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“The Free Market Failed”: Here’s Some More Good News About Obamacare. Too Bad It Won’t Dent The Debate

Whenever a health insurer announces that it will be requesting significant premium increases in the coming year, it’s guaranteed to generate news stories that are waved triumphantly by conservatives as proof that the Affordable Care Act is a failure and, just as they predicted, premiums are skyrocketing because the government is messing around in health care.

When a story like this one comes along, on the other hand, it seems to generate much less attention:

California’s Obamacare exchange negotiated a 4% average rate increase for the second year in a row, defying dire predictions about health insurance sticker shock across the country.

The modest price increases for 2016 may be welcome news for many of the 1.3 million Californians who buy individual policies through the state marketplace, known as Covered California.

California’s rates are a key barometer of how the Affordable Care Act is working nationwide, and the results indicate that industry giants Anthem and Kaiser Permanente are eager to compete for customers in the nation’s biggest Obamacare market.

Leading up to Monday’s announcement there had been a steady drumbeat of news about major insurers outside California seeking hefty rate hikes of 20% to 40% for Obamacare open enrollment this fall.

Keep in mind that before the ACA went into effect, annual premium increases of 10 percent or so had become the norm. California is only one state, and when you go across the country the picture is complicated — in some states premiums are rising more slowly than they did before the law; in other states they’ve jumped; and in some places they’ve declined. There are many reasons why. But what’s important to understand is that the predictions of the law’s critics — that both overall health spending and premiums would explode — were completely wrong.

The key word in this story comes in the first paragraph: “negotiated.” California is one of the states where officials running the health care exchange negotiate with insurers over rates, and when you have a negotiation, you can get better terms for the people you represent. Yet incredibly, we’re still arguing over whether what the health insurance market needs is less government involvement and more of that free market magic.

So for the millionth time: the reason we have the world’s most expensive health care system is precisely because the free market failed.

If conservatives were right and government is the problem, then in all the world’s other advanced nations, where there is much more government regulation of health care than we have, they’d be paying more for their health care than we do. But they spend far less, often with better health outcomes and usually with virtually no uninsured. And after watching this debate for the better part of a decade, I’ve yet to hear a single conservative explain why that’s the case, and how it squares with their beliefs about government and markets. How can it possibly be that government-heavy systems — whether you’re talking about a completely socialized one like Great Britain’s or a system like France’s that combines a basic government plan with heavily regulated private supplemental insurance — work so much better and cost so much less than ours? If you have a religious belief that markets are always right and government is always wrong, it’s just impossible to reconcile.

The point isn’t that the ACA is a perfect piece of legislation that has solved all our problems, because it isn’t and it hasn’t. The ACA is a gigantic kludge layered on top of what was already a terribly dysfunctional system. Health insurance in America remains incredibly complicated — for instance, if you’re on an exchange, in order to get the best rate you may have to shop around every year. Unfortunately, Republicans have made it impossible to fix the law’s weaknesses as we used to do with complex legislation, because they’ve fed their constituents a lie that any day now they’re going to repeal the whole thing, so there’s no point in trying to make it work better (and that doing so would be a compromise with evil, of course).

Fifty years ago this Thursday, Lyndon Johnson signed Medicare into law. At the time, Republicans predicted not only that the program would be a failure, but that it would send America hurtling toward a socialist nightmare of oppression. Ronald Reagan famously said that if the law passed, “we 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.” Yet this big-government, single-payer health insurance program for seniors turned out to be one of the most successful and popular pieces of legislation in American history. Not only that, due in part to the Affordable Care Act, the projected future cost of Medicare keeps going down — another conservative prediction about the ACA that has proven wrong by 180 degrees.

And today, Republicans pretend they love Medicare and only want to preserve it, while they present plans that would eliminate its guarantee of coverage and turn it into a voucher program, on the failed theory that whatever the private sector does in health care must be superior. These efforts always fail, because the program is just too popular.

The ACA isn’t politically bulletproof in the same way, in large part because it’s so many different things. No one “has” Obamacare in the way you have Medicare, with a card in your wallet; in fact, tens of millions of people are affected by the ACA, usually in positive ways, without ever realizing it. But here’s a crazy idea: What if we looked at where the law is succeeding and tried to build on that success, and looked at where it isn’t and tried to correct those shortcomings, doing it all with the best understanding of the actual facts we can gain?

Oh, who am I kidding.


By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Plum Line Blog, The Washington Post, July 28, 2015

July 29, 2015 Posted by | Affordable Care Act, Conservatives, Health Insurance Premiums | , , , , , , | 1 Comment

“What A Shocker”: Obamacare Is Working Best In States That Aren’t Trying To Sabotage It

The disappointing Affordable Care Act (ACA) numbers the Department of Health and Human Services (HHS) released on Wednesday revealed that the law is working best in the states that are — shockingly — implementing the law as it was designed.

Of the 106,185 people who have completed an application for health insurance, nearly 75 percent came from 14 states and the District of Columbia that both set up their own exchanges and expanded Medicaid.

Unsurprisingly, California and New York combined for the bulk of the enrollments, 51,769. But the most promising news from the Golden State wasn’t even included in this report.

Peter Lee, the executive director of Covered California, reported Wednesday that as of Tuesday, 60,000 Californians had signed up for insurance. Signups have increased to a rate of almost 2,500 enrollees per day in November. At that pace, the state could be expected to enroll 402,500 people by March 31 but Lee says that he expects to hit a goal of 500,000 to 700,000 people by then, which means he expects the pace to pick up by at least 640 people a day to over 3,000 enrollees.

Lee’s optimism is linked to more than the enrollment numbers. It seems California’s consumers are happy with the state’s website.

“Overall, nearly 70 percent of consumers who completed the survey found the application process easy to complete, and 88 percent of customers visiting found the information needed to choose a health plan that was right for them,” Covered California reported in a statement released Wednesday, giving Republicans another reason to hope that California isn’t a bellwether for the rest of the nation.

Red Kentucky is the only state in the union that voted for Mitt Romney and set up its own exchange, thanks in large part to Democratic governor Steve Beshear. The state’s site signed up a total of 32,485 Kentuckians, with 5,586 enrolling in private plans, in its first month of operation. This reduces the state’s uninsured population —estimated at 640,000 — by just over 5 percent.

Of course, it’s not hard for the states to look impressive next to the federal number that is anemically low. And not all the states that set up their own exchanges have succeeded. Oregon’s marketplace is so flawed, they didn’t even have numbers to report for October.

Implementing health care reform was never supposed to be easy.

“It’s like fixing an airplane while it’s in flight, if there is something terribly wrong with the plane,” said Timothy Jost, a health law professor at Washington & Lee University and an expert on the ACA.

And that’s without the unprecedented campaign of sabotage the right has waged. But the obstruction that has threatened the law most has been the combination of a mostly unforced error —’s disastrous launch — and Republican states refusing to launch their own exchanges. While the right is thrilled they’ve assisted in this catastrophe, it was the ancillary result of another sabotage strategy that was either masterminded or enthusiastically encouraged by Michael Cannon.


“Cannon is a health care policy expert at the libertarian Cato Institute,” reports The New Republic‘s Alec MacGillis. “He is also an avowed opponent of the Affordable Care Act, and has for several years now been embarked on a legal crusade that, while a ways from triumphing, may have inadvertently played an outsized role in suppressing the number of states setting up their own exchanges, thereby greatly confounding the law’s implementation.”

Cannon believes he has found a loophole in the law that could end up undoing it in any state that didn’t set up an exchange. With that in mind, he helped successfully convince every state with a Republican governor to reject their right to build their own site.

By opting out, states made the success of the president’s signature legislative accomplishment dependent on one single portal that needed to reach its tentacles into three dozen complex insurance markets at one time.

That — it turns out — is a lot more complicated than the administration expected it to be.

The best state numbers show that the ACA can be implemented with participation rates that are in at least in the same ballpark as Massachusetts’ Romneycare or Medicare Part D.

Medicare Part D Romneycare implementation

And there were some other numbers in the HHS report that bode well for reform.

HHS reports that 26,876,527 different users accessed the site and 3,158,436 calls were made to its center. A total of 1,477,853 applications processed to the point of where eligibility could be determined. This shows that the demand for what the marketplace is offering definitely exists.

Clearly and undeniably, the fate of the law now depends most on one thing.

“The October report is clearly disappointing,” Timothy Jost wrote in his blog. ”But the really important reports will be the December report, which will tell us how many will be enrolled for coverage that begins in January, and the March report, which will tell us how many will be enrolled for 2014.  If is up and running by December, there is every reason to believe those reports will be much more promising.”


By: Jason Sattler, The National Memo, November 14, 2013

November 15, 2013 Posted by | Affordable Care Act, Obamacare, Republicans | , , , , , , | Leave a comment


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