“The GOP’s Hypocrisy On Obamacare”: Republicans Get The Vapors And Become Outraged About The Problems They Created
Last spring, the Senate Finance Committee held a hearing on implementation of the Affordable Care Act, otherwise known as Obamacare. Sen. Max Baucus, a Montana Democrat and the chairman of the committee, was not pleased with how things were going.
The Obama administration originally had asked for more than half a billion dollars to spend on public relations and outreach for the law. House Republicans had returned with an offer of nothing. That’s right: zero dollars. Without necessary funds, the Department of Health and Human Services worried it would not have the necessary money to pay for navigators to help people enroll in health care, for the technology needed to implement the exchanges and for the public relations campaign that was required to inform citizens about what the law actually did.
HHS Secretary Kathleen Sebelius made the controversial move of asking insurance companies and nonprofit organizations to donate money and help. Republicans were outraged. She asked for more money. She was refused.
Then, when she tried to move some money from the PR budget to replace cuts to other areas, Baucus became quite upset. He was concerned that if the administration did not do more to inform people about the law and get implementation going, there would be problems:
“A lot of people have no idea about all of this,” he said. “People just don’t know a lot about it, and the Kaiser poll pointed that out. I understand you’ve hired a contractor. I’m just worried that that’s gonna be money down the drain because contractors like to make money. … I just tell ya, I just see a huge train wreck coming down.”
As I’ve said before, it’s important to note that the “train wreck” Baucus was describing was a botched implementation because not enough was being done to make things go smoothly.
It wasn’t a description of the law itself but of what might occur if the government did not devote enough resources to making it work. Sebelius’ response was not surprising to those who were paying attention. She said that she was “incredibly disappointed” that all her requests for resources were being denied by Republicans.
That was then. Today, implementation has arrived, and if it’s not a train wreck, then it’s certainly close. The administration is still under fire because people cannot get the insurance they want through the exchanges. But while I will continue to point out the problems with implementation and fault the administration for mistakes they’ve made, how does one ignore the apparent hypocrisy from many politicians who are now “outraged” about the very problems they’ve helped to create.
Republicans refused to appropriate money needed to implement Obamacare. When Sebelius tried to shift money from other areas to help do what needed to be done, she was attacked by Senate Republicans. At every step, Republicans fought measures to get money to put towards implementation.
Is it really a surprise then that implementation hasn’t gone smoothly?
Federal legislators aren’t the only ones to blame. Let’s remember that original versions of the bill called for one big national exchange. This would have been much easier to implement. But conservatives declared that insurance should be left to the states and kept out of the hands of the federal government. So as a compromise (yes, those did occur), exchanges were made state-based instead of national.
As a precaution, the law stipulated that if states failed to do their duty and enact exchanges, the federal government would step in and pick up the slack. This was to prevent obstructionism from killing the law. Surprisingly, it was many of the same conservative states that demanded local control that refused to implement state-based exchanges, leaving the federal government to do it for them.
That made implementation much harder.
There have been books, webinars and meetings explaining how to sabotage the implementation of Obamacare. There have been campaigns trying to persuade young adults not to use the exchanges. It is, therefore, somewhat ironic that many of the same people who have been part of all of this obstructionism seem so “upset” by the fact that people can’t easily use the exchanges.
For goodness sake, the government was shut down just a few weeks ago because some of the same people who are now bemoaning poorly functioning websites were determined to see that not one dime went to Obamacare.
Lest you think I’m defending this month’s rollout, I encourage you to review my last article here. I still maintain that the administration has had a failure in management in overseeing and reporting on progress towards October 1. But I’m also sympathetic that they’ve had a hard job to do. I would like to see this go better. I’d like to see millions more get insurance. I’d like to see the law of the land function as well as it can, and if it doesn’t, I’d like to see Congress continue to amend it to make it work better. I’d like a better health care system.
What I cannot ignore, however, are the many people who actively worked to see implementation fail now get the vapors over its poor start. The truth is, they got what they wanted. A victory lap is somewhat warranted, not concern-trolling.
If, on the other hand, their concern is real, then I’m sure the administration would welcome their help in making things right.
By: Aaron Carroll, Director, Center for Health Policy and Professionalism Research, Indiana University School of Medicine, Special to CNN, October 28, 2013
“Purposeful Lying”: Time To Investigate Those Health Insurance Company Letters
As a follow-up to this post, I want to talk about the thing that spawns some of these phony Obamacare victim stories: the letters that insurers are sending to people in the individual market. People all over the country are getting these letters, which say “We’re cancelling your current policy because of the new health-care law. Here’s another policy you can get for much more money.” Reporters are doing stories about these people and their terrifying letters without bothering to check what other insurance options are available to them.
There’s something fishy going on here, not just from the reporters, but from the insurance companies. It’s time somebody did a detailed investigation of these letters to find out just what they’re telling their customers. Because they could have told them, “As a result of the new health-care law, your plan, StrawberryCare, has now been changed to include more benefits. The premium is going up, just as your premium has gone up every year since forever.” But instead, they’re just eliminating those plans entirely and offering people new plans. If the woman I discussed from that NBC story is any indication, what the insurance company is offering is something much more expensive, even though they might have something cheaper available. They may be taking the opportunity to try to shunt people into higher-priced plans. It’s as though you get a letter from your car dealer saying, “That 2010 Toyota Corolla you’re leasing has been recalled. We can supply you with a Toyota Avalon for twice the price.” They’re not telling you that you can also get a 2013 Toyota Corolla for something like what you’re paying now.
I’m not sure that’s what’s happening, and it may be happening only with some insurers but not others. But with hundreds of thousands of these letters going out and frightening people into thinking they have no choice but to sign up for a much more expensive plan, it’s definitely something someone should look into. Like, say, giant news organizations with lots of money and resources.
Now, it should be said that when President Obama said during the debate over the Affordable Care Act in Congress that if you like your health coverage you can keep it, he was only half right. The reason he repeated it so many times was that he and his advisors firmly believed that one of the main reasons Bill Clinton’s health-care reform failed was that it changed things too much for too many, and people fear change. In Clinton’s plan, pretty much everybody not on Medicare or Medicaid would have had to go into a new insurance plan. That those plans might be better than what they had didn’t matter; the idea frightened people. So the Obama administration took pains to emphasize that the government would not require anyone to change their insurance. That didn’t mean they were guaranteeing that no insurance company would ever make changes to anyone’s plan, because insurance companies do that all the time. But the law wouldn’t mandate that, say, you leave Aetna and join Blue Cross.
The more complex reality is that because the law imposed new requirements on insurers for what they have to cover and what they can charge, the insurers were inevitably going to make changes to their existing plans in response. And yes, that means many people’s insurance is going to change. In most cases it will change for the better, and the effect all this is going to have on premiums is yet to be seen. But it sure looks like insurance companies are trying to make sure anyone who’s displeased aims their ire at the government, and if they can get people to buy a more expensive product along the way, they’ll be happy to do that.
By: Paul Waldman, Contributing Editor, The American Prospect, October 29, 2013
“Getting Better Coverage”: Obamacare “Sticker Shock”? What Under-Insured Think They Have Versus What They Actually Have
In a comment on resurgent talk of “sticker shock” for premiums on insurance bought through the Obamacare exchanges, Kevin Drum makes two points that are important to keep in mind. The first is that the number of people likely to see a major increase in net insurance costs–in excess of the subsidies they may qualify for–is not as large as you might think:
This probably doesn’t describe a huge demographic—people who are just barely above the subsidy threshold and currently have individual coverage and are young enough to see premium increases—but there’s no question they exist.
Those who do fit into this relatively narrow band of people will typically get better coverage for their additional dollars, but they may not appreciate it just yet. Kevin points to a woman quoted in an L.A. Times article on “sticker shock” as illustrative:
“Fullerton resident Jennifer Harris thought she had a great deal, paying $98 a month for an individual plan through Health Net Inc. She got a rude surprise this month when the company said it would cancel her policy at the end of this year. Her current plan does not conform with the new federal rules, which require more generous levels of coverage.
“Now Harris, a self-employed lawyer, must shop for replacement insurance. The cheapest plan she has found will cost her $238 a month. She and her husband don’t qualify for federal premium subsidies because they earn too much money, about $80,000 a year combined.
“‘It doesn’t seem right to make the middle class pay so much more in order to give health insurance to everybody else,” said Harris, who is three months pregnant. “This increase is simply not affordable.'”
I don’t know for sure how this plays out in the real world, but I’d be shocked if Harris’s $98 plan covers expenses related to pregnancy. If it does, the out-of-pocket max is probably astronomical. A bronze plan under Obamacare is still no picnic, but I’m willing to bet it covers a whole lot more of Harris’s maternity expenses than her current plan. In other words, there’s a pretty good chance that she’ll make up for her extra annual expense of $1,700 by sometime around, oh, April or so.
And even if she doesn’t, she now has insurance that will protect her from unforeseen medical conditions and out-of-pocket expenses even if they don’t occur. It is sometimes forgotten that every kind of insurance involves the potential of “excessive” premiums if you get lucky and don’t need it.
But more basically, the politics of Obamacare will indeed be affected by the attitudes of people who do or don’t view their enhanced insurance as having value, and do or don’t think they’re just shelling out dollars to “give health insurance to everybody else.”
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, October 28, 2013
“Obamacare Death Spirals”: The Latest Prediction Of Doom Hits The Conservative Blogosphere
A new meme has arrived on the scene from the voices and pens of the anti-Obamacare devotees who remain more committed to frightening than informing when it comes to healthcare reform.
It’s the Obamacare “death spiral”— and it’s coming to a conservative blog near you.
Through a series of articles already going viral—thanks to a piece published on National Review Online and one by my Forbes colleague, Dr. Scott Gottlieb –we learn that the threat of impending doom ‘du jour’ comes via an allegation that, due to the poor launch of the healthcare.gov website, younger and healthier participants will now be more likely to stay away than sign up.
This, the falsely fearful argue, will result in an insurance pool jammed with older and sicker people without the required participation of younger and healthier Americans needed to balance the pools.
The result of such an event?
As insurance companies are forced to pay out more claims —due to their older and sicker participant base—without sufficient premium income from younger and healthier people less likely to call upon the insurer to pay for medical care, the insurance company is forced to raise their premium costs so they don’t loose money. As this problem builds upon itself year after year, it becomes, as it is termed in the insurance industry, a ‘death spiral’ as, sooner or later, the insurers are forced out of business when the premium costs get too high to be affordable by much of anyone.
Clearly, the authors suffer from a lack of understanding of human behavior—particularly when it comes to young people who are not given to dealing with these sort of issues until the deadline approaches…meaning we really don’t yet know anything about the potential success or failure of the insurance pools available on the health care exchanges.
If you doubt this, you might want to review what took place with the forerunner of Obamacare—Romneycare.
According to Jonathan Gruber, one of the key architects of the Massachusetts health care exchange—a program that the overwhelming majority of Massachusetts residents favor and support—and one of nation’s leading experts on all things Obamacare, “Massachusetts launched its health insurance program at the beginning of 2007 but enrollment didn’t fully flesh out for a year. In fact, it was less than 6% of the year’s total by the end of the second month. (emphasis added)”
In other words, people of all ages tend to wait until the deadline is upon them before coming to grips with an obligation like purchasing health insurance. But if you have kids, you know that younger people are even more likely to delay matters such as this.
Yet, here we have the opponents of the Affordable Care Act, ready to declare the entire program DOA based on a prediction of ultimate demise via the ‘death spiral’—and all because the slow start of the federally operated state healthcare exchanges are precluding younger and healthier prospective participants from signing up during the initial weeks of availability.
Even stranger, Dr. Gottlieb argues that, as a result of the failures of the federal website launch and the negative cascading effect he suggests will likely follow, more people will be driven out of the exchanges due to higher premiums in future years. In its place, Gottlieb proposes, these people will turn to “off-exchange” policies, purchased by going directly to an insurance company, broker, etc. for policies that are not offered on the exchange.
Gottlieb writes—
“Over time, conforming and non-conforming insurance policies sold entirely outside the exchanges could look increasingly attractive to consumers; even accounting for the subsidies many people would get for staying inside the exchanges.”
Why would they do this? Because, Dr. Gottlieb suggests, the off-exchange policies will be cheaper.
Setting aside that I have no idea what Gottlieb is referring to when he speaks of “non-conforming” insurance policies as every individual insurance policy, whether available on the exchange or not, must, for all practical purposes, meet the basic benefits requirements set forth in the Affordable Care Act, I can’t quite fathom why buying less expensive insurance off the exchanges would be a bad thing.
There is a tendency among those dedicated to burying healthcare reform to miss the point when it comes to the objectives of Obamacare. They spend so much time working out how to creatively attack the law that they simply cannot recall why we needed healthcare reform in the first place.
At its core, the law is designed to do three things—get insurance company abuses under control, make healthcare coverage more readily available to virtually all Americans and institute a series of experiments designed to bend the cost curve in healthcare delivery.
This being the case, why would anyone care whether you buy your insurance coverage off-exchange or on-exchange, so long as you obtain healthcare coverage? What’s more, the individual mandate does not require that you shop on the exchanges—it only requires you to purchase a qualifying policy.
The healthcare exchanges are designed to create competition among insurance companies. Should it not work, and Dr. Gottlieb is correct that the events occurring on the exchange will produce lower costs of an off-exchange policy—even for those who qualify for subsidies which are only available on the exchange—then we will have learned that the exchanges did not create the intended competition.
But, if Gottlieb is right and people can buy a cheaper policy that meets the requirements of the ACA off-exchange, then the objective of the law will be accomplished.
The bottom line here is that, by any reasonable and rational metric, it is far too early to know whether or not the insurance programs offered on the healthcare exchanges will manage to maintain the balance required of sick versus healthy and old versus young. In the final analysis, the doomsayers may turn out to be right. Maybe it just won’t work.
Or, maybe it will.
This is something we will simply not know for quite a few years.
Therefore, where exactly is the benefit of predicting a dire result at this stage of the game based on no available evidence whatsoever? Can there be any possible use of this information aside from giving political opponents some newly minted ammunition? Will the knowledge that insurance policies offered on the exchanges could experience a death spiral—a possibility that has existed for health insurers since the dawn of the industry—do anything to improve the odds of success?
If there is anything we can be sure of, it is that there will be a great many surprises along the way as we make these major adjustments to our healthcare system—some that will be good and some that will not.
As for the suggestion that we are in some immediate crisis because the healthcare.gov website has not yet worked as required, Jonathan Gruber, again, provides a reasonable and rational explanation of what is really happening and what it means.
USA Today reports that Gruber describes the current situation as “DEFCON 1″—a political problem, but probably not a problem yet for the marketplace.
If healthcare.gov is not running by Thanksgiving, it would be “DEFCON 2″, a real problem because people want to get insurance by January, but it’s not a crisis.
The crisis, according to Gruber, arrives if people cannot get insurance until March of 2014.
Gruber added that, in Massachusetts, officials were not focused on how well enrollment went on a day-to-day basis. They looked at the long-term potential, and expected that people would sign up in time to avoid the penalty.
Finally, Gruber noted, “I’m pretty confident they’ll have it up and going by Thanksgiving.”
So, how about we leave the death spiral stuff in the back room until the moment comes to actually haul it out and parade it around?
After all, at the rate Obamacare opponents are tossing out and using up their theories of pending disaster, they will soon run through their play book and have nothing left in their quiver.
Wouldn’t that be a shame?
By: Rick Ungar, Op-Ed Contributor, Forbes, October 28, 2013
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