“Separating Myth From Reality On Obamacare”: The Greatest Good For The Greatest Number, More People Are Better Off In The End
My heart sank when I got an email late last month from my friend Robert, who has been battling multiple sclerosis for the past decade. He wrote to tell me that he was among the many Americans who in recent weeks received letters from their insurance companies saying that their policies won’t be available next year.
Insurance companies are sending those letters primarily because the policies they will no longer offer don’t provide enough coverage — or have deductibles that are too high — to comply with the Affordable Care Act. In many cases, however, the policyholders getting those letters are simply victims of a business practice insurers have engaged in for years: discontinuing policies because they’re no longer sufficiently profitable.
Robert understandably was worried. Like most of us, he’d been seeing the news stories about people who had received similar letters and seemed to be resigned to having to pay more in premiums next year for comparable or even less coverage, thanks to Obamacare.
Considering his very serious and costly preexisting condition — his medications alone cost more than $5,000 a month — Robert was nervous as he started looking for a replacement policy. How much more would he have to pay to stay insured?
A couple of weeks went by. I assumed Robert, like many others, was still waiting for the Obama administration to fix Healthcare.gov so he could shop online for coverage. It turns out Robert wasn’t willing to just wait. He decided to call an insurance agent and talk to a real live human being about his options for next year.
He could barely believe what he heard: he could get better coverage than the policy being discontinued — and pay less — thanks to Obamacare.
“The overall cost of the plans I’m considering is cheaper than the plan I am currently paying for,” he wrote me this week. “My total cost for coverage now, including premiums and out of pocket costs, is about $9,800. Two of the plans I’m seriously considering for next year have total costs of $8,400. I’m shocked, but in a good way.”
So not only did Robert not experience the sticker shock he had been expecting, he will save $1,400 next year on health insurance.
The plan he is leaning toward — a top-of-the line “platinum” plan — will have a higher monthly premium, but he will still save on average about $117 a month because of the way his out-of-pocket costs will be calculated.
Robert is among many who are losing their current coverage but in the end will be better off. In fact, considering that many folks buying coverage on the individual market have at least one pre-existing condition — which insurers can no longer take into consideration when pricing their policies — it’s likely that more people will get more for their insurance buck next year than less.
In addition, most of the people who buy coverage through the new insurance marketplaces (as Robert will when the balky Healthcare.gov website is working more smoothly) will be eligible for tax credits and subsidies from the federal government that will lower their monthly and overall costs even more.
Robert knows that you can’t determine how much you’ll spend on coverage during a given year just by multiplying the monthly premium by 12. If you don’t take into consideration out-of-pocket costs and just pick the policy with the cheapest premium, you could wind up paying more overall than if you picked a plan with a slightly higher monthly premium.
Robert also will be able to spread the cost of his coverage more evenly over the year. Under his current plan, he had to have at least $5,000 in the bank at the beginning of every year when his policy renewed to cover the cost of his medications for just one month. Under the new plans he is considering for next year, his monthly out-of-pocket costs will range from $80 to $120 a month.
“It will be easier to manage paying for my drugs spread out over a period of 12 months instead of in one lump sum at the beginning of the year,” Robert told me.
Robert said the insurance agent told him his case is not unique, that a lot of the people she talks to who have been frightened by the media coverage are pleasantly surprised to learn that they will get better coverage for less money next year. Once the Healthcare.gov website is fixed, more people who have received letters from their insurance companies will get a similar pleasant surprise.
By: Wendell Potter, The Center for Public Integrity, November 12, 2013
“No Outside Commission Here”: Lara Logan Won’t Lose Her Job Because CBS Doesn’t Fear Liberals The Way It Fears Conservatives
In case you haven’t heard, CBS News is in a bit (but only a bit) of hot water over a story 60 Minutes recently aired about the attack on the American consulate in Benghazi. It centered on a breathless account from a security contractor, who just happened to have written a book about it being published by a conservative imprint of a publishing house owned by CBS (that’s synergy, baby). He told of the harrowing events of that night, including his own heroism and the spinelessness of the big shots who sit in their cushy offices while men of action like him do what must be done and get hung out to dry. The only problem was, he appears to be a liar who fabricated much of what 60 Minutes relayed in the story, which was reported by Lara Logan.
After insisting for weeks that everything in its story checked out, CBS finally conceded that the contractor, one Dylan Davies, was lying to them and through them to their audience. On Sunday night, Logan delivered an extraordinarily half-assed on-air apology, full of passive verbs and obfuscations plainly intended to minimize the whole thing; most critically, it gave no indication that CBS is going to make any effort to figure out why it happened. So who’s going to be punished for this enormous screw-up? I’ll tell you who: Nobody.
We’ll get to why in a moment. This incident has been compared to the one that occurred back in 2004, when Dan Rather aired a report on 60 Minutes II relying on documents purporting to show the steps taken by George W. Bush and his family to get him into the “Champagne Unit” of the Texas Air Guard so that he wouldn’t have to go to Vietnam, and documenting what he did and didn’t do once he got in. The documents proved to be forgeries (essentially an effort to frame a guilty man, but that’s a topic for another day), and the fallout was severe. 60 Minutes II was canceled, four producers were fired, and Rather himself, despite a storied decades-long career at CBS, was pushed out as well; he gave his last broadcast as anchor of the CBS Evening News in the spring of 2005 (here’s the whole story).
A lot of people thought it happened because Dan Rather was a liberal who was out to get Bush. There’s no doubt where Lara Logan stood on Benghazi; here’s a speech she gave in 2012, making clear her belief that investigations are for pussies and what the U.S. needed to do was start killing some people posthaste: “The last time we were attacked like this was the USS Cole, which was a prelude to the 1998 embassy bombings, which was a prelude to 9/11,” she said. “And you’re sending in FBI to investigate? I hope to God that you’re sending in your best clandestine warriors who are going to exact revenge and let the world know that the United States will not be attacked on its own soil, that its ambassadors will not be murdered, and the United States will not stand by and do nothing about it.” With the talk of “exact[ing] revenge,” Logan sounded less like a journalist who values the perception of fairness and objectivity and more like a right-wing radio host. But that doesn’t necessarily mean she was incapable of subsequently producing careful, accurate reporting on the topic. The problem is, she didn’t.
But Logan won’t get pushed out like Rather did. The first reason is that Rather was heading toward the end of his career; folks at CBS were already looking past him. Logan, on the other hand, is young, beautiful (this is television we’re talking about, after all), and perceived as a rising star. But much more important is that there was an organized campaign to get Rather, and there isn’t an organized campaign to get Logan, at least not one that CBS fears.
It’s true that Media Matters has been criticizing this story from the beginning, though it hasn’t actually called for Logan or anyone else to get fired (full disclosure: I worked at Media Matters from 2005 to 2009). But it’s basically alone. There aren’t Democratic senators holding hearings, there aren’t a hundred left-wing radio hosts drumming up outrage, and there’s little visible pressure coming from the White House to encourage heads to roll. In the case of the National Guard report, the conservative movement put on a top-to-bottom, full-court press to make sure Dan Rather was punished. They had hated him for years, and when they got their chance they did everything in their power to crush him.
The plain fact of it is that news organizations like CBS are afraid of the right, but they aren’t afraid of the left. Big media outlets like CBS are terrified of right-wing pressure campaigns, precisely because most journalists are, in fact, liberals. That doesn’t mean the news has a liberal bias (there are lots of biases in the news, and reporters injecting their ideological beliefs about policy into their stories is about the 20th most consequential), but it does mean that they’re overly sensitive about being called liberal. The way they usually handle that fear is to bend over backward to be contemptuous of Democrats and to take every opportunity they can to prove that they aren’t what conservatives say they are.
If Logan got fired for this—or if anybody got fired for this—well that would only be taken by the right as evidence that those liberals at CBS will do Barack Obama’s bidding. And that’s the last thing they want to be seen as doing. After the National Guard story, CBS went so far as to hire an outside commission to investigate; it produced a 224-page report on the matter, and all those people got fired, including the news division’s biggest star. Is it going to do anything similar with the Benghazi story debacle? I wouldn’t bet on it. More likely CBS is just going to say, we made some mistakes but it’s all in the past now, and we have full confidence in Lara Logan’s journalistic integrity and professionalism. Move along, nothing to see here.
By: Paul Waldman, Contributing Editor, The American Prospect, November 12, 2013
“This Is How Obamacare Works”: Listen Up Dipsticks, You Can’t Fix Health Insurance Without Changing Health Insurance
Bill Clinton has been one of Obamacare’s most effective advocates—the “Secretary of Explaining Things,” as President Obama famously called him. But in a new interview already getting attention and sure to get more, Clinton didn’t explain things very well. He made a statement that’s likely to create some misimpressions about the possibilities of health care reform, while giving the administration and its allies yet another political headache. But maybe it’s also an opportunity to have a serious conversation about the law’s tradeoffs—the one that should have happened a while ago.
In the interview, with Ozy Media, the former president fielded a question about the health care law. “The big lesson,” he said, “is that we’re better off with this law without it.” He went on to put the technological problems of healthcare.gov into some perspective: Medicare Part D had similar problems, he noted, “and they fixed it.” And he made a plea with Republican lawmakers to stop blocking the expansion of Medicaid. Fine, fine, and fine.
But then Clinton made news. He said that some young people facing higher premiums under the new system should have the right to keep their old plans, even if it requires a change in the law. Clinton framed it carefully: He said specifically he had in mind only those young people whose incomes were higher than four times the poverty line, making them ineligible for subsidies. (That’s about $45,000 for a single adult.) But he also suggested it was a matter of principle, because those people had heard the vow that they could keep their plans: “I personally believe, even if it takes a change to the law, the president should honor the commitment the federal government made to those people and let them keep what they got.”
Clinton’s statement makes it seem as if there is some simple way to let people keep their current plans—to avoid any disruption in the existing non-group market while still delivering the law’s benefits. As readers of this space know, no such magic solution exists. Broadly speaking, the Affordable Care Act seeks to make two sets of changes to what’s called the “non-group” market. It establishes a minimum set of benefits, which means everything from covering “essential” services to eliminating annual or lifetime limits on payments. At the same time, the law prohibits insurers from discriminating among customers: They can’t charge higher prices, withhold benefits, or deny coverage altogether to people who represent medical risks. They have to take everybody, varying price only for age (within a three-to-one ratio) and for tobacco use.
If you buy your own insurance now, it probably doesn’t live up to these standards. For starters, it probably isn’t as comprehensive as you think. It may not cover prescription drugs, for example, or it might leave out rehabilitative services and mental health. It might expose you to out-of-pocket expenses greater than $6,350 (if you have a single person’s policy) or a $12,700 (if you have a family policy). Until three years ago, when Obamacare’s first regulations went into effect, it was even possible the insurer could yank it retroactively—a process known as “rescission”—if you got sick and the carrier scrubbed your medical records for some previous sign of illness, maybe even one you didn’t know you had.
In addition, unless you live in a handful of states, the premiums you are paying come from insurers who knew, going in, they wouldn’t have to cover people who represent high medical risks. If the policy is affordable, that’s because the insurer figured you were pretty healthy and unlikely to have big medical bills. If you’ve had the policy for a while, and prices haven’t gone way up, that’s because the insurer is still making money from this arrangement—which means, overall, the people in this plan aren’t very sick. Until now, insurers have been able to hike premiums on plans that start to lose healthy customers, and they keep doing so until they become unaffordable—leaving those remaining subscribers unable to find new policies at affordable rates.
The Affordable Care Act includes a so-called grandfather clause. That allows insurers to keep renewing plans, without changes or benefits and prices, as long as they were available before March 2010, when the Affordable Care Act became law. But the non-group market is volatile: Very few people stay on plans for more than two years anyway. And the grandfather clause is narrow, by design: If insurers made even modest changes, the protection goes away. Those plans are subject to the new regulations that take effect in January. As a result, the majority of people who buy insurance on their own are learning they can’t have what they had before, even though Obama promised everybody they could. Either their premiums are going up, as insurers accommodate the new regulations, or the plans are disappearing altogether. In those cases, people have to find new plans. And the sticker price of what they’ll find is higher than what they pay now.
This is not a glitch or an accident. This is the way health care reform is supposed to work. And it’s important to put these changes into context. For one thing, it’s a small number of people relative to the population as a whole. The vast majority of Americans get coverage through employers or a large government program like Medicare. These changes don’t really affect them. The law also anticipates these changes by, among other things, offering tax credits that discount the premiums—in many cases, by thousands of dollars. (Other provisions of the law, like a limit on insurance company profits and overhead, should restrain prices more.) As a result, many people buying coverage on their own will be paying less money for benefits that are as good, if not better, than what they have now.
But there are real people who must pay more and, in some cases, put up with less. Some of them are people walking around with junk insurance, the kind are practically worthless because they pay out so little. Some of them are young people, particularly young men, whom insurers have coveted and wooed with absurdly low premiums—and make too much money to qualify for substantial subsidies. And some of them are reasonably affluent, healthy people with generous, open-ended policies that are hard to find even through employers. Insurers kept selling them because they could restrict enrollment to healthy people. Absent that ability, insurers are canceling them or raising premiums so high only the truly rich can pay for them.
Those people are the ones everybody is hearing about now, partly because they are a compelling, sometimes well-connected group—and partly because, absent a well-functioning website, stories of people benefitting from the law’s changes aren’t competing for attention. It’s impossible to know how big this group is. The data on existing coverage just isn’t that good. The anecdotes are frequently, although not always, more complicated than they seem at first blush. It’s probably one to two percent of the population, which doesn’t sound like much—except that, in a country of 300 million, that’s 3 to 6 million people. Most experts I trust think they represent a minority of people buying coverage on their own, but nobody can say with certainty.
Is that a worthwhile tradeoff for reform? Obviously that’s a matter of opinion. The fact that some people—even a small, relatively affluent group—are giving up something they had makes their plight (genuinely) more sympathetic. They are right to feel burned, since Obama did not make clear his promise might not apply to them. And there’s a principled argument about whether people should be responsible for services they’re unlikely to use presently, whether it’s fifty-something year olds paying for maternity care or twenty-something year olds paying for cardiac stress tests.
But the principle of broad-risk sharing—of the healthy subsidizing the sick, of the young subsidizing the old, and everybody paying for services like pediatrics and maternity care—is one built into the insurance most Americans already have. Employers, after all, don’t charge employees different premiums because of their age or gender. What’s more, the people with good, affordable coverage in the old non-group market were the beneficiaries of a system that marginalized many more. They were paying relatively cheap rates for insurance only because insurers trusted they were unlikely to get sick. Of course, some of them did get sick. And when it happened, many made an unpleasant discovery: The policies they carried left them exposed to huge bills. Giving up these plans isn’t merely an act of altruism. It’s also an act of enlightened self-interest.
Oddly, Clinton himself recognized this: In his soliloquy, he mentioned that a young man he met was upset at having to pay more for a plan—even though the young man knew it would help him more if he got sick. As Clinton surely knows, the whole point of reform—not just the pricing and benefit requirements, but also the individual mandate, which Clinton has repeatedly endorsed—is that people need to take steps to protect themselves against future hardship.
Rhetorically, Clinton’s statement actually isn’t that different from what Obama said in his interview with NBC’s Chuck Todd the other night—that he’d like to find a way to let more people keep their coverage. But it wouldn’t be easy to do. Attempting to rewrite the grandfather clause, so that it applies to more existing plans, could cause insurers to raise prices in 2014 for 2015. It’s also not clear that insurers could or would quickly renew existing policies at existing prices. Clinton mentioned specifically that something should be done only for those people facing higher prices—another echo of Obama’s statement. But distinguishing between groups wouldn’t be easy.
Maybe there’s some muddled, half-solution that will ease the transition without causing real damage. Or maybe there’s some brilliant administrative or legislative fix the experts can’t see. But absent an infusion of extra money—say, to create some kind of transitional assistance fund—any effort to slow changes to the non-group market might not just stop the bad things from happening. It might also stop the good. The latter might outweigh the former, by quite a lot.
You wouldn’t know it from all the press, but Obamacare actually disrupts very little relative to what it accomplishes. The problem is that eliminating disruption altogether simply isn’t possible. You can’t fix health insurance without changing health insurance. And there are bound to be some people for whom that change isn’t good. Those trade-offs should be clear. Maybe now they are.
By: Jonathan Cohn, The New Republic, November 12, 2013
“And This Too Shall Fail”: The GOP Wants To Solve Its “Woman Problem” By Rebranding Its War On Women
Three women in Virginia have started a consulting firm to help the Republican party appeal to women voters, which seems like it will be a real challenge since the Republican party is terrible on the issues that many women care about.
The women behind the firm — two Mitt Romney 2012 campaign alums and a Republican pollster — launched Burning Glass Consulting because they “want to get smarter about how we communicate the Republican message specifically to women,” Katie Packer Gage, a former deputy campaign manager for Romney, explained to the New York Times. “Certainly there are challenges with other demographic groups, but women represent 53 percent of the electorate.”
But better messaging will do little to save the party from its core platform, which the Times frames as an opinion held only by Democratic strategists, but really just seems like common sense. The GOP has for years been buttering its bread with increasingly extreme positions on contraception, abortion, voting rights and other issues that negatively impact and alienate single women voters — the group Burning Glass would most like to reach.
“There were something like 53 million unmarried women eligible to vote in 2012, but on campaigns you don’t hear a specific strategy discussed of ‘How are we going to reach unmarried women?’” said Gage.
The firm seems to think that Democrats have just gotten very good at framing the Republican party as hostile to women, which misses the point that the Republican party is actually very hostile to women.
When you have the chair of the Republican Women’s Policy Committee laughing on Fox News about how women should have to shoulder the financial burden of maternity coverage alone because a man “has never delivered a baby,” you know the problem isn’t about messaging.
When you have a state attorney general wondering aloud why God hasn’t punished the United States for guaranteeing women their constitutional right to abortion care, you know the problem isn’t about messaging.
As Cecile Richards, president of Planned Parenthood Federation of America noted last week after single women helped defeat Ken Cuccinnelli in Virginia, “The lesson for candidates in 2014 is unmistakable: Dismiss and demean women at your peril.”
By: Katie McDonough, Salon, November 12, 2013
“No Health Insurance, Just Drink”: Koch Brothers Generation Opportunity Campaign Against Obamacare Is Insanely Irresponsible
This is the strangest P.R. campaign yet against the Affordable Care Act. Generation Opportunity, the Koch-funded group behind the Creepy Uncle Sam ads, is throwing tailgate parties to “educate” young people about the exchanges. Read: To convince young people to forgo health insurance.
The group’s communication director, David Pasch, wrote an email to The Tampa Bay Times describing a drunken event at Saturday’s University of Miami-Virginia Tech football game:
“We rolled in with a fleet of Hummers, F-150’s and Suburbans, each vehicle equipped with an 8’ high balloon bouquet floating overhead. We hired a popular student DJ from UMiami (DJ Joey), set up OptOut cornhole sets, beer pong tables, bought 75 pizzas, and hired 8 ‘brand ambassadors’ aka models with bullhorns to help out.”
Mr. Pasch specified that “student activists,” rather than anyone employed directly by Generation Opportunity, “brought (lots of) beer and liquor for consumption by those 21 and over.”
As a sort of afterthought, he added, “Oh yeah, and we educated students about their healthcare options outside the expensive and creepy Obamacare exchanges.”
According to Think Progress, this isn’t a one-time thing: “The group is touring 20 different campuses this fall in a $750,000 effort to convince college students that they’re better off being uninsured than getting health coverage through Obamacare.”
That’s a lot of money for a campaign that’s not only insanely irresponsible, but also insanely dumb. Generation Opportunity is the old guy at a house party, convinced he can win the cool kids’ respect with booze.
By: Juliet Lapidos, Editors Blog, The New York Times, November 11, 2013
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