No, Ben Nelson didn't scuttle the ACA's federal exchange

[Update, 1/29/15: As Jonathan Cohn reports, Nelson has just precisely confirmed the reading below of his position re federal and state exchanges.]

The latest bit of sophistry deployed by Halbig supporters to convince the world that the Senate Democrats who drafted the ACA deliberately barred subsidies from flowing through any exchange set up by the federal government is a claim that "Ben Nelson made them do it," Here's David Catron in The American Spectator (retailed without value-add by the Wall Street Journal's James Taranto):

Jonathan Cohn advises his New Republic readers, “Like other journalists who were following the process closely, I never heard any of them suggest subsidies would not be available in states where officials decided not to operate their own marketplaces.”

This is an odd statement indeed considering that high-profile publications were reporting a lively debate over this very issue. And Ben Nelson’s name was frequently mentioned. In January of 2010, for example, Politico reported that he regarded federal control of Obamacare’s exchanges as “a dealbreaker.” Nelson said that too much federal involvement would inevitably lead to government-run health care: “I wouldn’t support something that would start us down the road of federal regulation of insurance and a single-payer plan.”

He reiterated his objection to federal exchanges in this 2010 video, wherein Greta Van Susteran presses him to provide a legitimate motive for ultimately voting in favor of health care “reform.” Nelson vehemently insists that no one bought his vote: “I had requirements… no government-run plan, no federal exchange… and adequate language to deal with abortion. Those were requirements, but no one was buying any vote.” Nelson clearly implies that these conditions had been met and this is why he flip-flopped and voted for the bill.

These statements prove nothing, and indicate nothing.There was precisely zero public debate over whether the Senate bill allowed a federal exchange to credit subsidies. Catron strips the context out of the Politico article, which in fact indicates the opposite of what Catron and Taranto imply.

Republicans wouldn't scrap the main driver of ACA rate shock

As the reality that millions have benefited from full implementation of the Affordable Care Act takes hold, more and more Republicans are resorting to what Ezra Klein has dubbed Fauxbamacare: propose to repeal the hated law, replace all its popular components without providing any details.

Progressives counter that if you claim you want to make health insurance affordable to all, unless you come out in favor of a single payer system there is no real alternative to the basic structure of the ACA: guaranteed issue (that is, no variation in health plan price based on a person's medical history), an individual mandate or equivalent* to offset the influx of sick people into the risk pool, and subsidies (or Medicaid) for those who can't afford the premiums.

While that's mostly true, it's also true that some plans crafted to current conservative specs look significantly if not radically different from the ACA. The vast majority of Republican elected officials have shied from putting forward such a plan -- or ignored the one put forward by Senators Coburn, Burr and Hatch --  since such alternatives require tough tradeoffs. The main difference is that conservative schemes give insurers more leeway to sell plans with skimpier benefits and lower premiums. They eliminate or vastly reduce the Essential Health Benefits (EHBs) mandated by the ACA. They loosen the allowing "age banding" of premiums -- the degree to which older buyers can be charged more than younger ones -- from the ACA-mandated 3-to-1 to the pre-ACA norm of 5-to-1.

It's true that for healthy people who were buying insurance in the individual market prior to the ACA, the law's coverage rules substantially drove up the premium price. Rate shock is a real phenomenon. As the complaints poured forth, the EHBs were a prime attack point.  "I'm 55 -- I don't need childbirth coverage." "I'm of sound mind -- I don't need mental health coverage."  Limited age-banding was also a rallying point, since the 5-to-1 ratio was based on actuarial calculations.  Why should a 23 year-old pay more so that a 58 year-old can pay less?

These complaints have some legitimacy. The EHBs and age-banding limits involve tradeoffs that can be argued from either side. But they are not the prime drivers of the rate hikes caused by the ACA.

Quote of the decade

... that came very early in the decade, 1/28/10*. Remember when Scott Brown won his Senate seat, Democrats were running around like chickens with their heads cut off, Obama's trumpet was still uncertain, and Nancy Pelosi said this?

You go through the gate. If the gate's closed, you go over the fence. If the fence is too high, we'll pole vault in. If that doesn't work, we'll parachute in. But we're going to get health care reform passed for the American people.

 That, ducks, is leadership. Followed through with a whip job for the ages.


* Yeah, yeah, that was the last decade, technically. And?

Attention, Barney Frank: Obama was the partisan warrior when it counted most

Scott Lemieux does a nice job rebutting Barney Frank's contention that health care reform was an inevitable loser for Democrats (and strategic error for Obama) because "When you tell [people with health insurance] that you’re going to extend health care to people who don’t now have it, they don’t see how you can do that without hurting them." So Frank told  Jason Zegerle in a long debriefing published this week. Lemieux, bemused that the normally combative and often courageous Frank would avoid that heavy lift, retorts:

This is – uncharacteristically — essentially an argument against most progressive change. Anything that challenges privilege and disrupts the status quo carries risk and disrupts people’s sensitivities.

Frank's anomalous pusillanimity with respect to health reform was evident at the crisis hour when Scott Brown won the special election for Ted Kennedy's Senate seat in January 2010, ending the Democrats' filibuster-proof majority and thereby endangering reconciliation of the passed House and Senate versions of what became the Affordable Care Act.  Frank led the cut-and-run chorus, putting out  this statement on January 19:

Dionne, give the Dems a break

No one in the reality-based community would object to E.J. Dionne's core point below. But I do have a problem with the final sentence (helpfully boldfaced..):

Can a nation remain a superpower if its internal politics are incorrigibly stupid? 

Start with taxes. In every other serious democracy, conservative political parties feel at least some obligation to match their tax policies with their spending plans. David Cameron, the new Conservative prime minister in Britain, is a leading example.

He recently offered a rather brutal budget that includes severe cutbacks. I have doubts about some of them, but at least Cameron cared enough about reducing his country's deficit that alongside the cuts, he also proposed an increase in the value-added tax from 17.5 percent to 20 percent. Imagine: a fiscal conservative who really is a fiscal conservative.

That could never happen here because the fairy tale of supply-side economics insists that taxes are always too high, especially on the rich.

This is why Democrats will be fools if they don’t try to turn the Republicans’ refusal to raise taxes on families earning more than $250,000 a year into an election issue. If Democrats go into a headlong retreat on this, they will have no standing to govern.

That last sentence triggers in me a feeling I have experienced more than once recently: a vicarious weariness on behalf of Democrats in Congress.

Still Kicking: Nancy Pelosi

Ever since Scott Brown's election on Jan. 19 seemingly blew the Democratic caucus into pieces, Nancy Pelosi has been a rock. While acknowledging some tactical uncertainty in the immediate aftermath, she never wavered in her assurance that Democrats would find a way to pass comprehensive reform.

On Jan. 21, she caused some anguish by acknowledging that she did not have the votes to pass the Senate bill as is. She did glance at the possibility of piecemeal reform. But the dominant chord even then was that a path to meaningful reform would be found. Note the refusal to panic:

"There's a recognition that there's a foundation in that bill [the Senate bill] that's important. So one way or another those areas of agreement that we have will have to be advanced, whether it's by passing the Senate bill with any changes that can be made, or just taking [pieces of it]," Pelosi said.

"We have to get a bill passed -- we know that. That's a predicate that we all subscribe to."

When will that happen? Who knows!

"We're in no rush," Pelosi said.

On Jan. 28, she took heart from Obama's defense of comprehensive reform in the State of the Union address and responded to his call to Congress to get it passed:

“You go through the gate. If the gate’s closed, you go over the fence. If the fence is too high, we’ll pole-vault in. If that doesn’t work, we’ll parachute in. But we’re going to get health care reform passed for the American people.”

"Shorter Scott Brown"

Reading the suicide screed of the IRS kamikaze bomber, my first thought was that it was a distillation of the  noxious brew of inchoate rage that's fueling the tea party movement. Then I thought, don't go there -- let's not insta- politicize the paranoid homicidal insanity of someone who complains of "the storm raging in my head." True, Stack understood his own grievance as a political one, but he was so clearly insane that I would hesitate to impute his craziness to the tenor of ideas that his resemble, even if those ideas are finding extreme expression in what now passes for our mainstream. But then, Scott Brown swiftly drew a political moral, expressing implicit approval of the focal points of Stack's insane rage:

Appearing on Fox News soon after Stack flew an airplane into a building, Brown told the national television audience that he "feels for the families" affected by the attack. In the next breath, however, the senator added:

"I don't know if it's related but I can just sense not only in my election, but since being here in Washington, people are frustrated. They want transparency. They want their elected officials to be accountable and open and talk about the things affecting their daily lives. So I am not sure if there is a connection, I certainly hope not, but we need to do things better."

Brown added that an incident like the one in Austin is "extreme," but added, "No one likes paying taxes obviously."

A commenter on Steve Benen's site caught Brown's logic perfectly:

Shorter Scott Brown: People are so frustrated and despairing that they are starting to do dangerous and crazy things, like crashing planes and voting for people like me.

Viewed another way, Scott's reaction is analogous to that of people who clucked that the 9/11 attack was deplorable but understandable, given U.S. actions in the Middle East.