“A Gaping Wound In The Republican Psyche”: Obamacare Is No Longer Doomed, It Will Become A Scandal
Obamacare — actual, real, Obamacare, with doctors and cards and everything — has been operational for nearly a week now. It has been … extremely boring. It does not look like Stalinist collectivization. There aren’t even any beheadings. It looks like regular medical insurance, except several million more people now have it than before.
How conservatives will respond next to this mundane new world has become the subject of combative speculation. Greg Sargent predicts Republicans will soon come to terms with the law and begin negotiating for incremental improvements. On the right, Conn Carroll angrily replies that the law’s demise remains “inevitable” and liberals will turn against the law, citing Michael Moore as a harbinger of pro-single-payer liberals who will help Republicans dismantle Obamacare, somehow.
I predict a slightly different outcome than either. Obamacare will neither collapse, nor will Republicans accept its legitimacy, but the nature of their opposition will instead slowly morph. Gleeful predictions of imminent collapse will give way to bitter recriminations at the nefarious tactics used to make the law work. Obamacare will cease to be the something certain to destroy Obama and become something Obama has gotten away with.
In recent weeks, it has begun to dawn on some conservatives that the actuarial death spiral they confidently predicted for years — in which the young and healthy shun the exchanges, leading to sicker and costlier patients and rising prices, in turn driving out the remaining healthy customers — may not actually transpire. It won’t for several reasons, one of them being a set of protections embedded in the law itself called risk corridors and reinsurance, which compensate insurance companies that wind up with a sicker customer base in the first three years of the law’s operation, thus preventing a death spiral.
Republicans, having just learned of these provisions, demand that they be abolished, to hasten the death spirals. Repentant immigration reformer Marco Rubio is at the forefront with a bill to strike them from the law. Obviously Obama would never sign such a bill, but Charles Krauthammer offers a solution: demand he sign it or else refuse to lift the debt ceiling. The program is “a huge government bailout,” argues Krauthammer. This is true in the sense that any cost overrun by a defense contractor is also a huge government bailout — which is to say, it’s not true.
But it feels true, and that is the important thing. The premise that Republicans will seek to alter Obamacare in conservative-friendly ways assumes that the policy design of health-care law is their primary motivating force. Everything about the history of Republican health-care thought suggests the opposite. Just five years ago, Mitt Romney was running on a platform of taking his Massachusetts plan, with its individual mandate, national, provoking only the mildest grumbling on the right.
Obamacare is a gaping wound in the Republican psyche, representing not only the rise of a majority moocher class but a potential symbol of a successful Obama presidency. Health-care reform, George F. Will has ludicrously if representatively declared, amounts to Obama’s “single” achievement. If it lives, it will vindicate his presidency as a liberal Reagan, rather than the reprise of Jimmy Carter (or George W. Bush) Republicans wish him to be.
If and when the law melds into the national fabric, the proximate Republican response will not be to adapt their policy ideas to it, but to denounce it as a kind of stolen law. You can see this spirit creeping out not only in Rubio’s proposal but elsewhere. Eleven Republican attorneys general have denounced Obama’s various administrative maneuvers to make the law functional as illegal. “It was powerful corporate America, with its influential lobbyists, that got an additional year to meet the insurance mandate — when individuals did not,” complains The Wall Street Journal columnist Kimberly Strassel, “It was the unions that got a reprieve from a health-insurance tax — when individuals and small businesses were left to pick up the tab.” The hapless Obamacare is slowly giving way to the devious Obamacare.
In the very long run, Obamacare may become a thing, like Social Security and Medicare, that Republicans initially predict will destroy the fabric of capitalism but eventually accept and then finally swear up and down they will not harm. In the shorter term, it will remain a bloody shirt. Obamacare will be Benghazi or the IRS scandal writ large.
By: Jonathan Chait, Daily Intelligencier, New York Magazine, January 5, 2014
“Can A Cure Be Found For Obamacare Brain Meltdown Syndrome?”: Putting The Lie To The Anti-ACA Talking Heads
As we launch into 2014, I must regrettably report that we have yet to develop a vaccine or cure that can assist those who have contracted the insidious Obamacare Brain Meltdown Syndrome (OBMS)–a tragic illness affecting roughly 50 percent of Americans who now lack all ability to review ACA data with any measure of balance and reason.
While we await the critically needed medical advances and discoveries that can bring relief to the afflicted—assuming such a program has not been ground into the dust as a result of sequestration cuts to medical research—we continue in the attempt to bring actual data to the attention of the long-suffering, in the hope that the rumors, half-truths and outright lies can be retired through the presentation of the facts.
One of the more pervasive rumors, half-truths and outright lies making the rounds these days is the meme that more people have lost their insurance as a result of Obamacare than have gained coverage thanks to healthcare reform.
As the story goes, some five million people have had their insurance cancelled because of the ACA while the numbers of those who have gained coverage currently stands somewhere around two million—and we don’t even know how many of those who have enlisted will actually bother to pay the first premium for their newly acquired insurance policy. Based on these numbers the math is simple—the law has hurt three million more than it has helped.
This line of reasoning makes for a terrific story as it is a tale both easy to understand and clear in its result.
The problem is, the story is clearly not true.
A report out this week from the Minority Staff of the House Committee on Energy and Commerce reveals that 99.8 percent of those who received an insurance cancellation can now either re-up their existing plans for another year, as a result of the changes made in recent weeks, or, alternatively, obtain a catastrophic coverage policy. As a result of these changes, the report finds that about 10,000 Americans —representing 0.2 percent of those who received cancellation notices—will actually find themselves without access to an affordable health insurance alternative.
That said, I recognize that the report was issued by the Democrats on the committee— making the study something less than the best possible authority for those suffering from OBMS. I also recognize that 10,000 people lacking the access they once had to affordable health care insurance are 10,000 people too many.
Accordingly, let’s just pretend that the Minority staff report never happened and that we are still working off the suggestion that five million people really have been left fully exposed as the metric that should be used for comparison.
With that as our comparison point, surely the argument suggesting that Obamacare has hurt more Americans than it has helped can be justified, yes?
Actually, no.
In fact, based on the hard data, we are now able to see that at least 9.4 million Americans have health insurance coverage as a result of Obamacare.
Let’s go to the numbers—
We know that approximately 2.1 million people have purchased a health insurance policy from either a health care exchange operated by the federal government or from one of the 14 state operated exchanges. Indeed, even the harshest ACA critics appear to have accepted this number—although they insist on noting that, somehow, many of these people went to the trouble of buying a policy but will refuse to pay the first premium by January 10th, as required.
While I don’t doubt that there will be a few purchasers who will fall into this category, it would require the most extreme case of Obamacare Brain Meltdown Syndrome to imagine that the number of those who went to the bother of signing up—but won’t pay up—will be statistically significant.
Next, I remind you that, as of November 30, 2013, 3.9 million new participants were enrolled in Medicaid as a result of the program’s expansion. These are 3.9 million who were not previously qualified. As reported by Michael Hiltzik over at the Los Angeles Times and Josh Marshall—using the data that has been compiled by Charles Gaba who has been carefully tracking the Obamacare math (I strongly recommend you review Mr. Gaba’s spreadsheet) since the beginning—the number of Medicaid sign-ups through the end of the year have now risen to a total of 4.3 million.
As you add up these numbers, you quickly arrive at 6.4 million Americans who now have insurance as a direct result of the ACA—a number, while in excess of the 5 million allegedly left without insurance coverage as a result of Obamacare, thereby disproving the meme—does not equal the 9.4 million Americans being served by Obamacare that I suggested earlier.
Clearly, this can only be the math of an Obama loving liberal, yes?
Or might you be missing something? Might that something be the roughly 3 million young Americans who have yet to reach 26 years of age who remain on their parents’ health insurance policy thanks to Obamacare?
Because this provision has been in effect for a few years, those afflicted with OBMS have managed to simply erase this number from their minds as if these young Americans either do not exist or simply do not “count”.
They very much do count as, prior to the ACA, these were precisely the people who were among the least likely to purchase a health insurance policy yet, thanks to the law, now have healthcare insurance. They are also the people who add the badly needed healthy participants to the insurance pools.
Add these people to the mix and you reach 9.4 million Americans with insurance as a result of the Affordable Care Act.
What’s more, the number is probably higher given that that we are not taking into consideration those who are purchasing their individual Obamacare policies off the exchanges by going to their insurance agent or directly to their insurance company. These are the folks who are not qualified for subsidies and, therefore, have no reason to deal directly with the exchange if they choose not to do so.
None of this data, by the way, proves that Obamacare is necessarily working. As I have long noted, success is far more tied to the composition of the insurance pools resulting from the ACA (the ratio of healthy to unhealthy) than it is tied to the raw number of sign-ups. This is data we do not yet have.
What this data does prove is that there are clearly far more Americans benefitting from Obamacare than those who are claimed to be losing coverage as a result of the law. The data also highlights that those with Obamacare Brain Meltdown Syndrome must fight through the fog that has descended upon them and try to face up to the actual numbers as, only then, can we continue a rational conversation about this law.
Until we find that cure for OBMS, we can only hope that those afflicted with this tragic illness will turn to that famous old saw that instructs, “then you will know the truth and the truth will set you free.”
By: Rick Ungar, Op-Ed Contributor, Forbes, January 4, 2014
“The Scourge Of The Wingnut Hole”: Coverage Totals Would Be Far Greater If Not For “Red” States Refusing Medicaid Expansion
We have a reasonably good sense of how many Americans have enrolled in the health care system in recent months, signing up for coverage made available through the Affordable Care Act. For a more ambitious tally, Josh Marshall includes exchanges, Medicaid, young adults staying on their family plans, and those who were able to bypass exchanges to buy ACA-compliant policies directly from insurance carriers, for a grand total of about 10 million.
But every time these numbers are culled, it’s worth remembering that the coverage totals would be far greater were it not for “red” states refusing to accept Medicaid expansion.
The original plan, you’ll recall, was to simply mandate the greater access. The U.S. Supreme Court, however, said states must have a choice as to whether or not to accept the good deal. Most Republican-led states, naturally, rejected the policy, leaving millions behind for no particular reason.
But how many million? The Associated Press published a report this week with a striking figure.
About 5 million people will be without health care next year that they would have gotten simply if they lived somewhere else in America.
They make up a coverage gap in President Barack Obama’s signature health care law created by the domino effects of last year’s Supreme Court ruling and states’ subsequent policy decisions.
This coverage gap clearly needs a name. Ed Kilgore started calling it the “wingnut hole” months ago, and it’s certainly a descriptive phrase. Ryan Cooper added the other day:
It’s worth remembering that the federal government will pay 100 percent of the cost of the Medicaid expansion through 2016 and 90 percent of the cost afterward. It could very well work out that refusenik states will not even save money because of additional spending on the uninsured in emergency rooms and elsewhere.
But regardless of the pitiful sums involved, make no mistake: This action is utterly gratuitous.
Quite right. In fact, as we’ve discussed many times, Republicans at the state level who refuse Medicaid expansion generally struggle to explain their position in any kind of coherent way.
What’s more, let’s not forget the irony of the larger context: congressional Republicans spent most of their waking hours complaining about a sliver of the population receiving “cancellation notices” through the Affordable Care Act because of changes to the individual market. Indeed, GOP officials routinely claim this will leave 5 million Americans behind with nothing (a total that appears to have been exaggerated by a factor of 500).
And yet, if their concern were genuine, wouldn’t Republicans necessarily be outraged by these 5 million Americans who are suffering because some red-state policymakers are acting out of petty partisan spite?
By: Steve Benen, The Maddow Blog, January 3, 2014
“A Million Here, A Million There”: Millions Of People Have Health Insurance Thanks To Obamacare
The big number in the news this week was 1.1 million – the number of people who signed up for health insurance through Obamacare’s federal insurance marketplace this year. This is an important figure, especially given the fact that it stood at little more than 100,000 at the end of November.
Nevertheless, that 1.1 million figure dramatically understates what the Affordable Care Act has already accomplished. The number we should be talking about is at least 9 million and could be 14 million people who are currently getting coverage under the law.
How many people are currently covered through the law? Start with the 1.1 million who have gotten care through the federal website. If you layer on the number of enrollees who have gotten coverage through state-run exchanges that number tops 2.1 million, Secretary of Health and Human Services Kathleen Sebelius announced Tuesday. Then throw in the 3.9 million people who have gotten health coverage under Obamacare’s Medicaid expansion. Oh and don’t forget about the young adults under 26 who are still covered by their parents’ health insurance plans thanks to the Affordable Care Act. A year-and-a-half ago, the Department of Health and Human Services put the number at 3.1 million but an August study by the Commonwealth Fund, a private foundation that focuses on health policy research, estimated that the figure had reached 7.8 million. Total those numbers and you get a minimum of 9 million Americans covered through Obamacare and a maximum of nearly 14 million.
To borrow Everett Dirksen’s old adage: A million here, a million there, and pretty soon you’re talking about real coverage. This is why Wisconsin Sen. Ron Johnson told the New York Times last week that the Affordable Care Act is “no longer just a piece of paper that you can repeal and it goes away. … We have to deal with the people that are currently covered under Obamacare.”
To be sure there are provisos and qualifications. Obamacare critics will point out that some number of those insured are only replacing coverage they lost thanks to the law disqualifying their plans (of course that will require those same critics to acknowledge that very few of the people losing their health coverage are now bereft); and in the context of 50 million uninsured it’s only a start – but it is a start. And while I’m writing this in the waning hours of 2013, it doesn’t take a great feat of prognostication to know that the first days of 2014 may well bring another round of Obamacare horror stories as people find out that they don’t have coverage they thought they signed up for. The October website disaster’s effects are still being felt – the administration had been aiming for 3.3 million signups by now, for example, so the 2 million figure is well short.
The law’s well-publicized stumbles have certainly taken their toll in polls. Finally clear of its shutdown self-immolation, the GOP seems to be building its 2014 strategy around Obamacare’s flaws. “Ideally, we’d freeze things the way they are in amber until November,” a senior House Republican aide told Time’s Jay Newton-Small last month.
But putting aside for a moment the fact that 11 months is an age and a day in politics, there’s a fundamental flaw in this GOP calculus: Obamacare’s not the cutting issue they seem to think it is. Democratic pollsters Stan Greenberg, James Carville and Erica Seifert surveyed the 86 most competitive House districts and found that the country remains deeply divided on the Affordable Care Act. “Health care is not a wedge issue,” they concluded.
The right’s problem is that it fixates on approval-disapproval numbers without digging into them. So while a CNN/ORC poll conducted in mid-December found that 35 percent favor the law and 62 percent oppose it, only 43 percent oppose the law because it’s too liberal; if you add the 35 percent who favor the law to the 15 percent who dislike it because they wish it did more, the GOP 2014 game plan becomes more puzzling. An early December New York Times/CBS News poll tells the same story: 50 percent oppose the law while only 39 percent approve. But only 42 percent think the law goes too far while a total of 50 percent think it either doesn’t go far enough or is just right.
Those are the figures right now. But in February of last year, the Congressional Budget Office estimated that 7 million people would be covered this year through the exchanges. Is that figure realistic? The Washington Post’s Obamacare guru, Sarah Kliff, reported this week that the health research firm Avalere Health estimated what the pace of enrollments should look like, modeling it off of the 2006 Medicare drug program rollout. Their guess for Obamacare was 2.4 million people by the end of 2013, making the 7 million target plausible.
One factor which will help? The health insurance industry is going all-in on the law. As the Wall Street Journal reported last month, health insurers are fighting for these millions of new customers. The Journal suggested that insurers will spend $500 million on local TV ads in 2014. Here’s my favorite part of the article: “The ad campaigns are a major shift in strategy for health insurers, most of whom have never really had to market directly to consumers aggressively until now.” It’s the free-market flipside of Obama’s infamous promise: If you don’t like your insurer, you don’t have to keep it. A full fight for customers could help the law reach the 7 million mark – bringing the total number of people insured under it to nearly 20 million.
Is the GOP really going to spend the fall campaigning to take health care away from nearly 20 million people?
By: Robert Schlesinger, U. S. News and World Report, January 3, 2014
“The Fight Is History, Done, Finito”: The Affordable Care Act Is Here To Stay
Now that the fight over Obamacare is history, perhaps everyone can finally focus on making the program work the way it was designed. Or, preferably, better.
The fight is history, you realize. Done. Finito. Yesterday’s news.
Any existential threat to the Affordable Care Act (ACA) ended with the popping of champagne corks as the new year arrived. That was when an estimated 6 million uninsured Americans received coverage through expanded Medicaid eligibility or the federal and state health insurance exchanges. Obamacare is now a fait accompli; nobody is going to take this coverage away.
There may be more huffing, puffing and symbolic attempts at repeal by Republicans in Congress. There may be continued resistance and sabotage by Republican governors and GOP-controlled state legislatures. But the whole context has changed.
Now, officials in states that refused to participate in Medicaid expansion will have to explain why so many of their constituents — about 5 million nationwide — remain uninsured when they could have qualified for coverage. More than 1 million of these needlessly uninsured Americans live in Texas, which is targeted by Democrats as ripe for inroads because of its rapidly changing demographics. Will Gov. Rick Perry (R) be forced to reconsider his Obamacare rejectionism? Or will he ultimately be remembered for speeding the state’s transition from red to blue?
Performance of the federal insurance exchange Web site, HealthCare.gov, will continue to improve, if only because the initial flood of applicants is bound to subside. Meanwhile, insurance costs and benefits in states that refused to set up their own exchanges will be compared with those in states that did. There will be questions about how the new law is performing — but no one will be able to pretend it does not exist.
And we will surely hear more stories about individuals taking advantage of the law’s consumer benefits, especially the fact that preexisting conditions can no longer be used to deny coverage. This is life-changing for insurance seekers who suffer from chronic illnesses such as diabetes or who have survived cancer.
Opponents of the law can hardly advocate going back to a system in which those who really need insurance can’t get it. What they can do, and surely will, is make lots of noise by pretending that any problem with anyone’s health insurance is due to the Affordable Care Act. Before Obamacare, millions of Americans had their policies canceled by the insurance companies every year. Millions more had their premiums raised, their coverage reduced or both. Now when these things happen, critics will try to blame the new law.
Increasingly, though, the GOP will sound foolish and irrelevant if it continues to put all of its eggs in the “repeal and replace” basket. The problem is that the Affordable Care Act is a set of free-market reforms based on ideas developed in conservative think tanks. Republicans who want to repeal Obamacare would have to replace it with something suspiciously similar.
If Republicans in Congress would work with the administration to make technical corrections to the Affordable Care Act, they could claim a victory of sorts: Obama gave you this mess and we cleaned it up. But after demonizing the program — and the president — for so long, the party has painted itself into a corner.
Note to the GOP: “We refuse, under any circumstances, to make the law work better for the citizens we represent” is perhaps not the ideal campaign slogan for the midterm election.
The real problem with the ACA, and let’s be honest, is that it doesn’t go far enough. The decision to work within the existing framework of private, for-profit insurance companies meant building a tremendously complicated new system that still doesn’t quite get the job done: Even if all the states were fully participating, only about 30 million of the 48 million uninsured would be covered.
But Obamacare does establish the principle that health care is a right, not a privilege — and that this is true not just for children, the elderly and the poor but for all Americans.
Throughout the nation’s history, it has taken long, hard work to win universal recognition of what we consider our basic rights. Perhaps future legislation will expand and streamline the ACA reforms until everyone is covered. Or perhaps we’ll move toward a single-payer system, possibly by expanding Medicare and Medicaid until they meet in the middle.
I don’t know how we’ll get there, but we’re now on the road to universal health care. There’s no turning back.
By: Eugene Robinson, Opinion Writer, The Washington Post, January 3, 2014
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