“Reverse Sticker Shock”: Reality-Based Evidence On Obamacare In California Amidst All The GOP Hysteria
For months now we’ve been told that the Affordable Care Act would produce a cataclysm of skyrocketing health insurance premiums, particularly in the individual insurance markets that the law most affects. Earlier this week alarms were raised particularly in California with the news that three major insurance companies had decided against participating in the health care exchanges that would offer Obamacare coverage.
So it’s a bit of a shock–sort of a reverse sticker shock–today to learn that preliminary assessments of the cost of the new, improved (because subject to new minimum coverage requirements) policies in California once the exchanges are up and running will in most cases be lower than what citizens of this high-cost state are accustomed to paying. TNR’s Jonathan Cohn summarizes the news:
Based on the premiums that insurers have submitted for final regulatory approval, the majority of Californians buying coverage on the state’s new insurance exchange will be paying less—in many cases, far less—than they would pay for equivalent coverage today. And while a minority will still end up writing bigger premium checks than they do now, even they won’t be paying outrageous amounts. Meanwhile, all of these consumers will have access to the kind of comprehensive benefits that are frequently unavailable today, at any price, because of the way insurers try to avoid the old and the sick.
Sarah Kliff of Wonkblog has more details:
Health insurers will charge 25-year-olds between $142 and $190 per month for a bare-bones health plan in Los Angeles.
A 40-year-old in San Francisco who wants a top-of-the-line plan would receive a bill between $451 and $525. Downgrade to a less robust option, and premiums fall as low as $221.
These premium rates, released Thursday, help answer one of the biggest questions about Obamacare: How much health insurance will cost. They do so in California, the state with 7.1 million uninsured residents, more than any other place in the country.
Multiple projections expected premiums to be relatively high.
The Congressional Budget Office predicted back in November 2009 that a medium-cost plan on the health exchange – known as a “silver plan” – would have an annual premium of $5,200. A separate report from actuarial firm Milliman projected that, in California, the average silver plan would have a $450 monthly premium.
Now we have California’s rates, and they appear to be significantly less expensive than what forecasters expected.
On average, the most affordable “silver plan” – which covers 70 percent of the average subscriber’s medical costs – comes with a $276 monthly premium.
Such numbers, it is important to note, do not reflect the actual cost to the estimated 2.6 million Californians who will qualify for Obamacare tax subsidies (available to those with incomes up to 400% of the federal poverty rate).
One of the “horror stories” we’ve been hearing from Obamacare opponents for years now is that the whole scheme will collapse once healthy, low-income young people realize they’ll face large news costs for the kind of minimum high-deductible catastrophic coverage they actually need. They’ll bail, it has been suggested, not only from Obamacare (screwing up the broad-based risk pools that make affordable coverage for older and sicker people possible), but from Obama’s political coalition as well. So this comment from Kliff about the California numbers is worth noting:
For a less robust “bronze” plan, which covers 60 percent of the average beneficiary’s costs, the tax credit could actually cover the entire premium for low-income twenty-somethings.
None of this should really be that surprising; the idea that a broader pool plus competition and guaranteed benefits would provide a better bargain (plus vastly greater security) for consumers in the individual market was central to the entire Affordable Care Act architecture. But it’s taken a while for facts to catch up with all the negative agitprop. It won’t keep House Republicans from voting to repeal the entire law a 38th or 39th or 40th time before the bulk of the Affordable Care Act becomes effective next year. Still, it’s nice to see some reality-based evidence amidst all the hysteria.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, May 24, 2013
“Willfully Disobeying The Law”: Republican Leaders Refuse To Make Appointments To Key Obamacare Panel
The top two Republicans in Congress informed President Obama on Thursday that they will refuse to fulfill their duty under the Affordable Care Act to recommend members of a new board with the power to contain Medicare spending.
It’s a dramatic power-play driven by the explosive partisan politics of Obamacare and with potentially important implications for federal health care policy.
In a letter to President Obama, House Speaker John Boehner (R-OH) and Senate Minority Leader Mitch McConnell (R-KY) noted their original opposition to Obamacare, reiterated their intent to repeal it entirely, and declared that they would not make any appointments to the Independent Payment Advisory Board.
The IPAB is a 15-member panel whose members must be confirmed by the Senate. The President selects three members himself and is required by law to seek three recommendations each from the top Democrat and Republican in each chamber. With Thursday’s letter, Boehner and McConnell refused to make any recommendations.
The IPAB will be stood up in 2014 by Obamacare and tasked with making cuts to Medicare provider payments (it may not touch benefits) if costs exceed economic growth plus an additional percentage point in any given year. Congress can override it by passing equally large cuts with a simple majority or waiving the cuts entirely with a three-fifths majority.
“Because the law will give IPAB’s 15 unelected, unaccountable individuals the ability to deny seniors access to innovative care, we respectfully decline to recommend appointments,” Boehner and McConnell wrote in the letter.
But there is a catch: if IPAB fails to do its work for any reason, the Health and Human Services secretary must order the cuts herself. So in a way, Boehner and McConnell are surrendering some of their power in order to appear as though they’re thwarting Obamacare — when in reality they’re merely turning over more control to the executive branch.
“Under the ACA, if the IPAB fails to make a recommendation as required under the IPAB provision, the Secretary may make a recommendation in its place,” said Tim Jost, a professor of health law at Washington and Lee University. “So if no IPAB is created, it is not fatal.”
IPAB is, however, capable of functioning without all of its members confirmed. But the letter reflects a continuation of broader GOP obstruction of Obamacare implementation. Senate Republicans have suggested that they may filibuster any IPAB nominee, period.
This approach makes it easier for a future Republican president to neuter IPAB by executive fiat. In the short term, it puts the Obama administration more directly in the political line of fire for any cuts that it does approve.
The other political incentive for Republicans to oppose IPAB is that spending Medicare dollars more wisely makes it easier to sustain the single-payer structure of the program, and makes it harder to argue that it needs to be privatized, as the Paul Ryan budget does.
There is some irony as well in Boehner and McConnell refusing to play ball on IPAB — a key cost containment mechanism in Obamacare — while their party is complaining about potential cost increases under the law, and government spending more generally. Limiting Medicare spending and cutting the deficit, part of the rationale for IPAB, are routinely touted as central GOP goals.
“We believe Congress should repeal IPAB, just as we believe we ought to repeal the entire health care law,” Boehner and McConnell wrote. “In its place, we should work in a bipartisan manner to develop the long-term structural changes that are needed to strengthen and protect Medicare for today’s seniors, their children, and their grandchildren. We hope establishing this board never becomes a reality, which is why full repeal of the Affordable Care Act remains our goal.”
By: Sahil Kapur, Talking Points Memo, May 9, 2013
“Panic Is Just What Republicans Want”: Democrats Shouldn’t Take GOP’s Bait On Obamacare Implementation
The notion that Obamacare’s implementation could become a major liability for Democrats in 2014 is gaining widespread currency, and today it’s the subject of a big New York Times piece reporting on confident predictions by Republicans that implementation problems will give them a powerful weapon against Dem candidates. Obama is set to do a series of events designed to educate the public on the challenges of implementing the law, beginning with one on Friday where he’ll promote the law’s benefits for women.
It strikes me that GOP Obamacare implementation triumphalism is a tad premature.
Here is how the Times characterizes the sentiment in Dem circles about the coming war over implementation:
Democrats are worried about 2014 — a president’s party typically loses seats in midterm years — and some have gone public with concerns about the pace of carrying out the law. Senator Harry Reid of Nevada, the majority leader, told an interviewer last week that he agreed with a recent comment by Senator Max Baucus of Montana, a Democratic architect of the law, who said “a train wreck” could occur this fall if preparations fell short.
The White House has allayed some worries, with briefings for Democrats about their public education plans, including PowerPoint presentations that show areas with target populations down to the block level.
“There’s clearly some concern” among Democrats “that their constituents don’t yet have all facts on how it will work, and that Republicans are filling that vacuum with partisan talking points,” said Representative Steve Israel of New York, head of the House Democrats’ campaign committee. “And the administration must use every tool they have to get around the obstructions and make it work.”
Quotes like these are widely held up as evidence that Republicans are right that Obamacare implementation is shaping up as a major problem for Dems. But this amounts to a fundamental misreading of what it is these Dems are actually saying. Democrats are simply doing exactly what they should be doing — that is, calling for care and caution in the implementation of Obamacare, and calling for a serious effort to educate the public about the challenges and potential pitfalls it entails. This is not tantamount to running away from the law wholesale; nor is it a concession that implementation will amount to a major political albatross.
As Jonathan Cohn has detailed at length, it’s very possible there will be real problems with the health law’s implementation. If that happens, Republicans will relentlessly try to tie Dem candidates to those difficulties, in hopes for a rerun of 2010. But in 2010, public reactions to the new health law were largely suffused with deep anxiety about the severe economic crisis and uncertainty about the new president’s ability to cope with it. Republicans and allied groups made the assault on Obamacare central in 2012, in the presidential race and in many Senate contests, with absolutely nothing to show for it.
Will implementation make things different in 2014? By all means, the problems could be very real, particularly with Republicans intent on subverting implementation wherever possible. Dems should remain vigilant and prepare for turbulence. But they needn’t fret this too much. For one thing, as Josh Barro has noted, implementation is likely to be most keenly felt among those who currently lack insurance, who will naturally see getting insurance as a preferable outcome to nothing at all, even if it proves logistically difficult.
Dem candidates can strike a balance here: They can call for careful implementation and criticize it when it goes awry, while standing squarely behind the law’s overall goal of expanding coverage to the millions of Americans who lack it. What’s more, they can continue to remind the public that Republicans are offering no alternative of their own and simply want to return the country to a pre-reform free-for-all that nobody, particularly the large ranks of the uninsured, wants. This position is the correct one to take, substantively and politically, and it shouldn’t be that hard to get the balance right. After all, whatever the unpopularity of Obamacare, offering nothing in the way of reform isn’t exactly a winning message, either. Major reforms are not easy, and Dems can say so, while pointing to the endless GOP drive to repeal the law to reinforce the notion that Republicans have no interest in actually addressing the country’s most pressing problems.
Dems should refrain from displays of political panic, since panicking is exactly what Republicans want them to do. “A lot of this is psychological warfare,” is how Dem strategist Doug Thornell recently put it. “I would tell Dems not to take the bait.” So would I.
By: Greg Sargent, The Plum Line, The Washington Post, May 7, 2013
“Eight Months Until The End Of Job Lock”: A Reminder About One Of The Best Things Obamacare Does
For years, even before Barack Obama was elected, one of the many complaints liberals (mostly) had about the current employer-based health insurance system was “job lock”—if you have insurance at your job, particularly if you or someone in your family has health issues, then you’re going to be hesitant to leave that job. You won’t start your own business, or join somebody else’s struggling startup (unless they provide insurance), and this constrains people’s opportunities and dampens the country’s entrepreneurial spirit.
That this occurs is intuitively obvious—you probably know someone who has experienced it, or have experienced it yourself. And today there’s an article in that pro-Democrat hippie rag The Wall Street Journal entitled “Will Health-Care Law Beget Entrepreneurs?” Amid the worrying about the implementation of Obamacare in January, and the quite reasonable concern that the news could be filled with stories of confusion, missteps, and dirtbags like that Papa John’s guy cutting employees’ hours rather than give them insurance, to avoid the horror of increasing the cost of a pizza by a dime,11This is important: when you hear a story about an employer who cut his employees’ hours so he wouldn’t have to abide by the law, what you’re reading about is a jerk who doesn’t want to offer his employees insurance, not some inevitable consequence of the law. That’s a choice he makes. And don’t forget too that the employer mandate only applies to companies with 50 or more employers, and 96 percent of them already offer health insurance, even without a mandate. it’s a reminder that there will probably be lots of stories like this one in the news too, stories about people whose lives have been changed for the better by the fact that Americans will have something they’ve never had before: health security.
So what kind of effect could the elimination of job lock have on the economy? That’s tough to say. The study referred to in the WSJ article finds that people are much more likely to start a business if they get their health insurance from their spouse’s job than if they get it from their own job; in the former case you’d still have insurance if you started a business, while in the latter case you’d lose it. In addition, and this is particularly interesting, even though you might think of 65-year-olds as looking forward to days of golf and eating dinner at 4 p.m., a large number of people seem to start businesses pretty much the minute they become eligible for Medicare. While it’s hard to get insurance in the current private market if you’re 44, it’s basically impossible if you’re 64.
So it seems that the fact that after January, job lock will be history means that more businesses will be started. How many more? Well, we don’t know yet, and it could depend in part on how affordable the insurance you can get through the exchanges is compared to what people are getting from their employers. And it will be hard to measure precisely how much more economic activity is generated by businesses that wouldn’t have otherwise been started. Obviously, some will succeed and more will fail.
Nevertheless, beyond additions to GDP, there’s something psychological that shouldn’t be discounted, touchy-feely though it might be. The end of job lock means the end of a certain kind of fear that all of us under the age of 65 live with to one degree or another. It’s the fear that leaving a job, voluntarily or otherwise, could become an utter financial calamity if we or one of our loved ones has a health problem. Even if you wish reform hadn’t been grafted on to the existing employer-based system (I’ll raise my hand on that one), ending that fear is huge; it’s one of the best things Obamacare does. Even if it’s difficult to communicate on a bumper sticker.
By: Paul Waldman, Contributing Editor, The American Prospect, May 9, 2013
“Unconscionable But Irrelevant”: Florida GOP Legislature Puts Politics Over People
It seemed like a breakthrough moment. In late February, Florida Gov. Rick Scott (R), who had made hating “Obamacare” his raison d’etre, announced his support for the Medicaid expansion policy in the Affordable Care Act. The Republican governor said at the time, “I cannot, in good conscience, deny the uninsured access to care.”
It was an open question whether Scott’s principal concerns were with the uninsured or the state hospitals he’s been friendly with in the past, it was nevertheless welcome news for health care advocates. Florida’s governor, an unlikely ally, had cleared the way for bringing health care access to 1.3 million Americans, expanding the reach of Obamacare to new heights.
At least, we thought so at the time. What was unexpected was Rick Scott’s own legislative allies ignoring the governor’s wishes and punishing Florida on purpose.
Scott wouldn’t be the one to “deny Floridians” a part of the health care law — but the Florida legislature had other plans. Lawmakers adjourned Friday after passing a budget that does not include funding for a Medicaid expansion. Unless the Republican-controlled legislature comes back for a special session later this year — which some Democrats are calling for — Florida will not expand Medicaid in 2014.
In Florida, where one in five non-elderly residents lack insurance coverage, the consequences are especially large: An estimated 1.3 million Floridians were expected to gain coverage through the Medicaid expansion. About a quarter of those people — Floridians earning between 100 and 133 percent of the Federal Poverty Line — would still be eligible for tax subsidies on the health insurance exchange.
As we talked about in March, Scott isn’t the only Republican governor in this boat. In Ohio and Arizona, GOP state lawmakers remain reluctant to accept Medicaid expansion, regardless of its benefits, and regardless of the wishes of their Republican partner in the governor’s office.
But the move in Florida is especially jarring given the circumstances — the state has an enormous Medicaid-eligible population, and was poised to receive $66 billion in federal funds over the next decade. What’s more, Florida already has struggling public hospitals, which will now be in even worse shape.
A Democratic state senator called the Medicaid decision “unconscionable,” which is true, but apparently irrelevant to state GOP lawmakers.
By: Steve Benen, The Maddow Blog, May 6, 2013
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 