“The GOP Blocking Of Medicaid Expansion”: The Huge Obamacare Story You Aren’t Reading About That Could Help Even More People
Today it’s a few hundred thousand people. By next year, it will be at least a few million. Their health insurance status is changing dramatically: What they have in 2014 and beyond will look nothing like what they had in 2013 and before. For many of these people, the difference will be hundreds or even thousands of dollars a year. In a few cases, it may be the difference between life and death.
You probably think I’m talking about the people getting cancellation notices about their private insurance policies. I’m not. I’m talking about the people getting Medicaid. Both stories are consequences of the Affordable Care Act. But one is getting way, way more attention than the other.
It’s no mystery why. Stories of people losing something are more compelling than stories of people gaining something. The policy cancellation story is also newsier, because fewer people expected it to happen. Obamacare’s expansion of Medicaid was something the advocates of reform advertised. Reform’s effect on people with skimpy or medically underwritten insurance policies they liked was something that few advocates, including the president, even acknowledged. Had Obama pointed out, all along, that some people might lose existing plans or pay more for coverage in 2014, it would seem a lot less shocking.
But there is also a class element to the way this debate has evolved. By and large, the people receiving those cancellation notices and facing large premium increases are at least reasonably affluent. They’re not necessarily rich, particularly if they live in higher cost areas of the country. Many of them sweat monthly bills just like most of the country does. But, by definition, they don’t qualify for huge subsidies that would offset premium increases mostly or completely. By contrast, the people getting Medicaid are poor. They have to be, because it’s the only way to sign up for the program. And as political scientists have shown, the poor don’t command the same kind of attention from politicians that the middle class—and particularly the upper middle class—does.
And this fact, I suspect, is also magnifying the impact of those cancellation letters. The best estimates suggest that 12 to 15 million people currently buy coverage on their own—i.e, in what’s known as the non-group market. It appears that only a fraction of them will get to keep their current policies. The rest will end up having to get new coverage, or updated versions of their old coverage, that offers greater benefits and/or is available to everybody, regardless of pre-existing condition. That will drive up the price of insurance.
But when you take into account the subsidies, which for many people will knock the price of insurance right back down, and the number of people who would gladly pay more for insurance that offers real protection from financial shock, the number of people who truly end up feeling worse off ends up a lot smaller than 12 or 15 million. And even those people will end up with good health insurance, though they’ll be paying more for it and may not want it.
Meanwhile, the best available projections suggest that 13 million people will eventually sign up for Medicaid. That’s a much larger number of people, most of whom had no insurance—none—before. That doesn’t even include more than ten million presently uninsured people expected to get insurance through employers and the new marketplaces, assuming all of the websites start working better, or the millions of seniors getting extra help with their prescrpition drugs.
Of course, the story of the Medicaid expansion is also one of suffering. But that’s because Republicans governors and lawmakers are blocking expansion of Medicaid in their states. About 5 million people who would be eligible for Medicaid under Obamacare’s new guidelines won’t be getting it. Here’s a mental exercise. How many stories have cable news and the networks run about people with private insurance getting cancellation notices? And how many have they run about people who would be getting Medicaid if only their state lawmakers would stop blocking expansion?
You can find examples. My colleague Alec MacGillis has waged a lonely crusade to remind people about this situation. The New York Times had a terrific front-page story on this in early October. In the Washington Post, Ruth Marcus on Friday wrote about Paul Tumulty, in Texas, who can’t get insurance because Governor Rick Perry has blocked that state’s Medicaid expansion. Tumulty, who is the brother of Post staff writer Karen, has kidney disease. Wiithout Medicaid he can’t get comprehensive coverage, because, as Karen put it, “he is, paradoxically, too poor for subsidies.”
But these articles are the exception more than the rule. Obama tried to draw attention to the issue last week, when he visited Texas. But the trip didn’t generate much in the way of new coverage of Medicaid.
Should the president have been more candid about the impact his plan would have on people buying their own coverage? Yes. Should we pay attention to those people, particularly when they must now pay more for equivalent coverage? Definitely. Should this put extra pressure on the administration and some states to fix their websites? You bet. But that’s not the only Obamacare news right now. The law is making life better for a great many people—and would help even more if only Republican lawmakers would relent. Those stories need attention, too.
By: Jonathan Cohn, the New Republic, November 10, 2013
“Why Isn’t Everyone More Worried About Me?”: Maybe The Most Ridiculous Obamacare “Victim” Story Yet
Apparently, there was a meeting of the editors at The New York Times op-ed page in which someone said, “You know how every time someone does a story about one of these Obamacare ‘victims’ whose insurance companies are cancelling their plans, it turns out they could do really well on the exchange, but no one bothers to check? We should get one of them to write an op-ed, but not bother to ask what options they’ll have.” And then someone else responded, “Right, don’t bother with the fact-checking. But we need a new twist. What if we find someone who’ll complain that the problem with Obamacare is that other people care too much about poor people and the uninsured, while what they ought to be doing is spending more time liking her Facebook post about her possibly increased premiums?” The editors looked at each other and said, “That’s gold. Gold!”
And this was the result. Written by Lori Gottlieb, a Los Angeles psychotherapist and author, it relates how she got a cancellation letter from Anthem Blue Cross and was offered a plan for $5,400 more a year, then had a frustrating phone call with the company. Did she go to the California health exchange and find out what sorts of deals would be available to her? Apparently not. She took Anthem at their word—you can always trust insurance companies, after all!—then took to Facebook, where she “vented about the call and wrote that the president should be protecting the middle class, not making our lives substantially harder.”
And here’s where our story takes a shocking turn. Instead of expressing what she felt was the appropriate sympathy, those 1,037 people on Facebook she thought were her friends but turned out just to be “friends” had the nerve to point out that the Affordable Care Act will help millions of previously uninsured and uninsurable people get coverage. Gottlieb was disgusted with these people she termed the “smug insureds.” And none of them even “liked” her post!
Like Bridget Jones’s “smug marrieds,” the “smug insureds” — friends who were covered through their own or spouses’ employers or who were grandfathered into their plans — asked why I didn’t “just” switch all of our long-term doctors, suck it up and pay an extra $200 a month for a restrictive network on the exchange, or marry the guy I’m dating. How romantic: “I didn’t marry you just to save money, honey. I married you for your provider network.”
Along with the smug insureds, President Obama doesn’t care much about the relatively small percentage of us with canceled coverage and no viable replacement. He keeps apologizing while maintaining that it’s for the good of the country, a vast improvement “over all.”
And the “over all” might agree. But the self-employed middle class is being sacrificed at the altar of politically correct rhetoric, with nobody helping to ensure our health, fiscal or otherwise, because it’s trendy to cheer for the underdog. Embracing the noble cause is all very well — as long as yours isn’t the “fortunate” family that loses its access to comprehensive, affordable health care while the rest of the nation gets it.
The truly noble act here is being performed by my friend Nicole, who keeps posting Obamacare fiasco stories on my Facebook page, despite being conspicuously ignored, except for my single “like.” It’s the lone “like” that falls in the forest, the click nobody wants to hear.
How terribly smug, to think that the fate of millions of poor people who will now get insurance is as important as the suffering of this one person who might have to pay more for comprehensive coverage, and also happens to have access to The New York Times where she can air her grievances! If only it weren’t so “trendy to cheer for the underdog.”
It’s one thing to feel your own problems more acutely than those of other people, even millions of other people, even many whose problems make yours look trivial by comparison. We all do that, and we could barely function if we didn’t. It’s quite another thing to expect that other people will see your problems as more important than those of millions. I sprained my ankle a few weeks ago, and I’ll admit that in the time since I’ve given more thought to my ankle’s recovery than I have to the 660,000 people who die every year from malaria. But if I asked you why you aren’t thinking more about my ankle than you are about malaria, you’d wonder if it was my brain that I had sprained.
I imagine that after her disappointment at the response to her Facebook post, Gottlieb will be even more disappointed with the response to her op-ed explaining her disappointment with the response to her Facebook post. So if she wants to feel better, the first thing she ought to do is go to the exchange and she what her options are. There’s almost certainly something better than the plan her insurance company is trying to get her to buy. And then she can go to Facebook and ask her “friends” to celebrate her good fortune.
By: Paul Waldman, Contributing Editor, The American Prospect, November 11, 2013
“60 Minutes, 90 Seconds”: CBS News, Lindsey Graham And The Exploitation Of Fools Gold
The 90-second “apology” aired on 60 Minutes last night for the shabby reporting and conflicts of interest associated with Lara Logan’s Benghazi! report two weeks ago was, quite literally, the least CBS and its beleaguered reporter could do. Here’s the story , via the New York Times‘ Stelter and Carter:
Ms. Logan said that Dylan Davies, one of the main sources for a two-week-old piece about the attack on the American diplomatic mission in Benghazi, Libya, had misled the program’s staff when he gave an account of rushing to the compound the night the attack took place. “It was a mistake to include him in our report. For that, we are very sorry,” Ms. Logan said.
The apology lasted only 90 seconds and revealed nothing new about why CBS had trusted Mr. Davies, who appeared on the program under the pseudonym Morgan Jones. Off-camera, CBS executives were left to wonder how viewers would react to the exceptionally rare correction.
HuffPost’s Jack Mirkinson summarized the reaction of media critics as notably unimpressed:
Predictably, her Sunday mea culpa offered little insight into why Davies was chosen as the key source for the report, and why “60 Minutes” had so fervently defended him, even amid mounting evidence of his unreliability. Also unmentioned was what role, if any, corporate ties played in placing Davies at the heart of the piece. A conservative imprint of Simon and Schuster, which is also owned by CBS, had published a book about Benghazi by Davies. That book has since been recalled.
The lack of investigative zeal exhibited by this showcase of investigative journalism–before, during and after the episode aired–is interesting. You almost wonder if the folk at CBS aren’t smirking behind their hands that they’ve finally managed to get the ancient “liberal bias” monkey off their backs in one fell swoop.
Unfortunately, a messed-up report that raises more questions than it answers provides still more cannon-fodder for congressional Republicans, particularly Sen. Lindsey Graham, who seems about ten minutes away from threatening a fresh government shutdown if he doesn’t get everyone’s attention when he regales South Carolina conservatives with his latest “investigations” of Benghazi!
As WaPo’s Emily Heil notes:
The South Carolina Republican’s umbrage was apparently inspired by a segment he’d caught on “60 Minutes” featuring a man claiming to be an eyewitness to the violence. But on Friday, CBS reporter Lara Logan retracted the story, explaining that she and her team had been duped by a source in whom they no longer “had confidence.”
Graham isn’t walking back on the pledge to hold up President Obama’s nominees, though. Like a bell that can’t be un-rung, he said Sunday on CNN’s “State of the Union,” nothing’s changed.
Of course not. Graham’s exploitation of the fool’s gold of Benghazi! will never end until he was won renomination in 2014 or is finally dragged out the Senate kicking and screaming. But Logan and 60 Minutes have, I am sure, earned his undying gratitude for making the subject topical again.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, November 11, 2013
“What’s The Matter With Motherhood?”: Hey Conservatives, Health Coverage Including Maternity Care Is A Right-To-Life Issue
If you’re a conservative strongly opposed to abortion, shouldn’t you want to give all the help you can to women who want to bring their children into the world? In particular, wouldn’t you hope they’d get the proper medical attention during and after their pregnancy?
This would seem a safe assumption, which is why it ought to be astonishing that conservatives are positively obsessed with trashing the Affordable Care Act’s regulation requiring insurance policies to include maternity coverage.
Never mind that we who are lucky enough to have health insurance end up paying to cover conditions we may never suffer ourselves. We all want to avoid cancer, but we don’t begrudge those who do get it when the premiums we pay into our shared insurance pools help them receive care.
Yet critics of Obamacare apparently think there is something particularly odious when a person who might not have a baby pays premiums to assist someone who does. It’s true that men cannot have babies, although it is worth mentioning that they do play a rather important role in their creation. In any event, it is hardly very radical to argue that society is better off when kids are born healthy to healthy moms.
Yet the conservatives’ ire over this issue knows no bounds.
“And so what if a health policy lacks maternity care?” wrote Deroy Murdoch on National Review’s Web site , the italics on that impatient “so what” being his. “Not all women want to bear more children — or any children at all. . . . And how about lesbians who do not want kids, and are highly unlikely to become pregnant accidentally?” It’s touching, actually, to see such concern for lesbians in a conservative publication. Behold the miracles Obamacare already has called forth.
On “Fox News Sunday” this month, host Chris Wallace was very worked up as he pressed Zeke Emanuel, a former health-care adviser to President Obama, over how unfair it is that a single woman with a 24-year-old son would be forced to pay for such coverage. “She’s not going to have any more children,” Wallace said with great certainty. “She’s not going to need maternity services.”
Writing on the FreedomWorks Web site, Julie Borowski declared, unhappily: “Maternity coverage will be mandatory — even for men. . . . Adding coverage for things that some people do not want will only increase insurance costs for everyone .”
Well, not exactly. But you get the drift. Who knew that supporting motherhood was suddenly controversial?
All of which ought to present members of the right-to-life movement with a challenge. In the name of consistency, they need to break with their conservative allies and insist that maternity coverage be included in all health-care plans. Shouldn’t those who want to prevent abortion be in the forefront of making the case that a woman will be far more likely to choose to have her baby if she knows that both she and her child will get regular medical attention?
For too many politicians on the right, what they say about abortion is at odds with what they say about so many other issues. They speak with great concern and compassion for the unborn, and I respect that. You don’t have to support making abortion illegal to think that there are too many of them in the United States.
To their great credit, some right-to-lifers really do follow the logic of their position and support expanded health coverage, food stamps, the Women, Infants and Children feeding program and other measures that help parents after their kids are born. This reflects a consistent ethic.
But many other conservatives would make abortion illegal and leave it at that. Thus we have the spectacle in Texas of right-wing politicians trying to make it as difficult as possible for a woman to obtain an abortion while proudly blocking the state’s participation in the expansion of Medicaid to cover the near-poor. Does it serve the cause of life to keep more than 1.8 million Texans from getting health insurance?
President Obama apologized last week after all the criticisms of what’s happening in the individual insurance market. But where is the outrage over governors and legislators flatly cutting off so many lower-income Americans from access to Medicaid? The Urban Institute estimates that 6 million to 7 million people will be deprived of coverage in states that are refusing to accept the expansion.
If health coverage — yes, including maternity care — isn’t a right-to-life issue, I don’t know what is.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, November 10, 2013
“Why I Still Support Obamacare”: A Health Care Safety Net Under The Majority Is Morally Right And In The Interest Of A Stable Society
At the recent New York Times forum in Singapore, Eleonora Sharef, a co-founder of HireArt, was explaining what new skills employers were seeking from job applicants, but she really got the audience’s attention when she mentioned that her search firm was recently told by one employer that it wouldn’t look at any applicant for a marketing job who didn’t have at least 2,000 Twitter followers — and the more the better. She didn’t disclose the name of the firm, but she told me that it wasn’t Twitter.
At a meeting with students at Fudan University in Shanghai a few days earlier, I was struck by how anxious some of the Chinese students were about the question: “Am I going to have a job?” If you’re a software engineer in China, you’ll do fine, also a factory worker — but a plain-old college grad? The Times reported earlier this year that in China today “among people in their early 20s, those with a college degree were four times as likely to be unemployed as those with only an elementary school education.”
Stories like these explain why I really hope that Obamacare succeeds. Say what?
Here’s the logic: The Cold War era I grew up in was a world of insulated walls, both geopolitical and economic, so the pace of change was slower — you could work for the same company for 30 years — and because bosses had fewer alternatives, unions had greater leverage. The result was a middle class built on something called a high-wage or a decent-wage medium-skilled job, and the benefits that went with it.
The proliferation of such jobs meant that many people could lead a middle-class lifestyle — with less education and more security — because they didn’t have to compete so directly with either a computer or a machine that could do their jobs faster and better (by far the biggest source of job churn) or against an Indian or Chinese who would do their jobs cheaper. And by a middle-class lifestyle, I don’t mean just scraping by. I mean having status: enough money to buy a house, enjoy some leisure and offer your kids the opportunity to do better than you.
But thanks to the merger of globalization and the I.T. revolution that has unfolded over the last two decades — which is rapidly and radically transforming how knowledge and information are generated, disseminated and collaborated on to create value — “the high-wage, medium-skilled job is over,” says Stefanie Sanford, the chief of global policy and advocacy for the College Board. The only high-wage jobs that will support the kind of middle-class lifestyle of old will be high-skilled ones, requiring a commitment to rigorous education, adaptability and innovation, she added.
But will even this prescription for creating enough jobs with decent middle-class incomes suffice, asks James Manyika, who leads research on economic and technology trends at the McKinsey Global Institute. While these prescriptions are certainly “correct,” notes Manyika, they “may not be enough to solve for the scale and nature of the problem.” The pace of technologically driven productivity growth, he said, suggests that we may not need as many workers to drive equivalent levels of output and G.D.P.
As the M.I.T. economists Erik Brynjolfsson and Andrew McAfee show in their book “Race Against the Machine,” for the last two centuries productivity, median income and employment all rose together. No longer. Now we have record productivity, wealth and innovation, yet median incomes are falling, inequality is rising and high unemployment remains persistent.
To be sure, notes Manyika, a similar thing happened when we introduced technology to agriculture. We did not need as many people to produce food, so everybody shifted to manufacturing. As the same thing happened there, many people shifted to services.
But now, adds Manyika, “a growing share of high-paying services and knowledge work is also falling prey to technology.” And while new companies like Twitter are exciting, they do not employ people with high-paying jobs in large numbers. The economy and the service sector will still offer large numbers of jobs, but many simply may not sustain a true middle-class lifestyle.
As a result, argues Manyika, how we think about “employment” to sustain a middle-class lifestyle may need to expand “to include a broader set of possibilities for generating income” compared with the traditional job, with benefits and a well-grooved career path. To be in the middle class, you may need to consider not only high-skilled jobs, “but also more nontraditional forms of work,” explained Manyika. Work itself may have to be thought of as “a form of entrepreneurship” where you draw on all kinds of assets and skills to generate income.
This could mean leveraging your skills through Task Rabbit, or your car through Uber, or your spare bedroom through AirBnB to add up to a middle-class income.
In the end, this transition we’re going through could prove more exciting than people think, but right now asking large numbers of people to go from being an “employee” to a “work entrepreneur” feels scary and uncertain. Having a national health care safety net under the vast majority of Americans — to ease and enable people to make this transition — is both morally right and in the interest of everyone who wants a stable society.
By: Thomas L. Friedman, Op-Ed Columnist, The New york Times, November 10, 2013
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