“Millions And Millions”: How Many People Has Obamacare Helped?
As the deadline to sign up for an insurance policy that takes effect in 2014 passes on December 23, the next crucial step in the debate about the future of the Affordable Care Act begins.
On January 1, Republicans will make the case that because of the estimated five million cancelation notices that went out last year, more people are uninsured under the president’s signature legislative accomplishment than newly insured.
The White House is preparing to rebut that argument aggressively. Last week, an administration official asserted that only about 10 percent of those who received those notices had not found a replacement plan, as most were offered another option by their current insurer. The remaining 500,000 or so have been offered a special exemption from the individual mandate.
But it will be almost impossible to know right away if the number of net insured went up in January, The Washington Post‘s Sarah Kliff explained on Friday.
“It’s the exact opposite of weather forecasting,” Stan Dorn, a senior expert at the Urban Institute, told Kliff. “There, you can be pretty confident of what will happen tomorrow but no idea about the future. Here it’s the reverse: Over time there will be significant gains, but that will take years, not months.”
All we have now is estimates, as some states are reporting signups and some are announcing actual enrollment numbers. As of Friday, 3.3 million people had signed up for insurance through the Affordable Care Act, with at least 970,000 of them having enrolled in private insurance plans, according to ACAsignups.net.
But these numbers don’t tell the whole story, Campaign for America’s Future’s Dave Johnson points out:
—71 million Americans on private insurance have gained coverage for at least one free preventive health care service such as a mammogram, birth control, or an immunization in 2011 and 2012. In the first 11 months of 2013 alone, an additional 25 million people with traditional Medicare have received at least one preventive service at no out-of-pocket cost.
—Up to 129 million Americans with pre-existing conditions—including up to 17 million children —will no longer have to worry about being denied health coverage or charged higher premiums because of their health status.
—Approximately 60 million Americans have gained expanded mental health and substance use disorder benefits and/or federal parity protections.
—41 million uninsured Americans will have new health insurance options through Medicaid or private health plans in the Marketplace. Nearly 6 in 10 of these individuals could pay less than $100 per month for coverage.
—Consumers have saved $5 billion over the past two years due to a new requirement that insurance companies have to spend at least 80 percent of premium dollars on care for patients (at least 85 percent for large group insurers). If they don’t, they must send consumers a rebate. In 2013, 8.5 million enrollees will receive rebates averaging $100 per family.
—Insurance companies must submit premium increases of 10 percent or more for review by experts. In 2012, 6.8 million Americans saved an estimated $1.2 billion on health insurance premiums after their insurers cut back on planned increases as a result of this process.
—Since the health care law was enacted, more than 7 million seniors and people with disabilities have saved an average of $1,200 per person on prescription drugs as the health care law closes Medicare’s “donut hole.”
—Over three million young adults have gained health insurance because they can now stay on their parents’ health plans until age 26.
—Individuals no longer have to worry about having their health benefits cut off after they reach a lifetime limit on benefits. Starting in January, 105 million Americans will no longer have to worry about annual limits, either.
—Using funds available through the Affordable Care Act, health centers are expanding access to care by building new sites and renovating existing sites. Health centers served approximately 21 million patients in 2012.
The millions and millions of people who’ve been helped by the law won’t be counted as the press tries to game out if Obamacare will reach the seven million private insurance signups the Congressional Budget Office predicted for its first year. But they’re definitely out there, and they’d be among the millions who would be affected if the GOP is ever successful in repealing the law.
By: Jason Sattler, The National Memo, December 22, 2013
“What Obamacare Death Spiral?”: So Sorry Republicans, The Rumors Have Been Greatly Exaggerated
Supporters of the Affordable Care Act have been terrified for months now that a combination of a botched online enrollment system, terrible press, and Republican sabotage could send the individual market part of the new system into the much-discussed “death spiral” where a disproportionately large population of older and sicker enrollees would produce very high premiums, which would in turn repel younger and healthier eligibles even more, creating a self-perpetuating disaster.
At Wonkblog today Sarah Kliff reports some research from the Kaiser Family Foundation indicating that fears of a “death spiral” are significantly overblown:
The rumors of an Obamacare death spiral have been greatly exaggerated. So say Larry Levitt, Gary Claxton and Anthony Damico, experts at the Kaiser Family Foundation who have put together a new brief analyzing what would happen if young adults snubbed the Affordable Care Act. Even if young people sign up at half the rate the administration hopes for, it would nudge premiums up only by a few percentage points, their report says.
“When you do the math, it matters, but not nearly as much as the conventional wisdom suggests,” Levitt says….
If young adults (those under 35) were 25 percent less likely than the rest of the population to sign up for Obamacare, they would represent 33 percent of exchange enrollees — rather than 40 percent. This means there would be fewer young people to subsidize older insurance subscribers. To make up that difference, the experts estimated, insurers would need to increase premiums by a terrifying … 1 percent. Yes, exactly 1 percent.
Levitt, Claxton and Damico also tested a scenario where young adults are half as likely as older shoppers to enroll. In that case, the younger enrollees would make up only a quarter of the exchange market. Premiums would fall 2.5 percent short of covering subscribers.
Wow. If these numbers are accurate, the widespread assumption (particularly among happy Republicans) that there’s nothing ahead for exchange enrollees beyond “sticker shock” forever could give way to the expectation that Obamacare will eventually be self-stabilizing, at least for most enrollees. That in turn would upset GOP calculations that they can perpetually benefit from Obamacare’s problems without coming up with their own credible “replacement” proposal (the ones we’ve seen so far, which rely on destructive gimmicks like interstate insurance sales and state-run high-risk pools, while vastly disrupting employer-based coverage, just aren’t credible once you get beyond the slogans).
A whole lot of GOP strategery for 2014 and 2016 depends on an Obamacare crash. They might want to start seriously considering a Plan B that isn’t even worse than the pre-Obamacare status quo ante.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 18, 2013
“No Way Out”: GOP Eyes “Obamacare Trap” Warily
Rep. Marlin Stutzman (R) held an event in his Indiana district this week, at which health care was a major topic of conversation. According to a local press account, not everyone in this Republican area necessarily opposes “Obamacare.”
But Stutzman seemed to realize at the event that simply condemning what he doesn’t like won’t be enough. “What are you replacing it with? That’s what everybody is asking right now,” the congressman said, adding, “There’s several Republican plans that are competing with each other right now just internally. After the first of the year, we are going to try to sort through that.”
That last part was actually rather newsworthy – we didn’t know that House Republicans are planning to finally present their alternative to the Affordable Care Act sometime in 2014. In fact, Byron York reported that intra-party talks are still underway.
[I]n private discussions, House Republicans stress their differences over the details of an Obamacare alternative. For example, there’s no agreement on precisely how to fix the tax inequity for people who don’t receive health coverage at work. There are similar disagreements over all sorts of other points of policy. “Getting unanimity is a tall order for a divided, leaderless party,” says the GOP aide.
As Democrats can attest, getting unanimity is a tall order for a united party with strong leaders, too.
Regardless, while York describes an “Obamacare trap” in which Republican lawmakers struggle with whether to fix or destroy the existing system, the circumstances lead me to believe a very different kind of trap is set.
Let’s say, after five years of effort, House Republicans finally emerge from behind closed doors with a health care reform package they’re proud of and willing to present to the public. What then? The GOP plan will be subjected to some policy scrutiny, which is where the party is likely to run into some trouble.
It’s easy to imagine a side-by-side comparison, in which the Affordable Care Act is tested against the Republican alternative. Which covers more uninsured Americans? Which reduces the deficit more? Which offers the stronger consumer protections? Which is more effective in controlling long-term costs?
I’d bet good money that on all of these questions, the GOP plan will lose – not because Republican policies are necessarily worse than Democratic policies, but because Republicans have already said their approach to health care would eschew regulations and public investments. And while it’s possible to create a health care plan without spending or safeguards, it’s not possible to create a good health care plan without them.
Ultimately, that’s the “trap” GOP officials need to be mindful of. On the one hand, they can continue to offer nothing in the way of an alternative, effectively telling the public they’re not serious about the issue and they prefer to take cheap shots rather than govern. On the other, they can build a consensus around an Obamacare alternative that almost certainly won’t be nearly as good as the ACA. (Remember, the basic framework of the Affordable Care Act was the Republican policy up until a few years ago.)
The trap is set. The question isn’t whether Republicans will fall in, but rather, whether they can get out.
By: Steve Benen, The Maddow Blog, December 18, 2013
“The “I Hate Everything” Vote”: The GOP Base That’s Always Been Around, But Given A Fresh Identity By The Tea Party Movement
There’s a new ABC-WaPo poll out showing about what you’d expect: the president’s job approval rating is at 43%, about what it was last month but way down from a year ago.
But at The Fix, Sean Sullivan and Scott Clement look at a large slice of the electorate they call “haters,” and see a potential GOP landslide coming. The “haters” are people who disapprove of the president and both congressional parties.
Seventy-two percent of voters who disapprove of the job Obama, congressional Democrats and congressional Republicans are doing say they’d vote for the GOP candidate for U.S. House in their district if the election were held today, according to a new Washington Post-ABC News poll released Tuesday. Just 14 percent say they’d vote for the Democrat….
[T]he haters don’t tilt as heavily toward the GOP now as they did on the eve of the GOP wave election of 2010, when 85 percent said they planned to vote for the GOP candidate.
Now you might look at some of these numbers and conclude that Democrats should be frantically appealing to the “haters,” since they are “between” the two parties and open to both. But you’d be wrong: the people we are talking about are largely GOP “base” voters if they vote at all. They’ve always been around, but the Tea Party Movement has given them a fresh identity: people who will vote for any Republican over any Democrat 99 out of 100 times, but can’t bring themselves to say they approve of any major party that’s not busily tearing down the welfare state or eliminating taxes. To their credit, Sullivan and Clement note the “haters” strong right-ward tilt:
Thirty-four percent identify as Republicans and another 38 percent are independents who lean Republican. Just 13 percent are independents with no lean and just 10 percent are Democrats.
So in any poll of the popularity of the two parties, you have to put a fat thumb on the scale for Republicans because so many of their own just won’t admit their proclivities. Yes, haters are gonna hate both parties, but they’re sure not up for grabs at the ballot box.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 17, 2013
“The Battle For The Republican Party”: Just Another GOP Pity Party, Looking For Sympathy In All The Wrong Places
Imagine what would happen if:
• The budget deal passes the Senate with a handful of Republicans;
• Immigration reform passes the House and something is agreed upon by the Senate;
• In 2014 the House lead expands;
• All Senate incumbents defeat their right-wing challengers and the GOP takes the Senate;
• If not a grand bargain, then a modest bargain with some entitlement reform is passed; and
• One or more tea party favorites run in 2016 and lose decisively to a mainstream GOP nominee who wins the presidency.
Well, that would be a triumph of the center-right and the demise of the tea party, at least from an electoral and governance standpoint. It would reaffirm the GOP as a national, if not dominate, party. And it would move the national agenda significantly to the right since the GOP would hold both houses of Congress and the White House.
One can see, then, that what is of tremendous benefit to mainstream Republicans (and to the agenda of conservative reform) puts the tea party professionals — those inside the Beltway right wingers who gain glory and make money by attacking Republicans and blocking legislative compromise — largely out of business. Sure, they remain active participants in electoral politics, even more active critics and occasional contributors to national policy debates, but they no longer have the influence to either elect or primary candidates. They become merely gadflies and kibitzers.
That is one possible scenario that plays out over the next few years. One can see how the interests of mainstream and tea party conservatives collide and why, for example, the recent budget deal was a threat to the latter. The enemy (not of conservatism) but of the right wingers who depend on controversy, resentment and defeat is center-right governance. Functional government of the center-right saps the interest in throwing the “traitors” out. It discourages primaries from the right. It dulls the interest of donors.
It is important to distinguish here between conservatives who largely embrace the modern Reagan and post-Reagan agenda (best exemplified these days by GOP governors) and right wingers, those whose volume is always turned to high, see politics as all-or-nothing, want to take the country back to the pre-New Deal or even pre-Progressive era, and aim to freeze the United States demographically by keeping immigrants out and socially by refusing to accept changed beliefs on topics like gay marriage. The entities and politicians (the Heritage Action, angry talk radio, Sen. Ted Cruz crowd) that populate the second group flourish when the GOP is in the minority, so defeat is their ally.
The contrast between the two groups is evident in the trajectory of Sen. Mike Lee (R-Utah), pre- and post-shutdown. His ideology didn’t change, but his tone, outlook and purpose sure did after he saw the destruction wrought by the shutdown. He moved from the group that relishes defeat and delights in spreading resentment to the group that wants to govern. I’d suggest in the wake of the shutdown, and now the budget deal, we will see more conservatives follow Lee’s lead.
Now, there is another scenario, maybe less likely but certainly possible over the next few years:
• The budget deal passes the Senate with no Republicans;
• Immigration reform never passes the House and nothing is agreed upon with the Senate;
• In 2014 the House GOP lead stays the same or shrinks;
• Some Senate incumbents defeat their right-wing challengers, but others do not and the GOP doesn’t take the Senate;
• No bargains are struck for the remainder of the Obama term; and
• One or more tea party favorites runs in 2016, one wins the nomination and loses decisively to Hillary Clinton while the GOP House majority is lost as well.
In that case we return to an era of Democratic rule and the GOP becomes a marginal player on the national scene. It is impossible, I would suggest, for the country to be governed mostly, let alone entirely, by the GOP if the tea party contingent triumphs within the GOP. The people who brought us the shutdown do not reflect the desires, outlook and views of a majority of the country. When presented with that alternative, the lion share of the country will choose the Democrats time and time again.
Which one will it be? It’s up to GOP office holders, candidates and voters.
By: Jennifer Rubin, Opinion Blogger, Right Turn; The Washington Post, December 16, 2013
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