when the public option was permanently nixed, the Obama loyalists went on and on saying that the health care law was a small step toward single payer, when it was actually a big step toward entrenching the private health insurance industry in a much stronger position, and ensuring that single payer will never be possible in America unless monumental upheaval of our failed political system is achieved (i.e. dethroning our two party system, iron-clad campaign finance reform, etc.).
In the meantime, the democrats will never admit to this and will simply blame liberals for not supporting this corporatist pile of crap and the so-called “progressives” who helped make such corporatist crap the law of the land.
Well, you can’t have tax subsidies before the act. Hense, they’ve got to be in the year following the payment of premiums.
As soon as I heard about the “back room” deal regarding pharma for the HCR bill, I knew we’d all been sold out. From that point on, the whole structure did become a big bargain for insurance companies. This is why the GOP will not fully gut it, because the masters at the insurance companies want this revenue stream.
I used to admire Bill Clinton, even with his picadillos, but today, I see him for what he was, the guy greasing the way for the Bush financial fiasco and Obama. I spent a whole year in 2009 saying how I still believed in Obama, even as my doubts knawed at me, based on real evidence. In 2010 I knew it was a lost cause, but I didn’t know how lost.
I think this is a bit of a red herring.
Right now most people will not be able to afford coverage and will end up paying the penalty. Making unaffordable coverage, more unfordable does no real damage.
The only “improvement” to HCR we need to watch for, is when they try (and they will) to up the penalty.
Does show just how little principle Obama has, though. Won’t even bother to protect his signature legislation. As long as he got his “WIN” he doesn’t care.
Did you miss the part where she (accurately) pointed out that the Constitution requires that all revenue bills must originate in the House?
The law (Bush/Obama tax cuts) requires that these cuts expire unless reauthorised by the entire Congress. No “valid” case here.
“So if Hillary runs…?”
Not gonna happen. Hillary is still trying to pay off her campaign debt from the last time. There is no chance she can raise the money for another shot.
Besides, Hillary is just another DLC corporatist.
Thanks!
I’m glad I’m not totally mis-remembering Jr High Government Class!
Crime-in-ately.
As much as I’ve always hated the ACA, for some strange reason I assumed that there was a plan to pay the vendors directly (like how Section 8 housing pays landlords directly), because obviously there are a lot of people who can’t afford American luxuries like health insurance, and these people are living paycheck to paycheck. They’re not sitting on top of savings AND making a real decision not to be insured, so I don’t see how they could have waited for tax credits. I want to stress I never thought any needy people would have been helped either way in the public-option-less plan.
I didn’t even find out about the backroom deal until a few months after the democrats played up Lieberman as the villain of the week who single-handedly took down the public option. /facetious
Sadly, as someone who voted only for Ross Perot and Ralph Nader for President in my lifetime until 2008 when I foolishly voted for Obama, I believed in Obama’s “sincerity” until the last 2 weeks of 2009.
It was clear to me, as an uninsured person, that this “mandate” that was supposed to get 30 million (or however many million) uninsured people insurance was going to nothing of the kind. It simply imposed a penalty on me if I did not buy the insurance. Whenever this begins to take effect, all that I am going to do is figure the math on the cost of the premium (less whatever subsidy) versus the penalty. If the penalty is less, I will continue to go uninsured. I expect many thousands of people will do the same.
Most likely, all that this law will accomplish is to impose a significant tax on me for nothing, a tax on just being alive in America. If you think people are mad now, just wait till this kicks in.
I understand Mr Goolsbee in the White House has some kind of paper showing that the average uninsured family will still be able to afford the necessities and still pay for this insurance premium. I imagine it doesn’t say anything about being able to afford the deductible and co-pays. I suppose it is works on one of those “Chained CPI” principles that supposes people can just move down to buying cheaper things to afford the premiums.
“It was clear to me, as an uninsured person, that this “mandate” that was supposed to get 30 million (or however many million) uninsured people insurance was going to nothing of the kind. It simply imposed a penalty on me if I did not buy the insurance.”
Indeed. That’s exactly what it was always about: Forcing people under penalty of law to buy a product. I can’t think of a purer expression of Corporatism.
I’d take a DLCer over whatever twisted ideology Obama ascribes to any day of the week. But she won’t run again-regardless of her campaign debt-because, whatever else she may be, she’s not a masochist.
“I expect many thousands of people will do the same.”
Thousands? I think you’re severely underestimating. I would say millions of uninsured would be a low end estimate, I’m inclined to believe that at least 10 million will still be uninsured. I think the very low enrollment in the so-called “high risk pools” provides a decent amount of foreshadowing to demonstrate just how horrible the ACA is.
Going to Ryan plan – lower rates with loophole closing, is a 10% tax cut for the rich and much more than a 10% increase for the rest of us.
As to the spread of the Bush tax cuts, the child credit increase is the vast majority of the benefit the non-rich got, so pass a new child credit but this time pay for it with a tax increase on the rich – heck add the two other “non-rich” items – the marriage penalty fix and the AMT fix – and tou still have 80% of that $3,5 trillion saved.
So yes – a return to the Clinton rates is indeed a tax cut for the non-rich compared to the plans the GOP has out there.
spot on
You get the voucher before you buy, even thought it is called a tax refund credit.
There is a subsidization of insurance premiums for individuals with income up to 400% of the poverty line. Section 1401(36B) of PPACA explains that the subsidy will be provided as an advanceable, refundable tax credit and gives a formula for its calculation. A Refundable tax credit is a way to provide government benefit to people even with no tax liability (example: Earned Income Credit). Employed individuals who pay more than 9.5% of their income on health insurance premiums will be permitted to purchase subsidized private insurance through the exchanges. If the employer provides an employer sponsored plan but the individual earns less than 400% of the Federal Poverty level and could qualify for a government subsidy, the employee is entitled to obtain a “free choice voucher” from the employer of equivalent value to the employer’s offering which can be spent in the exchange to buy a subsidized policy of his own choosing.]
As noted above, You get the voucher before you buy, even thought it is called a tax refund credit.
There is a subsidization of insurance premiums for individuals with income up to 400% of the poverty line. Section 1401(36B) of PPACA explains that the subsidy will be provided as an advanceable, refundable tax credit and gives a formula for its calculation. A Refundable tax credit is a way to provide government benefit to people even with no tax liability (example: Earned Income Credit). Employed individuals who pay more than 9.5% of their income on health insurance premiums will be permitted to purchase subsidized private insurance through the exchanges. If the employer provides an employer sponsored plan but the individual earns less than 400% of the Federal Poverty level and could qualify for a government subsidy, the employee is entitled to obtain a “free choice voucher” from the employer of equivalent value to the employer’s offering which can be spent in the exchange to buy a subsidized policy of his own choosing.]