“Life Changing And Life Saving”: Remembering What Matters About The Affordable Care Act
On the Affordable Care Act front today, there’s very good practical news, and not-so-good political news. That gives us an excellent opportunity to remind ourselves to keep in mind what’s really important when we talk about health care.
Let’s start with the good news. First, as Marketplace reported this morning, a new report from PriceWaterhouseCoopers shows that the average health insurance premium on the exchanges is actually lower than the average premium in employer-sponsored plans. And it isn’t because the coverage is inadequate; according to a spokesperson, “even when you factor in all the out-of-pocket costs, the average top tier gold and platinum plans are similar to employer ones.” It’s hard to overstate what a success this is. If you’ve ever bought health insurance on the individual market before now, you know that if you could get covered at all, you were likely to get a plan that was expensive but had lots of gaps and lots of cost-sharing. The whole point of the exchanges was to give people buying insurance on their own the same advantage of pooling large numbers of customers that you get when you’re covered through your employer. If it’s working, then that’s something to celebrate.
Second, as Jonathan Cohn tells us, Wellpoint, one of the nation’s largest insurers, is reporting that exchange sign-ups are meeting their expectations; they have 400,000 new customers, and expect the number to rise to a million by the end of open enrollment. Even more critically, although their new customers are slightly older than the population as a whole, they expected this because people with a more pressing need for insurance would be the first to sign up, and they already incorporated that into their rates for this year. That means they’re unlikely to lose money, there is unlikely to be a huge rate spike next year, and the dreaded “death spiral” looks less and less likely.
This supports the contention I’ve had for some time, that in its first few years the Affordable Care Act is going to basically be fine—it may not create a health care paradise, but nor will it be the disaster conservatives are so fervently hoping for.
Before we get to sorting through what matters from what doesn’t, let’s look at the not-so-good political news. The Kaiser Family Foundation is out with their latest health care tracking poll, and there isn’t a lot to be glad about. More people have an unfavorable than a favorable view of the ACA. Most Americans are unaware that almost all the provisions of the law are now in force. And maybe most troubling, nearly half of Americans are still unaware of the law’s most popular provision, that insurance companies are no longer allowed to discriminate against people with pre-existing conditions:
Before you say, “Obama should have told people about it!” I must remind you that during the last four years you spent away from Earth, the administration and its allies did in fact repeat over and over and over again that the ACA prohibits insurance companies from denying you coverage if you have a pre-existing condition. There are many reasons why so many people haven’t yet understood, but you can’t say they didn’t try (you can read more about the myth of the bad sales job here).
In any case, here’s what we have to remember: On the scales of history, a person with a pre-existing condition who gets health coverage weighs much more than a person who doesn’t know that because of the ACA, people with pre-existing conditions can get health coverage. We spend so much time talking about politics that it’s easy to forget that politics are not an end in themselves, they’re a means to an end. Liberals advocated for comprehensive health insurance reform for so many decades not because it was politically advantageous (at some times it was, and at other times the voters didn’t seem to care), but because it was right. The fact that so many millions of Americans had no health security up until now was a moral obscenity. The ACA is beginning to fix things—slower and less completely than we might like, but it is a beginning. And if it never becomes the political boon you were hoping for, it was still the right thing to do.
That isn’t to say that political effects don’t matter, because they do. If the Republicans take over the Senate this fall, bad things would result, particularly if they also win the White House two years later, and if the ACA’s political troubles contributed to that turn of events, it would be unfortunate. But in the long run, what matters most is the effect on Americans’ lives. When you get distressed by a story about a Democratic member of Congress who’s in a tough race where her opponent is hitting her for supporting Obamacare, you can think of the families who never had health coverage before, but do now. For millions of people it will life-changing, and for many, literally life-saving. Try not to forget.
By: Paul Waldman, Contributing Editor, The American Prospect, January 30, 2014
“Mitch Has Got Some ‘Splainin’ To Do”: McConnell Recycles His Own Ad, Ignores 188,130 Kentuckians Whose Insurance He’d Repeal
Senate Minority Leader Mitch McConnell (R-KY) failed in his goal to make President Obama a one-term president, but he’s still one of the most crafty and ruthless campaigners in politics, as his latest ad proves.
McConnell’s new ad recycles a message the senator knows works because it helped him win in 2008. The new ad is far more affecting. It focuses entirely on Robert Pierce, a worker from the Paducah Gaseous Diffusion Plant, where exposure to radiation left several employees with cancer. Pierce says throat cancer has weakened his own whispery voice, but he praises the senator for using his voice to help him.
McConnell is boldly trumpeting his help to the plant with the testimony of a man few will want to question. The record is much more complex, according to The Huffington Post‘s Jason Cherkis and Zach Carter.
The senator didn’t “spring into action” on Paducah until 1999, 14 years after the first workers became sick, when a Washington Post article uncovered that radioactive exposure was still occurring at the plant. But once the story was in the limelight, McConnell pushed for a practical solution: “He worked to pass what amounted to a new entitlement that allowed plant workers over age 50 access to free body scans and free health care.” Recently McConnell’s absence from the debate about the plant’s potential closing has led a union leader to say the senator has “given up on Paducah.”
An ad touting the ability to get people government-run health care is an unlikely way to open the campaign of a man who has vowed to repeal Obamacare “root and branch.”
Thanks to the president’s health reforms, 188,130 residents of McConnell’s state now have health coverage; of those, 100,359 have completely subsidized health insurance through Medicaid or SCHIP.
McConnell needs to explain what will happen to the more than 100,000 people who would lose coverage if his goal of repealing Obamacare is accomplished, says The Washington Post‘s Greg Sargent.
“McConnell’s new ad tells us he should be re-elected because his efforts to bring health coverage to people who lack it shows his willingness to ‘knock down walls’ for Kentucky’s ‘working families,’ helping ‘save people’s lives,’” Sargent writes. “So what about all the working people who would lose coverage if McConnell got his way?”
Unfortunately for McConnell, 2014 isn’t 2008.
Six years ago the senator could brag about providing some deserving workers with government health care without having to go into his actual policies on health care. In 2014, Obamacare is no longer theoretical; millions of Americans have gained coverage through Obamacare exchanges or by remaining on their parents’ coverage until age 26, thanks to the law.
If McConnell is arguing he did the right thing by helping those in need, he must also explain what would happen to these people if he gets his way and they lose their coverage.
By: Jason Sattler, The National Memo, January 22, 2014
“Becoming Increasingly Clear”: Despite What The Critics Say, Obamacare Is Working
Despite the treasured right-wing talking points, it’s increasingly clear that Obamacare is a success. Moreover, in places where Obamacare is not succeeding, it’s also clear that the right wing is to blame. Well, it’s clear to any who look at the state-by-state numbers of the newly insured. A whole lot of Americans will have to look, however, for the program’s success to redound to Democrats’ advantage.
Charles Gaba, an enterprising Web site designer, has taken it upon himself to track the number of Americans who have gained health insurance under the Affordable Care Act (ACA). Tallying those who have signed up on the state and federal exchanges (2.1 million), those who have obtained Medicaid coverage (4.4 million) and those who gained coverage through the law’s requirement that private plans allow parents to cover their children up to age 26 (3.1 million), he cites more than 9 million newly insured through Obamacare.
The meaning of that number is, to be sure, a little fuzzy. To begin, it’s a gross, not a net, increase. Some of the 2.1 million who purchased insurance on exchanges did so after their previous plans were altered or canceled. In some states, the increase in those insured through Medicaid does not distinguish between those not eligible previously and those who are simply renewing coverage.
All that said, whether the total is 9 million or 7 million, it’s a big number and it’s rising rapidly: December sign-ups far exceeded those in November, and the number is expected to continue growing through 2014.
Whether you can access the benefits of the ACA, however, depends on where you live. In states that set up their own exchanges and accepted federal funding for Medicaid expansion, the increase in the number of insured vastly exceeds that in states that declined to do either.
Theda Skocpol, a Harvard professor of government and sociology, has compared state totals of those who gained insurance through the exchanges and Medicaid with Congressional Budget Office projections of the number of enrollees in each state for the first year the ACA is in effect, as well as with the Kaiser Medicaid Commission’s projections of new Medicaid recipients in that first year.
In the three months since the exchanges opened, she wrote this week, the 14 states that established their own exchanges and accepted Medicaid funding reported increases amounting to 37.2 percent of the projected yearly exchange purchases and 42.9 percent of the projected Medicaid enrollments. In the 23 states that refused to establish insurance exchanges, refused to cooperate in making the federal Web site easily accessible and declined to expand Medicaid, exchange purchases were just 5.6 percent of the projected increase and Medicaid enrollments just 1.5 percent. (The 13 states that partially embraced the programs generally had increases lower than the 14 full implementers but higher than the 23 refusniks.)
Which is to say, the ACA is working as planned, perhaps a little better, in the states where governors and legislatures chose to implement it, such as California and New York. It is barely working in those states where governors and legislators have refused to implement it, such as Texas. Although the number of states declining any participation probably will diminish over time, as the tea party’s grip on the Republican Party wanes or as older white conservative voters die off, the resulting red-blue division between the states probably will be a feature of the nation’s political economy for some time.
Consider the implications: A larger share of Californians will be able to afford regular medical check-ups than Texans. A smaller share of Californians is likely to be bankrupted by the expense of major medical treatment than Texans. When the law’s tax penalties take effect, a smaller share of Californians will be subject to the penalties that come with the individual mandates than will Texans. In the coming years, a smaller share of California hospitals will face financial risk for indigent care than hospitals in Texas, where fewer of the sick and poor will be covered by Medicaid.
The conservative argument that the ACA is a disaster is true only when it’s a self-fulfilling prophecy: Most of the negative consequences that right-wingers have warned against have occurred only in those places where right-wingers have subverted implementation of the law. What supporters of the ACA must keep in mind, however, is that Americans who live in states where implementation has been stymied may continue to see the act as a failure and continue to blame President Obama and his party.
Only by publicizing the act’s manifest success in states where it has been implemented can supporters begin to change the public’s verdict.
By: Harold Meyerson, Opinion Writer, The Washington Post, January 8, 2014
“No Defense For Nonsense”: How Not To Argue Against Medicaid Expansion
Medicaid expansion is a sensible move for literally every state, but Mississippi, with more than its share of residents who lack insurance, live near the poverty line, and suffer from poor health, needs the policy more than most. Even Mississippi’s insurance commissioner, a conservative Republican, has urged Gov. Phil Bryant (R) to put aside ideology and embrace the provisions of “Obamacare” for the good of the state.
But Bryant has refused. Last March, the governor said he wouldn’t accept Medicaid expansion in part because the Affordable Care Act is not “the law of the land.” By any standard, the argument was gibberish.
This week, the Republican governor came up with a new argument.
“For us to enter into an expansion program would be a fool’s errand. I mean, here we would be saying to 300,000 Mississippians, ‘We’re going to provide Medicaid coverage to you,’ and then the federal government through Congress or through the Senate, would do away with or alter the Affordable Care Act, and then we have no way to pay that. We have no way to continue the coverage.”
Let’s think about this for a minute. There are, by everyone’s estimation, several hundred thousand folks in Mississippi who would benefit from Medicaid expansion. According to Bryant, the state could help them, but he doesn’t want to – because in his mind, Congress might repeal the health care law at some point in the future, and the state wouldn’t be able to afford to pick up the slack.
But even by GOP standards, it’s impossible to take this seriously. For one thing, it’s pretty obvious Congress isn’t going to repeal the law, as even the most right-wing lawmakers on Capitol Hill are grudgingly conceding.
For another, even in the extraordinarily unlikely event that the law is repealed sometime after 2017, Mississippi could simply revert back to its current policy once the federal well runs dry. In other words, Bryant is effectively telling struggling families, “We’ll refuse to help you now because of the remote possibility we may no longer be able to help you later. It’s better to leave you with nothing now and for the foreseeable future than risk helping you and your family for the next several years.”
There is simply no defense for such nonsense.
Postscript: In the same interview, the governor was asked about drug testing, and why it’s limited to welfare recipients, as opposed to corporate leaders whose companies get state tax money and/or public employees like himself.
“If I was receiving any federal or state benefits to help raise my family, I’d be glad to take a drug test,” he replied.
Bryant receives $122,160 a year in taxpayer money as his salary. He also has the people of the state of Mississippi to thank for his health care benefits.
By: Steve Benen, The Maddow Blog, January 2, 2014
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