Was I on the edge of my seat, waiting for the Supreme Court decision on Obamacare subsidies? No — I was pacing the room, too nervous to sit, worried that the court would use one sloppily worded sentence to deprive millions of health insurance, condemn tens of thousands to financial ruin, and send thousands to premature death.
It didn’t. And that means that the big distractions — the teething problems of the website, the objectively ludicrous but nonetheless menacing attempts at legal sabotage — are behind us, and we can focus on the reality of health reform. The Affordable Care Act is now in its second year of full operation; how’s it doing?
The answer is, better than even many supporters realize.
Start with the act’s most basic purpose, to cover the previously uninsured. Opponents of the law insisted that it would actually reduce coverage; in reality, around 15 million Americans have gained insurance.
But isn’t that a very partial success, with millions still uncovered? Well, many of those still uninsured are in that position because their state governments have refused to let the federal government enroll them in Medicaid.
Beyond that, you need to realize that the law was never intended or expected to cover everyone. Undocumented immigrants aren’t eligible, and any system that doesn’t enroll people automatically will see some of the population fall through the cracks. Massachusetts has had guaranteed health coverage for almost a decade, but 5 percent of its nonelderly adult population remains uninsured.
Suppose we use 5 percent uninsured as a benchmark. How much progress have we made toward getting there? In states that have implemented the act in full and expanded Medicaid, data from the Urban Institute show the uninsured falling from more than 16 percent to just 7.5 percent — that is, in year two we’re already around 80 percent of the way there. Most of the way with the A.C.A.!
But how good is that coverage? Cheaper plans under the law do have relatively large deductibles and impose significant out-of-pocket costs. Still, the plans are vastly better than no coverage at all, or the bare-bones plans that the act made illegal. The newly insured have seen a sharp drop in health-related financial distress, and report a high degree of satisfaction with their coverage.
What about costs? In 2013 there were dire warnings about a looming “rate shock”; instead, premiums came in well below expectations. In 2014 the usual suspects declared that huge premium increases were looming for 2015; the actual rise was just 2 percent. There was another flurry of scare stories about rate hikes earlier this year, but as more information comes in it looks as if premium increases for 2016 will be bigger than for this year but still modest by historical standards — which means that premiums remain much lower than expected.
And there has also been a sharp slowdown in the growth of overall health spending, which is probably due in part to the cost-control measures, largely aimed at Medicare, that were also an important part of health reform.
What about economic side effects? One of the many, many Republican votes against Obamacare involved passing something called the Repealing the Job-Killing Health Care Law Act, and opponents have consistently warned that helping Americans afford health care would lead to economic doom. But there’s no job-killing in the data: The U.S. economy has added more than 240,000 jobs a month on average since Obamacare went into effect, its biggest gains since the 1990s.
Finally, what about claims that health reform would cause the budget deficit to explode? In reality, the deficit has continued to decline, and the Congressional Budget Office recently reaffirmed its conclusion that repealing Obamacare would increase, not reduce, the deficit.
Put all these things together, and what you have is a portrait of policy triumph — a law that, despite everything its opponents have done to undermine it, is achieving its goals, costing less than expected, and making the lives of millions of Americans better and more secure.
Now, you might wonder why a law that works so well and does so much good is the object of so much political venom — venom that is, by the way, on full display in Justice Antonin Scalia’s dissenting opinion, with its rants against “interpretive jiggery-pokery.” But what conservatives have always feared about health reform is the possibility that it might succeed, and in so doing remind voters that sometimes government action can improve ordinary Americans’ lives.
That’s why the right went all out to destroy the Clinton health plan in 1993, and tried to do the same to the Affordable Care Act. But Obamacare has survived, it’s here, and it’s working. The great conservative nightmare has come true. And it’s a beautiful thing.
By: Paul Krugman, Op-Ed Columnist, The New York Times, June 25, 2015
In early 2013, Florida Gov. Rick Scott (R) surprised nearly everyone by announcing he’d changed his mind about Medicaid expansion through the Affordable Care Act. The Republican governor had long condemned the idea, but he apparently had a change of heart.
“I cannot, in good conscience, deny the uninsured access to care,” he said at the time. Scott added that Medicaid expansion is “a compassionate, common sense step forward.” The governor even referenced the death of his mother when explaining his rationale.
“A few months ago, my mother passed away, and I lost one of the only constants in my life,” Scott said. “Losing someone so close to you puts everything in new perspective … especially the big decisions…. As I wrestled with this decision, I thought about my Mom’s struggles raising five kids with very little money.”
That was February 2013. In April 2015, Scott reversed course again, announcing his renewed opposition to the policy he’d endorsed. And today, the local CBS affiliate in Miami reports that the governor offered an unexpected explanation for his posture two years ago.
Scott conceded this week that was all a ruse. He now says his support for Medicaid expansion was a calculated move designed to win support from the Obama administration for the state’s proposal to hand over control of Medicaid to private insurance companies. At the time, he denied that his support was tied to a deal with the federal government.
Now that he’s succeeded in privatizing Medicaid, Scott is again railing against Medicaid expansion and is suing the federal government for allegedly forcing it on him.
Of course, if you notice that CBS/Associated Press excerpt, you’ll notice that it’s missing something: a quote. The entire report appears to be a paraphrase of Scott’s comments, and the exact wording always matters.
Indeed, the governor’s office this afternoon pushed back against the AP’s reporting, saying the piece “editorialized” Scott’s comments.
So, which is it? On Twitter, Gary Fineout, an AP reporter in Florida, fleshed this out in a little more detail, explaining the argument Scott presented yesterday. As Fineout described it, the governor may have claimed at the time that his mother’s death inspired him to change his perspective, but in reality – according to Scott’s comments yesterday – the Florida Republican only supported Medicaid expansion as part of “a quid pro quo” to get a waiver from the Obama administration for Medicaid privatization.
Scott may have publicly claimed in 2013 that his position was about his “conscience” and deceased mother, but according to the governor’s new version of events, the rhetoric wasn’t actually sincere – his previous position was a calculated move to gain approval for his privatization plan.
In other words, the governor didn’t literally use the word “ruse” yesterday, so much as he effectively described a scheme in which he told the public something untrue in order to get what he wanted at the time.
I don’t expect much from Florida politics, but when a governor references his deceased mother to make a deliberately misleading argument, the Sunshine State is quite possibly breaking new ground in ugliness.
By: Steve Benen, The Maddow Blog, May 7, 2015
“Obamacare Opponents Still Await The Apocalypse”: Opponents Are As Wrong About Obamacare As Reagan Was About Medicare
A while back, progressive activists and politicians pushed for legislation to provide health insurance for a cohort of Americans who could not easily pay for their doctors’ visits and medications. Predictably, that effort was met with fierce resistance from conservatives, who didn’t seem concerned about those less-fortunate citizens who couldn’t afford medical care.
Conservatives denounced the plan as “socialized medicine” or a “communist takeover” of the American health care system. One notable conservative was especially alarmist, declaring that if the proposal passed Congress, “… you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.”
No, that hysterical tirade didn’t come in response to the Affordable Care Act. Those words were spoken in 1961 by Ronald Reagan, who was crisscrossing the country to campaign against the adoption of Medicare. Yes, Medicare, which Congress passed in 1965 and is widely considered a resounding success.
Fast-forward a few decades. The same alarms were sounded more recently, as progressive activists and politicians pushed for legislation to provide inexpensive health insurance for those who couldn’t afford it. Actually, the denunciations of the Patient Protection and Affordable Care Act, usually called “Obamacare,” may have been even more hysterical.
As the law neared passage, I watched angry crowds gather near the White House — many holding vicious, racially charged signs lambasting the president — to chant about “socialism” and “communism.” Strangely, the most vehement criticisms came from Americans 65 and older, the very cohort that benefits from Medicare.
President Obama signed the Affordable Care Act in March 2010, so it has been the law of the land for five years. Given that, it’s possible to make a reasoned assessment of its strengths and weaknesses.
First off, let’s note that there has been no “socialist takeover” of American medicine. Obamacare uses private health insurance providers; the law merely sets requirements for health insurance plans and issues subsidies to patients who cannot afford to purchase policies.
As you might expect, the number of Americans with health insurance — and, therefore, with access to preventive medical care — has increased in the last five years. Before the law went into effect, there were 48 million uninsured Americans. Now, with 16 million people having signed up for Obamacare, that number has been cut by a third.
Furthermore, health insurance companies are no longer allowed to deny coverage to patients who are already sick or to set a “lifetime cap” on the amount of money a company will pay for medical care. Adult children, who might be in college or working at low-paying jobs without benefits, can stay on their parents’ policies until they are 26.
The Affordable Care Act may also have decreased the rate at which health care costs were escalating. Five years ago, medical care costs were skyrocketing, well beyond the rate of general inflation. Now, those costs are still going up — but at the lowest rate in 50 years. While economists aren’t certain that Obamacare’s cost-containment measures are responsible, many of them give the law credit.
To be sure, the Affordable Care Act has been no panacea. There are still 32 million Americans without health insurance. And, despite the president’s early pledge that people already insured could retain their policies, a tiny but vocal group lost their insurance because Obamacare deemed those policies inadequate. Many in that group ended up paying more for insurance, hardly a happy outcome.
But the worst failings of the Affordable Care Act are beyond its supporters’ control. Because of persistent, irrational Republican opposition, more than 20 states have refused to expand Medicaid — even though the feds would pay the lion’s share of costs. That means that millions of working-class Americans are not getting the health care they need. Furthermore, Obamacare’s unrelenting antagonists have mounted yet another challenge to the law before the U.S. Supreme Court.
It’s hard to fathom. The Affordable Care Act has failed to produce the apocalypse (remember “death panels”?) its fiercest critics predicted; instead, it has given millions of people access to decent health care. Its opponents are as wrong about Obamacare as Ronald Reagan was about Medicare.
By: Cynthia Tucker, Pulitzer Prize for Commentary in 2007; The National Memo, March 28, 2015
A day after announcing his White House bid – which included beating on the Affordable Care Act, his favorite punching bag – Sen. Ted Cruz, R-Texas, says he’s signing up for Obamacare.
Yes, you read that correctly: The man whose signature applause line is a promise to “repeal each and every word of Obamacare,” went on Healthcare.gov and got himself some benefits. Hypocrisy? Sure, but not in the way you might think.
Cruz had been covered through his wife’s employer, Goldman Sachs. If some insurance plans are Cadillacs, hers was a chauffeured, solid-gold Fleetwood, reportedly worth some $20,000 a year — around half of Texas’ median income. Heidi Cruz is taking a year or so of unpaid leave to help him on his campaign, though, so her health care coverage evaporates along with her likely very substantial paycheck.
Now, the senator – or maybe an aide, or an intern or campaign volunteer or someone – will schlep to the computer, log on to Healthcare.gov and hunch down over the keyboard to do the Obamacare two-step to get coverage for the upcoming year.
Cruz says he had to get health coverage Obamacare, and he’s right: Sen. Chuck Grassley, R-Iowa, inserted an ACA amendment that requires all members of Congress to sign up through the federal exchange. That means Cruz has to if he wants health insurance, although, unlike a lot of Obamacare enrollees, his $174,000 annual Senate salary covers the premiums.
“Well, it is written in the law that members will be on the exchanges without subsidies just like millions of Americans so that’s – I think the same rules should apply to all of us,” Cruz told the Des Moines Register. “Members of Congress should not be exempt.”
Cruz has come up with his own Obamacare alternative, a plan which shifts a lot of control to the states — including ones like Texas, that opted out of Obamacare and all that federal money that went with it. If it were available, he probably would have signed up for Cruzcare instead.
Cruz: 2, Hypocrisy: Undecided. Still, let’s take a closer look.
If Cruz wanted to stand on no-Obamacare, no-way principle, however, perhaps he could opt out of government-sponsored health care entirely, just like the 6.3 million Texans who don’t have health insurance — in part because his state, and his party, decided to block it. That includes 1.2 million children just like Cruz’s two little girls who can’t get health care if they get sick.
That’s made Texas the state with the highest number of uninsured people, nearly twice the national average.
Further, if you squint, the changes the Cruz family are undergoing — loss of a job or a dramatic life change that reduces income — are the top reasons people lose health insurance, and among the reasons Obamacare exists in the first place. And if a parent or spouse gets sick without insurance, it can lead to some serious financial hardship.
It’s perhaps safe to say Cruz understands that intuitively, even if he probably would never say so explicitly. Which is probably why he signed up, and where the hypocrisy comes in.
Even though it exposes him to a modicum of ridicule, allegations of hypocrisy and getting the stink-eye from some of his die-hard supporters, Ted’s Excellent Obamacare Adventure speaks more loudly than his “repeal every word of Obamacare” applause line. When it came down to brass tacks and he lost his wife’s coverage, he opted-in.
He may be a fierce Obamacare critic, and he may agree with the decision to deny affordable health insurance to more than 6 million Texans who, one imagines, he assumes would rather have liberty than Lipitor. But when it becomes a personal matter involving his own family, his conservative ideals don’t necessarily apply.
By: Joseph P. Williams, Washington Whispers, U. S. News and World Report, march 24, 2015
Americans learned yesterday that the Affordable Care Act has extended health care coverage to 16.4 million people, slashing the nation’s uninsured rate by over a third, against the backdrop of related system-wide good news. This puts “Obamacare” critics in an unenviable position: trying to characterize a law that’s working as a horrible failure, all evidence to the contrary notwithstanding.
Sen. John Barrasso (R-Wyo.), who’s struggled in this area before despite being the Senate GOP’s point person on health care, gave it his best shot. “Millions of people have lost coverage they liked,” the far-right senator told the New York Times, repeating a dubious claim unsupported by the evidence. He added that extending coverage to millions through Medicaid expansion is “hardly worth celebrating.”
He didn’t say why, exactly, he finds it discouraging when low-income families receive coverage through Medicaid.
But the funnier reaction came by way of a Wall Street Journal piece.
Edmund Haislmaier, senior fellow at the Heritage Foundation, a conservative research group, said the report also doesn’t include essential information on how many people who signed up on exchanges were previously uninsured.
“It’s premature to say it’s ACA-related,” Mr. Haislmaier said.
The number of uninsured historically also has been closely aligned with the economy, with numbers rising during recessions and falling as conditions improve.
The economic argument is itself politically tricky for ACA detractors, because it leaves Republicans in a position of arguing, “Let’s not credit Obama’s health care policies for the good news; let’s instead credit Obama’s economic policies.”
But it’s the Heritage Foundation’s other argument that’s truly amazing. The Affordable Care Act was created in large part to expand Americans’ access to affordable medical care. Once the law was implemented, its provisions worked like a charm and uninsured rate dropped. If the Wall Street Journal quoted Edmund Haislmaier fairly, the Heritage argument seems to be that the success might just be a coincidence – the ACA set out to reduce the uninsured rate, the law was implemented, and the uninsured rate fell at its fastest rate in four decades, but it’s “premature” to say the progress and the law are related.
Jon Chait joked:
Right, I mean, who can really say? Yes, there has been a sudden and extremely sharp plunge in the uninsured rates among the populations eligible for coverage under Obamacare that begins at the exact time Obamacare took effect:
But that could be anything. Survey error. People being excited about Republicans winning the midterm. Sunspots. You never know. Probably not the sudden availability of a major new federal health-care law enrolling millions of people.
Perish the thought.
For context, it’s worth noting that the Heritage Foundation used to be one of the leading conservative think tanks in the nation, even sketching out a health-care-reform blueprint several years ago that resembles the “Obamacare” model now. In recent years, however, Heritage’s focus has shifted away from scholarship and towards political activism.
By: Steve Benen, The Maddow Blog, March 17, 2015