“Surprise, Surprise”: The Real Numbers On ‘The Obamacare Effect’ Are In, Now Let The Crow Eating Begin
After years of negative speculation on the part of the opponents of Obamacare, hard data is finally coming in with respect to the anticipated negative side-effects of the law.
The results are guaranteed to both surprise and depress those who have built their narrative around the effort to destroy the Affordable Care Act.
Let’s begin with the meme threatening that healthcare reform will lead to a serious decline in full-time employment as employers reduce workforce hours to below 30 per week in the effort to avoid their responsibility to provide health benefits to their employees.
It turns out that there has, in fact, been no such rush to reduce work hours. Indeed, numbers released last week reveal that precisely the opposite is taking place.
According to the Bureau of Labor Statistics (BLS), the number of part-time workers in the United States has fallen by 300,000 since March of 2010 when the Affordable Care Act was passed into law. What’s more, in the past year alone—the time period in which the nation was approaching the start date for Obamacare—full-time employment grew by over 2 million while part-time employment declined by 230,000.
And it gets even more interesting.
Despite the cries of anguish over the coming destruction of private sector work opportunities at the hands of Obamacare, it turns out that the only significant ‘cutter’ of work hours turns out to be in the public sector where cops, teachers, prison guards and the like are experiencing cuts in work time as cities, states and universities seek to avoid the obligations of the health reform law.
Correct me if I am wrong, but is it not the very same folks who strenuously oppose Obamacare who are constantly screaming for smaller government? Are these not the same people who have, for as many years as I can recall, been carping about swollen government payrolls?
But the false narrative that has been peddled to make us believe that the private sector can’t wait to lower our hours of employment turns out not to be the only false note being played by anti-Obamacare forces.
For months now, we have been pounded with the story of the millions of Americans who have lost their non-group, individual health insurance policy due to cancellations forced by Obamacare.
Yet, a new study just out by Lisa Clemons-Cope and Nathaniel Anderson of the Urban Institute tells a very different story.
How many times have readers, along with television and radio audiences, read or heard me point out that few ever expected to hang onto their individual insurance policy for longer than a year or two following date of purchase? Long before there was Obamacare, it was always clear that when someone purchased an individual health instance policy, it was pretty much a given that they would either be moving on to an employer provided group plan when they get a job or that their policy would respond to the ordinary, pre-Obamacare changes that occurred from year to year and result in the consumer having to purchasing a new plan after a short period of time.
Indeed, it was this very reality that made it clear to those who follow the health insurance industry that Obama’s “If you like your policy you can keep your policy” proclamation was a near impossibility for those participating in the individual marketplace. This simply wasn’t the way the individual market worked.
The Urban Institute study bears this out, noting that “the non-group market has historically been highly volatile, with just 17 percent retaining coverage for more than two years.”
While Obamacare foes have been quick to jump on this statistic when it comes to condemning the President for uttering his promise that you could keep your insurance if you are happy with your policy, the same people have somehow managed to miss the reality that a huge percentage of those who received cancellation notices last year were going to get that notice even if the Affordable Care Act had never existed.
But that is not all that critics have been missing as they’ve sought to exploit the supposed high number of cancellations they claim are due to Obamacare.
To find out just how many people have really been put into an insurance fix, the Urban Institute’s Health Reform Monitoring Survey, in December of 2013, asked people between the ages of 18 and 64 the following question:
“Did you receive a notice in the past few months from a health insurance company saying that your policy is cancelled or will no longer be offered at the end of 2013?”
The following bar published in Health Affairs provides the results—
Note that the number of people who saw their policy cancelled because it did not meet the Obamacare minimum requirements was 18.6 percent—dangerously close to the 17 percent of individual policyholders who were losing their individual market policies pre-Obamacare.
Also note that the 18.6 percent equates to roughly 2.6 million people whose plans were cancelled as a result of Obamacare—a number well below the estimates of 5 million or considerably more being tossed about by Obamacare opposition.
So, what happens to these folks who saw their health insurance policy cancelled?
According to the Urban Institute researchers :
“While our sample size of those with non-group health insurance who report that their plan was cancelled due to ACA compliance is small (N=123), we estimate that over half of this population is likely to be eligible for coverage assistance, mostly through Marketplace subsidies. Consistent with these findings, other work by Urban Institute researchers estimated that slightly more than half of adults with pre-reform, nongroup coverage would be eligible for Marketplace subsidies or Medicaid.”
So what does this data tell us?
As a result of at least half of those cancelled being able to either enroll in a Medicaid program or receive subsidies on the healthcare exchanges, many—if not most—will now find health care coverage at a price lower than previously paid while greatly improving the quality of coverage.
Still, roughly one million people will have to replace their cancelled policy with something that may cost them more. This is not a good thing but it is far, far less dramatic than what we’ve been hearing. It is also a part of the expected upheaval that has always—and will always—result from the passage of reforms designed to benefit the greatest number of people. Traditionally, those who are disadvantaged in this way find that things are sorted out in amendments to the initial legislation, amendments that can only result when Republicans in Congress stop playing politics and begin the serious work of making the law better for Americans.
There is another problem noted in the study—
Because of the amount of focus placed on scaring the you-know-what out of people when it comes to the alleged dire effects of Obamacare rather than educating them, people remain in the dark as to what is available on the exchanges or via the state Medicaid programs.
Per the Urban Institute study—
“Yet making the best enrollment choice may be difficult for consumers. HRMS findings show that many people are not aware of the new state Marketplaces, few know whether their state is expanding Medicaid, and many lack the confidence to enroll, make choices, and pay their premiums.”
Once again, politics trumps policy and the critical needs of those our elected officials are sworn to serve.
I highly encourage everyone—whether friend or foe of healthcare reform—to take a look at the study cited above and the BLS statistics. While most all would agree that there are some repairs that need to be made to the Affordable Care Act, workable fixes designed to benefit the public and improve American healthcare cannot happen so long as politicians, pundits and special interests are devoted to lying about what Obamacare means and what it does not mean to the American public.
Facts matter—even when they screw up an effective disinformation campaign.
UPDATE: Monday, 12:15pm EST:
The news just keeps on coming.
The Gallup-Healthways Well-Being Index is out this morning and reveals that 15.9 percent of American adults are now uninsured, down from 17.1 percent for the last three months of 2013 and has shown improvements in every major demographic group with the exception of Hispanics who did not advance.
That translates roughly to 3 million to 4 million people getting coverage who did not have it before.
According to Gallup, the number of Americans who still do not have health insurance coverage is on track to reach the lowest quarterly number since 2008.
This is one statistic that is going to be tough for Obamacare critics to overcome.
By: Rick Ungar, Op-Ed Contributor, Forbes, March 10, 2014
“Let Them Eat Dignity”: Conservatives Assure The Poor That The Health Of Their Souls Demands They Go Hungry
A few days ago, Paul Ryan got caught repeating a little fib in his speech at the Conservative Political Action Conference. It was of a not-uncommon type, in which a vivid anecdote somebody hears from somewhere gets told and retold in a game of political telephone in which the facts get mangled and the story from elsewhere becomes something the speaker claims happened to her. We can forgive Ryan for repeating it, since the falsehood didn’t originate with him. But the real power of the story lies in its revelation of the cruelty that underlies the way contemporary American conservatives look at the poor, and the wispy veil they try to pull over that cruelty in the hopes we won’t see it for what it is.
To start, here’s the story Ryan told, about Eloise Anderson, who directs the Wisconsin Department of Children and Families:
She once met a young boy from a very poor family, and every day at school, he would get a free lunch from a government program. He told Eloise he didn’t want a free lunch. He wanted his own lunch, one in a brown-paper bag just like the other kids. He wanted one, he said, because he knew a kid with a brown-paper bag had someone who cared for him. This is what the left does not understand.
As the Washington Post‘s Glenn Kessler explained, though Anderson indeed told this story at a congressional hearing, it actually didn’t happen to her, but came from a book (which she later admitted). More important, she changed the story to make it more closely fit conservative ideology; in real life, the child in question wasn’t getting a lunch from the government, but from a rich lady he met; and more important, it wasn’t that he didn’t want a free lunch, he just wanted his free lunch in a paper bag so the other kids wouldn’t know he was getting help. That’s an old story about poverty and shame—a relationship, by the way, that conservatives work hard to maintain.
But here’s the part of Ryan’s speech that really matters: “The left is making a mistake here,” he said. “What they’re offering people is a full stomach and an empty soul.” And later: “People don’t just want a life of comfort. They want a life of dignity.” Ah yes, the “life of comfort” you get when you are able to eat not one, not two, but as many as three meals a day! Talk about easy street.
Whenever conservatives start throwing around ideas like “dignity” and talking about the contents of people’s souls, watch out. Because it almost always means that what they’re proposing is to make the lives of the vulnerable a little tougher and a little more deprived. This’ll hurt you more than it hurts them.
And that is indeed what Ryan proposes. The last budget plan he released, like those before it, sought to cut hundreds of billions of dollars from Medicaid, food stamps, and other programs that provide assistance to the poor—because as Ryan once said, “we don’t want to turn the safety net into a hammock that lulls able-bodied people to lives of dependency and complacency, that drains them of their will and their incentive to make the most of their lives.”
I suspect conservatives talk this way as much for their own benefit—for the maintenance of their souls, if you will—as for the poor people they’re ostensibly addressing. Almost all of us, with the exception of a few true-believing Ayn Rand cultists, believe that we have obligations to one another, no matter how selfish we might be on most days. If you’re literally taking food from the mouths of hungry children, you have to justify it somehow, to assure yourself that you’re still a moral person. So you tell yourself that you’re doing it to help them. You’re giving them something more valuable than food, because you care so deeply about them. When that six-year-old gets that grumble in her stomach, you can tell her what she’s feeling is the growing pains of her soul, as it swells with its newfound dignity.
The souls of the wealthy, on the other hand, are apparently so healthy and strong they can withstand the indignity of government help. Special tax treatment for investment income? The mortgage interest deduction? Cuts to upper-income tax rates? The rich are truly blessed with souls so resilient that they remain intact even in the face of such injuries of government largesse.
But that’s the way it is with everything. Conservatives are not worried that hedge-fund managers will be slowly sapped of their will to work when their income is taxed at an absurd 15 percent rate because of the carried interest loophole, leaving the rest of us to pick up their slack. When they address that question, there is no talk of dignity. Only when it comes time to cut food stamps or kick people off of the first health insurance they’ve ever had (as Ryan also wants to do, by eliminating the Affordable Care Act’s expansion of Medicaid) do conservatives turn so philosophical, casting their gaze beyond the trivialities of daily existence, like food, and toward such higher considerations.
If you were being unkind, you might say that when it comes to poor people’s dignity, the right has mostly been concerned of late in seeing that they have as little as possible, by advocating things like forcing people to take drug tests before getting welfare benefits. Perhaps they believe that a combination of hunger and humiliation will be just the encouragement those lazy poor need to take a firm hold of their bootstraps and pull. True, that expression originally meant doing something that is physically impossible—you can tug on your bootstraps all you like, but it won’t pull you out of a hole. You will be carried aloft by your soul, though, so long as it isn’t sullied by safety net programs.
This, in the end, is the essence of conservative thought on these issues. Better a child should go hungry than get a free lunch. Better a poor person should have no health insurance at all than get insurance from the government. Their suffering may multiply, but they’ll still have their dignity. If only you could eat it.
By: Paul Waldman, Contributing Editor, The American Prospect, March 10, 2014
“The Last Rural Abortion Clinics In Texas Just Shut Down”: Back-Alley Procedures Are About To Become A Lot More Common
Since November, the last abortion clinics in East Texas and the Rio Grande Valley, some of the poorest and most remote parts of the state, have been hanging on by their fingernails. The two clinics, both outposts of a network of abortion providers called Whole Woman’s Health, stayed open with slimmed-down staffs while their owner, Amy Hagstrom Miller, struggled to comply with the first chunk of HB2—the voluminous anti-choice law passed by the Texas legislature last summer—which requires abortion doctors to obtain admitting privileges at a local hospital. Today, after weeks of failed negotiations with nearby hospitals, Hagstrom Miller announced that both clinics are closing their doors.
The clinics in Beaumont, about an hour east of Houston, and McAllen, just north of the Mexico border in the Rio Grande Valley, were the last rural abortion providers left in Texas. Between July, when HB2 passed, and November, when the admitting privileges requirement went into effect, nearly half of the state’s 44 abortion clinics folded, unable to comply with the new rules. The health center in McAllen stopped offering abortions and pared down its staff, providing ultrasounds and counseling to the women who continued to walk in the door and helping them coordinate travel to the nearest clinic, two hours north in Corpus Christi. The Beaumont clinic survived this initial purge because one of its physicians had admitting privileges, but he’s in his seventies and wants to retire. His colleagues couldn’t get privileges in his stead, leaving the clinic in a precarious position.
“I had to come to terms with the fact that those clinics had no future,” Hagstrom Miller says. She might have kept looking for a way to keep them open, if she wasn’t facing a much bigger threat. In September, the rest of HB2 will go into effect, requiring all abortion providers to conform to the same standards as ambulatory surgical centers (ASCs), outpatient care units that offer more complicated procedures, usually involving high levels of anesthesia. Only one of Hagstrom Miller’s remaining three clinics, the Whole Woman’s Health in Fort Worth, qualifies as an ASC. Updating the other two clinics to comply with ASC regulations—which include wider hallways and specialized heating and cooling systems—could cost $6 million.
The Corpus Christi clinic (which isn’t one of Hagstrom Miller’s) also has until September to renovate. If that clinic closes, Rio Grande residents will have to embark on a five-hour trek to San Antonio. Women in Beaumont won’t have as far to drive, but they will have to make multiple trips. Under Texas law, women seeking an abortion must obtain a sonogram from the doctor who will be performing the procedure at least 24 hours ahead of time. If you live more than 100 miles from the clinic, you’re exempt from the law. Unfortunately for Beaumont women, their town is a mere 90 miles from the nearest abortion provider in Houston.
For many women, a long drive, an overnight stay, and a few days off work are a substantial burden, but not impossible. For the residents of the Rio Grande Valley, though, these new hurdles could make abortion as difficult to obtain as if it were illegal. McAllen is one of the poorest cities in the country, second only to Brownsville, another town nearby. Last fall, Sarah Posner documented some of the barriers that keep women in the Rio Grande from accessing basic reproductive healthcare like birth control. Unpaved roads, erratic electricity, and poor sanitation are common in the surrounding communities. Few of the Rio Grande’s residents have jobs with sick leave. By Hagstrom Miller’s estimate, around one-third of her patients are undocumented immigrants who can’t drive beyond the border checkpoints north of McAllen without risking deportation.
Rather than waiting for months to scrape together the money for the procedure and the trip—a Sisyphean task in itself, since the price for abortion skyrockets from as little as $300 in the first trimester to several thousand dollars by the end of the second—more women may take matters into their own hands. The Rio Grande Valley already has one of the highest rates of self-induced abortion in the country. A 2012 survey found that 12 percent of women in clinics near the Mexico border said they had attempted to end their pregnancy on their own before seeking professional help. “They’re getting drugs from Mexico, drinking teas, eating herbs, falling down the stairs on purpose or convincing their boyfriends to beat them up,” Hagstrom Miller says. “Any of those methods could be fatal.”
The problem is compounded by the Texas legislature’s decision, in 2011, to slash funding for family planning services. Dan Grossman, the vice president for research at Ibis Reproductive Health, a pro-choice think tank, has been investigating the effects of these cuts as co-principal investigator of the Texas Policy Evaluation Project at the University of Texas-Austin. In a 2012 survey of women seeking abortions, nearly half of the respondents said they hadn’t been able to obtain their preferred form of birth control in the past three months. “The cuts in family planning are leading to a rise in unintended pregnancy and an increased demand for abortion,” Grossman says. “More clinic closures means that women will have to wait longer to get the procedure, which means a higher risk of complications.”
In 2013, 38 percent of people living in the Rio Grande Valley were uninsured. When state-funded family planning clinics in the region folded, poor women lost their only source of affordable birth control. Now, some may be getting access to contraception once again, thanks to the rollout of Obamacare. But Texas’s refusal to participate in Medicaid expansion means that many Rio Grande residents will fall into the “coverage gap”—earning too much to be covered under Medicaid but too little to qualify for insurance tax credits—and won’t be able to get the no-cost birth control promised by the Affordable Care Act. Others are undocumented and unable to buy insurance on the exchanges.
Long wait times for appointments will undoubtedly become the norm. By next fall, when the ASC requirement kicks in, six clinics in major urban centers—Houston, Austin, San Antonio, Dallas, and Fort Worth—could be responsible for performing more than 70,000 abortions each year. Hagstrom Miller and others are fundraising to help poor women pay for transportation to these cities, but for many, a trip to Mexico to buy illegal abortion drugs might seem like a better bet.
By: Amelia Thompson-Deveaux, The American Prospect, March 6, 2014
“Liberty, Equality, Efficiency”: What’s Good For The “One-Percent” Isn’t Good For America
Most people, if pressed on the subject, would probably agree that extreme income inequality is a bad thing, although a fair number of conservatives believe that the whole subject of income distribution should be banned from public discourse. (Rick Santorum, the former senator and presidential candidate, wants to ban the term “middle class,” which he says is “class-envy, leftist language.” Who knew?) But what can be done about it?
The standard answer in American politics is, “Not much.” Almost 40 years ago Arthur Okun, chief economic adviser to President Lyndon Johnson, published a classic book titled “Equality and Efficiency: The Big Tradeoff,” arguing that redistributing income from the rich to the poor takes a toll on economic growth. Okun’s book set the terms for almost all the debate that followed: liberals might argue that the efficiency costs of redistribution were small, while conservatives argued that they were large, but everybody knew that doing anything to reduce inequality would have at least some negative impact on G.D.P.
But it appears that what everyone knew isn’t true. Taking action to reduce the extreme inequality of 21st-century America would probably increase, not reduce, economic growth.
Let’s start with the evidence.
It’s widely known that income inequality varies a great deal among advanced countries. In particular, disposable income in the United States and Britain is much more unequally distributed than it is in France, Germany or Scandinavia. It’s less well known that this difference is primarily the result of government policies. Data assembled by the Luxembourg Income Study (with which I will be associated starting this summer) show that primary income — income from wages, salaries, assets, and so on — is very unequally distributed in almost all countries. But taxes and transfers (aid in cash or kind) reduce this underlying inequality to varying degrees: some but not a lot in America, much more in many other countries.
So does reducing inequality through redistribution hurt economic growth? Not according to two landmark studies by economists at the International Monetary Fund, which is hardly a leftist organization. The first study looked at the historical relationship between inequality and growth, and found that nations with relatively low income inequality do better at achieving sustained economic growth as opposed to occasional “spurts.” The second, released last month, looked directly at the effect of income redistribution, and found that “redistribution appears generally benign in terms of its impact on growth.”
In short, Okun’s big trade-off doesn’t seem to be a trade-off at all. Nobody is proposing that we try to be Cuba, but moving American policies part of the way toward European norms would probably increase, not reduce, economic efficiency.
At this point someone is sure to say, “But doesn’t the crisis in Europe show the destructive effects of the welfare state?” No, it doesn’t. Europe is paying a heavy price for creating monetary union without political union. But within the euro area, countries doing a lot of redistribution have, if anything, weathered the crisis better than those that do less.
But how can the effects of redistribution on growth be benign? Doesn’t generous aid to the poor reduce their incentive to work? Don’t taxes on the rich reduce their incentive to get even richer? Yes and yes — but incentives aren’t the only things that matter. Resources matter too — and in a highly unequal society, many people don’t have them.
Think, in particular, about the ever-popular slogan that we should seek equality of opportunity, not equality of outcomes. That may sound good to people with no idea what life is like for tens of millions of Americans; but for those with any reality sense, it’s a cruel joke. Almost 40 percent of American children live in poverty or near-poverty. Do you really think they have the same access to education and jobs as the children of the affluent?
In fact, low-income children are much less likely to complete college than their affluent counterparts, with the gap widening rapidly. And this isn’t just bad for those unlucky enough to be born to the wrong parents; it represents a huge and growing waste of human potential — a waste that surely acts as a powerful if invisible drag on economic growth.
Now, I don’t want to claim that addressing income inequality would help everyone. The very affluent would lose more from higher taxes than they gained from better economic growth. But it’s pretty clear that taking on inequality would be good, not just for the poor, but for the middle class (sorry, Senator Santorum).
In short, what’s good for the 1 percent isn’t good for America. And we don’t have to keep living in a new Gilded Age if we don’t want to.
By: Paul Krugman, Op-Ed Columnist, The New York Times, March 9, 2014
“The Winds Are Shifting”: How Corporate America Is Losing The Debate On Taxes
If there is one clear loser in President Obama’s budget this year, it’s U.S. multinationals.
With six new ideas designed to plug some major leaks in the tax code, the 2015 budget proposes a total of more than $276 billion in higher taxes on overseas earnings for U.S. multinationals over the next decade, about $120 billion more than last year’s budget. (A sample of the policy just to give you an idea of how deep in the guts the administration is going: “Create a new category of Subpart F income for transactions involving digital goods or services.”)
So much for the White House’s attempts to strike common ground with big company chief executives, who have been howling for years about paying too much in taxes with the federal corporate tax rate at 35 percent. The companies have also poured money into an endless parade of coalitions with names like ACT, RATE, WIN, TIE AND LIFT.
The trouble with the executives’ complaints is that many companies don’t pay nearly the 35 percent rate. GE, for instance, in its most recent annual filing said it paid an effective tax rate of 4.2 percent. (See this graphic we ran last year showing taxes paid by companies in the Dow 30.) These firms insist that the high rate is merely forcing them to find complex ways to lower their tax bills. But with this budget, it’s clear the administration isn’t buying it.
“The problem is not an international tax system that unacceptably handicaps U.S. businesses,” said Ed Kleinbard, a professor at the University of Southern California’s Gould School of Law who has done extensive research on the way companies shuffle their income overseas to lower their tax bills. “Instead the problem is an international tax system both in the United States and other countries that U.S. multinational firms have demonstrated they are highly skilled at gaming.”
The president’s budget is the latest sign for corporate tax lobbyists that the winds are perhaps shifting against them. Last month’s tax reform plan from House Ways and Means Chairman Dave Camp (R-Mich.) also included a number of ideas unpopular with business, including a bank tax. His section on international tax reform was somewhat more generous to big firms, giving them a lower rate on overseas earnings with anti-abuse measures that Kleinbard says don’t go far enough.
Of course, expectations are low that either the president or Camp’s policies will ever make the leap to reality. But after spending hundreds of millions of dollars on lobbyists, corporate America is not exactly seeing its worldview reflected in these blue prints.
By: Jia Lynn Yang, WonkBlog, The Washington Post, March 5, 2014
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