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“Blood On GOP’s Hands”: How Many Would Be Covered Without Its Sabotage Plan?

The cynicism of the GOP’s anti-Obamacare strategy has been obvious forever, but some particular kinks in it only became clear as the enrollment deadline approached and it seemed the Obama administration would not just meet but beat its public-exchange enrollment target. Republicans went from shrieking about what an awful program it was to complaining that not enough people had signed up, and then, when the goal was met, complaining that not enough uninsured people had gotten coverage, and of course lying about that, too.

The lunacy of their complaint – “This program is a nightmare – but not enough people are being helped by it!” – is like the old joke about the kvetchy restaurant patron who complains the food is terrible, and the portions are too small. It would be funny if it weren’t sad.

I confess that the freakout over the federal exchange’s rocky start had me convinced the administration would miss its enrollment target. So hitting the seven million mark is cause for elation, but also anger: Imagine how many people might have enrolled if the entire Republican Party coast to coast hadn’t spent the last six months telling them not to?

Let’s take it further: Imagine if all 50 states had implemented their own exchanges, instead of just 17 of them. Imagine if all 50 states had expanded Medicaid, instead of just 27. Imagine if a well-funded noise machine, from Fox to Rush to the online swarm hadn’t publicized every glitch and every allegation of someone losing their insurance, often fabricating the problems, sometimes lying outright, while ignoring every positive story.

It’s absolutely true that this first enrollment period still leaves most of the uninsured without insurance. Still, at least 9.5 million of the uninsured now have care, thanks to the state and federal exchanges, Medicaid expansion and people buying coverage privately. (On Fox, Charles Krauthammer simply lied when he says it’s only 1 million.) It must be noted that states that built their own exchanges and expanded Medicaid did much better when it comes to covering the uninsured. The Los Angeles Times estimates that at least 27 percent of the newly insured were previously uninsured; in Kentucky, it’s 75 percent and in New York it’s 70 percent. If Republican governors and legislatures hadn’t sabotaged the program in roughly half the states, we would see numbers like that nationwide.

When you add in young people covered by their parents’ insurance and people with pre-existing conditions who can now get coverage, the number goes higher still. As President Obama noted in his Rose Garden victory lap, 100 million people have received free preventive care under new regulations for insurance plans. It’s no wonder that the latest Washington Post/ABC News poll showed approval of the Affordable Care Act topping disapproval for the first time ever, with approval jumping from 40 percent in November to 49 percent last week. Barring a major meltdown, those numbers are likely to climb too.

This is, of course, what the GOP feared – not that the plan would fail, but that it would work. Again, it’s not perfect – we still don’t know exactly who signed up, and whether the balance of young and old, sick and well will make plans affordable. But this enormous milestone should make Democrats smarter about how to make Republicans pay for their obstruction in 2014. The conventional wisdom is that Obamacare will be a millstone in the midterms, especially for red state Democrats, but conventional wisdom is often wrong.

Democrats should challenge Republicans to take away that free preventive care from 100 million Americans. Challenge them to transfer money from women back to men, by letting insurance companies once again charge women more, sometimes much more, for health insurance. Take insurance away from people with pre-existing conditions; kick young people off their parents’ plans. Roll back Medicaid expansion in the 27 states that participated. Go on and tell the American people you’re going to do that, Republicans. The midterms might not be the cakewalk you think.

 

By: Joan Walsh, Editor at Large, Salon, April 2, 2014

April 3, 2014 Posted by | Affordable Care Act, GOP, Obamacare | , , , , , , | Leave a comment

“Burying The Lede”: Obamacare Denialism Is More Futile Than Ever

So it turns out that millions of people dealt with the Affordable Care Act enrollment cutoff pretty much the way they habitually deal with the April 15 income tax filing deadline: procrastinating until the last minute to insure maximum stress and standing in line. Like mobbing shopping malls on the day after Thanksgiving, it’s the American way of life.

One result was predictably negative headlines like this classic in The Washington Post: “HealthCare.gov tumbles on deadline day as consumers race to sign up for insurance.” Because as we all know, temporary computer glitches—which never happen in the flawlessly efficient corporate sector, of course—are the big story here.

In the news business, this is called “burying the lede.” It’s the equivalent of a sports story headlined “Third inning errors mar Red Sox World Series win.” Because the real news, sports fans, is that Obamacare has met and even surpassed every enrollment projection. Oddly, millions of last-minute shoppers decided they’d be better off with health insurance after all.

Who could have guessed?

At this writing, it appears that the late buying surge will carry Obamacare beyond the 7 million enrollments projected by the Congressional Budget Office. Too bad, because that quite ruins the visual effect of a comically misleading Fox News bar graph that contrived to make the 6 million citizens enrolled as of last week appear to be a small fraction of the 7 million CBO projection, rather than 84 percent of it. An alert basset hound wouldn’t have been fooled. Do they think viewers are morons?

But more about what Ed Kilgore calls “Obamacare denialism” to come. According to a Rand Corporation study reported in the Los Angeles Times, along with the 7 million newly enrolled in private insurance plans, roughly 4.5 million previously uninsured Americans have enrolled in Medicaid since the new law came online last November. Another 3 million young adults gained coverage through their parents’ insurance plans, as Obamacare allows.

Rand estimates that another 9 million Americans have bought directly from insurance companies, although many of those were previously insured. Overall, the uninsured rate has dropped from an estimated 20.9 percent to 16.6 percent in the law’s first year—hardly the sudden revolution in American health care some dreamed of, but a creditable start.

What’s more, the numbers are dramatically better in states that worked to implement rather than obstruct the Affordable Care Act. New York State told CNBC that 59 percent of those buying health insurance through the state’s marketplace had been previously uninsured. In Kentucky, it’s 75 percent—immeasurably improving the lives of rural Kentuckians particularly.

How long will their neighbors, in, say, Tennessee be able to hold out against Obamacare as word gets around?

So how are Republicans whose congressmen have voted over 50 times to repeal the law handling the unwelcome good news? About the way they dealt with allegedly “skewed” poll numbers back in 2012. Who can forget the Weekly Standard’s bold election eve prediction? “New Projection of Election Results: Romney 52, Obama 47.” According to pundit Fred Barnes, a 10-point Romney landslide was entirely likely.

The New Republic’s Jonathan Cohn summarizes: “[Republicans] are doing what they almost always do when data confounds their previously held beliefs. They are challenging the statistics—primarily, by suggesting that most of the people getting insurance already had coverage. Some, like Senator John Barrasso of Wyoming, say the administration is ‘cooking the books.’ Others, like Senator Ted Cruz, say that the number of people without insurance is actually rising.”

We await Senator Cruz’s thunderous proof.

Meanwhile, something else that’s been happening right in the face of all those Koch-financed “Americans for Prosperity” ads lamenting that the Affordable Care Act “just doesn’t work,” is that the law’s popularity among the public has been steadily rising. The latest ABC News/Washington Post poll released this week shows Obamacare supported by more Americans than oppose it, albeit by a scant margin of 49 to 48 percent.

Interestingly, 36 percent of self-described conservatives now support the law, as opposed to 17 percent last November. How that will play into November 2014 congressional elections remains to be seen. However, it’s already become clear to the saner sort of conservative thinker that the Affordable Care Act is here to stay.

The market has spoken. The political rebellion and/or actuarial collapse dreamed of on the right clearly isn’t going to happen. “[W]herever they go and whatever they do, writes Ross Douthat in the New York Times, conservatives “will have to deal with the reality that Obamacare, thrice-buried, looks very much alive.”

Longer term, Obamacare denialism appears even more futile. The ever-prescient Kevin Drum points out that Republicans can’t dream of repealing the law as long as its namesake lives in the White House. And by 2017 the CBO estimates the law’s benefits will extend to 36 million Americans—a formidable constituency indeed.

 

By: Gene Lyons, The National Memo, April 2, 2014

April 2, 2014 Posted by | Affordable Care Act, Obamacare, Republicans | , , , , , , , , | Leave a comment

“And Four Years Later?”: How Much “Repeal” Must “Replace” Involve?

If you’re wondering why it’s taking so long for congressional Republicans to unite behind an Obamacare Replacement plan when there are several of them out there, look no further than the North Carolina U.S. Senate primary, where “Establishment” candidate Thom Tillis has incautiously said not all aspects of Obamacare are bad, yet appears to be afraid to endorse the “replacement” bill originally cosponsored by the senior senator from that state, Richard Burr. WaPo’s Greg Sargent has more:

Tillis has so far refrained from endorsing the Burr plan. And similarly, in interviews, he has claimed that of course he would replace Obamacare with something that would protect people with preexisting conditions and others who need protection, without specifying what that replacement would be. Republicans appear increasingly aware that they can’t be just for repeal, and have to promise replacements that would accomplishment some of what Obamacare accomplishes….

As the case of Tillis shows…Republicans must also simultaneously remain vague enough about those replacements so as to avoid embracing the tradeoffs they would require — since specificity there risks angering the right. Indeed, Tillis’ embrace of even some of Obamacare’s general goals has drawn fire from his primary opponent, Tea Partyer Greg Brannon.

The Coburn-Burr-Hatch proposal is dangerous politically for a primary-challenged Republican because it simultaneously embraces aspects of Obamacare (an insurance purchasing exchange, albeit one selling “deregulated”—which means less generous—products; and subsidies for purchases on those exchanges by certain low-income folk) and aspects of more conventional conservative health care thinking that are wildly disruptive of the status quo at a time when Republicans are making big hay over Obamacare “disruptions” (notably the partial rollback of the federal tax write-off for employer-based plans). Indeed, messing with employer-based coverage has been a conservative policy pet rock for years, even though GOP politicians have been leery of it since John McCain proposed junking it in 2008, and left himself exposed to a “tax increase” charge.

There simply isn’t, and can’t be, an “Obamacare replacement” proposal that lets everyone who likes the status quo keep it, while dealing with pre-existing condition exclusions, expanding coverage, and holding down costs. This is why Republicans prefer to insist they want to repeal Obamacare and are stilling “working” on a replacement, four years after enactment of the Affordable Care Act.

 

By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, April 1, 2014

 

April 2, 2014 Posted by | Affordable Care Act, Obamacare, Republicans | , , , , , , | Leave a comment

“A Big Flipping Deal”: Conservatives Need To Acknowledge That They’ve Lost This Battle

President Barack Obama should have skipped his Obamacare victory lap and instead let Vice President Joe Biden talk about the Affordable Care Act officially surpassing 7.1 million enrollees because achieving that milestone is – to paraphrase the colorful expression for which the vice president is well remembered – a big flipping deal.

Let’s be clear on what it’s not: It’s not a definitive number in the sense that there are many questions left to be answered which will help clarify its meaning. As a House GOP leadership aide noted to reporters after White House Press Secretary Jay Carney announced that the 7.1 million figure had indeed been surpassed, we still need to know how many of the enrollees were previously uninsured, how many have paid their premiums, how many are getting subsidies and what the age breakdown is of the enrollees.

Some of these questions are not as mysterious as many conservative critics seem to believe: The Los Angeles Times’ Noam N. Levey reported Monday, for example, that roughly one-third of the initial six million enrollees were previously uninsured and that all told 9.5 million people who hadn’t had insurance have gotten it through Obamacare; 80 percent of enrollees having paid seems to be a consensus conservative estimate; and young people reportedly made up around 27 percent of those signing on through the Obamacare exchanges, though that number may well have been higher in the final surge and was reportedly higher among those signing up in the harder-to-track private market.

And in any case, this is only the first Obamacare enrollment window; nearly twice as many people are expected to enroll in 2015 as did this year, and many more the following year. And let’s keep the full scope of the Affordable Care Act in mind as well: Obamacare numbers guru Charles Gaba estimates that altogether somewhere between 14.6 and 22.1 million people have gotten coverage under the law.

So in short, the 7 million news is not a be-all, end-all vindication of the Affordable Care Act. It is, as Bloomberg’s Megan McArdle writes, “the end of the beginning” for the law (h/t BBC’s Anthony Zurcher).

But keeping all that in mind, we also need to acknowledge another thing that it’s not: It’s not the beginning of the end.

Commentary in recent weeks and months looking toward yesterday’s deadline contemplated almost solely the scope of the next presumed Obamacare failure – whether the law would fall short of the reduced-expectations 6 million enrollee figure, let alone the original 7 million benchmark. The fact that in the end the exchanges blew by the lower figure and even exceeded the positive one, even after the bungled initial rollout of the website and more glitches on the final day of the enrollment period, is a testament to not only the fact that the law has some life in it but also the mobilization skills the administration was able to marshal in the closing weeks. (It was, if anything, reminiscent of the 2012 presidential ground game; hey now that the enrollment deadline has passed, do you think the people who masterminded getting millions of people to sign up might be available to help Democrats mobilize their notoriously somnambulant off-year voters? Just wondering.)

Republicans and conservatives, of course, are insisting that there’s nothing to see here except for fraud or failure. But the former just recalls their 2012 “unskewed” infatuation while the latter, as Steve Benen points, has them taking on an increasingly Baghad Bob-style mien. They can insist that the story of Obamacare is one of unremitting, uninterrupted failure, but who are you going to believe – Republicans or your own eyes?

Those on the right who keep trying to poke holes in the law by raising questions need to answer one they’d like to ignore: What happened to Obamacare’s inevitable collapse? Because 7.1 million enrollees is, after all, a big flipping deal.

 

By: Robert Schlesinger, U. S. News and World Report, April 1, 2014

April 2, 2014 Posted by | Affordable Care Act, Conservatives, Obamacare | , , , , , | Leave a comment

“In Addition To Honesty, It Requires Accountability”: Ryan Unsuited To Lead ‘Adult Conversation’ About Poverty

These days, a favorite talking point of Republican Congressman Paul Ryan’s is calling for an “adult conversation” about poverty.

“It’s time for an adult conversation,” he told The Washington Post.

“If we actually have an adult conversation,” he said in remarks at the Brookings Institution, “I think we can make a difference.”

The problem is that a prerequisite for any adult conversation is telling the truth and it is there the congressman falls monumentally short.

In addition to Rep. Ryan’s recent, racially-coded comments about “our inner cities” where “generations of men [are] not even thinking about working,” his rhetoric around policy should raise red flags for anyone — including the media — assessing his credibility.

A report from Emily Oshima Lee, policy analyst at the Center for American Progress Action Fund, examines the hatchet job Rep. Ryan did on Medicaid in his 204-page account of antipoverty programs that The Washington Post generously described as a “critique.” Indeed, Ryan’s report — which would have been flagged by my excellent 10th grade English teacher for misrepresenting and cherry-picking data — is a dangerous disservice to a public which has neither the time nor the staff that Ryan has at his disposal to delve into literature assessing antipoverty programs.

Lee notes that Ryan misuses research to imply that Medicaid coverage leads to poorer health — that people enrolled in Medicaid will have worse health than those with private insurance and the uninsured.

“The privately insured comparison is patently unfair because these people tend to be higher income and that comes with a whole host of health privileges,” said Lee.

She notes that Medicaid enrollees tend to struggle a lot more with chronic conditions and illnesses than other populations.

“A large body of literature identifies various social determinants of health, including socioeconomic status and living and work environments, as risk factors for poor health outcomes,” writes Lee, in my opinion admirably resisting the temptation to add, “duh.”

As for the uninsured being healthier — it would be one thing if Ryan were making an “apples to apples” comparison, but he’s not.

“The uninsured is a diverse group and doesn’t only include low-income individuals. It may include people who are high-income and don’t really want insurance but can afford health services, and lower-income people who may not have previously enrolled in insurance for a number of reasons — including cost and not having any real health issues,” Lee says. “But again, to imply that Medicaid is somehow making people worse off is absurd.”

Ryan also argues that Medicaid coverage has little positive effect on enrollees’ health. But as Lee points out, Ryan conveniently overlooks studies showing an association between Medicaid and lower mortality rates; reduced low-weight births and infant and child mortality; and lower mortality for HIV-positive patients, among other heath benefits.

“In general, we need more data to accurately assess the effect of Medicaid coverage on people’s health,” Lee continues. “But several studies do indicate positive health and non-health effects of coverage — such as increased use of preventive care and greater financial security.”

Rep. Ryan also plays on fears of low-income people abusing the welfare system when he asserts that Medicaid coverage improperly increases enrollees’ use of health care services, including preventive care and emergency department services. Ryan makes this case too by comparing Medicaid enrollees to uninsured people, who, as Lee writes, “are less likely to use health care services due to significant financial barriers.”

“Presenting data that Medicaid enrollees use more health services than the uninsured affirms that insurance coverage allows people who need care to seek it out,” writes Lee, “and that being uninsured is a major barrier to receiving important medical care.”

Further, one of the two studies Ryan references explicitly states that “neither theory nor existing evidence provides a definitive answer to… whether we should expect increases or decreases in emergency-department use when Medicaid expands.”

Despite Ryan’s shabby work when it comes to antipoverty policy, the media repeatedly seems willing to overlook it. That’s another strike against the prospects of a truly adult conversation about poverty — in addition to honesty, it requires accountability.

 

By: Greg Kaufmann, Moyers and Company, Bill Moyers Blog, March 29, 2014

March 31, 2014 Posted by | Medicaid, Paul Ryan, Poverty | , , , , , | Leave a comment

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