“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
“Can We Please Get A Grip?”: Having The Backbone To Set Minimum Standards For Health Insurance
Democrats are showing once again they have the backbones of banana slugs.
The Affordable Care Act was meant to hold insurers to a higher standards. So it stands to reason that some insurers will have to cancel their lousy sub-standard policies.
But spineless Democrats (including my old boss Bill Clinton) are caving in to the Republican-fueled outrage that the President “misled” Americans into thinking they could keep their old lousy policies — and are now urging the White House to forget the new standards and let people keep what they had before.
And some congressional Republicans are all too eager to join them, and allow insurers to offer whatever crap they were offering before — exposing families to more than $12,700 in out-of-pocket expenses, canceling policies of people who get seriously sick, failing to cover prescription drugs, and so on.
Can we please get a grip? Whenever industry standards are lifted — a higher minimum wage, safer workplaces, non-toxic foods and drugs, safer cars — people no longer have the “freedom” to contract for the sub-standard goods and services.
But that freedom is usually a mirage because big businesses have most of the power and average people don’t have much of a choice. This has been especially the case with health insurance, which is why minimum standards here are essential.
Yes, the President might have spelled this out a bit more clearly beforehand, explaining that 95 percent of us aren’t in the private insurance market to begin with and won’t be affected, and that most of the 2 percent who lose their lousy policies and have to take better and more expensive ones will be subsidized.
But right now the President needs all the political support he can muster to hold insurers’ feet to the fire. Democrats should stand firm for a change.
By: Robert Reich, The Robert Reich Blog, November 15, 2013
“This Is How Obamacare Works”: Listen Up Dipsticks, You Can’t Fix Health Insurance Without Changing Health Insurance
Bill Clinton has been one of Obamacare’s most effective advocates—the “Secretary of Explaining Things,” as President Obama famously called him. But in a new interview already getting attention and sure to get more, Clinton didn’t explain things very well. He made a statement that’s likely to create some misimpressions about the possibilities of health care reform, while giving the administration and its allies yet another political headache. But maybe it’s also an opportunity to have a serious conversation about the law’s tradeoffs—the one that should have happened a while ago.
In the interview, with Ozy Media, the former president fielded a question about the health care law. “The big lesson,” he said, “is that we’re better off with this law without it.” He went on to put the technological problems of healthcare.gov into some perspective: Medicare Part D had similar problems, he noted, “and they fixed it.” And he made a plea with Republican lawmakers to stop blocking the expansion of Medicaid. Fine, fine, and fine.
But then Clinton made news. He said that some young people facing higher premiums under the new system should have the right to keep their old plans, even if it requires a change in the law. Clinton framed it carefully: He said specifically he had in mind only those young people whose incomes were higher than four times the poverty line, making them ineligible for subsidies. (That’s about $45,000 for a single adult.) But he also suggested it was a matter of principle, because those people had heard the vow that they could keep their plans: “I personally believe, even if it takes a change to the law, the president should honor the commitment the federal government made to those people and let them keep what they got.”
Clinton’s statement makes it seem as if there is some simple way to let people keep their current plans—to avoid any disruption in the existing non-group market while still delivering the law’s benefits. As readers of this space know, no such magic solution exists. Broadly speaking, the Affordable Care Act seeks to make two sets of changes to what’s called the “non-group” market. It establishes a minimum set of benefits, which means everything from covering “essential” services to eliminating annual or lifetime limits on payments. At the same time, the law prohibits insurers from discriminating among customers: They can’t charge higher prices, withhold benefits, or deny coverage altogether to people who represent medical risks. They have to take everybody, varying price only for age (within a three-to-one ratio) and for tobacco use.
If you buy your own insurance now, it probably doesn’t live up to these standards. For starters, it probably isn’t as comprehensive as you think. It may not cover prescription drugs, for example, or it might leave out rehabilitative services and mental health. It might expose you to out-of-pocket expenses greater than $6,350 (if you have a single person’s policy) or a $12,700 (if you have a family policy). Until three years ago, when Obamacare’s first regulations went into effect, it was even possible the insurer could yank it retroactively—a process known as “rescission”—if you got sick and the carrier scrubbed your medical records for some previous sign of illness, maybe even one you didn’t know you had.
In addition, unless you live in a handful of states, the premiums you are paying come from insurers who knew, going in, they wouldn’t have to cover people who represent high medical risks. If the policy is affordable, that’s because the insurer figured you were pretty healthy and unlikely to have big medical bills. If you’ve had the policy for a while, and prices haven’t gone way up, that’s because the insurer is still making money from this arrangement—which means, overall, the people in this plan aren’t very sick. Until now, insurers have been able to hike premiums on plans that start to lose healthy customers, and they keep doing so until they become unaffordable—leaving those remaining subscribers unable to find new policies at affordable rates.
The Affordable Care Act includes a so-called grandfather clause. That allows insurers to keep renewing plans, without changes or benefits and prices, as long as they were available before March 2010, when the Affordable Care Act became law. But the non-group market is volatile: Very few people stay on plans for more than two years anyway. And the grandfather clause is narrow, by design: If insurers made even modest changes, the protection goes away. Those plans are subject to the new regulations that take effect in January. As a result, the majority of people who buy insurance on their own are learning they can’t have what they had before, even though Obama promised everybody they could. Either their premiums are going up, as insurers accommodate the new regulations, or the plans are disappearing altogether. In those cases, people have to find new plans. And the sticker price of what they’ll find is higher than what they pay now.
This is not a glitch or an accident. This is the way health care reform is supposed to work. And it’s important to put these changes into context. For one thing, it’s a small number of people relative to the population as a whole. The vast majority of Americans get coverage through employers or a large government program like Medicare. These changes don’t really affect them. The law also anticipates these changes by, among other things, offering tax credits that discount the premiums—in many cases, by thousands of dollars. (Other provisions of the law, like a limit on insurance company profits and overhead, should restrain prices more.) As a result, many people buying coverage on their own will be paying less money for benefits that are as good, if not better, than what they have now.
But there are real people who must pay more and, in some cases, put up with less. Some of them are people walking around with junk insurance, the kind are practically worthless because they pay out so little. Some of them are young people, particularly young men, whom insurers have coveted and wooed with absurdly low premiums—and make too much money to qualify for substantial subsidies. And some of them are reasonably affluent, healthy people with generous, open-ended policies that are hard to find even through employers. Insurers kept selling them because they could restrict enrollment to healthy people. Absent that ability, insurers are canceling them or raising premiums so high only the truly rich can pay for them.
Those people are the ones everybody is hearing about now, partly because they are a compelling, sometimes well-connected group—and partly because, absent a well-functioning website, stories of people benefitting from the law’s changes aren’t competing for attention. It’s impossible to know how big this group is. The data on existing coverage just isn’t that good. The anecdotes are frequently, although not always, more complicated than they seem at first blush. It’s probably one to two percent of the population, which doesn’t sound like much—except that, in a country of 300 million, that’s 3 to 6 million people. Most experts I trust think they represent a minority of people buying coverage on their own, but nobody can say with certainty.
Is that a worthwhile tradeoff for reform? Obviously that’s a matter of opinion. The fact that some people—even a small, relatively affluent group—are giving up something they had makes their plight (genuinely) more sympathetic. They are right to feel burned, since Obama did not make clear his promise might not apply to them. And there’s a principled argument about whether people should be responsible for services they’re unlikely to use presently, whether it’s fifty-something year olds paying for maternity care or twenty-something year olds paying for cardiac stress tests.
But the principle of broad-risk sharing—of the healthy subsidizing the sick, of the young subsidizing the old, and everybody paying for services like pediatrics and maternity care—is one built into the insurance most Americans already have. Employers, after all, don’t charge employees different premiums because of their age or gender. What’s more, the people with good, affordable coverage in the old non-group market were the beneficiaries of a system that marginalized many more. They were paying relatively cheap rates for insurance only because insurers trusted they were unlikely to get sick. Of course, some of them did get sick. And when it happened, many made an unpleasant discovery: The policies they carried left them exposed to huge bills. Giving up these plans isn’t merely an act of altruism. It’s also an act of enlightened self-interest.
Oddly, Clinton himself recognized this: In his soliloquy, he mentioned that a young man he met was upset at having to pay more for a plan—even though the young man knew it would help him more if he got sick. As Clinton surely knows, the whole point of reform—not just the pricing and benefit requirements, but also the individual mandate, which Clinton has repeatedly endorsed—is that people need to take steps to protect themselves against future hardship.
Rhetorically, Clinton’s statement actually isn’t that different from what Obama said in his interview with NBC’s Chuck Todd the other night—that he’d like to find a way to let more people keep their coverage. But it wouldn’t be easy to do. Attempting to rewrite the grandfather clause, so that it applies to more existing plans, could cause insurers to raise prices in 2014 for 2015. It’s also not clear that insurers could or would quickly renew existing policies at existing prices. Clinton mentioned specifically that something should be done only for those people facing higher prices—another echo of Obama’s statement. But distinguishing between groups wouldn’t be easy.
Maybe there’s some muddled, half-solution that will ease the transition without causing real damage. Or maybe there’s some brilliant administrative or legislative fix the experts can’t see. But absent an infusion of extra money—say, to create some kind of transitional assistance fund—any effort to slow changes to the non-group market might not just stop the bad things from happening. It might also stop the good. The latter might outweigh the former, by quite a lot.
You wouldn’t know it from all the press, but Obamacare actually disrupts very little relative to what it accomplishes. The problem is that eliminating disruption altogether simply isn’t possible. You can’t fix health insurance without changing health insurance. And there are bound to be some people for whom that change isn’t good. Those trade-offs should be clear. Maybe now they are.
By: Jonathan Cohn, The New Republic, November 12, 2013
“The ‘Fraidy Cat Group”: Why We Probably Won’t Get Another Government Shutdown In January
So we probably now have a short-term continuing resolution set to expire in January. Does that mean another shutdown in January, after the two sides can’t reach an agreement? After all, that’s what happened in 1995 and 1996: a relatively brief shutdown in the fall was followed by a five-week deadlock in the winter. Is that what we’re going to get?
Probably not.
What the shutdown that appears to be ending today and the 1995-1996 episodes had in common was important: in both cases, one side really wanted the shutdown. In 1995, Newt Gingrich and many Republicans sincerely believed that Bill Clinton was personally weak and would fold if pressed hard enough. That turned out to be wrong; whether it was a foolish idea to test it in the way Gingrich did remains, I suppose, an open question.
This time around, the logic of the showdown gang was clearly foolish; no objective observers believed their stated plan would work; it would have required a massive surge of anger at the Democrats for allowing the government to be shut down over the Affordable Care Act (ACA), but most Democrats like the ACA, and polling indicated that practically no one outside of tea party circles favored a shutdown over it.
There have been a lot of very contentious budget arguments over the last few decades, but none of the others ended with a prolonged shutdown; the next-longest one after those was only three days.
What causes an extended shutdown, then, isn’t missing a deadline. In fact, deadlines are probably needed to get deals done. As long as neither side actively seeks a shutdown, one of three things will happen: they’ll make a deal by the deadline; they’ll miss the deadline but going over the deadline will be enough to get it done; or, they’ll agree to move the deadline.
The question as we approach the next finish line, then, isn’t whether we’ll go close to the edge. Of course we will, but that’s a feature, not a bug (on a shutdown; flirting with the brink on debt limit is a far riskier thing to do). Real negotiations are hard; it takes time to sort out what the real asks are and what’s just bluff. The question is whether a significant faction of the Republican Party wants to do this again, and, if so, whether the rest of the party will accommodate them again.
My guess, as of now, is that this one was devastating enough that we won’t see a repeat. That doesn’t mean that Republicans will back off their demands; it just means that they won’t see any additional utility in fighting through a shutdown.
My biggest worry? This wasn’t 1995-1996, when the GOP was generally united behind the belief that a shutdown would work for them. Instead, the dynamic this time was that a relatively small group wanted it, and a much larger ‘fraidy cat group was terrified of allowing any visible difference between themselves and the radicals. That could repeat itself next time — and the radicals, especially those in outside groups, may actually be pleased with the fundraising results of this fight, even if it hurt the party overall.
However, it’s reasonable to hope that mainstream conservatives learned their lesson from this one and won’t do it again; there’s also the hope that those radicals who are actually driven by policy goals may also have learned something.
Overall? One way or another, budget deadlines are absolutely necessary. And we won’t get a shutdown unless one side wants it.
By: Jonathan Bernstein, The Washington Post, October 16, 2013
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