“What A Shocker”: Obamacare Is Working Best In States That Aren’t Trying To Sabotage It
The disappointing Affordable Care Act (ACA) numbers the Department of Health and Human Services (HHS) released on Wednesday revealed that the law is working best in the states that are — shockingly — implementing the law as it was designed.
Of the 106,185 people who have completed an application for health insurance, nearly 75 percent came from 14 states and the District of Columbia that both set up their own exchanges and expanded Medicaid.
Unsurprisingly, California and New York combined for the bulk of the enrollments, 51,769. But the most promising news from the Golden State wasn’t even included in this report.
Peter Lee, the executive director of Covered California, reported Wednesday that as of Tuesday, 60,000 Californians had signed up for insurance. Signups have increased to a rate of almost 2,500 enrollees per day in November. At that pace, the state could be expected to enroll 402,500 people by March 31 but Lee says that he expects to hit a goal of 500,000 to 700,000 people by then, which means he expects the pace to pick up by at least 640 people a day to over 3,000 enrollees.
Lee’s optimism is linked to more than the enrollment numbers. It seems California’s consumers are happy with the state’s website.
“Overall, nearly 70 percent of consumers who completed the survey found the application process easy to complete, and 88 percent of customers visiting CoveredCA.com found the information needed to choose a health plan that was right for them,” Covered California reported in a statement released Wednesday, giving Republicans another reason to hope that California isn’t a bellwether for the rest of the nation.
Red Kentucky is the only state in the union that voted for Mitt Romney and set up its own exchange, thanks in large part to Democratic governor Steve Beshear. The state’s site signed up a total of 32,485 Kentuckians, with 5,586 enrolling in private plans, in its first month of operation. This reduces the state’s uninsured population —estimated at 640,000 — by just over 5 percent.
Of course, it’s not hard for the states to look impressive next to the federal number that is anemically low. And not all the states that set up their own exchanges have succeeded. Oregon’s marketplace is so flawed, they didn’t even have numbers to report for October.
Implementing health care reform was never supposed to be easy.
“It’s like fixing an airplane while it’s in flight, if there is something terribly wrong with the plane,” said Timothy Jost, a health law professor at Washington & Lee University and an expert on the ACA.
And that’s without the unprecedented campaign of sabotage the right has waged. But the obstruction that has threatened the law most has been the combination of a mostly unforced error — Healthcare.gov’s disastrous launch — and Republican states refusing to launch their own exchanges. While the right is thrilled they’ve assisted in this catastrophe, it was the ancillary result of another sabotage strategy that was either masterminded or enthusiastically encouraged by Michael Cannon.
Who?
“Cannon is a health care policy expert at the libertarian Cato Institute,” reports The New Republic‘s Alec MacGillis. “He is also an avowed opponent of the Affordable Care Act, and has for several years now been embarked on a legal crusade that, while a ways from triumphing, may have inadvertently played an outsized role in suppressing the number of states setting up their own exchanges, thereby greatly confounding the law’s implementation.”
Cannon believes he has found a loophole in the law that could end up undoing it in any state that didn’t set up an exchange. With that in mind, he helped successfully convince every state with a Republican governor to reject their right to build their own site.
By opting out, states made the success of the president’s signature legislative accomplishment dependent on one single portal that needed to reach its tentacles into three dozen complex insurance markets at one time.
That — it turns out — is a lot more complicated than the administration expected it to be.
The best state numbers show that the ACA can be implemented with participation rates that are in at least in the same ballpark as Massachusetts’ Romneycare or Medicare Part D.
And there were some other numbers in the HHS report that bode well for reform.
HHS reports that 26,876,527 different users accessed the site and 3,158,436 calls were made to its center. A total of 1,477,853 applications processed to the point of where eligibility could be determined. This shows that the demand for what the marketplace is offering definitely exists.
Clearly and undeniably, the fate of the law now depends most on one thing.
“The October report is clearly disappointing,” Timothy Jost wrote in his blog. ”But the really important reports will be the December report, which will tell us how many will be enrolled for coverage that begins in January, and the March report, which will tell us how many will be enrolled for 2014. If healthcare.gov is up and running by December, there is every reason to believe those reports will be much more promising.”
By: Jason Sattler, The National Memo, November 14, 2013
“What Will Republicans Do?”: Here Comes The Real Government Takeover Of Health Care
For the last few weeks, Republicans have been full of schadenfreude over President Obama’s broken “If you like your plan, you can keep it” promise.
Now, this issue is about to blow up in Republicans’ faces.
Sen. Mary Landrieu (D-La.), who faces a tough re-election fight in a red state next year, has introduced a bill to address the president’s broken promise through greater government control over the individual health insurance market. Her bill would obligate insurers to continue offering all the plans they offer today unless they entirely exit the health insurance business in a state.
What will Republicans do with this proposal? Do they really want a federal law that says health insurers can’t enter or exit specific lines of business?
Rep. Fred Upton (R-Mich.) has introduced a bill in the House that would allow insurers to continue offering plans that would have been prohibited under the Affordable Care Act, but his bill is vulnerable to the criticism that it will still lead to a raft of plan cancellations as insurers choose to discontinue plans because the ACA has changed the financial incentives they face.
If Congress really wants to make sure people can take their plans, it will need to use the heavy-handed Landrieu approach; the light-touch Upton approach won’t work. Erick Erickson (of all people!) understands this; he wrote a piece this morning called “It’s a trap“:
The House, with the help of a good number of Democrats, will pass the Upton plan and send it to the Senate. Harry Reid will substitute the Landrieu plan and send it back to the House. The House will be forced to either vote for the Landrieu plan or be characterized as siding with insurance companies against people.
In one fell swoop, the Democrats will have the GOP on record saving Mary Landrieu’s re-election in Louisiana by casting her as the one who saved Americans’ health care plans, and also getting on record as really being in favor of fixing Obamacare with the use of mandates.
Pretty much. And it’s the comeuppance conservatives are getting for (1) having no health care agenda of their own and (2) endorsing the bizarre idea that health reform should not lead to health plan changes. With no health policy guidestar other than they’re against what the president is for, Republicans are liable to walk into traps like demanding more health insurance regulation than the president wants.
By: Josh Barro, Business Insider, November 13, 2013
“What A Terrible Thing To Do To People”: Republican Attacks On Obamacare Are Turning Into An Argument Against Repeal
If health insurance isn’t important, why would receiving a letter telling you that you need to change your plan be a tragedy that can get you on Fox News nearly immediately?
Republicans have seized on the millions of cancellations of current plans happening as a result of the Affordable Care Act remaking the individual insurance market, which currently offers the worst customer satisfaction of any type of health coverage.
By glorifying these “horror” stories, which have often turned out to be overinflated at worst and actual Affordable Care Act (ACA) success stories at best, Republicans are sending a clear message to Americans: We must defend the sanctity of health insurance.
This powerful theme is extremely opportune, as long as cancellation notices are contradicting a promise the president made, Healthcare.gov is flagging and the ACA’s paid enrollment numbers are low. However, it becomes much more complicated as the site starts working and 2014 begins with millions of people enjoying health care coverage and subsidies that the GOP would be voting to take away.
This would effectively doom the “repeal” strategy Republicans have fixated on for years, argues Salon’s Brian Beutler:
Obamacare is driving policy cancellations right now, but it at least creates a coverage guarantee for those affected. Repeal without replace would impose a greater burden without providing any counterweight.
If they pass the Keep Your Health Plan Act this week, House Republicans will see their stylized sympathy for people whose policies have been canceled come into tension with their explicit desire to take Obamacare benefits away from many of the same people, and millions more.
Becoming the party that opposes all cancellations of insurance policies also completely undermines any Republican “plan” that might be an alternative to the ACA. “Such a starting position would make true market-oriented reform impossible,” explains The Washington Examiner‘s Philip Klein.
John McCain’s health care plan, one part of his platform conservatives love, would have ended health care tax exemptions for employers and employees. This would have likely resulted in millions and millions of Americans ending up in new plans. The Republican Study Committee has offered a “serious” Obamacare alternative that would try to end the system of employer-based health care, disrupting the current health care system far more than the ACA does.
Even as Republicans are vindictively leaping on any cancellation story, other right-wing groups are trying to spread the idea to people in their 20s to optout of the ACA, even though millions of younger Americans can get coverage for free. One Koch-funded group, Generation Opportunity, brought its scary Uncle Sam and some models to tailgate before the University of Miami-Virginia Tech football game to let the students know that opting out of health insurance is, as the kids say, cool.
So health insurance is lame and having it changed in any way whatsoever is the greatest atrocity an American can be expected to suffer.
Republicans have been fine with these kinds of contradictions throughout President Obama’s time in office. The deficit suddenly became a problem on January 21, 2009. Tea Partiers demanded that we get our gubmint hands off their Medicare. The GOP won the House by campaigning against cuts to Medicare that they then included in Paul Ryan’s budget.
But there is evidence that efforts to actually take something away from Americans results in a substantial backlash.
The wave of voting restrictions across the South after the 2010 election was mostly blocked by the federal courts empowered by a Voting Rights Act that had not yet been gutted. But Republicans did successfully restrict early voting in the crucial swing states of Ohio and Florida. Despite this, or as a result of it, African-American turnout hit an all-time high in the 2012 election.
North Carolina passed some of the most radical voting restrictions on students in the nation and local Republicans specifically attempted to block Elizabeth City State University senior Montravias King from running for city council where he was attending college. Their efforts backfired.
“On October 9, King was elected to the Elizabeth City city council, winning the most votes of any candidate,” The Nation‘s Ari Berman reported. “He’s now the youngest elected official in the state.”
Students must have figured: If voting weren’t important, why would Republicans be doing everything they can to stop me from doing it?
In only 10 states, 444,000 people have already signed up for Medicaid. The fact that the GOP would deny them and about five million more poor people health insurance isn’t big news for a couple of reasons.
First, they’re poor. Second, these people haven’t had anything taken away from them — yet.
But on January 1, the story changes. Suddenly Republicans will be trying to do exactly what they’re accusing President Obama of: taking away health insurance with nothing to replace it. And thanks to the GOP, now it’s clear what a terrible thing that is to do to a person.
By: Jason Sattler, The National Memo, November 12, 2013
“Medicaid Matters”: Where Is The Outrage Over GOP Governors Cutting Off Lower-Income Americans From Access To Medicaid
E.J. Dionne Jr. raises an argument in his column this morning that’s been getting short shrift by too much of the political world lately: Medicaid expansion matters, and far too many state Republican policymakers are blocking it for no reason.
“President Obama apologized last week after all the criticisms of what’s happening in the individual insurance market,” Dionne explained. “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.”
The recent disruption in the health care marketplace certainly matters, and the Obama administration has a lot of work to do to put things right. But if we’re going to talk about policymakers who need to apologize and show some semblance of regret, can we at least start to have a conversation about those keeping millions of struggling Americans from having access to coverage, largely out of partisan spite?
Jonathan Cohn published a good piece on this earlier:
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.
There’s been an obvious preoccupation – on Capitol Hill, with Beltway media, etc. – with website dysfunction and cancelation notices, while Medicaid expansion, which arguably affects a larger group of people, has been routinely overlooked.
Maybe it’s because Washington is “wired” for Republicans and it’s the right’s complaints that have been driving the recent conversation. Perhaps it’s the result of Medicaid beneficiaries lacking the kind of political capital that keeps their plight on the political world’s front-burner. Maybe it’s a matter of timeliness, with implementation disruption seeming “new” in ways Medicaid is not. Perhaps it’s a combination of things.
Regardless, by my standards, this is a genuine scandal. The administration’s missteps are real, but they’re not deliberate. “Red” states rejecting Medicaid expansion because of some misguided contempt for “Obamacare” are leaving struggling families behind on purpose. The callousness is outrageous.
Cohn concluded, “”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.”
By: Steve Benen, The Maddow Blog, November 11, 2013
“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
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