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“Putting The Train Wreck On Hold”: Everything Anti-Obamacare Republicans Predicted Is Proving To Be The Opposite Of Reality

The Affordable Care Act, like every landmark piece of legislation in modern times, has faced its share of trials. Getting it through Congress was nearly impossible, and the law was very nearly killed by the Republican appointees on the U.S. Supreme Court.

But with the law now secure and President Obama re-elected, there’s one more major challenge for “Obamacare” to overcome: the implementation hurdle. As we discussed several weeks ago, this is at least as big a hurdle as the others, and more than a few observers have raised the prospect of a “train wreck.” Even those who generally defend the law are worried.

They are, however, a little less worried today. As Matt Yglesias explained, implementation of the law is “fundamentally” going quite well.

The latest evidence comes to us today from California, America’s largest state and one of the states that’s tried the hardest to actually implement Obamacare. As Sarah Kliff explains, their exchanges are getting set up, and it looks like premiums for “silver” and “bronze” plans are both going to be lower than was previously expected. Far from a “train wreck,” in other words, the biggest single set of clients for the program is getting something like a nice, smooth high-speed train ride.

There was also good news from Oregon recently, where insurers that had initially come in with high premium bids are now asking to resubmit with cheaper offerings in the face of competition. And the Affordable Care Act’s goal of slowing the growth in aggregate health expenditures is also coming true.

Yep, at least for now, everything anti-ACA Republicans predicted — on premiums, on competition, on exchanges, on escalating costs — is proving to be the opposite of reality.

Now, because of state-by-state differences, there will be quite a bit of variety in outcomes. If you live in California or another state dominated by Democratic officials, you’ll likely have a very positive impression of how the law is being implemented, and how it benefits you, your family, and your community.

If you live in, say, Texas, you’re likely to have a very different kind of experience.

As Jonathan Cohn explained this morning:

Unfortunately, millions of uninsured and under-insured Americans live in places like Florida and Texas, where there is far less sympathy — and a great deal more hostility — to the idea of Obamacare. It’s entirely possible that the insurance bids in those states will be a lot higher, precisely because state officials there are doing nothing to help and quite a bit to hurt implementation. But if that happens, blame won’t belong with the heath care law or the federal officials in charge of its management. It will belong with the state officials who can’t, or won’t, deliver to their constituents the benefits that California’s officials appear to be providing theirs.

It’s not necessarily an explicitly partisan matter — I’m not saying that Democrats are necessarily better at health care governance. Rather, the point is, Democrats don’t have an ideological axe to grind when it comes to trying to sabotage federal health care law. Rick Perry, however, does.

To be sure, these red-state residents won’t be left out entirely, and they’ll still benefit from all kinds of consumer protections and expanded access that they’ll really appreciate, even if they don’t yet realize the available benefits. But the full benefits of implementation will elude them for a while in ways blue-state residents won’t have to deal with.

Regardless, the news out of California is a bit of a breakthrough, and heartening news for anyone hoping to see the Affordable Care Act succeed. For more on this, also take a look at the reports this morning from Klein, Krugman, and Beutler.

 

By: Steve Benen, The Maddow Blog, May 24, 2013

May 27, 2013 Posted by | Affordable Care Act, Republicans | , , , , , , , | 1 Comment

“Reverse Sticker Shock”: Reality-Based Evidence On Obamacare In California Amidst All The GOP Hysteria

For months now we’ve been told that the Affordable Care Act would produce a cataclysm of skyrocketing health insurance premiums, particularly in the individual insurance markets that the law most affects. Earlier this week alarms were raised particularly in California with the news that three major insurance companies had decided against participating in the health care exchanges that would offer Obamacare coverage.

So it’s a bit of a shock–sort of a reverse sticker shock–today to learn that preliminary assessments of the cost of the new, improved (because subject to new minimum coverage requirements) policies in California once the exchanges are up and running will in most cases be lower than what citizens of this high-cost state are accustomed to paying. TNR’s Jonathan Cohn summarizes the news:

Based on the premiums that insurers have submitted for final regulatory approval, the majority of Californians buying coverage on the state’s new insurance exchange will be paying less—in many cases, far less—than they would pay for equivalent coverage today. And while a minority will still end up writing bigger premium checks than they do now, even they won’t be paying outrageous amounts. Meanwhile, all of these consumers will have access to the kind of comprehensive benefits that are frequently unavailable today, at any price, because of the way insurers try to avoid the old and the sick.

Sarah Kliff of Wonkblog has more details:

Health insurers will charge 25-year-olds between $142 and $190 per month for a bare-bones health plan in Los Angeles.

A 40-year-old in San Francisco who wants a top-of-the-line plan would receive a bill between $451 and $525. Downgrade to a less robust option, and premiums fall as low as $221.

These premium rates, released Thursday, help answer one of the biggest questions about Obamacare: How much health insurance will cost. They do so in California, the state with 7.1 million uninsured residents, more than any other place in the country.

Multiple projections expected premiums to be relatively high.

The Congressional Budget Office predicted back in November 2009 that a medium-cost plan on the health exchange – known as a “silver plan” – would have an annual premium of $5,200. A separate report from actuarial firm Milliman projected that, in California, the average silver plan would have a $450 monthly premium.

Now we have California’s rates, and they appear to be significantly less expensive than what forecasters expected.

On average, the most affordable “silver plan” – which covers 70 percent of the average subscriber’s medical costs – comes with a $276 monthly premium.

Such numbers, it is important to note, do not reflect the actual cost to the estimated 2.6 million Californians who will qualify for Obamacare tax subsidies (available to those with incomes up to 400% of the federal poverty rate).

One of the “horror stories” we’ve been hearing from Obamacare opponents for years now is that the whole scheme will collapse once healthy, low-income young people realize they’ll face large news costs for the kind of minimum high-deductible catastrophic coverage they actually need. They’ll bail, it has been suggested, not only from Obamacare (screwing up the broad-based risk pools that make affordable coverage for older and sicker people possible), but from Obama’s political coalition as well. So this comment from Kliff about the California numbers is worth noting:

For a less robust “bronze” plan, which covers 60 percent of the average beneficiary’s costs, the tax credit could actually cover the entire premium for low-income twenty-somethings.

None of this should really be that surprising; the idea that a broader pool plus competition and guaranteed benefits would provide a better bargain (plus vastly greater security) for consumers in the individual market was central to the entire Affordable Care Act architecture. But it’s taken a while for facts to catch up with all the negative agitprop. It won’t keep House Republicans from voting to repeal the entire law a 38th or 39th or 40th time before the bulk of the Affordable Care Act becomes effective next year. Still, it’s nice to see some reality-based evidence amidst all the hysteria.

 

By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, May 24, 2013

May 25, 2013 Posted by | Affordable Care Act | , , , , , , , , | 1 Comment

“Opportunity And Equality”: What The “Takers” Really Want

The Republican far right has concluded that Mitt Romney’s loss was due in part to his excess moderation, but Romney and the right agree that the blame also rests with the 47 percent of Americans who are “takers,” whom the Democrats wooed with governmental largess. America is no longer dominated by “traditional” small-government Americans, as Bill O’Reilly put it on a glum election night at Fox News. In behind-closed-doors talks to his donors that were recorded (and are likely to remain the only talks of his entire campaign that anyone remembers), Romney concurred.

The Romney-right analysis shouldn’t be dismissed out of hand. Racial minorities, the young, single women — the groups whose share of the electorate is rising — all believe that government has a role to play in increasing opportunity and enlarging the rewards of work. They tend to support a larger government that provides more services than a smaller one with lower tax levels. That doesn’t make them “takers,” however, unless you believe that public spending on schools and on a retirement fund to which American workers contribute constitutes an illegitimate drain on private resources.

Indeed, many of these so-called takers have higher rates of workforce participation than “traditional” Americans. That is, to restate this without using the barely coded terminology of the right, Latinos and Asians have higher rates of labor-force participation than whites. While the level of labor-force participation for non-Hispanic whites was 64.6 percent, as measured by the Bureau of Labor Statistics from 2010 data, the level for Asians was 64.7 percent and for Latinos, 67.5 percent. So which group has more “takers” and which more workers?

But these industrious minorities believe that government can foster even more opportunity. A post-election American Values Survey, conducted for the Public Religion Research Institute, asked voters whether government should promote growth by spending more on education and infrastructure or should lower taxes on businesses and individuals. The groups that constitute the growing elements of the electorate all favored the spending option — 61 percent of Latinos favored it, 62 percent of blacks, 63 percent of voters under 30 and 64 percent of single women. White voters, however, preferred the lower-taxes option 52 percent to 42 percent.

On Election Day, California voters passed a tax-increase initiative to arrest the decimation of the state’s schools and universities, with a voter breakdown very much like that in the American Values Survey. Ending decades of voter opposition to ballot measures that increased tax rates, Californians raised taxes on incomes above $250,000 and boosted the sales tax by a quarter-cent to provide more funding to K-12 schools and the state’s public colleges and universities. While white voters split evenly on the measure, 67 percent of voters under 30 backed it, 61 percent of Asians favored it and 53 percent of Latinos supported it.

Ever since the passage of Howard Jarvis’s Proposition 13 in 1978 downsized California’s taxes and public sector, a majority of the state’s white voters have rejected this kind of tax-hike initiative. As California’s Latino population grew, so did a rift in the state’s voting patterns: Aging white voters opposed dozens of ballot measures for school bond authorization, while Latino voters, whose children often made up the majority in the school districts, supported them overwhelmingly — and in heavily Latino areas, they prevailed at the polls. This year, the Latino share of California voters was 23 percent, up from 18 percent in 2008; the share of Asians rose to 12 percent from 6 percent; and the share of voters under 30 rose to 27 percent from 20 percent. Confronted with this new electorate, Jarvis’s California was consigned to history’s dustbin.

One reason support for government spending on schools and the safety net is strong within these growing constituencies is that the lot of the “maker” — the hard worker who creates wealth — is declining for most Americans, particularly for young and working-class Americans. Median household income is shrinking as the share of company revenue going to wages descends and the share going to profits increases. If more private-sector workers were able to bargain collectively for wage increases, they would be less dependent on governmental income supplements and the safety net for rudimentary economic security. By all but destroying unions in the private sector, however, the same business executives who applauded Romney’s condemnation of “takers” greatly enlarged the pool of Americans who must “take” to survive. If these self-designated makers feel beleaguered by takers, they have only themselves to blame.

By: Harold Meyerson, Opinion Writer, The Washington Post, November 21, 2012

November 24, 2012 Posted by | Economic Inequality | , , , , , , , , | 2 Comments

“Saving His Own Skin”: Rep Steve King, States Can Ban Birth Control, But Not Foie Gras

Californians have recently voted to enact laws banning the sale and production of both eggs from cruelly housed hens and foie gras, a delicacy created by force-feeding ducks. While this may seem within the legal bounds of a state’s ability to regulate local commerce, one Congressman is up in arms about it: Steve King (R, IA). King, despite being one of the most outspoken proponents of states’ rights in Congress, is so convinced that California’s laws violate the Commerce Clause that he pushed through legislation overturning the animal rights acts and similar statutes in other states:

Rep. Steve King, an Iowa Republican who represents the country’s leading egg-producing state, said he introduced the amendment because the California law and others like it “scrambles and creates a patchwork quilt of state regulations.”

“If California wants to regulate eggs that come into the state, fine,” King said. “But don’t be telling the states that are producing a product that’s already approved by the USDA or the FDA how to produce that product.”

He said that the California requirement violates the commerce clause of the Constitution, which gives the federal government jurisdiction over interstate commerce issues.

King believes the entire Affordable Care Act – not simply the mandate, but the whole law – is an unconstitutional use of federal power under the Commerce Clause. This means that, according to King, any federal regulation of the insurance industry is unconstitutional. King also thinks states can ban contraception. These radical beliefs aren’t a surprise: King adheres to an extreme interpretation of the Tenth Amendment which aims to gut federal power.

So King appears to to think federal regulation of farming is constitutional, but regulation of the health care industry is not. A state ban on birth control is fine, but banning foie gras isn’t.

Of course, King has a perfectly good reason for going against his principles: saving his own skin. King is in the midst of a bruising reelection battle as a consequence of redistricting. The largest industry spending on his behalf is big agribusiness, which isn’t thrilled about California’s laws. King’s home state of Iowa has no standards for ethical caging of egg-producing hens, a fact which was linked to a significant salmonella outbreak in 2010.

King’s bill is so broadly worded that it might also overturn state safety standards for other agricultural products, including fruit, milk, and vegetables. It is currently attached as an amendment to the House Farm Bill, which would also take food stamps away from millions of needy Americans.

 

By: Zack Beauchamp, Think Progress, July 14, 2012

July 15, 2012 Posted by | Congress | , , , , , , , , | Leave a comment

What If Contraception Could Decimate The Abortion Rate?

In Ross Douthat’s weekend NY Times column, he mediates in the long-running argument  liberals and conservatives have waged over sex, abortion, and contraception. Liberals argue that widespread access to contraception is the surest way to reduce unwanted pregnancies, he writes, whereas conservatives believe “it’s more important to promote chastity, monogamy and fidelity than to  worry about whether there’s a prophylactic in every bedroom drawer or  bathroom cabinet.”
Both narratives are contradicted by the facts, he argues. For example, socially conservative regions feature higher rates of teenage parenthood and unwed pregnancy than the nation as a whole.
He goes on:

Liberals love to cite these numbers as proof that social conservatism is a flop. But the liberal narrative has glaring problems as well. To  begin with, a lack of contraceptive access simply doesn’t seem to be a  significant factor in unplanned pregnancy in the United States. When the Alan Guttmacher Institute surveyed more than 10,000 women who had procured abortions in 2000 and 2001, it found that only 12 percent cited problems  obtaining birth control as a reason for their pregnancies. A recent  Centers for Disease Control and Prevention study of teenage mothers found similar results: Only 13 percent of the teens reported having had trouble getting contraception.

Is the takeaway really that lack of contraceptive access isn’t a significant factor in unplanned pregnancy? If roughly 1 in 10 unplanned pregnancies is caused by lack of access to birth control, that seems very significant! If I approached Douthat, having devised a way to reduce the American abortion rate by just 5 percent without coercion or significant expense, I suspect he’d be very enthusiastic, and think I accomplished something important. The issue here is that he’s unpersuaded these teens would’ve avoided pregnancy even if they’d been given access to birth control.
As he writes:

…if liberal social policies really led  inexorably to fewer unplanned pregnancies and thus fewer abortions, you  would expect “blue” regions of the country to have lower teen pregnancy  rates and fewer abortions per capita than demographically similar “red”  regions. But that isn’t what the data show. Instead, abortion rates are  frequently higher in more liberal states, where access is often largely  unrestricted, than in more conservative states, which are more likely to have parental consent laws, waiting periods, and so on. “Safe, legal  and rare” is a nice slogan, but liberal policies don’t always seem to  deliver the “rare” part.

But the “liberal social policies” he conflates can be teased apart. What if contraceptive access reduces unplanned pregnancies in some jurisdictions, even as women who do get pregnant in those same places have abortions at higher rates due to unrestricted access or the fact that abortion is less stigmatized? As if in anticipation of that very counterargument, he goes on to write:

What’s more, another Guttmacher Institute study suggests that liberal  states don’t necessarily do better than conservative ones at preventing  teenagers from getting pregnant in the first place. Instead, the lower  teenage birth rates in many blue states are mostly just a consequence of (again) their higher abortion rates. Liberal California, for instance,  has a higher teen pregnancy rate than socially conservative Alabama; the Californian teenage birth rate is only lower because the Californian  abortion rate is more than twice as high.

But California’s higher teenage pregnancy rate is substantially driven by Hispanic immigrants whose religious and cultural background is relatively antagonistic to contraceptives. And if we’re citing numbers generated by the Guttmacher Institute, surely the ones that followare relevant to this subject:

– Publicly funded family planning services help women to avoid pregnancies they do not want and to plan pregnancies they do. In 2008, these services helped women in California avoid 317,900 unintended pregnancies, which would likely have resulted in about 141,300 unintended births and 132,700 abortions.
– Contraceptive services provided at Title X-supported centers in California helped prevent 200,200 unintended pregnancies, which would likely have resulted in about 89,000 unintended births and 83,600 abortions.

If you think that abortion is the killing of an innocent human, surely you should regard a contraceptive policy thought to result in tens of thousands of fewer abortions per year as a significant achievement, unless you think that the policy is causing lots of other abortions to occur. The Guttmacher Institute has published analysis that reaches precisely the opposite conclusion.
And increasing the availability and effectiveness of contraception seems like a more achievable task than reducing abortions by re-establishing bygone norms of chastity, monogamy and fidelity (none of which, by the way, are incompatible with widespread access to effective birth control).

 

By: Conor Friedersdorf, The Atlantic, February 21, 2012

February 22, 2012 Posted by | Abortion, Birth Control | , , , , , , , | 1 Comment

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