“A Sobering Reminder”: The Number Of Uninsured Americans Increased By 7.9 Million Under George W. Bush
The week President Obama took office, initial jobless claims, the statistic that immediately gauges layoffs, hit a 26-year high with 637,000 applying for unemployment insurance in one week. It was clear that the president was inheriting a record deficit, a cratering economy and two floundering wars. But buried in all those crises was an unspoken slow-motion disaster that people rarely mentioned: the steady crumbling of our health care system.
“When [former president Bill] Clinton left office, the number of uninsured Americans stood at 38.4 million,” Ron Brownstein wrote in 2009. “By the time [former president George W.] Bush left office that number had grown to just over 46.3 million, an increase of nearly 8 million or 20.6 percent.”
The numbers were just as bad when you looked at the share of the uninsured.
When Clinton left office, 13.7 percent of the population was uninsured. Bush left with 15.4 percent lacking coverage. And the only health reform the last Republican to occupy the White House enacted in his eight years was to add an unfunded prescription drug benefit that guaranteed cuts would need to be made at some point.
So the 15.4 percent of Americans Bush left uninsured in 2008 continued to rise in 2009 to 16.1 percent, then peaked at 16.3 percent in 2010. In 2011, it dipped to 15.7 percent, the biggest drop since 1999. The last census report showed that 48.6 million Americans were uninsured – that’s 15.4 percent. Exactly where it was in 2008.
It would be easy to credit the recovering economy for the rise of insured Americans — initial jobless claims last week were half of what they were when Obama took office. But the percentage of the uninsured is now lower than it was in 2006, before the Great Recession hit.
The New York Times‘ Paul Krugman calls the Affordable Care Act’s role in bringing health-cost growth to its lowest rate on record the law’s “secret success.” But the other secret success is how Obamacare is helping to reverse the growth of the uninsured population. This began in 2011 with children and young adults being able to stay on their parents’ plans until age 26, covering more than three million. And it continues this year with millions of Americans being added to the Medicaid rolls and millions likely to sign up for private plans, if the law’s health care exchanges begin working well enough.
Still Republicans are playing up the estimated 5 million cancellations of plans due to Obamacare the same way they played up the deficit and faltering economy President Obama inherited as if it had been his fault.
We won’t know how many of these people end up in new plans until next year, but we do know that nearly all of them will pay the same or less with a new plan that cannot deny them coverage or charge them more if they get sick.
“To sum up, lots of people losing coverage are losing policies they never liked much, that they would have dropped soon anyway, and that would have left them facing potential financial ruin if they got sick,” The New Republic‘s Jonathan Cohn wrote. “Even those with truly good policies had no guarantees that in one year, let alone two or three, they’d still be able to pay for them.”
Now, millions of Americans are being offered affordable health insurance possibly for the first time in their lives, promising to cut the ranks of the uninsured by millions in just a few years.
While Republicans are mourning cancellations of the exact kinds of plans that left massive holes in our health care system, the question is: Where were those crocodile tears when almost 8 million Americans became uninsured under George W. Bush… and Republicans did nothing to stop it?
By: Jason Sattler, The National Memo, November 29, 2013
“A Range Of Options And A Very Good Deal”: Under The Affordable Care Act, Millions Eligible For Free Policies
Millions of people could qualify for federal subsidies that will pay the entire monthly cost of some health care plans being offered in the online marketplaces set up under President Obama’s health care law, a surprising figure that has not garnered much attention, in part because the zero-premium plans come with serious trade-offs.
Three independent estimates by Wall Street analysts and a consulting firm say up to seven million people could qualify for the plans, but federal officials and insurers are reluctant to push them too hard because they are concerned about encouraging people to sign up for something that might ultimately not fit their needs.
The bulk of these plans are so-called bronze policies, the least expensive available. They require people to pay the most in out-of-pocket costs, for doctor visits and other benefits like hospital stays.
Supporters of the Affordable Care Act say that the availability of free-premium plans — as well as inexpensive policies that cover more — shows that it is achieving its goal of making health insurance widely available. A large number of those who qualify have incomes that fall just above the threshold for Medicaid, the government program for the poor, according to an analysis by the consulting firm McKinsey and Company.
The latest analysis was conducted by McKinsey’s Center for U.S. Health System Reform, whose independent research has been cited by the federal government and others.
“The whole point of the law was not only to cover the uninsured, but so people didn’t have to make choices between food or drugs, or going to the doctor or dentist,” said Karen Davis, a health policy expert at the Johns Hopkins Bloomberg School of Public Health. “It’s what it is designed to do.”
Many insurers tried to price their least expensive plans so they would become free or nearly free with the addition of subsidies that are set based on a person’s income and the cost of a midlevel, or silver, plan.
Independence Blue Cross in Philadelphia has four plans that are free to some customers. But the company, along with other insurers, has been careful not to publicize its free coverage for fear of alienating customers who will need to pay more.
“We’re not advertising zero dollar,” said Brian Lobley, a senior vice president at Independence Blue Cross. But the company is promoting monthly premiums in the $20 to $30 range, he said.
The Obama administration has also stressed affordability over coverage with no monthly charge, frequently saying that the cost of coverage will be less than a monthly cellphone bill for many consumers. Officials at the Department of Health and Human Services would not comment on the McKinsey analysis, saying in a statement that the goal of the health law was to provide a range of options for people with differing needs and budgets.
The analysis found that five million to six million people who are uninsured will qualify for subsidies that will be greater than the cost of the cheapest bronze or silver plan. A million more people with individual insurance could also be eligible, according to McKinsey, although estimates of the size of the market for private individual insurance vary widely. None of the people in the analysis qualify for Medicaid.
The availability of zero-premium plans may make the deal especially enticing to the healthy young people the marketplace needs to succeed, said Mark V. Pauly, a professor of health care management at the University of Pennsylvania’s Wharton School. “This is such a good deal that you’d have to believe you were immortal not to really pick it up,” he said.
Although they vary in their design, bronze plans generally cover about 60 percent of a person’s medical costs. All plans, including bronze, must cover standard benefits like prescription drugs, maternity care and mental health treatment.
The availability of the zero-premium plans varies across the country. McKinsey found that about 40 percent of the uninsured in Missouri will be able to select a no-cost bronze plan, for example, compared with 2 percent of the uninsured in New Jersey.
Its estimate, based on an analysis of premiums for plans offered in the marketplaces in all 50 states and the District of Columbia, is in line with two other estimates, by Credit Suisse and Morgan Stanley.
The McKinsey researchers also found that about half of the people eligible for zero-premium plans were under 39 and uninsured. The Obama administration has been emphasizing the affordability of its plans for young people, a critical group because their participation in the marketplaces will help keep overall premiums low.
It is impossible to know who will actually sign up, and whether they will choose a zero-premium plan.
For many people, paying slightly more for a silver plan may be a much better option, experts said. Ninety percent of those who will have the option of buying the no-cost plans make less than 250 percent of the federal poverty level, which is $28,725 for an individual, and $58,875 for a family of four. People earning below those thresholds are eligible for the most generous assistance, but only if they choose a silver plan.
About a million of those who will qualify for free coverage will be able to buy a silver plan for no monthly cost. McKinsey, which is releasing a report about the new insurance marketplaces, estimates that the cost of silver plans for the people who qualify for a zero-premium bronze plan will range from $40 to $50 a month.
“They may be getting zero premiums, but they’re also leaving a lot of money on the table if they don’t enroll in a silver-level plan,” said Sabrina Corlette, a professor at Georgetown University’s Health Policy Institute.
All plans, including bronze policies, limit annual out-of-pocket costs to $6,350 for individuals and $12,700 for families. But insurers and advocates said out-of-pocket costs — even those under that limit — can be daunting to people with low incomes.
For Mark and Elisabeth Horst, both artists in Albuquerque, the risks of signing up for a bronze plan were outweighed by the prospect of getting it free. The Horsts, who make $24,000 a year between them, qualified for $612 in monthly subsidies, but the cost of a bronze plan was $581 a month.
“We’re in good health,” Mr. Horst said.
Besides, he said, they can always switch to a better plan next year. “At this point, it’s a little bit of a gamble.”
Not everyone selects the cheapest option. Dante Olivia Smith, a lighting designer from Manhattan, learned that federal subsidies would allow her to buy a bronze plan for $24 a month.
“It was astounding,” she said. “I almost started crying, and called my mom.”
In the end, however, she went with a silver plan for $91 a month that included dental and vision coverage. Ms. Smith, who is 30, said she opted for the more comprehensive plan because of her work, which requires her to climb ladders and use power tools.
“If I had a different job, for 24 dollars a month I would have been like ‘Woo-hoo!’ ” she said. “But the reality is, I know what my risks are in my life.”
By: Reed Abelson and Katie Thomas, The New York Times, November 3, 2013
“From Obsession To Insanity”: The GOP Is Unhinged By Obamacare
Whacking yourself on the head with a ball-peen hammer would be stupid. But doing it again and again — that’s insane.
Welcome to your U.S. House of Representatives, presently led by a pack of Tea Party Republicans. They are so crazed by Obamacare that they repeatedly hammer themselves over the head with it, having voted 46 times (so far) to dismantle, defund, delay, deny, and otherwise destroy this landmark health care bill — all to no avail. They would be hilarious, were they not so pathetic.
But now, their anti-government, anti-Obama obsession has turned into insanity. Acting as though the USA is nothing more substantial than a banana republic, this Tea Party clique of petty potentates has forced a shutdown of our national government. The craziest part of their stunt is the duplicitous claim that finally providing health care for millions of uninsured Americans will have, as one leader of the mad-dog pack put it, “horrific effects.”
Yet, even as they publicly insist that they’re heroes for trying to save the people from the horror of receiving fairly decent health coverage, the GOP hierarchy is quietly warning its members that defeating Obamacare now is essential to their own health. Why? Because they know the program will work, providing better care and nearly universal coverage at a cheaper price. It will become widely popular, and any politico who tries to kill it later will become wildly unpopular. Even the senator from Oz, Ted Cruz, understood that the program had to be aborted before it was born. It will be so loved, Cruz candidly conceded (as he desperately tried to suffocate Obamacare with a painfully-long “filibuster”), that the public will be “hooked” on it for the long haul.
Yes, Sen. Oz, the American people tend to support policies that are beneficial to them. What’s crazy is you and your cohorts thinking they’re crazy for thinking that.
So now, Dr. Hightower offers this advice: Don’t fume about the GOP’s lunatic effort to kill health care reform — just laugh at their farcical show. It won’t affect them, but it can improve your mental health.
For starters, take Ted Cruz’s 21-hour blabathon that he said would stop Obamacare in its tracks. Not only did he fail spectacularly, but senators voted 100 to zero against his crazy ploy. Yes, that means that even he ended up voting against it! What a hoot he is.
A shameful hypocrite, too. While going to extremes to keep millions of Americans from getting vitally needed health coverage, Cruz goes to great lengths to keep the people from being reminded of his own health care, past and present.
Having been born in Calgary, Canada, little Ted’s parents were able to take advantage of the country’s universal health care, or as the Tea Party darlings like to call it, “socialized” medicine. That’s right, for the first four years of Ted’s life in Calgary, he was covered under government subsidized healthcare. I find it absolutely hysterical that little Ted would grow up to throw a 21-hour-long temper tantrum over affordable health care for hardworking American people. Recently, Cruz had been repeatedly refusing to answer whether taxpayers covered his health care. Finally, he piously responded that he was eligible for taxpayer coverage, but had nobly declined.
Such slapstick! It turns out that Ted was fibbing, for he’s covered by his wife’s policy. As a millionaire top executive at Goldman Sachs, she and her family are given gold-plated Cadillac coverage by the Wall Street giant. Goldman pays some $40,000 a year for her and Ted’s policy (more than most families make in a year) — a benefit-cost that the firm passes on to us taxpayers by deducting it from its corporate tax bill. Hilarious, huh?
Then there’s the comic twist that’s included in Congress’ current government shutdown. While more than a million regular government workers are going without a paycheck, the congresscritters who forced the furlough continue to collect their $174,000 in annual pay. Some lawmakers are donating their checks to charity, but four out of five are happily pocketing theirs. “Dang straight,” barked Rep. Lee Terry. “I’ve got a nice house and a kid in college,” the Nebraska Republican said. “Giving our paycheck away when you still worked and earned it? That’s just not going to fly,” Terry told his constituents.
And that’s your Congress at work. Laugh ’til it hurts.
By: Jim Hightower, Featured Post, The National Memo, October 10, 2013
“States Of Health”: Obamacare And GOP Obstructionism
Ours can be an unforgiving country. Paul Sullivan was in his fifties, college-educated, and ran a successful small business in the Houston area. He owned a house and three cars. Then the local economy fell apart. Business dried up. He had savings, but, like more than a million people today in Harris County, Texas, he didn’t have health insurance. “I should have known better,” he says. When an illness put him in the hospital and his doctor found a precancerous lesion that required treatment, the unaffordable medical bills arrived. He had to sell his cars and, eventually, his house. To his shock, he had to move into a homeless shelter, carrying his belongings in a suitcase wherever he went.
This week, the centerpiece of the Affordable Care Act, which provides health-insurance coverage to millions of people like Sullivan, is slated to go into effect. Republican leaders have described the event in apocalyptic terms, as Republican leaders have described proposals to expand health coverage for three-quarters of a century. In 1946, Senator Robert Taft denounced President Harry Truman’s plan for national health insurance as “the most socialistic measure this Congress has ever had before it.” Fifteen years later, Ronald Reagan argued that, if Medicare were to be enacted, “one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” And now comes Senate Minority Leader Mitch McConnell describing the Affordable Care Act as a “monstrosity,” “a disaster,” and the “single worst piece of legislation passed in the last fifty years.” Lacking the votes to repeal the law, Republican hard-liners want to shut down the federal government unless Democrats agree to halt its implementation.
The law’s actual manifestation, however, is rather anodyne: as of October 1st, healthcare.gov is scheduled to open for business. A Web site where people who don’t have health coverage through an employer or the government can find a range of health plans available to them, it resembles nothing more sinister than an eBay for insurance. Because it’s a marketplace, prices keep falling lower than the Congressional Budget Office predicted, by more than sixteen per cent on average. Federal subsidies trim costs even further, and more people living near the poverty level will qualify for free Medicaid coverage.
How this will unfold, though, depends on where you live. Governors and legislatures in about half the states—from California to New York, Minnesota to Maryland—are working faithfully to implement the law with as few glitches as possible. In the other half—Indiana to Texas, Utah to South Carolina—they are working equally faithfully to obstruct its implementation. Still fundamentally in dispute is whether we as a society have a duty to protect people like Paul Sullivan. Not only do conservatives not think so; they seem to see providing that protection as a threat to America itself.
Obstructionism has taken three forms. The first is a refusal by some states to accept federal funds to expand their Medicaid programs. Under the law, the funds cover a hundred per cent of state costs for three years and no less than ninety per cent thereafter. Every calculation shows substantial savings for state budgets and millions more people covered. Nonetheless, twenty-five states are turning down the assistance. The second is a refusal to operate a state health exchange that would provide individuals with insurance options. In effect, conservatives are choosing to make Washington set up the insurance market, and then complaining about a government takeover. The third form of obstructionism is outright sabotage. Conservative groups are campaigning to persuade young people, in particular, that going without insurance is “better for you”—advice that no responsible parent would ever give to a child. Congress has also tied up funding for the Web site, making delays and snags that much more inevitable.
Some states are going further, passing measures to make it difficult for people to enroll. The health-care-reform act enables local health centers and other organizations to provide “navigators” to help those who have difficulties enrolling, because they are ill, or disabled, or simply overwhelmed by the choices. Medicare has a virtually identical program to help senior citizens sort through their coverage options. No one has had a problem with Medicare navigators. But more than a dozen states have passed measures subjecting health-exchange navigators to strict requirements: licensing exams, heavy licensing fees, insurance bonds. Florida has attempted to ban them from county health departments, where large numbers of uninsured people go for care. Tennessee recently adopted an emergency rule declaring that anyone who could be described as an “enrollment assister” must undergo a criminal background check, fingerprinting, and twelve hours of course work. The hurdles would hamper hospital financial counsellors in the state—and, by some interpretations, ordinary good Samaritans—from simply helping someone get insurance.
This kind of obstructionism has been seen before. After the Supreme Court’s ruling in Brown v. Board of Education, in 1954, Virginia shut down schools in Charlottesville, Norfolk, and Warren County rather than accept black children in white schools. When the courts forced the schools to open, the governor followed a number of other Southern states in instituting hurdles such as “pupil placement” reviews, “freedom of choice” plans that provided nothing of the sort, and incessant legal delays. While in some states meaningful progress occurred rapidly, in others it took many years. We face a similar situation with health-care reform. In some states, Paul Sullivan’s fate will become rare. In others, it will remain a reality for an unconscionable number of people. Of some three thousand counties in the nation, a hundred and fourteen account for half of the uninsured. Sixty-two of those counties are in states that have accepted the key elements of Obamacare, including funding to expand Medicaid. Fifty-two are not.
So far, the health-care-reform law has allowed more than three million people under the age of twenty-six to stay on their parents’ insurance policy. The seventeen million children with preëxisting medical conditions cannot be excluded from insurance eligibility or forced to pay inflated rates. And more than twenty million uninsured will gain protection they didn’t have. It won’t be the thirty-two million hoped for, and it’s becoming clear that the meaning of the plan’s legacy will be fought over not for a few months but for years. Still, state by state, a new norm is coming into being: if you’re a freelancer, or between jobs, or want to start your own business but have a family member with a serious health issue, or if you become injured or ill, you are entitled to basic protection.
Conservatives keep hoping that they can drive the system to collapse. That won’t happen. Enough people, states, and health-care interests are committed to making it work, just as the Massachusetts version has for the past seven years. And people now have a straightforward way to resist the forces of obstruction: sign up for coverage, if they don’t have it, and help others do so as well.
By: Atul Gawande, MD, The New Yorker, Published September 29, 2013
“Rand Paul’s Dangerous Lasik Obsession”: But When It Comes To The Uninsured, Nobody Has A Right To Health Care
Senator Rand Paul has spent much of the August recess engaged in typical political activities—attending a roundtable on school reform, participating in a fundraiser for a fellow Republican, and speaking at a local ham breakfast. But Paul also set aside some time for one more unusual activity: Helping some people to see. Paul, an ophthalmologist, performed several eye surgeries. All of them were for patients who don’t have insurance. And he donated his services for free.
I know what you’re thinking: Paul and his advisers decided to publicize his day of charity care, in order to create the impression that he’s a do-gooder. You’re probably right. I first learned about it from an article by Katrina Trinko of National Review, who was on the scene to write about it. So were some other reporters, including a television crew. They didn’t get there by accident. But who cares? Maybe Paul was looking for good headlines or maybe he was trying to keep up his skills. (Senate rules prohibit him from maintaining a private practice while in office.) Regardless, Paul appears to have a genuine history of charity work: According to his official biography, he helped establish the Southern Kentucky Lions Eye Clinic and has won awards for his humanitarian work. Now, thanks to this latest surgical effort, a handful of people have better sight. Good for them and good for Rand Paul.
Of course, as Trinko’s story makes clear, Paul would have you believe that his good deeds—and his experience as a physician—justify his positions on health care policy. That’s another matter entirely. Paul is a well-known critic of government-run and government-regulated health care programs, starting with the Affordable Care Act. The opposition is in many ways philosophical: Nobody has a “right” to health care, he says, because that would mean people have a right to commandeer the labor of those who provide care. Trinko, in her article, quotes Paul explaining this position during a speaking event:
“As humans, yeah, we do have an obligation to give people water, to give people food, to give people health care,” Paul muses. “But it’s not a right because once you conscript people and say, ‘Oh, it’s a right,’ then really you’re in charge, it’s servitude, you’re in charge of me and I’m supposed to do whatever you tell me to do. . . . It really shouldn’t be seen that way.”
It’s a strange, almost nonsensical argument, for reasons that Paul Waldman notes at the American Prospect:
saying that health care is a right doesn’t mean that doctors have to treat people without being paid, any more than saying that education is a right means that public school teachers have to work for free. Because we all agree that education is a right, we set up a system where every child can be educated, whether their families could afford to pay for it themselves or not. It doesn’t mean that any kid can walk up to a teacher in the street and say, “I command you to teach me trigonometry for free. Be at my house at 9 tomorrow. You must do this, because I have a right to education and that means I am in charge of you and you’re supposed to do whatever I tell you to do.”
Of course, Paul is also making a practical argument. With less government interference and regulation, and more people paying for services directly rather than through insurance, the market would bring down prices on its own—and medical care would become more affordable for everybody. As proof, he points to a procedure ophthalmologists know well: Lasik, the laser eye surgery that eliminates the need for glasses or contact lenses. Via Trinko, again:
“Insurance doesn’t cover Lasik surgery, the surgery to get rid of glasses,” Paul remarks. “So it started at about $2,000 an eye, maybe even $2,500 an eye, and it’s down in some communities to under $500 an eye because competition works and people call on average four doctors to get the price and see how much it’s going to cost.”
Libertarians and conservatives love to cite Lasik. But Lasik tells you almost nothing about the rest of the health care system, for reasons Jeff Levin-Scherz, a physician at the Harvard School of Public Health, has pointed out:
1. Lasik surgery is entirely elective. No one NEEDS it!
2. Lasik surgery is never an emergency. Hence, it’s much more “shoppable” than most health care
3. Lasik surgery is highly automated—the computers actually do a substantial amount of the work. Therefore quality is more uniform than most health care
4. There is very high fixed cost for the Lasik laser—and the low variable cost makes it more likely that providers will price this at “marginal” cost—leading to large discounts. That’s not true of cognitive services.
Ten extra visits with a neurologists cost almost ten times as much as a single visit given the large variable cost of the neurologist’s labor. Ten extra Lasik surgeries cost only a small amount more than a single surgery—since the cost of the ophthalmologist and technician is a relatively smaller portion of the total cost.
And that’s not to mention the fact that the Lasik market has been prone to more problems than promoters like Paul let on. Paul Ginsburg, the economist and president of the Center for the Study of Health Systems Change, testified about this some years ago:
LASIK has the greatest potential for effective price shopping because it is elective, non-urgent, and consumers can get somewhat useful price information over the telephone. Prices have indeed fallen over time. But consumer protection problems have tarnished this market, with both the Federal Trade Commission and some state attorneys general intervening to curb deceptive advertising and poorly communicated bundling practices. Many of us have seen LASIK advertisements for prices of $299 per eye, but in fact only a tiny proportion of consumers seeking the LASIK procedure meet the clinical qualifications for those prices. Indeed, only 3 percent of LASIK procedures cost less than $1,000 per eye, and the average price is about $2,000.
Mostly, though, the problem with Paul’s position on health care reform is the number of people it leaves out. Like every other Republican who has demanded repeal of Obamacare, he’s never proposed anything that would come close to covering as many people, or providing the same level of protection. On the contrary, he’s proposed radical changes to Medicaid that would almost certainly even higher rates of uninsurance than exist today.
According to Trinko’s article, one of the patients Paul treats is a 55-year-old woman. She says she has no insurance because it would cost her $700 a month—money that she doesn’t have. Under Obamacare, people in her position would be eligible for subsidies worth hundreds or even thousands of dollars a month—or they’d have a chance to enroll in Medicaid, as long as their state officials weren’t refusing to participate Obamacare’s expansion of the program.
Paul helped that woman to see. But if he has his way, millions of Americans in similar situations won’t be as lucky. They won’t have the same access to care or they’ll face financial ruin. Ultimately, what Paul does at a surgical center matters a lot less than what he does at the Capitol—or, potentially, the White House.
By: Jonathan Cohn, Senior Editor, The New Republic, August 27, 2013
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 