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Wonkbook: The GOP’s dangerous Obamacare strategy

Welcome to Wonkbook, Ezra Klein and Evan Soltas's morning policy news primer. To subscribe by e-mail, click here. Send comments, criticism, or ideas to Wonkbook at Gmail dot com. To read more by Ezra and his team, go to Wonkblog.

Ever heard the line "no plan survives first contact with the enemy?" Well, no big law ever fully survives first contact with reality. There are always provisions that prove poorly drafted, or parts that don't elicit quite the behavior you expected. Then there are the parts that work better than you expected, and which you want to expand.

Medicare was signed into law in 1965. In 1967, Congress passed a bill making a suite of technical changes and modest reforms to the new program. They did the same in 1972. The 1986 immigration bill was corrected in 1988. Social Security was altered in 1939, and has been changed time and again in the intervening years. Medicare Part D's difficult implementation process led to Democrats calling hearings to gather ideas on how to fix it. This is how it should be. Laws are written on paper, not stone. They can be easily changed.


In today's New York Times, Jonathan Weisman and Robert Pear report on a peculiar problem faced by the Affordable Care Act: Republicans who're unable to repeal it also refuse to permit any tweaks or technical correction that would help it work better. In fact, they're creating new problems by withholding implementation funds.

This is a real problem for the law, and for the country. Back in January 2011, I called it the biggest danger for health reform, and I still think that's right: If it persists, "what America will get is not the Affordable Care Act, and nor will it be repeal of the Affordable Care Act. It'll be a hobbled version of the Affordable Care Act, where what works isn't expanded and what fails isn't replaced. And though that might be better than nothing for the uninsured, it will be pretty terrible policy."

There's both a strategy and a principle at play here. The GOP really, truly hates Obamacare. They believe that their best chance to repeal it is to make it as big a mess as possible. Anything that makes it easier to live with makes it harder to get rid of. But they know that the chances of repeal are pretty slim. That's where the politics come in. They think their best chance to retake the Senate in 2014 is to make Obamacare as big a mess as possible and then ride the outrage in the midterms.

They may be right about that, or they may be very wrong. But this is a theory that requires Republicans to knowingly damage America's health-care system on the off-chance the damage is severe enough to help them accomplish a much larger policy goal. It's a theory that requires them to choose to let problems fester because the pain is more politically useful than the cure.

There's an emergent argument, and some strong evidence, that Obamacare is going to work much better in 2014 than Republicans realize, at least in the states that are actually trying to implement it. Whether that argument is right, few analysts, in my reporting, think the law won't be figured out by 2015 or 2016. And even under the most optimistic possible future for the Republican Party, they don't have anyone in the White House willing to sign repeal until 2017 -- by which point it will likely be far too late.

The question then is when the GOP makes sufficient peace with Obamacare that they can begin engaging with it constructively and passing bills that fix the parts they and their constituents don't like. Those laws can, of course, be framed as victories for the Republican Party and admissions by Democrats that Obamacare is imperfect. That's politics, and it's fine. What's dangerous is if the heighten-the-contradictions strategy the GOP is currently previewing persists after 2014, or even after 2016. At some point, if they can't repeal Obamacare, they need to learn to live with it.

Wonkbook's Number of the Day: 54 percent. That is the share of Americans who say they oppose the Affordable Care Act.

Wonkbook's Quotation of the Day: “I don’t think it can be fixed,” Senator Mitch McConnell of Kentucky, the Republican leader, said in an interview. “Everything is interconnected, 2,700 pages of statute, 20,000 pages of regulations so far. The only solution is to repeal it, root and branch.”

Wonkblog's Graphs of the Day: America is the only rich country that doesn’t guarantee paid vacation or holidays.

Wonkbook's Top 5 Stories: 1) how to improve health reform; 2) austerity battle boils over; 3) could conservatives ever support immigration reform?; 4) understanding the IRS; and 5) the policy of paid holidays.

1) Top story: Obamacare's successes and missed opportunities

Political gridlock makes Obamacare tweaks impossible. "Almost no law as sprawling and consequential as the Affordable Care Act has passed without changes — significant structural changes or routine tweaks known as “technical corrections” — in subsequent months and years. The Children’s Health Insurance Program, for example, was fixed in the first months after its passage in 1997...Republicans simply want to see the entire law go away and will not take part in adjusting it. Democrats are petrified of reopening a politically charged law that threatens to derail careers as the Republicans once again seize on it before an election year. As a result, a landmark law that almost everyone agrees has flaws is likely to take effect unchanged." Jonathan Weisman and Robert Pear in The New York Times.

Why the 'Cadillac' tax matters. "While most of the attention on the Obama administration’s health care law has been on providing coverage to tens of millions of uninsured Americans by 2014, workers with employer-paid health insurance are also beginning to feel the effects. Companies hoping to avoid the tax are beginning to scale back the more generous health benefits they have traditionally offered and to look harder for ways to bring down the overall cost of care. In a way, the changes are right in line with the administration’s plan: To encourage employers to move away from plans that insulate workers from the cost of care and often lead to excessive procedures and tests, and galvanize employers to try to control ever-increasing medical costs. But the tax remains one of the law’s most controversial provisions." Reed Abelson in The New York Times.

@mattyglesias: Another ObamaCare success story; “Cadillac tax” working as intended

54 percent oppose Obamacare. "Fifty-four percent of Americans oppose President Barack Obama’s signature domestic policy achievement, according to a CNN poll released Monday, while 43 percent support the law. Majorities have consistently opposed the law, which subsidizes and expands coverage while making it mandatory for Americans to buy health insurance, since its passage in 2010...The poll of 923 adults has a margin of error of plus or minus three percentage points." Kevin Robillard in Politico.

State healthcare policies exclude poorest. "Starting next month, the administration and its allies will conduct a nationwide campaign encouraging Americans to take advantage of new high-quality affordable insurance options. But those options will be unavailable to some of the neediest people in states like Texas, Florida, Kansas, Alabama, Louisiana, Mississippi and Georgia, which are refusing to expand Medicaid. More than half of all people without health insurance live in states that are not planning to expand Medicaid." Robert Pear in The New York Times.

Emergency workers spend lots of time on Facebook. "The emergency department would seem, at first glance, to be one of the more bustling spaces in medicine. With multiple patients in critical condition, it seems like it would be hard for doctors and other health providers to find a spare minute. Except it’s apparently not that hard at all: A new study (flagged by Michael Ramlet of The Morning Consult) finds that for every hour emergency department workers use a computer, they spend an average of 12 minutes on Facebook — and that time on the site actually goes up as the department becomes busier." Sarah Kliff in The Washington Post.

KRUGMAN: The Obamacare shock. "It does look as if there’s an Obamacare shock coming: the shock of learning that a public program designed to help a lot of people can, strange to say, end up helping a lot of people — especially when government officials actually try to make it work." Paul Krugman in The New York Times.

BROOKS: Heroes of uncertainty. "All of this is not to damn people in the mental health fields. On the contrary, they are heroes who alleviate the most elusive of all suffering, even though they are overmatched by the complexity and variability of the problems that confront them. I just wish they would portray themselves as they really are. Psychiatrists are not heroes of science. They are heroes of uncertainty, using improvisation, knowledge and artistry to improve people’s lives." David Brooks in The New York Times.

Music recommendations interlude: What Daft Punk's "Get Lucky" sounds like on the banjo.

Top op-eds

IMASOGIE AND KOBYLARZ: How Lady Gaga adds to the GDP. "In the past two decades, intellectual property has emerged as the principal driver of economic growth in the U.S. and other developed countries. IP is now, in many respects, the new global currency. This is largely the result of America's successful effort to internationalize its views regarding the economic importance of IP protection, notwithstanding the continuing challenge of piracy. In short, America's place as a world economic leader depends on its ability to cultivate a sufficiently creative "mint" by which to generate, and profit from, this new global currency." Osagie Imasogie and Thaddeus J. Kobylarz in The Wall Street Journal.

FOLBRE: Let them make their own jobs, eat cake, etc. "A recent Congressional Budget Office report shows that small and medium-size companies had disproportionately greater job losses than large companies in recent years. The latest Intuit Small Business Employment Index registers levels far below that of 2007...Our national problem may be that we assume entrepreneurs are superheroes who can leap over macroeconomic constraints in a single bound, especially if liberated from the villainous clutches of government." Nancy Folbre in The New York Times.

DIONNE: The Obama riddle. "He’s an anti-ideological leader in an ideological age, a middle-of-the-road liberal skeptical of the demands placed on a movement leader, a politician often disdainful of the tasks that politics asks him to perform. He wants to invite the nation to reason together with him when nearly half the country thinks his premises and theirs are utterly at odds. Doing so is unlikely to get any easier. But being Barack Obama, he’ll keep trying." E.J. Dionne in The Washington Post.

PONNURU: Obama's contempt for the rule of law. "Whatever the investigation into misconduct at the Internal Revenue Service reveals, we already have all the evidence we need to understand President Barack Obama’s fundamental attitude toward the rule of law. That evidence is right there in the public record, and what it shows is indifference and contempt." Ramesh Ponnuru in Bloomberg.

Do not try this at home interlude: A very talented bear and his human friend.

2) Austerity battle boils over

Economists brawl over austerity. "Harvard economists Kenneth Rogoff and Carmen Reinhart over the weekend accused Princeton economist and New York Times columnist Paul Krugman of "spectacularly uncivil behavior" and of inaccurately alleging that they refused to share data supporting their work linking heavy debt levels to subsequent slow economic growth." Brenda Cronin in The Wall Street Journal.

Explainer: Economic data coming your way this weekAmrita Jayakumar in The Washington Post.

SEC targets accounting fraud. "[A]s the volume of crisis-related cases ebbs, top SEC officials are expected to announce soon a broad shuffling of resources in the agency's enforcement division that will include an increased focus on accounting fraud, according to people close to the agency...It isn't clear how much money or manpower will be devoted to the effort, though the SEC already is developing a computer program to sift language in financial reports for clues that executives might be misstating results, agency officials say." Jean Eaglesham in The Wall Street Journal.

Low commodity prices help growth. "Lower prices for commodities from cotton to copper are helping U.S. businesses by reducing their raw-material costs and buoying consumers by keeping a lid on prices paid. Copper, used in many goods including electronics, is off nearly 10% this year. Silver, which has various industrial uses, has tumbled more than 25%, and wheat is down more than 10%...In The Wall Street Journal's latest survey of economists, 47.5% said weakness in commodity prices was a worrying sign, but 52.5% saw an encouraging signal of lower costs for businesses and consumers." Neil Shah in The Wall Street Journal.

...One of the drivers: the American oil boom. "The American energy boom is deepening splits within the Organization of the Petroleum Exporting Countries, threatening to drive a wedge between African and Arab members as OPEC grapples with a revolution in the global oil trade. OPEC members gathering on Friday in Vienna will confront a disagreement over the impact of rising U.S. shale-oil production, with the most vulnerable countries arguing that the group should prepare for production cuts to prop up prices if they fall any lower. "We are heading toward some problems," said a Persian Gulf OPEC delegate." Benoit Faucon, Sarah Kent, and Hassan Hafidh in The Wall Street Journal

Silicon Valley works for money, not twentysomethings. "[M]any of the hottest tech start-ups are solving the problems of being a business, because that’s where all the money is...We’re much more interested in the tech sector when it’s claiming to change the world or disrupt some new industry than when it’s just developing better software for managing branding campaigns or tracking customer-service complaints. But that’s an enormous amount of what goes on in Silicon Valley, and it pans out more reliably than the messianic rhetoric does." Ezra Klein in The Washington Post.

How Arrested Development explains the housing boom and bust. "NINJA loans are shockingly, a real thing. Or at least they were, before the housing crash. But they’re slightly different from the kind of loan that Tobias and Lindsay get. NINJA loans, also called NINA loans (“No Income No Assets”) weren’t loans made to people who actually had no income or no assets, necessarily; they were loans where the lender didn’t ask for asset and income information from the borrower." Dylan Matthews in The Washington Post.

Literary interlude: Why you need to check out the "Mellow Pages."

3) Will conservatives come aboard immigration reform?

Rand Paul says he might vote for immigration reform. "Paul said that he could end up backing immigration reform if Senate negotiators will work with him on his push to certify that the border is secure. Paul though warned that the bill also goes in the wrong direction on work visas." Bernie Becker in The Hill.

...But conservatives are stymied in their attempts to alter the bill. "For hard-line foes of immigration reform, the lopsided outcome produced a moment of clarity about the challenges they face in repeating their 2007 feat of scuttling comprehensive immigration legislation. Unlike six years ago, the loudest voices of dissent were drowned out by a disciplined performance from a bipartisan group of eight senators who teamed up to fight off the most serious threats to the bill." David Nakamura in The Washington Post.

Gays still support immigration reform, despite dumped amendment. "Lawmakers supporting a bipartisan bill in the Senate to overhaul the immigration system faced a surge of outrage last week from gay rights advocates after a provision those groups supported was left off the legislation in committee at the last minute...Gay rights advocates, stepping back from the loss, said the overhaul still contained many measures that could benefit gay immigrants, most of which came through the committee gantlet unscathed. Other provisions that the committee agreed to add to the bill, dealing with asylum and immigration detention, had been the subject of vigorous lobbying by gay organizations." Julia Preston and Ashley Parker in The New York Times.

Good questions interlude: How to do copyright jurisdiction in space.

4) Why the IRS did what it did

Groups targeted by IRS tested rules on political engagement. "Representatives of these organizations have cried foul in recent weeks about their treatment by the I.R.S., saying they were among dozens of conservative groups unfairly targeted by the agency, harassed with inappropriate questionnaires and put off for months or years as the agency delayed decisions on their applications. But a close examination of these groups and others reveals an array of election activities that tax experts and former I.R.S. officials said would provide a legitimate basis for flagging them for closer review." Nicholas Confessore and Michael Luo in The New York Times.

Is no end in sight to the scandals? "Batten down the hatches and wait for the storm to clear. That’s the advice veteran Washington Democrats are urging on a White House that has been embattled for a full two weeks by the triad of controversies revolving around the IRS, Benghazi and the Justice Department’s seizure of reporters’ phone records. No-one expects the pressure to let up anytime soon...McDonough, as has been widely reported, wants to cap at 10 percent the amount of White House time that gets spent responding to the furors of the moment rather than advancing the president’s broader agenda." Niall Stanage in The Hill.

Amazing carvings interlude: Seriously, you have to see this. All of this is carved from wood.

5) Hope you had a good Memorial Day

America is the only rich country that doesn't guarantee paid vacation. "European countries establish legal rights to at least 20 days of paid vacation per year, with legal requirements of 25 and even 30 or more days in some countries. Australia and New Zealand both require employers to grant at least 20 vacation days per year; Canada and Japan mandate at least 10 paid days off. The gap between paid time off in the United States and the rest of the world is even larger if we include legally mandated paid holidays, where the United States offers none, but most of the rest of the world’s rich countries offer at least six paid holidays per year." Ezra Klein in The Washington Post.

...Just look at Europe! "To be fair, the CEPR notes that most workers in the United States do get paid vacation — about three-quarters overall. But there is a schism: Paid vacations are nearly universal for higher-paid workers, but the think tank says that only about half of lower-paid hourly wage workers receive paid time off." Howard Schneider in The Washington Post.

Reading material interlude: The best sentences Wonkblog read today.

Wonkblog Roundup

Japanese ownership of Sprint isn't a security riskTimothy B. Lee.

America is the only rich country that doesn’t guarantee paid vacation or holidaysEzra Klein.

The political fallout of natural disastersDan Hopkins.

How the used-car market could undermine Obama’s fuel-economy rulesBrad Plumer.

Is Silicon Valley only interested in the problems of twentysomethingsEzra Klein.

What Better Place’s bankruptcy tells us about the future of electric carsBrad Plumer.

Et Cetera

Need a Monday-morning longread? You should read Tony Dokoupil's piece on the rise in suicide rates in Newsweek. You also get to check out their new website.

Court ruling unanimously in advance of slew of controversial decisionsAdam Liptak in The New York Times.

Obama plans 3 nominations to federal appeals courtMichael D. Shear in The New York Times.

Gun manufacturers: Firearm homicides not our faultMike McIntire and Michael Luo in The New York Times.

States raise college budgets after years of cutsAmy Schatz in The Wall Street Journal.

John Boehner's shrinking powerMike Allen and Jim VandeHei in Politico.

Malnutrition has a global economic cost of $125bHelen Warrell in The Financial Times.

Got tips, additions, or comments? E-mail me.

Wonkbook is produced with help from Michelle Williams.