“Let’s Take Healthcare Away”: Lindsey Graham Struggles With Fiscal Basics
There was an exchange yesterday between Fox News’ Chris Wallace and Sen. Lindsey Graham (R-S.C.) that was hard to watch, but nevertheless illustrative of a larger point.
WALLACE: You know that if we go into the sequester the president is going to hammer Republicans. The White House has already put out a list of all the things, terrible things that will happen if a sequester kicks in: 70,000 children losing Head Start, 2,100 fewer food inspectors, small business will lose $900 million in loan guarantees. And, you know, Senator, the president is going to say your party is forcing this to protect tax cuts for the wealthy.
GRAHAM: Well, all I can say is the Commander-In-Chief thought — came up with the idea of sequestration, destroying the military and putting a lot of good programs at risk. Here’s my belief: let’s take “Obamacare” and put it on the table…. If you want to look at ways to find $1.2 trillion in savings over the next decade, let’s look at “Obamacare”. Let’s don’t destroy the military and just cut blindly across the board.
Now, the first point is obviously ridiculous. Republicans are heavily invested in the idea that automatic sequestration cuts were something President Obama “came up with,” but reality shows otherwise. It’s trivia anyway — what matters is resolving the threat, not imagining who created it — but what Graham chooses to overlook is every relevant detail: the sequester was part of the ransom paid to the Republican Party when it took the nation’s full faith and credit hostage for the first time in American history. GOP leaders, at time, bragged that this policy was their idea, not Obama’s.
If Graham doesn’t like the sequester — and he clearly seems to agree that it’s a serious problem — he can support scrapping the policy or coming up with a bipartisan alternative. For now, he’s opposed to both of those options, making his whining yesterday rather unpersuasive.
But Graham turning his focus to the Affordable Care Act serves as a reminder of just how unserious he is about public policy.
Let’s be clear about what the South Carolinian is saying here. About $1.2 trillion in automatic cuts are set to kick in, doing real harm to the economy, the military, and the country overall. Lawmakers could cancel or delay the policy, though Republicans aren’t interested in either of these options, or they can come up with a bipartisan alternative that replaces the sequester with something else.
With 11 days to go, Lindsey Graham’s contribution to the discussion, in effect, is, “I know! Let’s take health care benefits away from millions of Americans!”
It’s worth noting that even the most reflexive partisans should realize their anti-“Obamacare” preoccupation is quickly becoming laughable. Republican governors are implementing the law; House Speaker John Boehner (R-Ohio) recently conceded the Affordable Care Act is “the law of the land“; public support for repeal is evaporating; and when folks like Orrin Hatch and Michele Bachmann unveil repeal bills, even most GOP lawmakers ignore them.
Graham, in other words, really needs to get over it.
But more important from a substantive perspective is that the South Carolina Republican still doesn’t understand the basics of the fiscal debate. The point of looking for a sequester alternative is to find a new policy on debt-reduction. If policymakers scrapped the Affordable Care Act, it would make the debt worse, not better.
In other words, Graham thinks Washington can produce smaller deficits by producing larger deficits. That doesn’t make any sense.
By: Steve Benen, The Maddow Blog, February 18, 2013
“The Real Deficit Argument”: Only Politics Of A Very Degraded Kind Can Keep Us From Moving Forward
Should our politicians dedicate themselves to solving the problems we face now? Or should they spend their time constructing largely theoretical deficit solutions for years far in the future to satisfy certain ideological and aesthetic urges?
This is one of the two central choices the country faces at the beginning of President Obama’s second term. The other is related: Will the establishment, including business leaders and middle-of-the-road journalistic opinion, stand by silently as one side in the coming argument risks cratering the economy in an effort to reverse the verdict of the 2012 election? Yes, I am talking about using the debt ceiling as a political tool, something that was never done until the disaster of 2011.
My first questions are, admittedly, loaded. They refer to a difference of opinion we need to face squarely.
It is entirely true that in the wake of two budget agreements, in 2011 and the just-passed deal on the “fiscal cliff,” we have not reduced the deficit enough. The issue is: How much is enough?
Contrary to all the scare talk you keep hearing, Robert Greenstein, president of the Center on Budget and Policy Priorities, notes that we could put the deficit on a sustainable path for the next 10 years with one more deficit-reduction package equal to about $1.2 trillion, plus the resulting interest savings.
By sustainable, I mean keeping the debt from growing as a share of gross domestic product and holding it at around 73 percent of GDP for the next decade. This is a more than reasonable number by international standards. To put it in perspective: According to the International Monetary Fund, in 2011 Canada’s debt was at 85 percent of GDP, Germany’s was at 81.5 percent — and Greece’s was at 163.3 percent.
Holding the debt ratio in the low 70s is well within our sights. It could be achieved through a combination of $600 billion in cuts and $600 billion in additional revenue through tax reform — or through modest taxes on carbon or on financial transactions. (Okay, for now, I am dreaming on the last two, but they are still good ideas.) The cuts could be made without wrecking Medicare, Medicaid or Social Security, and without eviscerating government’s capacity to invest in the future.
We could then shelve our deficit obsession for a while and confront the problems that should be center-stage over the next few years: restoring shared economic growth, spurring the creation of good jobs, dealing with gun violence, reforming immigration laws, improving our education system, and taking steps on climate change.
But there is the other side of this debate, pushed not only by conservatives but also by a deficit-reduction industry that sees the only test of seriousness as a willingness to slash Medicare, Medicaid and Social Security for those who will retire 10, 20 or 30 years from now. They want to be able to admire nice predictions on a computer screen that show the debt dropping to 60 percent of GDP.
There is no objection in principle to discussing the modest changes that could improve the long-term stability of Social Security. But when it comes to health-care cost projections, there is so much we don’t know that it is truly foolish to make decisions now for, say, 2040.
Health-care cost inflation has been dropping. We can’t be sure how sustainable this trend is, but economists who study the matter think the cost curve may be bending downward for the longer run. The Affordable Care Act contains measures that could further restrain health expenditures.
Is it either sensible or humane to decide in 2013 on the basis of such limited knowledge to toss future seniors and low-income Medicaid recipients under the bus? Health-care costs are something we must keep working on. We can buy time for this difficult undertaking by getting the deficit down to a sustainable level.
And that brings us to the debt ceiling. The central weakness of a largely helpful fiscal cliff deal is that it did not save us from a debt-ceiling fight. It would be colossally stupid — there is no other word — to derail an economic recovery that is slowly but steadily taking hold with another battle over a silly provision in our law. Will all the respectable people who know this sit on the sidelines and let it happen, or will they speak out now?
We are finally on a promising path. Only politics of a very degraded kind can keep us from moving forward.
By: E. J. Dionne Jr., Opinion Writer, The Washington Post, January 6, 2013
“People Are More Than Numbers On A Page”: The Healthcare Lessons Mark Kirk Learned From His Stroke
Walk a mile in someone else’s shoes.
But how many of us actually do that? At least by choice?
Over a year ago Sen. Mark Kirk suffered a debilitating stroke. And his medical condition has sparked his interest in the experience of people on Medicaid. Kirk reminds me of the character William Hurt played in the movie The Doctor, a tale of a physician with no bedside manner who suddenly cares about his patients, once he himself becomes the patient, suffering with cancer.
Well D.C. isn’t Hollywood and Senator Kirk’s stroke was not something manufactured by Hollywood studios. The Illinois Republican had an opportunity he now realizes not everyone who suffers a stroke has: the opportunity to get his life back. Senator Kirk had that opportunity this week as he returned to Capitol Hill for the first time in a year, joining the new 2013 Senate.
Kirk’s illness made him realize that the unlimited medical care, access, and not to mention ability to have as many rehabilitation sessions as he needed to have a complete recovery from the stroke he suffered, is not available to most people, especially the poor—those who are on Medicaid. In the state of Illinois, if you are on Medicaid, you are only eligible for 11 rehab sessions following a stroke.
In an interview with the Chicago Sun Times, Senator Kirk said, “Had I been limited to that [referring to the 11 rehabilitation sessions], I would have had no chance to recover like I did. So unlike before suffering the stroke, I’m much more focused on Medicaid and what my fellow citizens face…I will look much more carefully at the Illinois Medicaid program to see how my fellow citizens are being cared for who have no income and if they suffer from a stroke.”
Senator Kirk has, by no choice of his own, walked a mile in another’s shoes…but not entirely. As a senator, he benefits from the very best medical care. He had undoubtedly the best doctors and access—and that access included unlimited rehabilitation sessions—as many as he needed. Each of us is unique and individual—our bodies respond differently one from another, even if we share the same illness or injury.
Although it is admirable that Senator Kirk has woken up to the reality that so many Americans face daily and struggle with so frequently, it’s sad that it took a stroke for him to come to this realization. So we must ponder the question: Does every GOP member of the House and the Senate need to become ill or have a family member become ill to fully understand that it is not only a right, but a necessity that any American have access to not only healthcare, but more so, proper healthcare? What type of society are we if only the rich are allowed to survive such things as a stroke? Or dare I say, only a politician?
Senator Kirk realized this. I know there are those critics out there who feel that Kirk is tapping into a group of potential voters that the GOP has largely ignored, and the GOP largely voted against legislation which would help this group of people.
As a liberal, a progressive, and a Democrat, who is married to a physician and who believes that all of us are truly created equal and should have equal access to the best medical care possible, it saddens me that it seems only when it affects an individual or someone they love, especially those politicians on the right, that they can see what we on the left have been speaking of: fairness.
It isn’t fair that a senator has a stroke and returns to work one year later, when so many in Illinois and elsewhere may not be able to return to work or their lives as they knew them; and some don’t survive at all.
Senator Kirk at one time, as his colleagues, never looked at the people behind the term ‘patient,’ for they were just numbers to slash in cutting spending. Let’s hope that those in the GOP don’t need to suffer as Senator Kirk did to come to the realization that people hurting and in pain are more than numbers on a page.
By: Leslie Marshall, U. S. News and World Report, January 4, 2012
“Setting The Stage”: What The Health Law Will Bring In 2013
Most of the really big changes made by the 2010 health law don’t start for another year. That includes things like a ban on restricting pre-existing conditions, and required insurance coverage for most Americans. But Jan. 1, 2013, will nevertheless mark some major changes.
One of those changes that will affect everyone with private health insurance actually took effect last September. But most people won’t see it until they renew or apply for new health insurance. It’s called a summary of benefits and coverage. The idea is to help people actually understand what’s in their insurance policies.
“One of the big complaints of people in polls or focus groups is that they just … don’t understand either the coverage or the price,” said Jay Angoff, a former official at the U.S. Department of Health and Human Services who worked on implementing the health law.
But with the new document, he says, “there’s a standard format that allows people to compare benefits to make apples-to-apples comparisons, not just on price, but on benefits.”
Health plans will also have to provide consumers a glossary of insurance terms if they ask for it.
“It’s still harder than some people would want,” Angoff says. “It’s still a complicated area. But I think HHS has really done a very good job in making it as simple and as meaningful as possible.”
Later in 2013 will also bring a key launch date for the law, says Angoff: “Oct. 1, 2013, is when open enrollment begins.”
That’s when people can start signing up for their 2014 coverage through the new health exchanges, or marketplaces, that the states and federal government are creating. Angoff, who used to head the office that’s in charge of building those exchanges, says he’s confident that things will happen on time.
“HHS has met all statutory deadlines on this until this point, and I have confidence that HHS will continue to meet those deadlines,” he said.
But the majority of what happens on Jan. 1 is to pay for the changes in 2014. In other words, tax increases and cuts in tax deductions. For example, starting next year, people will only be able to put $2,500 pre-tax into Flexible Spending Accounts that they use to pay for items insurance doesn’t cover.
“For example if they buy eyeglasses, if they pay copays on drug benefits or to their physician, they can submit those claims and be reimbursed from the pretax dollars,” said Marilyn Moon of the American Institutes for Research.
Moon says that while the change may hurt some people with very high out-of-pocket spending not covered by insurance, lawmakers decided this was a fair way to raise some of the money needed to pay for the rest of the law.
“This is a benefit that largely accrues to higher-income individuals who can afford to set aside a certain amount of money every year, to pay towards their health care spending,” she said.
There’s another tax change coming next year for the wealthy. Individuals earning more than $200,000 a year and couples earning more than $250,000 will see a nearly 1 percentage point increase in their Medicare payroll tax. They’ll also have to pay a 3.8 percent Medicare tax on their non-wage income. Moon says that represents a big change.
“The payroll tax usually applies only to wages, and now this law will extend it to investment income as well,” she said.
Those who take deductions for medical expenses on their income taxes will also see a change starting in 2013. Right now, expenses in excess of 7.5 percent of adjusted gross income are deductible. That’s going up to 10 percent for all except the elderly.
It will affect some people who spend a lot on medical care, says Moon. But the new law should also reduce the number of people with those very large bills, “because if everyone has health insurance, many fewer people should have to pay large amounts out-of-pocket on health care. Ten percent will not affect very many people, one would hope, when they get better insurance coverage.”
Finally, there’s a key change made by the health law for 2013 that will affect only the poor. Starting Jan. 1, state Medicaid programs will be required to reimburse doctors who provide primary care at Medicare rates, which are substantially higher. The idea is to get more doctors into the Medicaid program, which will itself expand in 2014.
The Medicaid increase, however, is only for two years.
By:Julie Rovner, NPR, January 1, 2013
“Another Anti-Obamacare Headline”: Beware The Great Health Insurance Scam Of 2014
The anti-Obamacare world is atwitter over comments made last week by Aetna CEO, Mark Bertolini, who predicts that some insurance markets will “go up as much as much as 100 percent” when Obamacare takes hold in 2014—with the average increases running between 25 percent and 50 percent in the small group and individual segments of the business.
Mr. Bertolini has dubbed this phenomenon “premium shock”.
To be sure, this is a great headline for those who remain committed to defeating the Affordable Care Act with nothing better to suggest in its place. However, the facts reveal that Bertolini’s comments—while just maybe true for a very few participants buying coverage on the exchanges in the individual markets—are completely misleading with respect to the individual markets and likely completely untrue as applied to the small group market.
So, how is Mr. Bertolini arriving at his dire predictions?
Apparently, it’s all about (a) the new tax placed on health insurance company sales, (b) the community rating requirements that now prohibit older participants in a health insurance pool to be charged more than 3 times what is paid by younger members and (c) the new minimum standard of benefits that will need to be provided to those who purchase health coverage on the exchanges.
Pretty scary, yes?
The problem with Mr. Bertolini’s prediction is that it is completely and utterly at odds with not only the Congressional Budget Office (“CBO”) projections but with American Health Insurance Plans (AHIP) —the very lobbying organization that represents Aetna and was an active and hugely important supporter of Obamacare.
In 2009, the CBO projected that the Affordable Care Act will have little impact on small and large group policies. This is notable given the expectation that, by 2016, the small group market will represent 13 percent of the total insurance market while large groups will provide coverage for a full 70 percent of Americans with health insurance coverage. Do the math and you find that, according to the CBO, 83 percent of all covered Americans will experience little to no change in premium rates beyond normal increases that would occur had Obamacare never become the law of the land.
As for the individual markets, which will comprise 17 percent of the overall insurance market in 2016, premium rates are predicted to rise about 10 to 13 percent by 2016—considerably lower than the doubling Mr. Bertolini has suggested will take place in 2014.
What’s more, approximately half of those gaining coverage in the individual market will qualify for the government subsidies, thereby reducing the price of their insurance premiums below where they currently exist.
Of course, it is not uncommon for people to discount CBO projections and proclaim them to be biased when the projections fail to meet a desired political narrative.
So, let’s see what Aetna’s own trade association, AHIP, has to say.
A review of the AHIP website reveals that the sales tax imposed on the health insurance companies—and sure to be passed along to consumers—will account for a premium increase averaging 1.9 percent to 2.3 percent by 2014 and 2.8 percent to 3.7 percent by 2023.
Now, you may object to this potential increase—but it is a long way from the increases Mr. Bertolini is predicting.
On the subject of community rating—where insurance companies will now be prohibited from charging older participants in their health insurance pools as much as 10 times more than what they charge younger members even if the elder participants have no pre-existing health problems—AHIP indicates that limiting the rates for the older participants to only 3 times the rate charged the young will result in some younger insurance customers paying as much as 45 percent more in premium payments while older participants will pay 13 percent less.
No doubt, this is a large part of what Aetna’s Bertolini is relying on when trying to freak out the public.
The problem with Bertolini’s prediction is that even this large percentage increase, should it prove to be actuarially accurate, would not apply in the small and large group markets- it would apply only to a very limited number of people purchasing their health insurance on the exchanges who are (a) very young and (b) not qualified for subsidies.
The number is also misleading in its severity.
According to AHIP, the average premium paid by a 24 year old in the individual marketplace is $1200 a year. Using AHIP’s numbers, the price of making the cost of heath insurance more equitable for a 60 year old will potentially cost that 24 year old, on average, an extra $45 a month.
While I don’t mean to minimize this increase, as I recognize that every dollar counts when one is young and getting started, it is important to keep the actual price tag in perspective and weigh the equities when considering that those at the older age range have been overcharged for many years.
The reality is that the young have been paying unreasonably low premium rates for for a very long time—it being in the health insurance company’s profit interest to bring in as many young and healthy people as possible in the door by charging artificially low rates. The problem is that they make up for it by charging artificially high rates to the older people the insurance company would rather not have in the first place. What the ACA seeks to do is correct this situation so that 60 year olds are not precluded from gaining health insurance coverage by being priced out of the market.
Note that this problem could have been averted for younger Americans had we lowered the Medicare age to 55 however this was not acceptable to the Congressional GOP.
And that brings us to the topic of minimum benefits that must now be including in insurance policies offered on the health care exchanges, another area where large increases can be found in the effort to alarm the public.
According to AHIP, the additional costs attributable to health insurance companies actually having to provide a meaningful benefit ranges for as little as a tenth of a percentage point in Rhode Island to 33 percent in Maine where, apparently, health insurance policies do not provide much in the way of actual coverage. And, again, these numbers apply only to the individual marketplace on the exchange.
Thus, if you are one of the 8.5 percent of Americans who will be buying your coverage on the exchange in the state of Maine (making for a very, very tiny percentage) you may now have to pay more to actually get some health care coverage in exchange for what you pay.
So, what does all this tell us?
Gary Klaxon, Vice President of the Kaiser Family Foundation—one of the few health care think- tanks that just about everyone agrees is completely non-partisan and objective, had this to say about Mr. Bertolini’s predictions:
“That just seems silly. I can’t imagine anything going on in the small-group market that would change the average premium that much. On the individual market, there’s arguments for things changing, but those magnitudes seem high.”
Silly, indeed.
There is, of course, more to this than what the anti-Obamacare folks are choosing to report.
That would be the part where Bertolini noted in his ‘premium shock’ comments that this huge, one-time jump in premium rates to be expected in 2014 also includes increases in costs that would come even without the health care reform law.
Translation—health insurance companies have been trying to raise rates at a ridiculous pace ever since the word ‘Obamacare’ first entered the American lexicon, always seeking to blame these increases on the law even before the law became the law. So, when 2014 arrives, you can be certain that they will do everything in their power to grab as large an increase as they can get away with in order to preserve their profits.
Mr. Bertolini is merely laying the groundwork for that effort as Obamacare has provided the health insurance industry with a wonderful scapegoat, perfectly suited and even more perfectly timed to cover the inescapable truth of health insurance—it is a business model whose time has passed.
The sooner the American public realizes that private health insurance companies no longer work, the sooner we can get busy with the solutions that, while politically uncomfortable, can actually solve the nation’s health care challenges.
In the meantime, if you are a part of a large or small business health insurance group, there is no reason to expect that there should be significant—if any— increases in your premium charges in 2014. If you are an individual who will be shopping for health insurance on the exchanges, the 50 percent of you that will qualify for subsidies should experience premium costs at a lower rate than what you are currently paying, If you are in that other half, you may, indeed, see some increase in your rate—but nowhere near the ‘doubling’ the insurance industry would like you to believe is in your future.
By: Rick Ungar, Op-Ed Contributor, Forbes, December 20, 2012
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