“About Those Canceled Plans”: When “Victims” Become Beneficiaries
When pressed for specifics, the Affordable Care Act’s detractors tend to focus on two main areas of concern: the website and the cancelation notices. The website is obviously important and administration officials are doing what they can. Maybe it’ll be fixed quickly, maybe it won’t – we’ll find out soon enough.
But the cancelation notices are a different kind of concern. As we’ve discussed, we’re talking about a very small percentage of the population that has coverage through the individual, non-group market and are now finding that their plans are being scrapped. When the House Republican “playbook” looks for people saying, “Because of Obamacare, I lost my insurance,” these are the folks they’re talking about.
But the story about these “victims” of reform is coming into sharper focus all the time.
Only a small sliver of the Americans who buy their own health insurance plans and may be seeing them canceled under Obamacare will pay higher premiums, according to an analysis released Thursday.
More than seven in 10 Americans who purchase health plans directly will get subsidies to help pay for coverage under the Affordable Care Act, according to the report by Families USA, a Washington-based organization that supports the health care reform law.
“It is important to keep a perspective about the small portion of the population that might be adversely affected,” said Ron Pollack, executive director of Families USA. “That number is a tiny fraction of the 65 million non-elderly people with pre-existing health conditions who will gain new protections through the Affordable Care Act. It is also a small fraction of the tens of millions of uninsured Americans who can also get help.”
Let’s put this another way. A tiny percentage of consumers will receive cancelation notices, and of them, more than 70% will get new, more secure coverage that ends up costing them less.
They’re not, in other words, victims. They’re beneficiaries.
In fairness, many of them won’t know this for a while because they can’t yet go to healthcare.gov and see how much they’ll benefit, but we’re talking about the health care system itself – for all the talk about the cancelations, by a 2-to-1 margin, these folks are going to be better off, including receiving subsidies through the Affordable Care Act.
In reference to the remaining folks who’ll pay more, Pollack told the Huffington Post, “That’s approximately 1.5 million people, and that’s not trivial and I don’t in any way suggest that we shouldn’t be concerned about that group. But … the number of people at risk of this becoming a problem is considerably smaller than the tens of millions of people who are going to get substantial help.”
And here’s the larger question: if the evidence had pointed in the other direction, and 71% of these folks were poised to pay more, not less, would the story have gotten more attention? Would the coverage be dominated by “More bad news for Obamacare”?
This week, after years in which Obamacare critics said the law would fail to control costs, we saw remarkable evidence that the law is succeeding in controlling costs. Didn’t hear much about that? Neither did I.
I’m starting to get the sense that there’s an approved narrative – the Affordable Care Act is failing and is in deep trouble – and developments that point in the opposite direction are filtered out, while developments that reinforce the thesis are trumpeted.
The debate is often confusing enough, but this isn’t helping.
By: Steve Benen, The Maddow Blog, November 22, 2013
“When Ideology Collides With Reality”: Irrational Republican Exuberance Over Obamacare’s Problems
In these days of hyper-polarization, some readers may wonder why I always treat with great respect the findings and analysis of conservative number-cruncher Sean Trende of RealClearPolitics. I don’t always agree with what he says, but he’s willing to say uncomfortable things to people on his side of the barricades when data and history so indicate, as he did in a column today pouring ice water on the popular conservative idea that a collapse of Obamacare would lead to some sort of “existential crisis” for liberalism or “the welfare state.”
I’ve said before that our press corps suffers from histrionic personality disorder, and this is but the latest example. Wasn’t it just weeks ago that we were told the government shutdown could cost Republicans the House? But elections and the ideological orientation of the country don’t turn on such immediate, short-term events. The arc of history is long. Both parties, and both ideologies, have plenty of wins ahead of them, and neither is likely to suffer a knockout blow.
Let’s start by observing that we’re barely 50 days into Obamacare’s launch. While the program is clearly in much graver political danger than was the case a month ago, it’s still unclear that the ship won’t eventually be righted. Maybe the so-called “young invincibles” will sign up in droves, or maybe they won’t and the program will go into a death spiral. We just don’t know yet.
But even if the Affordable Care Act does collapse, I’m not sure that the liberal project will be kneecapped, much less destroyed. Americans have very short memories, and the pendulum will swing back quickly if Republicans mess up their next opportunity to govern.
Trende then goes through a long series of historical examples (dating back to 1890) of big political calamities for one party or the other that was followed in relatively short order, and sometimes almost instantly, by a big recovery, often because the other party over-estimated its advantages and overreached. And he notes that even in specific policy areas a misstep or defeat doesn’t necessarily take issues off the table:
Even the last failed attempt at health care reform, in the early 1990s, didn’t actually spell the end of reform efforts for the next two decades, as many suggest. It just proceeded incrementally, with some fairly significant steps. Congress in 1996 passed the Kennedy-Kassebaum bill, which established health insurance portability. The following year, Republicans helped to establish the State Children’s Health Insurance Program, which today provides health care for almost 8 million children. In 2001, before the 9/11 attacks, Congress was consumed with a debate over the Patient’s Bill of Rights, with the only major disagreement involving whether plaintiffs should be able to collect punitive damages while suing their HMO.
Sean even suggests an Obamacare “disaster” could produce an even more ambitious Democratic health care initiative:
[E]ven if Obamacare does collapse, the most liberal aspects of the American health care system — Medicare and Medicaid — will still be around. Democrats have already been pretty straightforward about what their “Plan B” will be: Medicare/Medicaid for all. Both programs are still very popular, and the Democratic standard-bearer in 2016 would almost certainly campaign on expanding them, perhaps to those over 55 for Medicare and under 25 for Medicaid. I’m not sure that would be a losing issue, even with an Obamacare collapse. In 10 years, I think it’d be a winner.
That is indeed the “silver lining” that a lot of single payer advocates have been seeing in the troubles involving the Obamacare exchanges, which are complex and hard to administer in no small part because of their reliance on a managed competition model many liberals never favored in the first place.
Trende thinks the major lesson here is that the ideological clash of ideas that activists often perceive in political events just isn’t shared by that many voters:
The American electorate is not intensely ideological, and is more motivated by things such as the state of the economy, whether there is peace abroad (or whether we’re winning a war), and whether the president is suffering from a major scandal.
I would agree in part, but would go further to say that today’s radicalized Republican Party has goals that have never commanded a majority of the electorate, and are even less likely to do so in the future. It is capable of making big gains when Democrats screw up, but is determined to risk them immediately to pursue an unpopular agenda. If the worst (or from their point of view, the best) happens and conservatives gain the power to implement that agenda, then the odds are extremely high they will, as Trende puts it, “mess up their next opportunity to govern.” And in that respect, ideology really does matter–when it collides with reality.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, November 20, 2013
“Calling-Out Bad Analysis”: False Equivalency And Crocodile Tears
I’m delighted to see that amongst the wailing and gnashing of teeth over the “nuclear option’s” invocation, there’s some robust calling-out of bad analysis and crocodile tears.
WaPo was Ground Zero for “centrist” bemoaning of the terrible partisanship this step would unleash. But Jonathan Chait was having none of it:
The bizarre, defining feature of this argument is that, unlike the crocodile tears being shed by Republicans, the centrist Establishmentarians all take the view that the Republican judicial blockade was completely unacceptable. They argue that the solution to the unacceptable blockade is that, as the Post piously insists, “Both parties should have stepped back and hammered out a bipartisan compromise reform.”
That Republicans did not offer to compromise or in any way back down from the stance the Post calls unacceptable is a fact so fatal to this argument that none of the three [WaPo]writers in any way acknowledges it. I would agree that a 50-vote threshold for lifetime judicial appointments represents a sub-optimal arrangement. It would be better if there were some way for the Senate to filter out extreme nominees without having the power to wantonly blockade a vital court for nakedly partisan reasons. Given the refusal of Republicans to back down, I prefer majoritarianism to the existing alternative. The Establishmentarians refuse to grapple with the trade-off. They are against fires and fire hoses alike.
Unfortunately, now that the “nuclear option” has been officially recorded as the efficient cause of whatever happens next in the descent to partisan polarization, it will become the ever-ready justification for future false equivalency arguments of the sort Chait eviscerates.
An even more interesting deconstruction of today’s wailathon comes from Jonathan Bernstein, writing, as it happens, at WaPo’s Plum Line. He suggests it may have been the “reasonable” Senate Republicans pitching the biggest fits about the nuclear option who precipitated it by their languid-at-best attempts at a preemptive deal, and who may actually welcome it privately because it gets them out of a jam:
The problem with the summer compromise is that it was horrible for deal-making Republicans. The deal essentially said: Republicans will continue to filibuster nominations, but will supply enough votes for almost all of them so that the filibusters will be defeated. But that meant that in practice a handful of Republicans were forced to tag-team their votes, making sure that Democrats always had 60. What’s more, the shutdown fight — which began right after the Senate deal was struck — revealed that radical Republicans led by Sen. Ted Cruz (R-Tex.) were eager to scapegoat those same deal-making Republicans. That raised the cost of the executive branch nominations agreement for tag-teamers such as Sens. Lamar Alexander (R-Tenn.), Bob Corker (R-Tenn.) and John McCain (R-Ariz.). In other words, the summer deal might or might not have been stable, but it certainly couldn’t hold in a world in which the majority of Republican senators are looking for ways to separate themselves from mainstream conservatives, and then using that separation to attack them.
Now Obama gets his judges, and “mainstream conservatives”–especially those like Alexander and Graham who are facing 2014 primary threats–can happily vote against them. What’s not to like?
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, November 22, 2013
“Stupid Obamacare!”: Profit Maximizing Private Insurance Companies Got You Down, Blame Obama
It has been said many times over the last few years that now that Democrats successfully passed a comprehensive overhaul of American health insurance, they own the health-care system, for good or ill. Every problem anyone has with health care will be blamed on Barack Obama, whether his reform had anything to do with it or not. Your kid got strep throat? It’s Obama’s fault! Doctor left a sponge in your chest cavity? Stupid Obama! Grandma died after a long illness at the age of 97? Damn you, Obama!
OK, so maybe it won’t be quite as bad as that, but pretty close. Here’s an instructive case in exactly how this plays out. Take a look at this article that ran in yesterday’s Washington Post, telling how in order to keep premiums down and attract customers, some insurers are limiting their networks. “As Americans have begun shopping for health plans on the insurance exchanges,” the article tells us, “they are discovering that insurers are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals.”
So insurance companies—private actors seeking to maximize profit—are making decisions that some potential customers find less than perfectly appealing. The article itself is clear about why this is happening, but in the newspaper’s print edition, the subtitle read, “Exchanges Exclude Doctors, Hospitals.” Of course, that’s completely false. The exchanges haven’t excluded any doctors and hospitals, the insurance companies offering plans on the exchanges have made a decision to exclude them. The insurance companies are perfectly free to make a different decision, but they’ve decided not to.
So the newspaper runs this story, with the headline writers mistakenly portraying what for some small number of people is an unwelcome development as a decision made by the Obama administration. Conservatives will then take articles like this and others like it, and say, “See? Obama said you could keep your doctor! He lied! This law is a disaster!” Barack Obama never said that he’d forbid any insurance company from ever changing anyone’s policy or offering policies that provide something less than spectacularly gold-plated coverage at absurdly low prices. But now, every profit-maximizing decision by a corporation becomes Barack Obama’s fault.
The second component of Barack Obama coming to own all the problems with the health-care system is that with the rollout of the ACA, you suddenly have a lot of political reporters doing stories on health care, and many of them have only the thinnest understanding of the law. That limited understanding makes it easier for them to just focus on whatever negative things are happening in health care, blaming them on the ACA, and assuring themselves that they’ve been appropriately “tough” in their reporting.
There’s nothing wrong with reporters fully exploring all the changes our ever-evolving health-care system goes through, so long as they do it accurately. But you might notice that they are completely uninterested in the stories of people who are being helped by the Affordable Care Act. Harold Pollack estimates that there are over 10 million uninsured Americans who have significant medical issues like a cancer diagnosis or diabetes, and thus find it difficult or impossible to get insurance on the individual market under the pre-ACA system. These people will now be able to get reasonably priced insurance, which for many will be literally life-saving. But journalists find these people boring and not worth talking about. They’re much more interested in people who find something problematic in the new system, and they’re working hard to find every last one of those people’s stories and share them with the country. And that’s how Barack Obama ends up owning the health-care system.
By: Paul Waldman, Contributing Editor, The American Prospect, November 22, 2013
“Ignoring The Elephant In The Room”: No, President Obama’s Policies Are Not Holding Back The Economy
Wall Street Journal columnist Daniel Henninger had fun this week arguing that President Obama’s problems implementing health reform pale next to his problems getting the economy back to health. The attack on Obama’s economic stewardship, however, looks just like the standard conservative attack on health reform: it’s light on sound arguments and ignores the elephant in the room — Republican obstructionism.
First, health care. As the president says, it’s on him that the rollout of HealthCare.gov and the health insurance marketplaces — where individuals can purchase health insurance to avoid the fine for not having it — has been, to put it kindly, rocky. But Republicans have provided no clear alternative to expand access to good quality, affordable health care, and they have made the rollout more difficult.
Many Republican governors and state legislatures have left implementation of their health insurance marketplaces (also known as exchanges) to the federal government rather than do it themselves — hardly the usual position of a party that believes in devolving as much power as possible to the states. And, at the moment, 25 states are not moving forward to implement the Medicaid expansions — which are a very good deal for them — leaving a significant coverage gap among low-income adults and complicating the determination of eligibility for coverage on the exchanges.
Finally, Republican proposals to “fix” the problem would undermine, not improve, health reform. The president’s proposal, while not perfect, is the best on the table.
Like problems with the health care rollout, the problems in the economy are plain to see. Henninger plays fair when he notes that the president did not cause the Great Recession, which is the source of the problems with which we’re still grappling. But, he’s wrong to say it’s the president who “has the economy on lockdown.”
First, he ignores what many economists and policymakers see as the main problem we still face – inadequate demand for goods and services. Second, he cavalierly dismisses the benefits of economic stimulus in such an economy. Third, he insists the main thing holding back the recovery is excessive business regulation. With that mindset, he naturally doesn’t acknowledge the drag on economic activity and job creation from the premature austerity that Congress has imposed on the economy since Republicans regained control of the House in the 2010 mid-term elections and the barriers that Republicans have put in the way of a budget plan that could boost the recovery in the short run while still putting deficits and debt on a sustainable longer-run trajectory.
Just a reminder to all who, like Henninger, parrot the shibboleth that stimulus did not work: the Congressional Budget Office finds that gross domestic product has been higher each year since 2009 than it would have been without the 2009 American Recovery and Reinvestment Act and unemployment has been lower (see chart).
CBO includes a broad range of estimates about the recovery act’s impact to encompass the views of economists who continue to doubt the mounting evidence that stimulus is highly effective under the economic conditions prevailing in recent years. But, that evidence suggests that act’s impact is quite likely much nearer the high than the low estimate.
Here’s what the International Monetary Fund says about that research, the expansionary effects of fiscal policy (tax cuts and increases in government spending) and the “old Keynesian mulitplier” that Henninger mocks: “While debate continues, the evidence seems stronger than before the crisis that fiscal policy can, under today’s special circumstances, have powerful effects on the economy in the short run [and] that fiscal multipliers are larger.”
The powerful effects of fiscal policy in today’s special circumstances work both ways. The economic forecasting firm Macroeconomic Advisers estimates that the economic uncertainty and policy choices to raise taxes and cut spending that we’ve made since 2010 have cost the economy up to a percentage point per year of slower economic growth and up to 2 million jobs.
It’s Republicans whose policy preferences have pulled policy toward greater near-term fiscal austerity through spending cuts; Democratic plans look more like bipartisan proposals for less spending restraint in the short term and more deficit reduction that’s balanced between revenues and spending down the road when the economy is stronger.
It’s Republicans who have the U.S. economy on lockdown.
By: Chad Stone, Chief Economist, Center on Budget and Policy Priorities, U. S. News and World Report, November 22, 2013
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