Making the ACA work 2014-2016: Administrative roads not taken

Subscribe to xpostfactoid

The Obama administration stood up the ACA's core programs in the face of a never-ending shitstorm of Republican defamation, disinformation, noncooperation on the state level, total litigation warfare, and fiscal sabotage. For that they deserve our undying thanks. 

By the time Obama left office, the ACA had cut the ranks of the uninsured by about 40 percent, mainly through Medicaid expansion. The marketplace and the expansion proved resilient through the Trump years and provided a vital safety net when the pandemic struck. Since February 2020, Medicaid enrollment by those rendered eligible by the expansion has increased by about 5 million, and marketplace enrollment (with a large push by the Biden administration) by close to two million.

In administering the ACA, however, the Obama administration operated under self-imposed restraints. Pre-Trump, and before Republicans passed their $2 trillion tax giveaway to the wealthy in 2017, Democrats had yet to recognize -- or rather, acknowledge --  the full extent of Republicans' economic fraudulence. Without new appropriations by Congress that they knew would not be forthcoming,  Obama and administration officials were reluctant to increase spending on ACA programs and so increase the deficit. They declined to take several measures that would make coverage more affordable or credible. These included the following.

Administration rebuke to Netanyahu name-checks those "indissoluble bonds"

Obama often alludes to "indissoluble" or "unbreakable" bonds between the U.S. and Israel. I've long thought this unseemly, a dangerous sign of unconditional support. If the United Kingdom went fascist in ten years, would our bonds with that longtime ally be indissoluble? Relations between countries should never be unconditional (though arguably, I guess, "bonds" could endure when political alliances fray).

It's worth noting that in rebuking Netanyahu's election rhetoric seeming to delegitimize the Arab vote and disavowing commitment to a Palestinian state,  the Obama administration name-checked those "bonds":

“The United States and this administration is deeply concerned about rhetoric that seeks to marginalize Arab-Israeli citizens," Earnest told reporters aboard Air Force One. "It undermines the values and Democratic ideals that have been important to our democracy and an important part of what binds the United States and Israel together.”

More substantively, Earnest implied that the basis in international law for the U.S.'s constant protection of Israel in the U.N. is also cracking:

Diplomatic fantasy hour

Cooling down from a run, I caught myself at the tail end of a little diplomatic fantasy: the Obama administration furnishes strong proof that the Assad regime carried out the chemical weapons attack -- and wins a Russian agreement to cut off the arms flow for long enough to equal the estimated damage of a contemplated U.S. missile strike. Or an Iranian agreement.

I know, I know....

UPDATE, 9/1/13:

1. Laura Rozen ‏@lrozen 25m

   IAEA or P5? RT @MeirJa: Head of #Iran AEOI Salehi says next round of #Iran - P5+1 talks scheduled for 27Sept http://ow.ly/osrjk 

   Expand
2. xpostfactoid ‏@xpostfactoid1 23m

   @lrozen @MeirJa Should mesh interestingly w/ possible strike on Syria. Deal? You cut off arms to Syria for 3 months; we won't bomb.

   
   

   Laura Rozen ‏@lrozen 18m  there are an awful lot of moving parts, some potentially pushing US & Iran to an understanding, incl. on Syria CW @xpostfactoid1 @ 
   
   Laura Rozen ‏@lrozen 9m
   

   ...steady stream of messages from Iran suggesting tacitly may accept US assessment re: Syria CW @Ali_Gharib: @thekarami @yjtorbati

Update 9/3: Barbara Slavin reports on signs that the U.S. may be opening the door to Iranian inclusion in Syrian peace talks.

Update 9/9: Today we learn that I didn't let my imagination go far enough:

Asked at a news conference in London if there were steps the Syrian president, Bashar al-Assad, could take to avoid an American-led attack, Mr. Kerry said, “Sure, he could turn over every single bit of his chemical weapons to the international community in the next week — turn it over, all of it, without delay and allow the full and total accounting.” He immediately dismissed the possibility that Mr. Assad would or could comply, saying, “But he isn’t about to do it, and it can’t be done.”

However, in Moscow, Russia’s foreign minister, Sergey V. Lavrov, who was meeting with Syria’s foreign minister, Walid al-Moallem, said in response that Russia would join any effort to put Syria’s stockpile of chemical weapons under international control and ultimately destroy them. 

Mr. Lavrov appeared at a previously unscheduled briefing only hours after Mr. Kerry made his statement in London, taking Mr. Kerry’s comments as a way to suggest a possible compromise. 

“We don’t know whether Syria will agree with this, but if the establishment of international control over chemical weapons in the country will prevent attacks, then we will immediately begin work with Damascus,” Mr. Lavrov said at the Foreign Ministry. “And we call on the Syrian leadership to not only agree to setting the chemical weapons storage sites under international control, but also to their subsequent destruction.” 

Mr. Moallem said later in a statement that his government welcomed the Russian proposal, Russia’s Interfax News Agency reported, in what appeared to be the first acknowledgment by the Syrian government that it even possessed chemical weapons. The Syrian government has historically neither confirmed nor denied possessing such weapons.

This has that too-good-to-be-true feeling, like the prospect in 2009 that Iran would send its highly enriched nuclear fuel to Russia or Turkey for safekeeping. But for a diplomatic moment I'll indulge sweet hope.

A spotlight on patient diplomacy

In the Times' account of the WikiLeaks revelations vis-a-vis Iran, the authors'* admiration for the Obama's administration's response to Iran's nuclear program is palpable:.

[The cables] also offer new insights into how President Obama, determined to merge his promise of “engagement” with his vow to raise the pressure on the Iranians, assembled a coalition that agreed to impose an array of sanctions considerably harsher than any before attempted.

When Mr. Obama took office, many allies feared that his offers of engagement would make him appear weak to the Iranians. But the cables show how Mr. Obama’s aides quickly countered those worries by rolling out a plan to encircle Iran with economic sanctions and antimissile defenses. In essence, the administration expected its outreach to fail, but believed that it had to make a bona fide attempt in order to build support for tougher measures.

Some green shoots of multipolar leadership?

Like all foreign policies, the Obama administration's more collaborative, less confrontational approach will be judged by its long-term  effects. The administration has certainly had its share of setbacks. Nonetheless, some recent green shoots are worth noting:

• The Chinese have announced that they will allow modest and gradual yuan appreciation - after signs that the Euro debt crisis might scotch their expected move in this direction. On this front, the administration has been under tremendous pressure to pressure, and has done so with delicacy -- amassing developing world allies in the effort, always placing the issue in the context of global rebalancing, sidestepping a deadline to deem or not deem China a "currency manipulator" -- and most recently, doubtless citing the pressure that Congress has been placing on the administration via threats to pass retaliatory legislation (as well as its own very pointed forbearance to this point).
  
  
• China was also brought on board, seemingly against the odds, for new sanctions against Iran.  While the likely impact of those sanctions is questionable at best, the harnessing of China and Russia seemed unlikely and does indicate progress in the U.S. ability to  choreograph collective action..
  
  
• The Israelis have just announced a significant easing of the Gaza blockade, brokered by Tony Blair but underwritten by the U.S. with an immediate rescheduling of the Netanyahu-Obama meeting that was postponed afer the Mavi Marmora boarding.  From the outset of that crisis, U.S. shielding of Israel from Security Council condemnation was balanced by insistence that the blockade in current form was "unsustainable."
  
  

Obama on indefinite detention: a Goldsmith blueprint?

The Obama Administration's National Security Strategy includes a statement of intent to develop a system of "prolonged detention" of "suspected violent extremists" who "cannot be prosecuted":

For detainees who cannot be prosecuted--but pose a danger to the American people--we must have clear, defensible, and lawful standards. We must have fair procedures and a through process of periodic review, so that any prolonged detention is carefully evaluated and justified. And keeping with our Constitutional system, it will be subject to checks and balances. The goal is an approach that can be sustained by future Administrations, with support from both political parties and all three branches of government (p. 36).

Three observations about this policy: 1) The report of Obama's Guantanamo Review Task Force, completed in January but just leaked to the Washington Post and published yesterday, elaborates in some detail why the Administration believes that 48 of the detainees at Guantanamo (and presumably many more at Bagram) cannot be prosecuted and cannot be released.  2)  Obama's basic intent on this front has been in place for more than a year -- he sketched out essentially the same policy in May 2009.   3) The system of "prolonged detention" he has in mind, only briefly elaborated in May 2009 and May 2010, seems to adhere to a more detailed proposed program laid out in February 2009 by Jack Goldsmith, the former head of the Bush Administration's Office of Legal Counsel who withdrew the torture memos and resigned after just nine months.

The Administration gets game on FinReg

Do I sense a wee change in tone in the administration's approach to "bipartisanship" as it pursues a financial reform bill?  From the Times' coverage of yesterday's meeting of Obama with Congressional leadership:

I am absolutely confident that the bill that emerges is going to be a bill that prevents bailouts. That’s the goal,” Mr. Obama said before the start of the meeting, directly answering assertions by the Senate Republican leader, Mitch McConnell of Kentucky, that the bill would encourage, rather than prevent, future taxpayer bailouts of financial companies. As Mr. Obama spoke, Mr. McConnell sat impassively nearby in the Cabinet Room.

Later, in a particularly pointed statement, the White House press secretary, Robert Gibbs, said Mr. Obama would not let the bill be thrown off course. 

“The president reiterated his belief that we are open to ideas and eager to work with anyone who is willing to work with us regardless of party,” Mr. Gibbs said. “He also made clear that bipartisanship should not be equated with an openness to lobbyists, loopholes and special interest carve outs and that he would be unwilling to negotiate on some key issues, and that he could not accept bad policy in pursuit of bipartisanship.”

Not only is there swift, strong pushback on Mitch McConnell's outrageous claim that giving regulators resolution authority to liquidate failing banks would encourage bailouts.  Note also the signal that the administration (contra Andrew Leonard) will not be content with claiming victory on the headline issues (here, the resolution authority; previously, the consumer protection agency) while letting banking interests have their way on more arcane matters, like regulation of securitizations or derivatives. On the latter, there's this from Geithner:

Larry Summers takes a long and multilateral view of China and trade rebalancing

As China signals that it is ready to start letting yuan appreciate again, Larry Summers, in an interview with the FT's Martin Wolf, gives some important hints as to the Administration's long-term approach  toward China.

With regard to exchange rates and a more general rebalancing of trade, both between the U.S. and China and more generally between high-export and high-consumption economies, two of Summers' emphases in particular are noteworthy: 1) a global rebalancing of supply and demand should be pursued through multilateral channels and institutions -- the U.S. should seek allies and so diffuse the expectation (and possibility) of gladiatorial combat between the U.S. and China over exchange rates; and  2) it's going to take time -- rebalancing the world economy is a project of years and probably decades, and yuan appreciation is only one piece in a complex (re)balancing act.

On the first point, Summers is very careful to build the multilateral context:

MW Okay, just tell me about where you are on the exchange rate question vis-a-vis China and the adjustment process vis-a-vis China.

LS The G20 made a common commitment last year in London, reiterated in Pittsburgh, to seeking more stable and balanced global growth. And I think we’ve made more progress in laying a foundation for restored global growth than has yet been made in assuring more balanced global growth - to be sure that growth, the pattern of growth over the last year, has been more balanced, with trade deficits and trade surpluses both coming down. But as the global economy recovers, it will be very important not to see a major resumption and a major widening of imbalances.

State-Croft in the Obama Administration, cont.: the Deputies' Committee

A detailed portrait of the Obama administration's foreign policy apparatus by the FT's Edward Luce and Daniel Dombey presents a mixed bag, a work in progress.  One key facet  has an interesting pedigree: personnel from the Clinton administration slotted into a structure adapted from the administration of George Bush, Sr.  That is the "deputies' meetings":

Mr Obama’s character is also stamped on the inter-agency process, set up and managed by Tom Donilon, deputy national security adviser. The nitty-gritty of foreign policy-making is done at these frequent “deputies’ meetings”, which can sometimes consume four to six hours a day
.
Described by one insider as “the most powerful man in the White House whose name isn’t widely known”, Mr Donilon, who was an official in the Clinton administration, is the man who keeps Mr Obama’s trains running on time. And there are a lot of trains. Last year, Mr Donilon held 270 deputies meetings – a workload described as “clinically insane” by a former senior diplomat under Bill Clinton.

The earth beneath their feet: Obama recasts health care reform

Reading the Obama Administration's letter setting out the terms of the Feb. 25 health care summit, it struck me that the obvious has crept up on us by inches. It's this: moving in his own deliberate fashion, President Obama has doubled down on health care reform.  Rather than gather his Democratic flock in the immediate aftermath of the Massachusetts debacle, he has moved the political ground beneath them as well as the Republicans.  He has issued a put-up-or-shut-up to the whole Congress. Of course, he knows that only the Democrats have something to put up. But he is going to make them put it up -- even if they vote it down. 

Look at how the work order, so to speak, is framed (the letter is under the signature of Rahm Emanuel and Kathleen Sebelius):

We have seen again in recent days that when it comes to health care, the status quo is unsustainable and unacceptable. The proof is right in front of us: just last week, a major insurer, Anthem Blue Cross, announced plans to increase premiums for many of its policyholders in California by as much as 39 percent on March 1.

As the President noted this week, if we don’t act on comprehensive health insurance reform, this enormous rate hike will be "just a preview of coming attractions. Premiums will continue to rise for folks with insurance; millions more will lose their coverage altogether; our deficits will continue to grow larger."

Now is the time to act on behalf of the millions of Americans and small businesses who are counting on meaningful health insurance reform. In the last year, there has been an extraordinary effort to craft effective legislation. There have been hundreds of hours of committee hearings and mark-ups in both the House of Representatives and Senate, with nearly all of those sessions televised on C-SPAN. The Senate spent over 160 hours on the Senate floor considering health insurance reform legislation and, for the first time in history, both the House of Representatives and Senate have approved comprehensive health reform legislation. This is the closest our Nation has been to resolving this issue in the nearly 100 years that it has been debated...[snip]

1995 Redux: Call the Republicans' shut-down-the-Senate bluff

It's a given by now that Republicans will do all they can to obstruct any deal between House and Senate Democrats entailing the House passing the Senate health care bill and amending it through the reconciliation process. Jeff Davis, Greg Sargent and Karen Tumulty have explained in numbing detail how Senate Republicans can stall reconciliation fixes. Sargent:

The GOP Senate leadership has privately settled on a strategy to derail health reform if Dems try to pass the Senate bill with a fix through reconciliation, aides say: Unleash an endless stream of amendments designed to stall for time and to force Dems to take untenable votes.

The aide described the planned GOP strategy as a “free for all of amendments,” vowing Dems would face “a mountain of amendments so politically toxic they'll make the first health debate look like a post office naming.”

Notwithstanding the difficulties, what remains striking is the difference in political will between the two parties. Republicans, as ever, will act as a body to do whatever it takes to get what they want -- the death of comprehensive health care reform, a Waterloo for Obama, an electoral debacle for the Democrats to dwarf 1994. 

Bypassing the bomb throwers

Bush tinkered a bit on the brink, but did the right thing:

"In the midst of a financial crisis...allowing the U.S. auto industry to collapse is not a responsible course of action," Mr. Bush said.

The terms are more lenient than in the deal the Senate Republicans scotched:

The deal generally tracks key provisions of the bailout legislation that nearly passed Congress earlier this month. But it is relatively lenient in allowing the companies to show their viability. It defines viability as having a positive net present value -- a way of gauging the companies' worth, taking into account all their future obligations.

Notably, it provides significant flexibility to the companies in showing their viability. It sets out targets for the companies to hit in determining their financial health, such as reducing debt and current cash payments for future health care obligations.

But according to a White House fact sheet, the targets "would be non-binding in the sense that negotiations can deviate from the quantitative targets...providing that the [company] reports the reasons for these deviations and makes the business case to achieve long-term viability in spite of the deviations."

One potential move that could help the companies achieve some savings: the companies will be required to reach new agreements with major stakeholders, including dealers and suppliers, by March 31.

Determining viability apparently will be up to the Obama administration. The agreement designates a person to oversee the government's effort, although officials stopped short of referring to that as a "car czar." For the outgoing Bush administration, that person will be Treasury Secretary Henry Paulson. President-elect Barack Obama will choose his own point person later.

Sometimes, kicking the can down the road is the only responsible course of action. Obama has said that he wants to bring all the auto industry stakeholders together to hammer out a deal. Bush has given him space to do it.