“About Those Canceled Plans”: When “Victims” Become Beneficiaries
When pressed for specifics, the Affordable Care Act’s detractors tend to focus on two main areas of concern: the website and the cancelation notices. The website is obviously important and administration officials are doing what they can. Maybe it’ll be fixed quickly, maybe it won’t – we’ll find out soon enough.
But the cancelation notices are a different kind of concern. As we’ve discussed, we’re talking about a very small percentage of the population that has coverage through the individual, non-group market and are now finding that their plans are being scrapped. When the House Republican “playbook” looks for people saying, “Because of Obamacare, I lost my insurance,” these are the folks they’re talking about.
But the story about these “victims” of reform is coming into sharper focus all the time.
Only a small sliver of the Americans who buy their own health insurance plans and may be seeing them canceled under Obamacare will pay higher premiums, according to an analysis released Thursday.
More than seven in 10 Americans who purchase health plans directly will get subsidies to help pay for coverage under the Affordable Care Act, according to the report by Families USA, a Washington-based organization that supports the health care reform law.
“It is important to keep a perspective about the small portion of the population that might be adversely affected,” said Ron Pollack, executive director of Families USA. “That number is a tiny fraction of the 65 million non-elderly people with pre-existing health conditions who will gain new protections through the Affordable Care Act. It is also a small fraction of the tens of millions of uninsured Americans who can also get help.”
Let’s put this another way. A tiny percentage of consumers will receive cancelation notices, and of them, more than 70% will get new, more secure coverage that ends up costing them less.
They’re not, in other words, victims. They’re beneficiaries.
In fairness, many of them won’t know this for a while because they can’t yet go to healthcare.gov and see how much they’ll benefit, but we’re talking about the health care system itself – for all the talk about the cancelations, by a 2-to-1 margin, these folks are going to be better off, including receiving subsidies through the Affordable Care Act.
In reference to the remaining folks who’ll pay more, Pollack told the Huffington Post, “That’s approximately 1.5 million people, and that’s not trivial and I don’t in any way suggest that we shouldn’t be concerned about that group. But … the number of people at risk of this becoming a problem is considerably smaller than the tens of millions of people who are going to get substantial help.”
And here’s the larger question: if the evidence had pointed in the other direction, and 71% of these folks were poised to pay more, not less, would the story have gotten more attention? Would the coverage be dominated by “More bad news for Obamacare”?
This week, after years in which Obamacare critics said the law would fail to control costs, we saw remarkable evidence that the law is succeeding in controlling costs. Didn’t hear much about that? Neither did I.
I’m starting to get the sense that there’s an approved narrative – the Affordable Care Act is failing and is in deep trouble – and developments that point in the opposite direction are filtered out, while developments that reinforce the thesis are trumpeted.
The debate is often confusing enough, but this isn’t helping.
By: Steve Benen, The Maddow Blog, November 22, 2013
“When Ideology Collides With Reality”: Irrational Republican Exuberance Over Obamacare’s Problems
In these days of hyper-polarization, some readers may wonder why I always treat with great respect the findings and analysis of conservative number-cruncher Sean Trende of RealClearPolitics. I don’t always agree with what he says, but he’s willing to say uncomfortable things to people on his side of the barricades when data and history so indicate, as he did in a column today pouring ice water on the popular conservative idea that a collapse of Obamacare would lead to some sort of “existential crisis” for liberalism or “the welfare state.”
I’ve said before that our press corps suffers from histrionic personality disorder, and this is but the latest example. Wasn’t it just weeks ago that we were told the government shutdown could cost Republicans the House? But elections and the ideological orientation of the country don’t turn on such immediate, short-term events. The arc of history is long. Both parties, and both ideologies, have plenty of wins ahead of them, and neither is likely to suffer a knockout blow.
Let’s start by observing that we’re barely 50 days into Obamacare’s launch. While the program is clearly in much graver political danger than was the case a month ago, it’s still unclear that the ship won’t eventually be righted. Maybe the so-called “young invincibles” will sign up in droves, or maybe they won’t and the program will go into a death spiral. We just don’t know yet.
But even if the Affordable Care Act does collapse, I’m not sure that the liberal project will be kneecapped, much less destroyed. Americans have very short memories, and the pendulum will swing back quickly if Republicans mess up their next opportunity to govern.
Trende then goes through a long series of historical examples (dating back to 1890) of big political calamities for one party or the other that was followed in relatively short order, and sometimes almost instantly, by a big recovery, often because the other party over-estimated its advantages and overreached. And he notes that even in specific policy areas a misstep or defeat doesn’t necessarily take issues off the table:
Even the last failed attempt at health care reform, in the early 1990s, didn’t actually spell the end of reform efforts for the next two decades, as many suggest. It just proceeded incrementally, with some fairly significant steps. Congress in 1996 passed the Kennedy-Kassebaum bill, which established health insurance portability. The following year, Republicans helped to establish the State Children’s Health Insurance Program, which today provides health care for almost 8 million children. In 2001, before the 9/11 attacks, Congress was consumed with a debate over the Patient’s Bill of Rights, with the only major disagreement involving whether plaintiffs should be able to collect punitive damages while suing their HMO.
Sean even suggests an Obamacare “disaster” could produce an even more ambitious Democratic health care initiative:
[E]ven if Obamacare does collapse, the most liberal aspects of the American health care system — Medicare and Medicaid — will still be around. Democrats have already been pretty straightforward about what their “Plan B” will be: Medicare/Medicaid for all. Both programs are still very popular, and the Democratic standard-bearer in 2016 would almost certainly campaign on expanding them, perhaps to those over 55 for Medicare and under 25 for Medicaid. I’m not sure that would be a losing issue, even with an Obamacare collapse. In 10 years, I think it’d be a winner.
That is indeed the “silver lining” that a lot of single payer advocates have been seeing in the troubles involving the Obamacare exchanges, which are complex and hard to administer in no small part because of their reliance on a managed competition model many liberals never favored in the first place.
Trende thinks the major lesson here is that the ideological clash of ideas that activists often perceive in political events just isn’t shared by that many voters:
The American electorate is not intensely ideological, and is more motivated by things such as the state of the economy, whether there is peace abroad (or whether we’re winning a war), and whether the president is suffering from a major scandal.
I would agree in part, but would go further to say that today’s radicalized Republican Party has goals that have never commanded a majority of the electorate, and are even less likely to do so in the future. It is capable of making big gains when Democrats screw up, but is determined to risk them immediately to pursue an unpopular agenda. If the worst (or from their point of view, the best) happens and conservatives gain the power to implement that agenda, then the odds are extremely high they will, as Trende puts it, “mess up their next opportunity to govern.” And in that respect, ideology really does matter–when it collides with reality.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, November 20, 2013
“Stupid Obamacare!”: Profit Maximizing Private Insurance Companies Got You Down, Blame Obama
It has been said many times over the last few years that now that Democrats successfully passed a comprehensive overhaul of American health insurance, they own the health-care system, for good or ill. Every problem anyone has with health care will be blamed on Barack Obama, whether his reform had anything to do with it or not. Your kid got strep throat? It’s Obama’s fault! Doctor left a sponge in your chest cavity? Stupid Obama! Grandma died after a long illness at the age of 97? Damn you, Obama!
OK, so maybe it won’t be quite as bad as that, but pretty close. Here’s an instructive case in exactly how this plays out. Take a look at this article that ran in yesterday’s Washington Post, telling how in order to keep premiums down and attract customers, some insurers are limiting their networks. “As Americans have begun shopping for health plans on the insurance exchanges,” the article tells us, “they are discovering that insurers are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals.”
So insurance companies—private actors seeking to maximize profit—are making decisions that some potential customers find less than perfectly appealing. The article itself is clear about why this is happening, but in the newspaper’s print edition, the subtitle read, “Exchanges Exclude Doctors, Hospitals.” Of course, that’s completely false. The exchanges haven’t excluded any doctors and hospitals, the insurance companies offering plans on the exchanges have made a decision to exclude them. The insurance companies are perfectly free to make a different decision, but they’ve decided not to.
So the newspaper runs this story, with the headline writers mistakenly portraying what for some small number of people is an unwelcome development as a decision made by the Obama administration. Conservatives will then take articles like this and others like it, and say, “See? Obama said you could keep your doctor! He lied! This law is a disaster!” Barack Obama never said that he’d forbid any insurance company from ever changing anyone’s policy or offering policies that provide something less than spectacularly gold-plated coverage at absurdly low prices. But now, every profit-maximizing decision by a corporation becomes Barack Obama’s fault.
The second component of Barack Obama coming to own all the problems with the health-care system is that with the rollout of the ACA, you suddenly have a lot of political reporters doing stories on health care, and many of them have only the thinnest understanding of the law. That limited understanding makes it easier for them to just focus on whatever negative things are happening in health care, blaming them on the ACA, and assuring themselves that they’ve been appropriately “tough” in their reporting.
There’s nothing wrong with reporters fully exploring all the changes our ever-evolving health-care system goes through, so long as they do it accurately. But you might notice that they are completely uninterested in the stories of people who are being helped by the Affordable Care Act. Harold Pollack estimates that there are over 10 million uninsured Americans who have significant medical issues like a cancer diagnosis or diabetes, and thus find it difficult or impossible to get insurance on the individual market under the pre-ACA system. These people will now be able to get reasonably priced insurance, which for many will be literally life-saving. But journalists find these people boring and not worth talking about. They’re much more interested in people who find something problematic in the new system, and they’re working hard to find every last one of those people’s stories and share them with the country. And that’s how Barack Obama ends up owning the health-care system.
By: Paul Waldman, Contributing Editor, The American Prospect, November 22, 2013
“This Is Sabotage, Plain And Simple”: The Unprecedented GOP Efforts To Undermine A Federal Law
Sen. Joe Manchin (D-W.Va.), who’s never been the Affordable Care Act’s biggest fan, appeared on MSNBC yesterday to join the critical chorus. In reference to the Obama administration, the conservative Democrat said, “The bottom line is that they messed up, they messed up royally. There’s no excuse for this.”
The administration’s missteps have been well documented, and officials have earned much of the criticism they’ve received. But to say there’s “no excuse” is to overlook Republican sabotage efforts that have made a real difference.
Todd Purdum recently made the case, for example, that “calculated sabotage by Republicans at every step” is a “less acknowledged cause” of the rollout’s troubles. Jamelle Bouie added this week, “If Republicans have shown anything over the last four years, it’s that they’ll do anything to stop the Affordable Care Act, even if it amounts to legislative sabotage.”
We’ve talked before about the scope of these unprecedented efforts to undermine a federal law, which include blocking necessary resources needed for implementation, public misinformation campaigns, discouraging public-private partnerships, blocking Medicaid expansion, blocking CMS nominees, refusing to create marketplaces, and prohibiting “Navigators” from doing their jobs. But the campaign is arguably intensifying now.
Dana Milbank reports on House Republican leaders who emerged from their weekly meeting yesterday and tried to scare the bejesus out of Americans.
The Republicans’ scary-movie strategy has some logic to it: If they can frighten young and healthy people from joining the health-care exchanges, the exchanges will become expensive and unmanageable. This is sabotage, plain and simple – much like the refusal by red-state governors to participate in setting up the exchanges in the first place.
The quotes from House GOP leaders are rather remarkable. Majority Leader Eric Cantor (R-Va.) said health care reform may lead to identity theft; Speaker John Boehner (R-Ohio) falsely claimed “premiums are going right through the roof”; Majority Whip Kevin McCarthy (R-Calif.) warned that consumers who visit healthcare.gov may become victims of fraud; and Caucus Chair Cathy McMorris Rodgers (R-Wash.) said vulnerable constituents may be put “on the casualty list.”
Milbank added, “Let’s hope the new health-care plans have generous coverage for anti-anxiety medication.”
Let’s not forget that the difference between a lie and a falsehood is intent – if you know the truth and say the opposite because your goal is deceit, you’re lying. And for the most part, congressional Republicans, whose interest in helping provide greater health security for Americans is easily trumped by their interested in destroying a Democratic law, have been reducing to lying.
But for saboteurs, honesty and serious policy debate are easily sacrificed for the larger goal. Indeed, they’re a small price to pay.
Also note, we’re looking at quite a one-two punch from the far-right – on the one hand we see the Koch brothers and their allies urge the uninsured to stay that way on purpose, in order to advance conservatives’ ideological goals, and on the other we see congressional Republicans try to terrify the public in the hopes that people who stand to benefit from “Obamacare” steer clear of the system.
President Obama added yesterday, during an interview with the Wall Street Journal, that if both parties were “invested in success,” the rollout wouldn’t have been quite so rocky. “One of the problems that we’ve had is that one side of Capitol Hill is invested in failure and that makes the kind of iterative process of fixing glitches as they come up and fine tuning the law more challenging,” he added.
There’s no denying that the dysfunctional health care website matters, and the administration’s missteps deserve criticism. But Republican sabotage matters, too.
Kevin Drum recently explained, “No federal program that I can remember faced quite the implacable hostility during its implementation that Obamacare has faced. This excuses neither the Obama administration’s poor decisions nor its timidity in the face of Republican attacks, but it certainly puts them in the proper perspective.”
By: Steve Benen, The Maddow Blog, November 20, 2013
“Let’s Work The Problem People”: Houston, We’ve Had A Health Care Problem For A Long Time
One of my favorite scenes in a movie is Ed Harris playing NASA ace Gene Kranz at mission control when Apollo 13 was about to burn up. He walks into a room full of engineers and scientists responsible for the mission as they are arguing and screaming at one another. He slams his fist down, quiets the crowd and says, “Let’s work the problem, people.”
That is how I feel about the launch of Obamacare. Fix it. Solve it. Make it work.
The other famous quote from that movie was Tom Hanks as Commander Jim Lovell when he said, “Houston, we have a problem.” The actual quote from Lovell was, “Houston we’ve had a problem.” Now that seems more appropriate for the herculean task of solving America’s health care problems.
We’ve had a problem, all right, for generations. We’ve failed to tackle the critical issue of health care in our country ever since Teddy Roosevelt. How can we justify more than 45 million Americans without health insurance? How can we rationalize a system that charges women twice as much as men? How can we not strike back against a system that would deny people health insurance because they had a pre-existing condition or that kicked them off because they hit a cap or got sick?
How can we possibly not recognize “we’ve had a problem” when costs have risen from $1,000 per person in the United States in 1980 to more than $8,000 in 2010? Costs going up 15 to 20 percent a year and eating up one-sixth of our economy are not sustainable.
The Republicans don’t want to work the problem, they want to sweep it back under the rug. Their goal is to turn this into a political football they can kick around between now and November. Five hearings in three days, more votes to destroy the Affordable Care Act. Not one suggested “fix” coming out of the Republicans in the House of Representatives.
I suggest House Speaker John Boehner and Rep. Darrell Issa watch the scene from Apollo 13 where the scientists react to Ed Harris. They put everything on the table that they have to work with in the space capsule and figure out how to bring the astronauts back safely to earth. They worked the problem; it is time for all concerned to do the same on health care. Mend it, don’t end it.
By: Peter Fenn, U. S. News and World Report, November 15, @013
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