“More People Have Health Insurance”: Another Day, Another Sign That Obamacare Is Working
It’s impossible to say how big an impact the Affordable Care Act is having on the uninsured. But it’s getting impossible to deny that it’s having an impact at all.
The latest evidence comes from the Gallup organization, which surveys respondents about insurance status. According to Gallup, the percentage of adults without health insurance has been falling since the middle of last year. Now, Gallup says, it’s down to 15.6 percent. That’s the lowest rate that Gallup has recorded since late 2008.
These tracking surveys on the uninsured are far from precise. Among other things, people answering these surveys aren’t always sure of their own insurance status. Nobody should treat them as gospel.
But Gallup also found the most dramatic change in insurance status among low-income and minority populations, which would be consistent with implementation of a law that has its most dramatic impact on people with the least money. It’s also consistent with three other pieces of information
- Health Reform Monitoring Survey. In this survey, conducted by the Urban Institute and supported by the Robert Wood Johnson Foundation, the rate of uninsurance among non-elderly adults fell from 17.6 percent in the first quarter of 2013 to 15.2 percent in the first quarter of 2014.
- The Rand Corporation. According to reporting by Noam Levey of the Los Angeles Times, unpublished research from Rand suggests that the percentage of uninsured Americans fell from 20.9 in late 2013 to 16.6 percent in early 2014.
- Department of Health and Human Services. Late last week, HHS announced that enrollment in Medicaid and CHIP was 3 million higher than it had been in late 2013.
The Congressional Budget Office has projected that 13 million Americans will get health insurance because of Obamacare. Gallup’s numbers would correspond to a significantly smaller decline, although the numbers depend on what you choose as a starting point. Then again, Gallup’s numbers don’t account for the end of open enrollment—when, by all accounts, large numbers of people rushed to sign up for coverage. They also don’t account for a full year of enrollment in Medicaid and the Children’s Health Insurance Program, since people can sign up for those programs all year long.
In short, it seems pretty clear that, because of Obamacare, more people have health insurance. And, yes, that accounts for people who lost existing coverage because insurers cancelled old policies. The question is how big a difference the law is making. And it’s going to be a while before anybody knows.
By: Jonathan Cohn, The New Republic, April, 7, 2014
“A Wink, A Smile And A Voice Vote”: The House GOP’s Down-Low, Backhanded Endorsement Of Obamacare
It’s not all that often that the lead piece on the Drudge Report attacks Republicans, so it’s worth a little savoring when it happens, and this one is especially delectable. The link was to an AP story reporting that two weeks ago, House Republicans stealthily voted for a measure that changed an aspect of the Affordable Care Act.
What? I know. In other words, Congress amends bill it passed a few years ago. In a normal moral universe, this would scarcely qualify as news. But when we speak of the House of Representatives, we are in the modern Republican Party’s moral universe, and there, the rules are different.
You see, by agreeing to amend Obamacare, Republicans are acknowledging the law’s existence and legitimacy. The only things they’re supposed to be doing with Obamacare are burning copies of it on the Capitol steps and voting to repeal it. But here they’ve done the exact opposite. And what made it even worse was the way they did it. The change was very quietly tucked into a larger bill, the Medicare “doc fix,” which helps payments to doctors who serve Medicare patients keep pace with inflation. Only House majority leadership—the Republicans—can do that. And then, to make matters still worse, the yellow-bellied quislings passed the thing by voice vote, so no one had to be on the record.
The change, by the way, removes deductible caps from certain plans small businesses can offer their employees. This allows the employers, according to the AP, to offer cheaper plans to individuals who also have health savings accounts, which conservatives have been pushing for 15 or 20 years. Only around 30 percent of American businesses offer HSAs, and large employers are more likely to include them than small ones. Hence, the target of opportunity for HSA partisans. So the change accomplished a GOP policy goal. But funny thing: apparently not a single Republican member of the House trumpeted the change or even said a word about it when the vote took place March 27.
It hardly matters what the change was. It could have been that the purchase of armor-piercing bullets was now covered under Obamacare and it wouldn’t help: The fact that Republicans used the ACA as the vehicle with which to make this change was the crime. Oh, did I have a jolly afternoon reading through the comment thread at Free Republic:
“The uniparty at work!”
“Appeasement Weasels.”
“Voice vote.”
“And I’ll say it right now: The Republican Party does not want Obamacare to be repealed and will not support candidates who do. I’d love to have someone come back around November 1, 2016 and show me that this prediction was wrong.”
“The G.O.P. (GAVE OBAMA POWER) is the party that created RomneyCARE/ObamaCARE
and imposed it FOR ALL, FOR ROMNEY, FOREVER.”
“Bastards!”
You get the picture. So what do we take away from this?
I think we take away from it that some of these “Freepers,” as they’re called on that site, are on to something. Republicans don’t really want to repeal Obamacare. Or no: they almost certainly want to, but they know they probably can’t. So even while they froth away for the cameras and town-hall meetings, there’s another, smaller, darker part of them that knows the truth, or the likely truth, which is that Hillary Clinton appears likely to be the next president, the Democrats will recapture the Senate in 2016 or vastly increase their majority if they didn’t lose it in 2014, and by the end of the next President Clinton’s first term, Obamacare will be nailed to the floor.
Remember, this happened on March 27: four days before the ACA’s enrollment deadline arrived, and therefore well before anyone knew the number would hit the target of seven million. So they were out there, on Fox and on all those acidic radio shows they do, talking about what a world-historical failure Obamacare was going to prove to be in just a matter of days, while meanwhile, with no one recording the roll call, they were buying shares of it.
This brings to mind some things I’ve read about civil rights and the Dixiecrats. The liberal Northern senators used to chat among themselves in the early and mid-1960s, wondering which of their Southern colleagues really and truly believed the racist pollution that poured out of their mouths. The consensus at the time was that Strom Thurmond really did. Richard Russell. Most of them, however, sorta-kinda believed it but just said it, because they knew that as long as they were 110 percenters on what they called “the n——-r question,” they could get reelected ‘til the end of time provided they weren’t caught with the proverbial live boy or dead girl.
There’s a story in Phil Hart’s biography—Hart, of Michigan, was one of the Senate’s most liberal members, and one of the key movers of the Voting Rights Act—about an encounter he had with Mississippi’s James Eastland. Eastland was as hard-shell as they came. But somehow, he and Hart became friends anyway. And so one day on the Senate floor, after delivering himself of a hideous racial tirade, as he walked back toward his desk, Eastland caught his friend Hart’s eye and winked.
Who knows how much of that kind of winking is taking place on the House floor now? “Hey, Steny, I don’t really mean everything I say ’bout y’all, but old so-and-so from the next district over just gave one helluva stemwinder about health care the other day, and I can’t let myself be out-Obamacared, know’ut I mean?” Oh, of course some Republicans are fire-breathers and diehards. But others seem to understand that if you’re going to try to have actual policy impact in the real world, you have to play ball in the real world. And the real world is Obamacare.
The latter group is probably a minority now. But I’m betting that one day they’ll be the majority, and that that day is going to come sooner than most people think. Maybe even—although they sure won’t admit it—before November.
By: Michael Tomasky, The Daily Beast, April 7, 2014
“An Endless Battle”: The Next GOP Scheme To Manufacture Obamacare “Horror Stories”
After the administration met a target of seven million new private insurance signups under the Affordable Care Act, and after pretty much every Obamacare “horror story” featured in a Koch-funded attack ad has turned out to be either completely false or extremely misleading at best, and after even some conservatives are telling their brethren to stop fooling themselves into thinking the ACA will inevitably implode, you might think that we could now start having a reasonable, factually grounded discussion about how we might improve the ACA going forward.
No such luck. In fact, there’s a new misleading “horror story” on its way: the worker whose hours are being cut back so their boss won’t have to comply with the ACA’s employer mandate. Watch out for it, because it’s coming.
Just as before, the decisions of private companies to attempt to screw over ordinary people are going to be blamed not on those companies, but on Obamacare. Before it was insurance companies, who tried to shunt their customers into overpriced policies when cheaper options were available on the exchanges. How many news stories did we see that featured someone’s anger at an insurer’s letter telling them they should sign up for a new, more costly plan, without even asking what other options the person had?
This time, the “horror story” will feature workers whose employers are trimming their hours back to avoid having to give them health insurance. Yesterday the House passed a bill, with every Republican voting in favor (along with 18 conservative Democrats) changing the law’s definition of full-time work from 30 hours a week to 40 hours a week. The purpose is to allow an employer to cut a full-time worker down to 39 hours and claim they’re “part time,” to avoid giving them health coverage (as it stands now, they’d have to cut them down to 29 hours).
President Obama would veto any such bill if it actually passed both houses. But still: this is the opening of a new front in the endless battle over the ACA.
So some context is in order. The ACA mandated that all companies with 50 or more workers offer health coverage. It’s vital to understand that this mandate actually affects only a small portion of workers, because most companies of that size already offer coverage. According to the Kaiser Family Foundation, 91 percent of firms with between 50 and 199 employees offer coverage today, before any mandate has taken effect. For companies with 200 or more employees, it’s virtually all of them (over 99 percent). Even most companies with fewer workers — 85 percent of those with between 25 and 49 employees — offer coverage.
So if, in the coming days, you see a story about an employer that’s trying to find ways not to cover their employees, the first thing to remember is that this an employer who is not giving their workers the benefits most people get. The second thing to remember is that the mandate has already been delayed. Companies with between 50 and 99 workers now have until 2016 to get their workers insured.
To be clear, there’s an argument for restructuring the employer mandate completely; there are other ways you could make sure that employees are covered. And as we learned in the Hobby Lobby case, the mandate isn’t truly a mandate; if a firm wants, it can decline to cover its workers, and pay a tax (which will cost a lot less than health coverage) to help defray the cost of them getting insurance through the exchanges.
I don’t even believe that people should be getting insurance through their employers at all; the fact that we do is an artifact of history that doesn’t have much practical rationale, particularly now (it started during World War II, when wage controls meant employers couldn’t give raises, so they began offering health benefits instead). But once coverage is required from all mid-size and large firms, it will be part of the cost of doing business for all of them — just as it is today for nearly all of them.
And by the way, this is true of lots of regulations: minimum wage laws, worker safety laws, laws against dumping toxic waste in the creek behind your factory, and a whole host of other laws that may increase a company’s expenses but get worked into the prices they charge for their goods and services.
As long as this is the system we have and there’s a mandate scheduled to take effect in 2016, we should be honest about what it means. If the claims about people getting dropped from individual coverage have taught us anything, it’s that whenever we see a new “Obamacare horror story,” it’s probably bogus. And this one will be no exception.
By: Paul Waldman, The Plum Line, The Washington Post, April 4, 2014
“Irrational Hatred Of Obamacare Is Hard To Fathom”: The GOP’s Relentless Opposition Has Been Puzzling
My friend Isatou has just received an invoice from Kaiser Permanente, testament to her new coverage through the Affordable Care Act — usually called “Obamacare.” She’s thrilled to finally have health insurance so she can get regular checkups, including dental care.
A reasonably healthy middle-aged woman, she knows she needs routine mammograms and screenings for maladies such as hypertension. But before Obamacare, she struggled to pay for those things. She once had to resort to the emergency room, which left her with a bill for nearly $20,000. (She settled the bill for far less, but it still left her deeply in debt.)
She is one of more than 7 million people who have signed up for health insurance through the ACA, stark evidence of the overwhelming market demand. Despite a badly bungled initial rollout, a multimillion-dollar conservative media campaign designed to discourage sign-ups, and a years-long Republican crusade against it (50 votes to change the law), millions got health insurance.
That hardly means Obamacare is a raging success. It’s much too early to know how it will affect health outcomes for the previously uninsured. But it’s abundantly clear that the ACA has already made great strides in improving access to health care. And that alone is quite an accomplishment.
Now, young adults can stay on their parents’ health insurance policies until they are 26 years old — a boon in an economy where many young folks are struggling to find decent jobs. Now, patients with previously diagnosed illnesses (“pre-existing conditions,” in insurance lingo) can’t be denied coverage. Now, the chronically ill don’t have to worry about hitting a lifetime cap that would deny them essential procedures or pharmaceuticals. Now, working folks who don’t get insurance through their employers can purchase affordable policies.
Factoring in the Medicaid expansion, the ACA has extended health care coverage to an additional 9.5 million people, according to the Los Angeles Times, which gathered data from national surveys. Needless to say, millions more would have been covered if so many Republican governors, mostly located in Southern states, had not callously refused to accept the Medicaid expansion despite the fact that it is largely paid through federal government funds.
The GOP’s relentless opposition has been puzzling. Republicans have resorted to extreme measures to try to derail Obamacare, including an implicit threat to prevent the National Football League from participating in a marketing campaign to encourage people to sign up.
Oh, did I mention 50 votes to repeal or alter the law?
Even acknowledging that our politics have become bitterly polarized, I don’t understand this one. Even taking into account the GOP’s irrational hatred for President Obama, I don’t get it. Even though I know that Republicans believe in less government, I don’t understand their approach to Obamacare.
First off, the ACA adheres to market-based ideas, many of which were first suggested by conservatives. Instead of a single-payer system like, say, Medicare, the ACA relies on private insurance companies. It adopts the individual mandate that was supported by many Republicans, including Newt Gingrich, back in the 1990s and later adopted by Mitt Romney in Massachusetts.
Second, Republicans are free to offer up a health care scheme that is more in keeping with conservative principles. But the “repeal and replace” mantra is rarely heard anymore since it has become increasingly clear that the GOP has no intention of coming up with a plan to replace Obamacare. While there are various counter-proposals floating about, none has garnered the support of a majority of Republicans in Congress.
Is the ACA perfect? Absolutely not. There is much in the law that needs to be worked on, refined, improved. But the GOP doesn’t seem interested in that. Instead, its members have taken to engaging in increasingly ridiculous criticisms, including the charge that the White House has made up the number of successful enrollees.
It’s strange. Could it be that Republicans are simply furious that millions of Americans like Isatou finally have health insurance?
By: Cynthia Tucker, Winner of the 2007 Pulitzer Prize for Commentary, is a Visiting Professor at the University of Georgia; Published in The National Memo, April 5, 2014
“The Moment Of Truth”: The GOP Must Admit It Was Wrong On Obamacare
Is there any accountability in American politics for being completely wrong? Is there any cost to those who say things that turn out not to be true and then, when their fabrications or false predictions are exposed, calmly move on to concocting new claims as if they had never made the old ones?
The fact that the Affordable Care Act (ACA) hit its original goal this week of signing up more than 7 million people through its insurance exchanges ought to be a moment of truth — literally as well as figuratively. It ought to give everyone, particularly members of the news media, pause over how reckless the opponents of change have been in making instant judgments and outlandish charges.
When the health-care Web site went haywire last fall, conservatives were absolutely certain this technological failure meant that the entire reform effort was doomed. If you doubt this, try a Google search keyed to that period relating the word “doomed” to the health-care law.
It should be said that the general public was much wiser. A CNN poll in November that Post blogger Greg Sargent highlighted at the time found a majority (54 percent to 45 percent) saying that the problems facing the law “will eventually be solved.” Political moderates took this view by 55 percent to 43 percent, independents by 50 percent to 48 percent. Only Republicans — by a whopping 72 percent to 27 percent — and conservatives (by 66 percent to 33 percent) thought the law could never be fixed.
Their representatives in Washington, moderate conservatives as well as the tea party’s loyalists, followed the base’s lead. In mid-November, for example, Sen. Rob Portman (R-Ohio) told Fox News flatly that the law is “destined to fail,” “fundamentally flawed” and “not ready for prime time.” House Speaker John Boehner predicted dire outcomes before the Web site fiasco. He repeatedly insisted, as he did in July, that “even the Obama administration knows the ‘train wreck’ will only get worse.”
This attitude affected more neutral observers. Forbes magazine posted a piece on Nov. 22 under the headline: “What to do if and when Obamacare collapses.” The op-ed modestly acknowledged that “it’s too soon to write an epitaph for Obamacare,” but then barged forward, since “its crises are piling up so fast that one has to begin looking ahead.”
At this point, the etiquette of commentary typically requires a “to be sure” paragraph, as in: To be sure, the law could still face other problems, blah, blah, blah. But such paragraphs are timid and often insincere hedges. After all, every successful program, even well-established ones such as Medicare, Social Security and food stamps, confronts ongoing challenges.
So let’s say it out loud: The ACA is doing exactly what its supporters said it would do. It is getting health insurance to millions who didn’t have it before. (The Los Angeles Times pegged the number at 9.5 million at the beginning of the week.) And it’s working especially well in places such as Kentucky, where state officials threw themselves fully and competently behind the cause of signing up the uninsured. Those who want to repeal the law will have to admit that they are willing to deprive these people, or some large percentage of them, of insurance.
Too many conservatives would prefer not to say upfront what they really believe: They don’t want the federal government to spend the significant sums of money needed to get everyone covered. Admitting this can sound cruel, so they insist that their objections are to the ACA’s alleged unworkability, or to “a Washington takeover of the health system” (which makes you wonder what they think of Medicare, a far more centralized program). Or they peddle isolated horror stories that the fact-checkers usually discover are untrue or misleading.
Thus the moment of truth, about the facts and about our purposes.
From now on, will there be more healthy skepticism about conservative claims against the ACA? Given how many times the law’s enemies have said the sky was falling when it wasn’t, will there be tougher interrogation of their next round of apocalyptic predictions? Will their so-called alternatives be analyzed closely to see how many now-insured people would actually lose coverage under the “replacement” plans?
Perhaps more importantly, will we finally be honest about the real argument here: Do we or do we not want to put in the effort and money it takes to guarantee all Americans health insurance? If we do — and we should — let’s get on with doing it the best way we can.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, April 2, 2014
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