“A Sordid Approach To The Uninsured”: Republican’s Increasingly Appear Eager To Punish The Poor Because They’re Poor
Even if the Affordable Care Act is implemented perfectly, and the system works exactly as planned, millions of Americans will go without access to affordable health care. Is it due to a flaw in the law? Not exactly.
The problem is Republican opposition to Medicaid expansion at the state level. If your income is between 100% and 138% of the poverty line, you can qualify for Medicaid and get covered – unless you live in a “red” state where GOP officials have rejected Medicaid expansion. If so, you can (a) move; (b) figure out a way to make more money; or (c) go without.
Just in recent days, we’ve seen reports reinforcing how inexplicable these states’ policies really are. Refusing Medicaid expansion will not only cost states billions, but it will also severely undermine state hospitals, all while hurting struggling families.
Kevin Drum today called it “one of the most sordid acts in recent American history.”
The cost to the states is tiny, and the help it would bring to the poor is immense. It’s paid for by taxes that residents of these states are going to pay regardless of whether they receive any of the benefits. And yet, merely because it has Obama’s name attached to it, they’ve decided that immiserating millions of poor people is worth it. It is hard to imagine a decision more depraved.
Alternatively, Republicans in Congress could agree to fix this problem and allow people without access to Medicaid to qualify for exchange subsidies. But of course they won’t do that either for the same reason.
Conservatives hate it when you accuse them of simply not caring about the poor. Sometimes they have a point. This is not one of those times.
I strongly agree, though I’d just add that it’s amazing to hear Republican governors who reject Medicaid expansion try to present their approach as sensible.
Wyoming Gov. Matt Mead (R) recently said he refused the policy because he doesn’t like exchange marketplaces, which doesn’t make any sense. Alaska Gov. Sean Parnell (R) justified his opposition by saying the health care law is a “mess,” which is shallow even by GOP standards. Wisconsin Gov. Scott Walker (R) appeared on MSNBC and said he rejected Medicaid expansion because, someday, federal officials may “renege on their promise” to reimburse states.
Has that ever happened? No. Is there any reason to believe it might happen? No. Could Wisconsin bring coverage to struggling families in the meantime, and then drop the policy in the event Washington refused to meet its obligations? Yes, but Walker doesn’t want to.
The larger takeaway here is that Republican officials increasingly appear eager to punish the poor because they’re poor. Indeed, it’s become a common theme in GOP policymaking just in recent weeks: no extension of unemployment benefits, no extension of the status quo on food stamps, no increase in the minimum wage, and wherever possible, no Medicaid expansion, either.
Republicans better hope low-income Americans vote in low numbers in the near future.
By: Steve Benen, The Maddow Blog, December 9, 2013
The latest polls on Obamacare are bleak. A Kaiser Family Foundation survey found that almost half of those questioned last week had an unfavorable opinion of the law. Just a third had a favorable opinion, even less than the 40 percent support for the law in the Nov. 14 Gallup poll.
But those poll numbers will change as more people like Bob Freukes of St. Louis and Donna Smith of Denver are finally able to shop for coverage on the new health insurance websites — and find coverage that is surprisingly affordable.
Considering all the negative stories about the malfunctioning HealthCare.gov website and policy cancellations folks have been receiving, the steep decline in support for Obamacare shouldn’t surprise anyone.
But in the very week that poll numbers reached an all-time low, people who had tried for more than a month to enroll online in a health plan were finally able to do so.
Just minutes after the administration’s tech surge team said 90 percent of applicants were now able to enroll online, I started getting emails from people eager to share their success stories.
“My wife and I are both self-employed small sole proprietors,” wrote Freukes, a photographer. “This will be the first time in our married lives we will have health insurance.”
Freukes said that over the course of the past year, he and his wife — married 30 years and are now in their fifties — rarely went to the doctor because of the expense.
“We paid for doctor visits, prescriptions, eye glasses and everything else out of [our] own pockets, always knowing we were one major illness away from bankruptcy.
“We tried to find an affordable policy, but the going rate for my wife and me was roughly $900-$1,400 dollars a month with deductibles in the $5,000 range.” Considering that their combined annual income is often no more than $25,000, health insurance was out of the question.
Not only will they finally have coverage starting January 1, it will cost the Freukes less than they had expected because of the federal tax credits available to low- and middle-income individuals who buy coverage on the state exchanges. In fact, with the tax credits, the Freukes will not have to pay monthly premiums at all.
“I sat rubbing my eyes in amazement as the website did the math. Our portion of the premium for both plans was ZERO. No cost to us at all. I was stunned.”
Donna Smith wasn’t that fortunate, but she at long last will be able to get a comprehensive policy that she can afford.
Like Bob Freukes, it took Smith weeks of effort before she was finally able to enroll in a plan. Her delay, though, was caused by a different, though no less frustrating quirk in the system. Colorado is one of 13 states and the District of Columbia operating their own exchanges, which generally have experienced fewer problems than the federal website, where residents of most states have been sent. Several thousand people were able to begin the application process in Colorado but they had to wait — and wait and wait — while state officials checked to see if the applicants were eligible for Medicaid.
Smith knew her income was too high to qualify for Medicaid, but she nevertheless had to fill out an extensive questionnaire and was put in what she described as a “bureaucratic black hole” for 37 days. It was an agonizing wait for Smith, a cancer survivor who — along with husband Larry — had to file for bankruptcy several years ago because of medical debt. If her name sounds familiar, by the way, it might be because you’ve seen her in the movies. When she wrote filmmaker Michael Moore about her plight, he included her in the 2007 documentary, SiCKO. Since then she has been an active supporter of health care reform.
After she finally got the Medicaid denial she was expecting, Smith called Connect for Health Colorado — the name of the state exchange — and worked with an employee to complete her application.
“If people can get through the Medicaid process, I think they’ll be pleasantly surprised,” said Smith, who has been paying $875 a month for an individual policy. Beginning next year, she will be covered in a better plan, but it will cost her only $450 a month after factoring in a $72 federal tax credit.
As happy as she was to discover she will soon have affordable coverage —and that it can’t be canceled if her cancer returns, thanks to Obamacare — she still believes a single-payer, Medicare-for-all type system would be better.
She has a point. The Affordable Care Act is far from perfect. But in the coming months and years, millions of us who have been unable to find affordable coverage will at long last be insured. Poll numbers will eventually reflect that.
By: Wendell Potter, The Center for Public Integrity, November 25, 2013
“A Sobering Reminder”: The Number Of Uninsured Americans Increased By 7.9 Million Under George W. Bush
The week President Obama took office, initial jobless claims, the statistic that immediately gauges layoffs, hit a 26-year high with 637,000 applying for unemployment insurance in one week. It was clear that the president was inheriting a record deficit, a cratering economy and two floundering wars. But buried in all those crises was an unspoken slow-motion disaster that people rarely mentioned: the steady crumbling of our health care system.
“When [former president Bill] Clinton left office, the number of uninsured Americans stood at 38.4 million,” Ron Brownstein wrote in 2009. “By the time [former president George W.] Bush left office that number had grown to just over 46.3 million, an increase of nearly 8 million or 20.6 percent.”
The numbers were just as bad when you looked at the share of the uninsured.
When Clinton left office, 13.7 percent of the population was uninsured. Bush left with 15.4 percent lacking coverage. And the only health reform the last Republican to occupy the White House enacted in his eight years was to add an unfunded prescription drug benefit that guaranteed cuts would need to be made at some point.
So the 15.4 percent of Americans Bush left uninsured in 2008 continued to rise in 2009 to 16.1 percent, then peaked at 16.3 percent in 2010. In 2011, it dipped to 15.7 percent, the biggest drop since 1999. The last census report showed that 48.6 million Americans were uninsured – that’s 15.4 percent. Exactly where it was in 2008.
It would be easy to credit the recovering economy for the rise of insured Americans — initial jobless claims last week were half of what they were when Obama took office. But the percentage of the uninsured is now lower than it was in 2006, before the Great Recession hit.
The New York Times‘ Paul Krugman calls the Affordable Care Act’s role in bringing health-cost growth to its lowest rate on record the law’s “secret success.” But the other secret success is how Obamacare is helping to reverse the growth of the uninsured population. This began in 2011 with children and young adults being able to stay on their parents’ plans until age 26, covering more than three million. And it continues this year with millions of Americans being added to the Medicaid rolls and millions likely to sign up for private plans, if the law’s health care exchanges begin working well enough.
Still Republicans are playing up the estimated 5 million cancellations of plans due to Obamacare the same way they played up the deficit and faltering economy President Obama inherited as if it had been his fault.
We won’t know how many of these people end up in new plans until next year, but we do know that nearly all of them will pay the same or less with a new plan that cannot deny them coverage or charge them more if they get sick.
“To sum up, lots of people losing coverage are losing policies they never liked much, that they would have dropped soon anyway, and that would have left them facing potential financial ruin if they got sick,” The New Republic‘s Jonathan Cohn wrote. “Even those with truly good policies had no guarantees that in one year, let alone two or three, they’d still be able to pay for them.”
Now, millions of Americans are being offered affordable health insurance possibly for the first time in their lives, promising to cut the ranks of the uninsured by millions in just a few years.
While Republicans are mourning cancellations of the exact kinds of plans that left massive holes in our health care system, the question is: Where were those crocodile tears when almost 8 million Americans became uninsured under George W. Bush… and Republicans did nothing to stop it?
By: Jason Sattler, The National Memo, November 29, 2013
“A Range Of Options And A Very Good Deal”: Under The Affordable Care Act, Millions Eligible For Free Policies
Millions of people could qualify for federal subsidies that will pay the entire monthly cost of some health care plans being offered in the online marketplaces set up under President Obama’s health care law, a surprising figure that has not garnered much attention, in part because the zero-premium plans come with serious trade-offs.
Three independent estimates by Wall Street analysts and a consulting firm say up to seven million people could qualify for the plans, but federal officials and insurers are reluctant to push them too hard because they are concerned about encouraging people to sign up for something that might ultimately not fit their needs.
The bulk of these plans are so-called bronze policies, the least expensive available. They require people to pay the most in out-of-pocket costs, for doctor visits and other benefits like hospital stays.
Supporters of the Affordable Care Act say that the availability of free-premium plans — as well as inexpensive policies that cover more — shows that it is achieving its goal of making health insurance widely available. A large number of those who qualify have incomes that fall just above the threshold for Medicaid, the government program for the poor, according to an analysis by the consulting firm McKinsey and Company.
The latest analysis was conducted by McKinsey’s Center for U.S. Health System Reform, whose independent research has been cited by the federal government and others.
“The whole point of the law was not only to cover the uninsured, but so people didn’t have to make choices between food or drugs, or going to the doctor or dentist,” said Karen Davis, a health policy expert at the Johns Hopkins Bloomberg School of Public Health. “It’s what it is designed to do.”
Many insurers tried to price their least expensive plans so they would become free or nearly free with the addition of subsidies that are set based on a person’s income and the cost of a midlevel, or silver, plan.
Independence Blue Cross in Philadelphia has four plans that are free to some customers. But the company, along with other insurers, has been careful not to publicize its free coverage for fear of alienating customers who will need to pay more.
“We’re not advertising zero dollar,” said Brian Lobley, a senior vice president at Independence Blue Cross. But the company is promoting monthly premiums in the $20 to $30 range, he said.
The Obama administration has also stressed affordability over coverage with no monthly charge, frequently saying that the cost of coverage will be less than a monthly cellphone bill for many consumers. Officials at the Department of Health and Human Services would not comment on the McKinsey analysis, saying in a statement that the goal of the health law was to provide a range of options for people with differing needs and budgets.
The analysis found that five million to six million people who are uninsured will qualify for subsidies that will be greater than the cost of the cheapest bronze or silver plan. A million more people with individual insurance could also be eligible, according to McKinsey, although estimates of the size of the market for private individual insurance vary widely. None of the people in the analysis qualify for Medicaid.
The availability of zero-premium plans may make the deal especially enticing to the healthy young people the marketplace needs to succeed, said Mark V. Pauly, a professor of health care management at the University of Pennsylvania’s Wharton School. “This is such a good deal that you’d have to believe you were immortal not to really pick it up,” he said.
Although they vary in their design, bronze plans generally cover about 60 percent of a person’s medical costs. All plans, including bronze, must cover standard benefits like prescription drugs, maternity care and mental health treatment.
The availability of the zero-premium plans varies across the country. McKinsey found that about 40 percent of the uninsured in Missouri will be able to select a no-cost bronze plan, for example, compared with 2 percent of the uninsured in New Jersey.
Its estimate, based on an analysis of premiums for plans offered in the marketplaces in all 50 states and the District of Columbia, is in line with two other estimates, by Credit Suisse and Morgan Stanley.
The McKinsey researchers also found that about half of the people eligible for zero-premium plans were under 39 and uninsured. The Obama administration has been emphasizing the affordability of its plans for young people, a critical group because their participation in the marketplaces will help keep overall premiums low.
It is impossible to know who will actually sign up, and whether they will choose a zero-premium plan.
For many people, paying slightly more for a silver plan may be a much better option, experts said. Ninety percent of those who will have the option of buying the no-cost plans make less than 250 percent of the federal poverty level, which is $28,725 for an individual, and $58,875 for a family of four. People earning below those thresholds are eligible for the most generous assistance, but only if they choose a silver plan.
About a million of those who will qualify for free coverage will be able to buy a silver plan for no monthly cost. McKinsey, which is releasing a report about the new insurance marketplaces, estimates that the cost of silver plans for the people who qualify for a zero-premium bronze plan will range from $40 to $50 a month.
“They may be getting zero premiums, but they’re also leaving a lot of money on the table if they don’t enroll in a silver-level plan,” said Sabrina Corlette, a professor at Georgetown University’s Health Policy Institute.
All plans, including bronze policies, limit annual out-of-pocket costs to $6,350 for individuals and $12,700 for families. But insurers and advocates said out-of-pocket costs — even those under that limit — can be daunting to people with low incomes.
For Mark and Elisabeth Horst, both artists in Albuquerque, the risks of signing up for a bronze plan were outweighed by the prospect of getting it free. The Horsts, who make $24,000 a year between them, qualified for $612 in monthly subsidies, but the cost of a bronze plan was $581 a month.
“We’re in good health,” Mr. Horst said.
Besides, he said, they can always switch to a better plan next year. “At this point, it’s a little bit of a gamble.”
Not everyone selects the cheapest option. Dante Olivia Smith, a lighting designer from Manhattan, learned that federal subsidies would allow her to buy a bronze plan for $24 a month.
“It was astounding,” she said. “I almost started crying, and called my mom.”
In the end, however, she went with a silver plan for $91 a month that included dental and vision coverage. Ms. Smith, who is 30, said she opted for the more comprehensive plan because of her work, which requires her to climb ladders and use power tools.
“If I had a different job, for 24 dollars a month I would have been like ‘Woo-hoo!’ ” she said. “But the reality is, I know what my risks are in my life.”
By: Reed Abelson and Katie Thomas, The New York Times, November 3, 2013
Whacking yourself on the head with a ball-peen hammer would be stupid. But doing it again and again — that’s insane.
Welcome to your U.S. House of Representatives, presently led by a pack of Tea Party Republicans. They are so crazed by Obamacare that they repeatedly hammer themselves over the head with it, having voted 46 times (so far) to dismantle, defund, delay, deny, and otherwise destroy this landmark health care bill — all to no avail. They would be hilarious, were they not so pathetic.
But now, their anti-government, anti-Obama obsession has turned into insanity. Acting as though the USA is nothing more substantial than a banana republic, this Tea Party clique of petty potentates has forced a shutdown of our national government. The craziest part of their stunt is the duplicitous claim that finally providing health care for millions of uninsured Americans will have, as one leader of the mad-dog pack put it, “horrific effects.”
Yet, even as they publicly insist that they’re heroes for trying to save the people from the horror of receiving fairly decent health coverage, the GOP hierarchy is quietly warning its members that defeating Obamacare now is essential to their own health. Why? Because they know the program will work, providing better care and nearly universal coverage at a cheaper price. It will become widely popular, and any politico who tries to kill it later will become wildly unpopular. Even the senator from Oz, Ted Cruz, understood that the program had to be aborted before it was born. It will be so loved, Cruz candidly conceded (as he desperately tried to suffocate Obamacare with a painfully-long “filibuster”), that the public will be “hooked” on it for the long haul.
Yes, Sen. Oz, the American people tend to support policies that are beneficial to them. What’s crazy is you and your cohorts thinking they’re crazy for thinking that.
So now, Dr. Hightower offers this advice: Don’t fume about the GOP’s lunatic effort to kill health care reform — just laugh at their farcical show. It won’t affect them, but it can improve your mental health.
For starters, take Ted Cruz’s 21-hour blabathon that he said would stop Obamacare in its tracks. Not only did he fail spectacularly, but senators voted 100 to zero against his crazy ploy. Yes, that means that even he ended up voting against it! What a hoot he is.
A shameful hypocrite, too. While going to extremes to keep millions of Americans from getting vitally needed health coverage, Cruz goes to great lengths to keep the people from being reminded of his own health care, past and present.
Having been born in Calgary, Canada, little Ted’s parents were able to take advantage of the country’s universal health care, or as the Tea Party darlings like to call it, “socialized” medicine. That’s right, for the first four years of Ted’s life in Calgary, he was covered under government subsidized healthcare. I find it absolutely hysterical that little Ted would grow up to throw a 21-hour-long temper tantrum over affordable health care for hardworking American people. Recently, Cruz had been repeatedly refusing to answer whether taxpayers covered his health care. Finally, he piously responded that he was eligible for taxpayer coverage, but had nobly declined.
Such slapstick! It turns out that Ted was fibbing, for he’s covered by his wife’s policy. As a millionaire top executive at Goldman Sachs, she and her family are given gold-plated Cadillac coverage by the Wall Street giant. Goldman pays some $40,000 a year for her and Ted’s policy (more than most families make in a year) — a benefit-cost that the firm passes on to us taxpayers by deducting it from its corporate tax bill. Hilarious, huh?
Then there’s the comic twist that’s included in Congress’ current government shutdown. While more than a million regular government workers are going without a paycheck, the congresscritters who forced the furlough continue to collect their $174,000 in annual pay. Some lawmakers are donating their checks to charity, but four out of five are happily pocketing theirs. “Dang straight,” barked Rep. Lee Terry. “I’ve got a nice house and a kid in college,” the Nebraska Republican said. “Giving our paycheck away when you still worked and earned it? That’s just not going to fly,” Terry told his constituents.
And that’s your Congress at work. Laugh ’til it hurts.
By: Jim Hightower, Featured Post, The National Memo, October 10, 2013