“What A Shocker”: Obamacare Is Working Best In States That Aren’t Trying To Sabotage It
The disappointing Affordable Care Act (ACA) numbers the Department of Health and Human Services (HHS) released on Wednesday revealed that the law is working best in the states that are — shockingly — implementing the law as it was designed.
Of the 106,185 people who have completed an application for health insurance, nearly 75 percent came from 14 states and the District of Columbia that both set up their own exchanges and expanded Medicaid.
Unsurprisingly, California and New York combined for the bulk of the enrollments, 51,769. But the most promising news from the Golden State wasn’t even included in this report.
Peter Lee, the executive director of Covered California, reported Wednesday that as of Tuesday, 60,000 Californians had signed up for insurance. Signups have increased to a rate of almost 2,500 enrollees per day in November. At that pace, the state could be expected to enroll 402,500 people by March 31 but Lee says that he expects to hit a goal of 500,000 to 700,000 people by then, which means he expects the pace to pick up by at least 640 people a day to over 3,000 enrollees.
Lee’s optimism is linked to more than the enrollment numbers. It seems California’s consumers are happy with the state’s website.
“Overall, nearly 70 percent of consumers who completed the survey found the application process easy to complete, and 88 percent of customers visiting CoveredCA.com found the information needed to choose a health plan that was right for them,” Covered California reported in a statement released Wednesday, giving Republicans another reason to hope that California isn’t a bellwether for the rest of the nation.
Red Kentucky is the only state in the union that voted for Mitt Romney and set up its own exchange, thanks in large part to Democratic governor Steve Beshear. The state’s site signed up a total of 32,485 Kentuckians, with 5,586 enrolling in private plans, in its first month of operation. This reduces the state’s uninsured population —estimated at 640,000 — by just over 5 percent.
Of course, it’s not hard for the states to look impressive next to the federal number that is anemically low. And not all the states that set up their own exchanges have succeeded. Oregon’s marketplace is so flawed, they didn’t even have numbers to report for October.
Implementing health care reform was never supposed to be easy.
“It’s like fixing an airplane while it’s in flight, if there is something terribly wrong with the plane,” said Timothy Jost, a health law professor at Washington & Lee University and an expert on the ACA.
And that’s without the unprecedented campaign of sabotage the right has waged. But the obstruction that has threatened the law most has been the combination of a mostly unforced error — Healthcare.gov’s disastrous launch — and Republican states refusing to launch their own exchanges. While the right is thrilled they’ve assisted in this catastrophe, it was the ancillary result of another sabotage strategy that was either masterminded or enthusiastically encouraged by Michael Cannon.
Who?
“Cannon is a health care policy expert at the libertarian Cato Institute,” reports The New Republic‘s Alec MacGillis. “He is also an avowed opponent of the Affordable Care Act, and has for several years now been embarked on a legal crusade that, while a ways from triumphing, may have inadvertently played an outsized role in suppressing the number of states setting up their own exchanges, thereby greatly confounding the law’s implementation.”
Cannon believes he has found a loophole in the law that could end up undoing it in any state that didn’t set up an exchange. With that in mind, he helped successfully convince every state with a Republican governor to reject their right to build their own site.
By opting out, states made the success of the president’s signature legislative accomplishment dependent on one single portal that needed to reach its tentacles into three dozen complex insurance markets at one time.
That — it turns out — is a lot more complicated than the administration expected it to be.
The best state numbers show that the ACA can be implemented with participation rates that are in at least in the same ballpark as Massachusetts’ Romneycare or Medicare Part D.
And there were some other numbers in the HHS report that bode well for reform.
HHS reports that 26,876,527 different users accessed the site and 3,158,436 calls were made to its center. A total of 1,477,853 applications processed to the point of where eligibility could be determined. This shows that the demand for what the marketplace is offering definitely exists.
Clearly and undeniably, the fate of the law now depends most on one thing.
“The October report is clearly disappointing,” Timothy Jost wrote in his blog. ”But the really important reports will be the December report, which will tell us how many will be enrolled for coverage that begins in January, and the March report, which will tell us how many will be enrolled for 2014. If healthcare.gov is up and running by December, there is every reason to believe those reports will be much more promising.”
By: Jason Sattler, The National Memo, November 14, 2013
“Obamacare’s Critical Moment”: It’s Time For Nervous Democrats To Have A Gut Check
At times like this, with the Obama administration weathering yet another controversy regarding the stumbling beginnings of the Affordable Care Act, it’s useful to remind ourselves that this too shall pass. I’ve been plenty critical of how Healthcare.gov has been handled (see here, or here, or here), but eventually it will get fixed, at least to the point at which it works well enough. Likewise, the fears now being experienced by people with individual insurance policies will, by and large, turn out to be unfounded. There will be some who have to pay more than they’ve been paying, but in almost all cases they’ll be getting more too.
But there’s no doubt that this is an escalating problem for the administration. The person who got sold a cheap insurance policy on the individual market because the insurer was confident that either a) they probably wouldn’t get sick any time soon, or b) the policy was so stingy (whether the customer knew it or not) that the insurer wouldn’t have to pay anything even if they did, has now become the victim whom all agree must be made whole. We’re all talking endlessly about Obama’s “If you like your current plan, you can keep it” pledge, but the fact is that if you have one of these junk insurance plans, you only like it if you haven’t had to use it. But no matter—the people on these plans (and not, say, people who are finally getting Medicaid, because they’re poor so who cares) are now the only people that matter. Congress is obsessed with them, the news media is obsessed with them, and Something Must Be Done.
The administration is clearly spooked, and so are Democrats. But everyone needs to take a breath and ask themselves whether what they do in the next couple of weeks is something they’ll be able to live with in a year or five years or twenty years.
No one should be under the illusion that the Republican proposals to “fix” the problem of people on the individual market who want to keep their current plan—one of which could be voted on today in the House—are anything other than an effort to cripple the ACA. Not only would they allow insurers to continue selling junk policies, they would also allow the insurers to deny people coverage because of pre-existing conditions. In other words, the Republicans propose to restore the abysmal status quo ante that led to passage of the ACA in the first place. They’d also have the likely effect of jacking up premiums in the exchange marketplace by allowing the insurers to cherry-pick healthy young people for the now still-legal junk policies, leaving older and sicker people to migrate to the exchanges, where premiums will almost surely skyrocket a year from now once the damage becomes clear. As Igor Volsky puts it, “On the eve of implementing hard fought reforms, lawmakers are essentially considering re-segregating the health care market: healthy uninsured individuals without an offer of employer-sponsored coverage, Medicare or Medicaid will be lured away into subprime policies that include few consumer protections (and probably won’t be there for them should they fall ill); sicker people will find themselves in exchanges that resemble high-risk insurance pools, paying ever-more for coverage.” Any Democrat who votes for something like that should be ashamed of themselves.
There’s a Democratic proposal from Mary Landrieu that’s almost as bad. Meanwhile, House Democrats are threatening the White House that they’ll sign on with the Republican plan if the White House doesn’t come up with some other solution that will allow them to cover their asses. But there may be no way to let people who have junk insurance keep it without undermining the law as a whole. As Ezra Klein says, “Solving a political problem now at the case of worsening a policy problem 10 months from now isn’t a good trade.” And that’s putting it way too mildly. They could easily try to solve a political problem now and give themselves a much worse political problem ten months from now by making it impossible for the law to succeed. If that happens, the fact that they signed on to the measure that all but destroyed the law isn’t going to save them with the voters. Obamacare’s fate is every Democrat’s fate, whether they like it or not.
You can say that Obama made his bed by repeating that “If you like your insurance, you can keep it,” and now he has to sleep in it. I’d have two responses to that. First, plans that were in effect when the ACA passed in 2010 fall under a grandfather clause, so strictly speaking, if you liked the plan you had when the law was passed and you still have it, you can keep it, even if it doesn’t meet the new requirements. But since the individual market is volatile (people move in and out of it frequently) and only plans that haven’t been altered since then fall under the grandfather clause, that’s a small number of people.
But much more importantly, we shouldn’t make a terrible policy choice just because it’s the one that we think would line up most precisely with a rhetorical pledge Barack Obama made three years ago. Yes, he should have said, “If you like your plan you can keep it, so long as it’s a plan that gives real coverage and doesn’t leave you vulnerable to bankruptcy if you get sick or have an accident.” But he didn’t. And today, we should make the policy choice that does the most good for the most people.
It would be nice if you could make an enormous policy change without leaving a single American worse off. But that was never possible. There are millions who are going to benefit from the ACA—people who had no insurance who will now be able to get it for free or for a modest cost, people with pre-existing conditions who couldn’t get coverage but now can, and yes, people who thought they were covered but weren’t and now will be, even if they have to pay a little more. Screwing huge numbers of them over for the sake of a small number of people who have been sold a bill of goods by their insurance company and want to keep their junk plans would be unconscionable.
As Josh Marshall says, it’s time for nervous Democrats to have a gut check. Republicans are positively slobbering at the opportunity they think they have to destroy the ACA. After all that’s happened—after a generation of waiting for health reform, after all the effort it took to pass it, after the Supreme Court case and the election and everything else—are there Democrats who want to find themselves telling their grandchildren, “Well, I helped the Republicans subvert the ACA and deprive millions of Americans of health security, because I was afraid somebody might run an ad against me in my next election”?
My confidence that your average member of Congress in either party fully understands the policy implications of what they might be voting for hovers somewhere near zero. But they need to get up to speed, and then find their moral centers. This is among the most critical moments in the already long and tortured history of this law. They’d better not screw it up.
By: Paul Waldman, Contributing Editor, The American Prospect, November 14, 2013
“Here We Go Again”: Democrats Need To Stop Freaking Out About Obamacare And Take Charge
The dawn of the 24-7 news cycle about 15 or so years ago brought with it a few new ways for the media to talk about and cover politics. With all that air time to fill, politics, and certain big news events like your major murders, became part soap opera. Soap operas, to keep the ratings steady, need running themes. What used to be called “Democrats in disarray,” known today in our hurried-up age as #demsindisarray, proved to be a compelling and durable one.
It developed, in part, because that dawn of cable happened to be the era of Clinton “scandals,” real and (mostly) imagined. Remember Craig Livingstone? If you don’t, Google him. If you do, you’re chuckling already, I know, because for about four days there on cable TV in 1996, Livingstone was supposed to be the ruination of Bill and Hillary Clinton. Democrats in disarray!
Yes, Republicans have been in disarray, too, from time to time—the low points of the Iraq War, Katrina, and just last month during the government shutdown. But for a variety of reasons, the 24-7 news cycle era has found Dems in disarray to be a far more potent story line than Republicans in disarray. It’s alliterative, for starters. And it has been, I readily concede, legitimately true at times. Plus, Fox, for many years, drove the agenda that the other cable nets swallowed hook, line, and sinker. MSNBC has been a liberal pushback channel only for five years or so, or less than half the life span of the 24-7 cycle. (Remember when Tucker Carlson was an MSNBC host?) And Republicans have tended to have tougher game faces, march more in lockstep, and not concede those crucial rhetorical inches that Democrats so often feel compelled to grant.
Of course, we are at one of these moments now. Bill Clinton conceded those rhetorical inches to the right on Obamacare, which Sen. Ted Cruz (R-TX) seized on immediately. At least two blue-state senators, Dianne Feinstein (CA) and Jeff Merkley (OR), have jumped on the “fix Obamacare” bandwagon. A week ago, Majority Leader Harry Reid was not going to allow any changes to the Affordable Care Act reach the floor of his Senate. Now he’s probably going to have to.
Undeniably, a lot of the damage is self-inflicted, and I’ve said that already more than once. It’s a pretty good time for President Obama to crack the whip. Why he evidently didn’t earlier is still mystifying. Or maybe it’s not. He just isn’t a kick-ass-and-take-names kind of guy. But the success of his presidency may be on the line here in the next few weeks, so it’s not the worst idea for him to become one.
At the same time, there’s no need for panic. Even with the continued existence and success of Fox, reality is still reality, and in the end, reality usually trumps cable and hyperventilating reports about who won the morning in Politico. And reality says the enrollment period doesn’t end until next spring, and it’s really not possible to tell how things are going until enrollment has ended and we see both the number of people who’ve enrolled and what percentage healthy vs. sick, because insurers made their guesstimates and pegged their rates to those guesstimates. Reality also says a legislative fix to address the problems faced by those buying insurance on the private market might not be so bad. A bill that allows—doesn’t order, but allows—insurers to keep offering existing policies for one more year while also restricting that offer only to existing customers wouldn’t necessarily blow a big hole in the precepts of the act. I’m not sure why Republicans would agree to it, but the first part of my equation comes from Rep. Fred Upton (R-MI)’s bill, so who knows.
Democrats—especially Obama, but all Democrats—have to take charge of the situation right now. In danger of losing the country’s trust, they must say in essence: “All right, we did screw up Round 1. We’re going to admit it, and we’re going to apologize, and we’re going to fix it, and we’re not going to bullshit you. But we’re also not going to panic. We’re going to make this thing work.”
If they do all those things, they will still come out looking a hell of a lot better than the radical obstructionists. Obama’s approval rating may be down to 40 percent, but that’s four times the Republican Congress’s rating. He can step in and take more control of the agenda here, and he and the Democrats can be seen as the ones sincerely trying to fix these problems, while the Republicans will inevitably be seen as wanting only to kill yet another law and throw yet another wrench into the engine. They will be led once again by Rep. Darrell Issa (R-CA), the man who has enticed his party to go down several rat holes already these past couple of years. He is now sitting up on his throne warning that hackers are about to steal applicants’ Social Security numbers, a charge that rings with all the veracity of his earlier accusation that the administration knowingly targeted conservative nonprofit groups.
The current situation is serious. But I remember a lot of other times when it was supposedly curtains for Obama, too, because inside the Beltway, the more disciplined Republicans, who after all are in the luxurious position of just sitting back and firing away, have an easier time winning news cycles. But out beyond the Beltway, the party that shut down the government for three weeks and killed immigration reform and wants to decimate food stamps and can’t even pass its own spending bills doesn’t look very appealing to most people. The fate of Obamacare can be changed. The DNA of the GOP cannot.
By: Michael Tomasky, The Daily Beast, November 14, 2013
“What Will Republicans Do?”: Here Comes The Real Government Takeover Of Health Care
For the last few weeks, Republicans have been full of schadenfreude over President Obama’s broken “If you like your plan, you can keep it” promise.
Now, this issue is about to blow up in Republicans’ faces.
Sen. Mary Landrieu (D-La.), who faces a tough re-election fight in a red state next year, has introduced a bill to address the president’s broken promise through greater government control over the individual health insurance market. Her bill would obligate insurers to continue offering all the plans they offer today unless they entirely exit the health insurance business in a state.
What will Republicans do with this proposal? Do they really want a federal law that says health insurers can’t enter or exit specific lines of business?
Rep. Fred Upton (R-Mich.) has introduced a bill in the House that would allow insurers to continue offering plans that would have been prohibited under the Affordable Care Act, but his bill is vulnerable to the criticism that it will still lead to a raft of plan cancellations as insurers choose to discontinue plans because the ACA has changed the financial incentives they face.
If Congress really wants to make sure people can take their plans, it will need to use the heavy-handed Landrieu approach; the light-touch Upton approach won’t work. Erick Erickson (of all people!) understands this; he wrote a piece this morning called “It’s a trap“:
The House, with the help of a good number of Democrats, will pass the Upton plan and send it to the Senate. Harry Reid will substitute the Landrieu plan and send it back to the House. The House will be forced to either vote for the Landrieu plan or be characterized as siding with insurance companies against people.
In one fell swoop, the Democrats will have the GOP on record saving Mary Landrieu’s re-election in Louisiana by casting her as the one who saved Americans’ health care plans, and also getting on record as really being in favor of fixing Obamacare with the use of mandates.
Pretty much. And it’s the comeuppance conservatives are getting for (1) having no health care agenda of their own and (2) endorsing the bizarre idea that health reform should not lead to health plan changes. With no health policy guidestar other than they’re against what the president is for, Republicans are liable to walk into traps like demanding more health insurance regulation than the president wants.
By: Josh Barro, Business Insider, November 13, 2013
“Unable To Win Elections”: They Tried To Break The Federal Government, Now They’re Going After The Courts
The astounding show of Republican recklessness that led to last month’s government shutdown made one thing very clear. The new Republican Party — the one ruled by the Tea Party — isn’t interested in making our government work. They want to break it.
Now, as if shutting down the government of the United States, furloughing hundreds of thousands of government employees, wasting billions of dollars and threatening to wreck America’s economy wasn’t enough, Republicans in Congress have set their sights on a new target: our justice system.
Yesterday, Senate Republicans took their campaign against our government to a whole new level when they blocked the nomination of Nina Pillard to the U.S. Court of Appeals for the District of Columbia Circuit, which is widely considered to be the nation’s second-highest court behind the Supreme Court.
Pillard is one of President Obama’s three nominees to fill vacancies on the D.C. Circuit, which is currently operating with nearly one-third of its active judgeships vacant. All three nominees have extraordinary professional qualifications. All three have support from across the ideological spectrum. Yet Senate Republicans are vowing to filibuster all three simply because they were nominated by President Obama.
One of the most basic functions of the U.S. Senate is to provide “advice and consent” to the president on his nominations to executive agencies and to the federal courts. For most of our country’s history, the Senate has generally taken this constitutional order responsibly, using its power to block only nominees whom senators found unqualified or dangerously far out of the mainstream. That is, until now.
The same party that shut down the government in an attempt to nullify a duly-enacted law that it does not like is now trying to prevent a twice-elected president from filling vacancies on an important court — a duty entrusted to him by the Constitution.
There’s a reason Republican obstructionists have targeted the D.C. Circuit. The court has the last word on important federal laws and administrative rules on issues ranging from clean air regulations to workers’ rights to cigarette labeling requirements to presidential recess appointments. Basically, just about any area that we regulate through our federal government is going to be affected by the D.C. Circuit. And it is currently dominated by conservative ideologues: nine of the 14 judges on the court (including “active” judges and senior judges who participate in panel decisions) were nominated by Republican presidents seeking to remake the courts in their ideological image.
Republicans want to keep it this way. President Obama has nominated five people to the court, yet Senate Republicans have allowed only one of these nominees to so much as receive a confirmation vote. By comparison, the Senate confirmed four of George W. Bush’s nominees to the court and eight of Ronald Reagan’s. In fact, the ninth, tenth, and eleventh seats that Republicans today demand remain vacant are ones that they ensured were filled when George W. Bush was president.
To give you an idea of just how conservative this court is as a result, just this month a George W. Bush nominee and a George H.W. Bush nominee ruled that employers who oppose birth control should be able to deny their employees access to affordable contraception through their insurance plans — an absurd twisting of the true meaning of religious liberty. A few months ago, the court ruled that a law requiring employers to display a poster listing employees’ legal rights violates the free speech rights of the employers. No, really!
Unable to win national elections, Republicans are trying to hold on to what power they still have — and that includes control of the powerful D.C. Circuit. Just like they couldn’t accept that the Affordable Care Act was the law of the land, the Tea Party won’t admit that Americans chose President Obama to be the one making picks to the federal courts.
The Tea Party thinks that it has some sort of intellectual property claim on the U.S. Constitution. But sometimes I wonder if its leaders have even read it.
By: Michael B. Keegan, President, People For The American Way, Published in The Huffington Post Blog, November 13, 2013
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