“No Shedding Crocodile Tears Here”: Obamacare Critics Should Stop Using Young Men To Fuel Their Arguments
In January, one of Obamacare’s most controversial provisions will come into effect:
Every person in America will be required to either have health insurance or pay a penalty.
Overall, the effect will likely be a net positive: Because of subsidies, the cost of insurance will be kept down for many households, and in many states, a Medicaid expansion will help even more families pay for their health care. But while the outlook is great for millions of workers, things are going to be tougher for at least one group: healthy, financially secure men in their twenties.
So, guess which group Obamacare critics have focused on when they attack the effects of the program? I’ll give you three guesses, but you’ll probably only need one.
On Wednesday, New York magazine’s Jonathan Chait pointed out the surprising trend, noting that critics of the Affordable Care Act have almost universally cited the group in their attacks. Likening the move to an old-time patent medicine show (“You, sir – the healthy 25-year-old in front who has never been hospitalized or needed medication in his life! Step right up!”), he suggested that the attacks on Obamacare are, to put it mildly, skewed.
On the surface, targeting the law’s impact on healthy 25-year-old men seems like a masterstroke. After all, it’s hard to argue for the fairness of a system that charges healthy young people to pay for the health care needs of sickly older ones. The trouble is, today’s healthy 25-year-old male could easily become tomorrow’s hit-and-run victim, desperately in need of long-term medical care. And, barring that, today’s healthy 20-something will, with any luck, become a less-healthy 50-something, in need of an affordable method to cover his medications and regular doctor’s visits.
(Or, as happened to me when I was an uninsured man in my mid-20s, today’s healthy young 25-year-old could be tomorrow’s guy paying out-of-pocket for wisdom teeth extraction.)
Obamacare has numerous provisions that will extend coverage and make health insurance cheaper. Among other things, it will help cover the Medicare Part D coverage gap, will end exclusions for pre-existing conditions, and will require health care plans to cover preventative care.
For tens of millions of people, these provisions, and others, will translate into lower medical costs, a previously unimaginable access to health care, and a generally improved quality of life. Given the huge potential benefits, maybe it’s time for Obamacare’s critics to stop shedding crocodile tears for the relatively small portion of the populace that is going to have to take one for the team — and, in the process, get insurance that may well make them safer and healthier.
By: Bruce Watson, Business Insider, Originally Published in DailyFinance, June 10, 2013
“A Matter Of Life And Death”: Leave It To Scott Walker To Turn Medicaid Expansion Into Medicaid Contraction
Several red states are turning down Medicaid expansion — only Scott Walker (R-WI) is actually using Obamacare as an excuse to cut Medicaid.
Wisconsin’s Badgercare health care plan is one of the best in the country. Families qualify for comprehensive coverage if they earn up to 185 percent of the federal poverty level.
So when the Affordable Care Act offered all 50 states a chance to expand their Medicaid programs to cover all the working poor who earn too much for Medicaid but make up to 133 percent of the poverty level, what did Governor Scott Walker decide to do?
He put forward a plan to drastically cut Badgercare.
If Walker gets his way, his state’s plan will only cover residents who earn 100 percent of the poverty level or below – $11,490 a year for a single adult.
Tens of thousands of Wisconsites will be forced from completely subsidized health care to the federal insurance exchanges, where they can purchase private plans with a subsidy. To do this, Walker has to give up federal funding that would cover 84,7000 residents, which would lead to a $119 million cut to his state budget.
“But a detailed analysis of the plan by the Legislative Fiscal Bureau finds that many of the people now receiving state Medicaid coverage would likely not buy the more costly insurance through the federal program,” The Milwaukee Journal Sentinel reports.
“As a general rule, they’re going to be really strapped to do it,” Jon Peacock, research director of the Wisconsin Council on Children and Families, told the Journal Sentinel. “They won’t scrape together the money unless they really need it.”
The Bureau estimates that 7 percent will not buy the coverage. Peacock thinks that’s overly optimistic.
A new UW Madison study shows that Badgercare – which was expanded in 2009 — reduces hospitalization and improves management of chronic disease.
Even Senate Majority Leader Scott Fitzgerald (R-Juneau) admits that Walker’s plan could send thousands to emergency rooms for care, driving up the cost of care for all residents. The legislature is considering additional payments to hospitals to make up for the costs of the uninsured.
Medicaid expansion is a great deal for the states. The federal government will fund 100 percent of the initial expense; that decreases to 90 percent over the next decade.
Rand Corporation just released a study that underlines the cruelty of rejecting expansion. “States rejecting the expansion will spend much more, get much, much less, and leave millions of their residents uninsured. That’s a lot of self-inflicted pain to make a political point,” according to The Washington Post‘s Ezra Klein and Evan Soltas.
“This is not a small issue,” writes The Guardian‘s Michael Cohen. “In fact, it is a matter of life and death.”
Cohen points to a New England Journal of Medicine study that shows increased access to Medicaid results in fewer deaths. A recent study in Oregon found that Medicaid eliminated economic hardships brought on by health problems and dramatically improved mental health.
What Walker is doing is even worse than his more than two dozen Republican colleagues who are rejecting expansion. He’s taking health care away from the working poor, knowing that doing so will cost his state money, well-being and even lives.
By: Jason Sattler, The National Memo, June 4, 2013
Imagine you went to Best Buy and found a great deal on a plasma television set. I want to be clear here: You didn’t find a great television set. This television set is actually a bit crummy. The picture is fuzzy. Consumer Reports says it breaks down a lot and it’s expensive to fix. But it’s really cheap. The price tag reads $109.
When you take it to the counter, the saleswoman tells you that the set will actually cost you $199. And count yourself lucky, she confides in a conspiratorial whisper. There are customers whom Best Buy won’t sell it to at any price. You ask her which customers those are. The ones who need the TV most, she replies.
So here’s the question: Does that television really cost $109?
Best Buy, of course, would never do this to you. If they say you can buy a television set for $109, you can buy it for $109. Plus, they’re handsome, and their customer service is great, and I hope they advertise in The Washington Post forevermore, amen.
But this is actually how the individual health-insurance market works. And understanding why is crucial to understanding a lot of what you’re going to read about health reform in the next year.
Last week, California released early information on the rates insurers intend to charge on the new insurance marketplaces — known as “exchanges” — that the state is setting up under Obamacare. They were far lower than anyone expected. Where analysts had anticipated average premiums of $400 to $500, insurers were actually charging $200 to $300. “This is a home run for consumers in every region of California,” crowed Peter Lee, director of the state’s exchanges.
The Affordable Care Act’s critics saw it differently. Avik Roy, a conservative health writer at Forbes, said Lee was being “misleading” and that “Obamacare, in fact, will increase individual-market premiums in California by as much as 146 percent.” Obamacare, he said, would trigger “rate shock,” the jolt people feel when they see higher rates. That doesn’t sound like a home run at all.
Who’s right? In typical columnist fashion, I’m not going to tell you just yet. But stick with me, and you’ll be able to parse the next year of confused and confusing Obamacare arguments with ease.
Here’s the first thing to know: We’re talking about a small fraction of the American health-care system. This isn’t about people on Medicare or Medicaid or employer-based insurance. It’s about people joining Obamacare’s insurance exchanges. That’s people who buy insurance on their own now, as well as some of the uninsured. In 2014, 7 million people, or 2.5 percent of the population, is expected to buy insurance through the exchanges. By 2023, that will rise to 24 million people, or 8 percent.
So we’re talking about a small portion of the market. Worse, we’re talking about that small portion of the market all wrong.
Roy got his 146 percent by heading to eHealthInsurance.com, running a search for insurance plans in California and comparing the cost of the cheapest plans to the cost of the plans being offered in the exchanges. That’s not just comparing apples to oranges. It’s comparing apples to oranges that the fruit guy may not even let you buy.
I ran the same search Roy did. I looked for insurance in Irvine, Calif. — my home town. The average monthly premiums of the five cheapest plans is $114. So I took the middle plan, HealthNet’s IFP PPO Value 4500. It’s got a $4,500 deductible, a $2,500 deductible for brand-name medications, huge co-pays and a little “bestseller” icon next to it. And it’s only $109 a month — if they’ll sell it to you for that price.
That’s the catch, and it’s a big one. Click to buy the plan and eventually you’ll have to answer pages and pages of questions about your health history. Ever had cancer? How about an ulcer? How about a headache? Do you feel sad when it rains? When it doesn’t rain? Is there a history of cardiovascular disease in your family? Have you ever known anyone who had the flu? The actual cost of the plan will depend on how you answer those questions.
According to HealthCare.gov, 14 percent of people who try to buy that plan are turned away outright. Another 12 percent are told they’ll have to pay more than $109. So a quarter of the people who try to buy this insurance product for $109 a month are told they can’t. Those are the people who need insurance most — they are sick, or were sick, or are likely to get sick. So, again, is $109 really the price of this plan?
Comparing the pre-underwriting price of this plan to those in Obamacare’s exchanges is ridiculous. The plans in Obamacare’s exchanges have to include those people. They can’t turn anyone away or jack up rates because of a history of arthritis or heart disease.
They also have to offer insurance that meets a certain minimum standard. Under Obamacare, for instance, the out-of-pocket limit for someone making 100 to 200 percent of the poverty line is $1,983. Under the Value 4500, you could spend up to $9,500 before the out-of-pocket limit kicked in. Obamacare also has subsidies for people making up to four times the poverty line. The poor pay next to nothing. The rich pay full freight.
“We as a society have never really said here’s what reasonable insurance is,” says Larry Levitt of the Kaiser Family Foundation. “It’s just been anything goes. For the first time they’re setting a minimum about what reasonable insurance should be.” They’re also setting a minimum about who should be able to get it, and at what cost. Now it really will work like Best Buy, where the price on the tag is the price everyone actually pays.
Some people will find the new rules make insurance more expensive. That’s in part because their health insurance was made cheap by turning away sick people. The new rules also won’t allow for as much discrimination based on age or gender. The flip side of that, of course, is that many will suddenly find their health insurance is much cheaper, or they will find that, for the first time, they’re not turned away when they try to buy health insurance.
That’s why the law is expected to insure almost 25 million people in the first decade: It makes health insurance affordable and accessible to millions who couldn’t get it before. To judge it from a baseline that leaves them out — a baseline that asks only what the wealthy and healthy will pay and ignores the benefits to the poor, the sick, the old, and women — well, that is a bit shocking.
By: Ezra Klein, Wonkblog, The Washington Post, June 1, 2013
As the reality of states refusing the insanely generous terms of the Affordable Care Act’s Medicaid expansion (viz., the Texas legislature’s proactive legislation prohibiting the state from participating), begin to sink in, with it comes the realization that a completely perverse situation will now prevail in these states. The New York Times‘ Robert Pear explains for anyone who hasn’t heard:
More than half of all people without health insurance live in states that are not planning to expand Medicaid.
People in those states who have incomes from the poverty level up to four times that amount ($11,490 to $45,960 a year for an individual) can get federal tax credits to subsidize the purchase of private health insurance. But many people below the poverty line will be unable to get tax credits, Medicaid or other help with health insurance.
You will occasionally hear that people left exposed by states refusing to expand Medicaid are “covered” by Obamacare health insurances exchanges, and that’s true for what little it’s worth. The subsidies designed to make coverage affordable for the working poor (and a big chunk of the middle class), however, don’t kick in until a beneficiary’s income is above the federal poverty line. That’s because it did not occur to the Affordable Care Act’s sponsors that the Medicaid expansion provisions covering all Americans up to the poverty line would become voluntary for the states. And you know what? Had they known the Supreme Court was going to so rule, they probably would have thought no state would hate its own poor people enough to turn down the fiscal deal represented by the expansion (that was certainly the assumption a lot of otherwise smart observers made when the Court’s decision came down). Turns out as many as 25 states may in fact go in that stupid and malevolent direction, leaving up to 5.7 million Americans at the very heart of Obamacare’s intended coverage population without meaningful access to health insurance.
Now normally you’d think a Court-created “hole” in a legislative plan of this size would lead to a legislative “fix,” wouldn’t you? But that is for sure not happening until such time as Democrats regain control of the House and of 60 Senate seats–the temporary majorities that made enactment of the Affordable Care Act over the united opposition of the GOP possible in the first place.
The scandal of state-level Republicans leaving so much federal money on the table and so many poor people in the lurch may well become a campaign issue in 2014. But while this treachery is very likely to become a long-term political issue for Republicans in the affected states–particularly in the South, where its racial dimensions are impossible to ignore–the overall landscape going into the 2014 midterm election is hardly promising for Democrats there or nationally.
So putting things right and holding the happy architects of this wildly unfair situation may take a good long while. But payback’s hell.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, May 28, 2013
“Reverse Sticker Shock”: Reality-Based Evidence On Obamacare In California Amidst All The GOP Hysteria
For months now we’ve been told that the Affordable Care Act would produce a cataclysm of skyrocketing health insurance premiums, particularly in the individual insurance markets that the law most affects. Earlier this week alarms were raised particularly in California with the news that three major insurance companies had decided against participating in the health care exchanges that would offer Obamacare coverage.
So it’s a bit of a shock–sort of a reverse sticker shock–today to learn that preliminary assessments of the cost of the new, improved (because subject to new minimum coverage requirements) policies in California once the exchanges are up and running will in most cases be lower than what citizens of this high-cost state are accustomed to paying. TNR’s Jonathan Cohn summarizes the news:
Based on the premiums that insurers have submitted for final regulatory approval, the majority of Californians buying coverage on the state’s new insurance exchange will be paying less—in many cases, far less—than they would pay for equivalent coverage today. And while a minority will still end up writing bigger premium checks than they do now, even they won’t be paying outrageous amounts. Meanwhile, all of these consumers will have access to the kind of comprehensive benefits that are frequently unavailable today, at any price, because of the way insurers try to avoid the old and the sick.
Sarah Kliff of Wonkblog has more details:
Health insurers will charge 25-year-olds between $142 and $190 per month for a bare-bones health plan in Los Angeles.
A 40-year-old in San Francisco who wants a top-of-the-line plan would receive a bill between $451 and $525. Downgrade to a less robust option, and premiums fall as low as $221.
These premium rates, released Thursday, help answer one of the biggest questions about Obamacare: How much health insurance will cost. They do so in California, the state with 7.1 million uninsured residents, more than any other place in the country.
Multiple projections expected premiums to be relatively high.
The Congressional Budget Office predicted back in November 2009 that a medium-cost plan on the health exchange – known as a “silver plan” – would have an annual premium of $5,200. A separate report from actuarial firm Milliman projected that, in California, the average silver plan would have a $450 monthly premium.
Now we have California’s rates, and they appear to be significantly less expensive than what forecasters expected.
On average, the most affordable “silver plan” – which covers 70 percent of the average subscriber’s medical costs – comes with a $276 monthly premium.
Such numbers, it is important to note, do not reflect the actual cost to the estimated 2.6 million Californians who will qualify for Obamacare tax subsidies (available to those with incomes up to 400% of the federal poverty rate).
One of the “horror stories” we’ve been hearing from Obamacare opponents for years now is that the whole scheme will collapse once healthy, low-income young people realize they’ll face large news costs for the kind of minimum high-deductible catastrophic coverage they actually need. They’ll bail, it has been suggested, not only from Obamacare (screwing up the broad-based risk pools that make affordable coverage for older and sicker people possible), but from Obama’s political coalition as well. So this comment from Kliff about the California numbers is worth noting:
For a less robust “bronze” plan, which covers 60 percent of the average beneficiary’s costs, the tax credit could actually cover the entire premium for low-income twenty-somethings.
None of this should really be that surprising; the idea that a broader pool plus competition and guaranteed benefits would provide a better bargain (plus vastly greater security) for consumers in the individual market was central to the entire Affordable Care Act architecture. But it’s taken a while for facts to catch up with all the negative agitprop. It won’t keep House Republicans from voting to repeal the entire law a 38th or 39th or 40th time before the bulk of the Affordable Care Act becomes effective next year. Still, it’s nice to see some reality-based evidence amidst all the hysteria.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, May 24, 2013