Thursday, August 21, 2014

Obamacare and the Mark Pryor-Tom Cotton Senate race

Posted By on Thu, Aug 21, 2014 at 1:45 PM

click to enlarge COTTON: Repeal Obamacare, start over, and do something something something.
  • COTTON: Repeal Obamacare, start over, and do something something something.

Yesterday, Sen. Mark Pryor did something that got national attention: he released an ad that actually took credit for the benefits of Obamacare. Pryor didn't go so far as to say what law he was talking about, but the move was nevertheless notable in a state where the law, and the president, remain deeply unpopular (and where Pryor's opponent, Rep. Tom Cotton, has mentioned Obamacare every chance he gets). 

I asked Cotton about the ad at today's press conference announcing the endorsement of former GOP presidential nominee Mitt Romney. Cotton said that he had not seen the ad (if you believe that, I've got a bridge in Dardanelle to sell you). 

What's fascinating is what Cotton didn't do: there was no direct attack on Pryor for staring into a camera and proudly declaring that he voted for the (unnamed) health care law. There are extenuating circumstances (Pryor's battle with cancer, noted in the ad, and the popularity of Pryor's father, who also appears in the ad) but if Obamacare attacks are a bit less potent than they once were, surely this is a sign: The Pryor campaign released an ad highlighting his vote for Obamacare(!) and Cotton didn't take the bait, responding in muted tones. In fact, he responded the same way he did when asked about the recent finding that Arkansas has cut its percentage of uninsured residents nearly in half — he dodged by saying he hadn't seen it, while implicitly acknowledging that Obamacare does have benefits which have helped Arkansans.  

"I will say the health care system was broken five years ago," Cotton said. "There's no doubt about that." Cotton cited insurance costs and people with pre-existing conditions who didn't have access to health insurance. Of course, Obamacare banned insurance companies from discriminating against people based on pre-existing conditions, which was what Pryor took credit for in the ad ("I helped pass a law that prevents insurance companies from cancelling your policy if you get sick or deny coverage based on pre-existing conditions").

Cotton said that issue did need to be addressed, just not via Obamacare, citing the standard list of conservative complaints about the health care law. "What we have to do is repeal Obamacare, start over, and get it right," Cotton said. "We don’t have to take over one sixth of the economy to address those problems like people who couldn’t afford health insurance. We can have reforms that are designed to help promote competition so people can get more value for their dollar, whether that’s giving them similar tax treatment that businesses get, or letting small businesses — which we have a lot of in Arkansas — pool their resources so they can buy insurance more effectively. ... Letting Arkansans shop across state lines for health insurance, the same way they can today for car insurance."

Whatever one thinks of these ideas, they wouldn't change the fact that repealing Obamacare would mean eliminating benefits, including benefits that are politically popular. Even if enacted, they don't amount to an actual plan that would replace the coverage and consumer protections of Obamacare in the wake of "starting over." Cotton says he doesn't like the "taxes and regulations" of Obamacare, but the protections for people with pre-existing conditions are one of the law's central regulations on the marketplace. After forcing insurance companies to take all customers and treat everyone equally regardless of health status, Obamacare's taxes and Medicare reimbursement cuts pay for subsidies to keep premiums affordable (and the dreaded individual mandate aims to prevent adverse selection on this regulated marketplace). If Cotton has a plan to keep all of the popular parts of Obamacare in place while simultaneously repealing Obamacare, he needs to say so.

Things get even more vague when it comes to the nearly 200,000 Arkansans who have gained coverage via the private option, the state's version of Medicaid expansion. I asked Cotton: "Would 'starting over' include coverage for the people on the private option?” (Cotton has consistently avoided taking any position on the private option.)  I'll print Cotton's response in full and will leave it to readers to divine whether Cotton answered the question: 

So when you start over on health care reform, you don’t just address Obamacare, you address our entire health care system to include Medicare and Medicaid, which right now is running out of money. We can’t keep spending money we don’t have, nor should we try to impose a one-size-fits-all solution on every state. Massachusetts is different from Arkansas is different from Califronia. So when we start over on health care reform, to get it right, one thing we can do is take all Medicaid funding, cut a lot of the red tape, a lot of the regulations and rules that we impose on states, and return that responsibility back to the states, so they can innovate not just for a small population but for their entire population — because again, our population in Arkansas is very different from other states. And states should be able to find their own solutions to craft for health care reform for people who need access. 

So every state is different. And he wants to cut red tape for Medicaid. Okay. But here's the thing: if you repeal Obamacare, you eliminate all of the funding for the private option. That means that almost 200,000 Arkansans would lose the health insurance they currently have. It could be possible to repeal Obamacare and offer coverage to those people in some other way, but given an opportunity to say so — or to explain how he might do that — Cotton consistently takes a pass. He wants to repeal Obamacare, but doesn't want to own the results. 

While Cotton is still calling for repeal, Romney was even more tempered than that. "Obamacare is not working for the people of Arkansas or America," he said. But get this (emphasis mine): "Tom Cotton is going to make sure that we change Obamacare, making sure that people can keep insurance and those that have pre-existing conditions can have coverage, but he doesn’t want to see the federal government telling people in Arkansas what kind of insurance they have to have or making it more expensive." Obamacare is bad, but Romney suggests Cotton will work to "change" the law, not destroy the monstrosity (we're a long way from Ted Cruz demanding to repeal "every bloody word"). And Romney wants to change it in a way that protects those who've benefited from Obamacare. The political strategy here is to be against "Obamacare" while meticulously avoiding stances on its more popular component parts

Lots of commentators noted that the Pryor ad released yesterday did some meticulous avoiding of its own: "I helped pass a law," Pryor says. And what might that law be? He doesn't say. Was Pryor really embracing the Affordable Care Act, critics asked, if it remains the law that dare not speak its name? Political ads, both positive and negative, usually focus on the content of a law or bill without naming it, so this actually isn't so unusual. Previous Pryor ads that have nothing to do with Obamacare almost always talked about what legislation does rather than what it's called.  Still, given all the hubbub over Obamacare in particular, it's impossible not to notice Pryor's omission.  

Basically, what we have here is one candidate, Cotton, who talks about being against "Obamacare" as much as possible, tossing out the name over and over like he has an incurable tic — but bobs and weaves when asked about the actual policy results of repeal. Meanwhile, Pryor will do everything he can to avoid saying "Obamacare," or even "Affordable Care Act," but is — slowly — starting to trumpet some of the policy benefits of the law. One of the biggest questions in the Senate race will be which is more politically potent: the name "Obamacare" and the abstract concept of the hated law passed by the president — or the law's component parts, many of which Pryor believes are winning issues for him? The nickname or the policy? 

This question may be particularly stark in Arkansas, which has seen the highest drop in the percentage of uninsured citizens in the nation thanks to the private option. Meanwhile, no plans in the state have been cancelled due to non-compliance with Obamacare; the Arkansas Insurance Department has allowed people to keep non-compliant plans through the fall of 2017 and all major carriers in the state are giving consumers that option. None of that changes the fact that people don't like "Obamacare." Polling results on something like the private option swing radically depending on whether "Obamacare" is included in the question. On the campaign trail, I've often seen that discussions of the ACA's component parts are a conversation starter; the word "Obamacare" is a conversation ender. In that sense, one can hardly fault Pryor for not naming the law: the name (or the nickname) muddies as much as it clarifies. 

Pryor's ad, instead, aims to shift the focus to a policy discussion. This week it's ending discrimination based on pre-existing conditions; I expect we'll see ads soon on the nearly 200,000 Arkansans who have gained coverage from the private option, or perhaps people who can stay on their parents' policies until they're 26. So far, Cotton prefers not to talk about that — or just what would happen to those folks if the health care law was repealed. He just wants you to know he's against Obamacare. 


p.s. Romney was asked what he thought of the Arkansas private option. His response: 

I like the idea that states take responsibilities for their own solutions. You may know, our plan in Massachusetts was a state-centered plan that was designed for the people there. I think it’s wise for states to have the opportunity to do that. I’m not going to weigh in on the private option versus Medicaid expansion versus pushing Medicaid back and refusing Medicaid dollars. That’s something for the governor and the people of Arkansas to decide. But I can tell you I like the idea of people being able to fashion their own solutions to make sure all people can be insured, to make sure young people can be covered on their parents health care plan, and make sure that pre-existing conditions are accommodated in the insurance system.  

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