“An Unhealthy Dose Of Politics”: Gov Matt Bevin Is Letting His Dislike For The President Blind Him To The Success Of Kynect
The New York Times reports that Kentucky Gov. Matt Bevin has informed the Obama administration that he intends to shut down his state’s health insurance exchange. The move will mean that Kentuckians will have to seek health insurance from the federal exchange. The newly-elected Republican governor may also make changes to the state’s Medicaid expansion program. Both moves would fulfill promises that Bevin made on the campaign trail last year.
Health insurance exchanges were established by the Affordable Care Act to serve as a marketplace for individuals who are not covered by the employer-based market. While the law envisioned that these exchanges would be run entirely by the states, in practice there are only 13 state-based exchanges, including the one in Washington, D.C. The rest of the states rely, either in part or entirely, on the federal exchange, Healthcare.gov.
Of the states that chose to run their own exchanges, Kentucky was doing well. The state’s exchange, known as Kynect, has in fact been lauded as one of Obamacare’s best success stories. The Washington Post reports that since it launched, Kynect has cut Kentucky’s uninsured rate in half. While some other states have struggled in their efforts to establish their own state-based exchange, Emily Beauregard, executive director of Kentucky Voices for Health, told the New York Times that “Kynect is working perfectly, and it’s been good for Kentucky.”
If the exchange had not been successful in reducing the state’s uninsured, Bevin’s plan would be justified. However, given Kynect’s effectiveness, Bevin’s plan to dismantle it makes little sense. His decision is driven purely by political motives and not with the welfare of his constituents in mind. Although the Obama administration has promised a “seamless” transition to Healthcare.gov for those who receive coverage through Kynect, there are still bound to be disruptions in coverage. For some, that disruption in coverage could be devastating.
Taking Kynect apart will also cost the state money. According to the Times, the previous governor’s administration estimated it will cost “at least $23 million” to shut it down. There’s also the question of unused grant money, approximately $57 million, which Kentucky might have to repay to the federal government. In contrast, leaving the exchange in place would provide consistency and predictability for its customers and allow the state to continue building on Kynect’s success, perhaps even lowering the state’s uninsured numbers further.
Unfortunately, Bevin is letting his dislike for the president blind him to the success of Kynect and its benefit to his constituents. Kynect has worked well for Kentucky, and the new governor should keep it in place.
By: Cary Gibson, Thomas Jefferson Street Blig, U. S. News and World Report, January 15, 2016
“A Political Disaster Of Unimaginable Proportions”: Why Republicans Wouldn’t Actually Repeal Obamacare
Last week, in a bold example of their governing prowess, congressional Republicans took their 62nd vote to repeal the Affordable Care Act, and this time they actually passed it through both houses and sent it to President Obama to be vetoed. Naturally, they were exultant at their triumph. Speaker Paul Ryan admitted that there is as yet no replacement for the ACA, but they’ll be getting around to putting one together before you know it. The fact that they’ve been promising that replacement for more than five years now might make you a bit skeptical.
What we know for sure is this: If a Republican wins the White House this November, he’ll make repeal of the ACA one of his first priorities, whether there’s a replacement ready or not. To listen to them talk, the only division between the candidates is whether they’ll do it on their first day in the Oval Office, in their first hour, or in the limo on the way back from the inauguration.
But I’ve got news for you: They aren’t going to do it, at least not in the way they’re promising. Because it would be an absolute catastrophe.
Let’s take a brief tour around the consequences of repealing the ACA. First, everyone who benefited from the expansion of Medicaid would immediately lose their health coverage. According to Charles Gaba of acasignups.net, who has been tracking these data as assiduously as anyone, that amounts to about nine million people. Granted, the working poor are not a group whose fate keeps too many Republicans up at night, but tossing nine million of them off their health coverage is at least bound to generate some uncomfortable headlines.
Then there’s all the people who now get their health coverage through the exchanges that the ACA set up. Remember how fake-outraged Republicans were back in the fall of 2013 because some people with crappy health plans got letters from their insurers telling them that they’d have to sign up for a plan that was compatible with the ACA’s new standards? The truth was that some of them would wind up paying more for coverage while others would pay less, but it was the subject of a thousand credulous news stories portraying them all as victims, to Republicans’ unending joy.
Now imagine that ten million people, the number signed up for private coverage through the exchanges, all had their coverage simultaneously thrown into doubt. Think that might cause some bad press for the party and the president who did it?
There’s more. The ACA also allowed young people to stay on their parents’ insurance until age 26; three million took advantage of the provision. They’d likely lose their insurance too. Oh, and if you’re a senior on Medicare? Get ready for the return of the “doughnut hole” in prescription drug coverage, which the ACA closed.
Let’s add in one more element (though there are lots of the ACA’s provisions we don’t have time to discuss). One of the central and most popular provisions of the ACA banned insurance companies from even asking about pre-existing conditions when they offer you a plan. About half of Americans have some kind of condition that in the old days would mean they either could get insurance but it wouldn’t cover that condition, or they couldn’t get covered at all. If you bought insurance in the old days, you remember what a hassle it was to document for the insurer every time you saw a doctor for years prior. You don’t have to do that now, but if Republicans succeed, we’ll be back to those bad old days. So they can look forward to lots of news stories about cancer survivors who now can’t get insurance anymore, thanks to the GOP.
But wait, they’ll say, our phantom replacement plan has a solution: high-risk pools! This is a common element of the various inchoate health-care plans Republicans have come up with. Anyone who knows anything about insurance knows why these are no solution at all. They take all the sickest people and put them together in one pool, which of course means that the premiums to insure them become incredibly high. As I’ve written elsewhere, high-risk pools are the health insurance equivalent of going to a loan shark: You might do it if you’re desperate and have no other option, but you’re going to pay through the nose. So good luck with that.
Even if Republicans could come together around a single replacement plan, that plan would still be a political disaster. The theory behind their health-care ideas is that once we inject some more market magic into health care, everything will be great. But there are a couple of important things to understand about this idea. First of all, their plans don’t even try to achieve anything like universal coverage. It just isn’t one of their goals, and as a consequence, implementing their plans is going to mean a lot more uninsured than we have now, a reversal of the progress the ACA is made, with millions or even tens of millions of people likely to lose coverage. Second, even if the market mechanisms they use were to work out how they predict—and it’s almost certain they won’t, but let’s give them the benefit of the doubt for a moment—it would take a substantial amount of time.
In this, the ACA is direct. You can’t afford coverage? Here’s a subsidy, now you can afford coverage. But under Republican plans, more people shopping around for their health care is, over time, supposed to bring costs down, which will eventually translate to lower premiums. But in the meantime, while we wait for the invisible hand to perform its alchemy, millions upon millions of Americans will get screwed. Think there’s going to be a political backlash?
I suspect that many conservatives understand that, but still think that in the long term, their small-government ideas will leave us with a superior system. But that still leaves them with a political dilemma. On one hand, repealing the ACA would be spectacularly disruptive—in fact, unwinding the law will probably be more disruptive than putting it in place was, now that the entire health-care and health-insurance industries have adapted to it—and there will be millions of people victimized by repeal. It will be a political disaster of unimaginable proportions.
On the other hand, they’ve invested so much emotional, political, and rhetorical energy over the last six years into their opposition to this law that they would seemingly have no choice but to repeal it, no matter the consequences. Liberals may argue that the ACA would have been a lot better if it hadn’t worked so hard to accommodate the market-based character of the American health-care system, but Republicans have been telling their constituents that it’s the most horrific case of government oppression since the Cultural Revolution (or as Ben Carson says, “the worst thing that’s happened to this nation since slavery”). They can’t exactly turn around to the people who elected them and say, “Look, I know we said we’d repeal this thing, but that’s going to be a real mess. How about if we just make some changes to it so it works more like we’d like?”
Or maybe they could. Just look what happened to Matt Bevin, the new governor of Kentucky. He ran on a platform of purging the state of every molecule of that despicable Obamacare, but now that he’s in office, things are looking a little more complicated. That’s because Kentucky is one of the great ACA success stories, where the expansion of Medicaid brought health insurance to a half a million low-income people who didn’t have it, and the state’s health-care exchange, Kynect, was a model of success. So Bevin is now backtracking on his promise, saying that instead of just eliminating the Medicaid expansion he’s going to reform it. And Kynect may get the axe (which would mean just turning it over to the federal government), but that won’t happen for quite some time, if at all.
And that’s what I think we’d see if we actually got a Republican president and a Republican Congress forced to deal with the consequences of what they’ve been promising for so long. Once they have the ability to bring down such a health-care calamity on the public, it’s not going to seem like such a great idea. They’ll say they’re as committed to it as ever, while behind the scenes they’ll be frantically trying to figure out how to do something they can call “repeal” but that won’t actually get rid of all the things people like about the law. I wouldn’t be surprised if we saw a “repeal” bill that, in the name of an effective transition, left much of the law in place, then slowly instituted their market-driven ideas over time. Because there are limits to even what kind of damage an all-Republican government would inflict—if not on the country, then at least on their political fortunes.
By: Paul Waldman, Senior Writer, The American Prospect, January 10, 2016
“The Urgency Of Six Years Later”: Ryan Sees ‘Urgent’ Need For GOP Alternative To Obamacare
House Speaker Paul Ryan (R-Wis.) delivered a fairly long speech at the Library of Congress yesterday, fleshing out his vision for making America “confident again” through a far-right approach to governing. There wasn’t anything particularly surprising about the remarks, and the Republican leader conceded his vision won’t be implemented so long as President Obama is in office.
But there was one part of the speech that jumped out at me as noteworthy. On health care policy, the new Speaker said “the other side” – presumably, Democrats – opposes giving consumers choices, while Republicans want to encourage “insurance companies to compete for your business.” It’s an odd line of attack, since the Affordable Care Act’s exchange marketplaces were specifically designed to invite insurers to compete for consumers’ business. I’m not sure how he could have missed this detail.
Ryan added:
“There are a lot of other ideas out there, but what all conservatives can agree on is this: We think government should encourage personal responsibility, not replace it. We think prices are going up because people have too few choices, not because they have too many. And we think this problem is so urgent that, next year, we are going to unveil a plan to replace every word of Obamacare.”
Let’s just skip the usual points about the efficacy of the ACA, the law’s many successes, and the millions of Americans benefiting from its implementation. Suffice it to say, there’s no credible reason to try – or even want to try, really – to replace “every word” of the Affordable Care Act.
What I found amusing, however, was Ryan’s use of the word “urgent.”
As the Republican leader sees it, there’s no time to waste. The problems in the health care system are so great that the Speaker believes it’s “urgent” for his party to present their conservative alternative – nearly six years after the ACA was signed into law, nearly two years after the ACA was fully implemented. Now Ryan’s serious about his party’s replacement plan.
It’s hard for even the most charitable observers not to laugh. On June 17, 2009, then-Rep. Roy Blunt (R-Mo.), a member of the House Republican leadership at the time, publicly declared that he was helping craft his party’s alternative to the Affordable Care Act. “I guarantee you we will provide you with a bill,” he said six and a half years ago.
The same week, then-Minority Whip Eric Cantor (R-Va.) told reporters that the official Republican version of “Obamacare” was just “weeks away.”
The Huffington Post’s Jeffrey Young has gotten quite a bit of mileage out of a joke, documenting all of the many, many times in recent years GOP officials have said they’re finally ready to unveil their big health care solution, only to quietly fail every time.
We were told 2014 would be different. In April 2014, House Majority Whip Kevin McCarthy (R-Calif.) said his party’s plan was nearly done, but was being delayed “at least a month.” That was 20 months ago.
Then we were told 2015 would be different. Ryan was tasked with personally heading up a Republican “working group” that would finally put together the GOP’s health care plan. Then-House Speaker John Boehner promised Fox News, “There will be an alternative, and you’re going to get to see it.”
That was 11 months ago.
As of yesterday, however, Ryan believes the issue is “so urgent” that we’ll see the Republican “plan” in 2016. And who knows, maybe we will. I wouldn’t bet on it, but anything’s possible.
But revisiting a piece from February, I think we can safely assume that the House GOP alternative to “Obamacare” – if it ever exists – is going to be cover-your-eyes horrible. How can I know that? Because in order to actually reform the pre-2010 health care system – “replacing every word” of the ACA – policymakers have to commit to extensive public investments, expansive government regulation of the insurance industry, and a commitment to help struggling families receive guaranteed benefits.
In other words, to do reform right, Republicans would have to willingly take policy steps that are anathema to everything they believe about government. It’s a safer bet they’ll do reform wrong – if they follow through at all – and when the GOP alternative stands alongside “Obamacare” and consumers are allowed to compare, it won’t be much of a contest.
This point is routinely lost on much of the chattering class, but Republicans don’t actually like health care reform, which is why we’ve waited so many years to see a plan that still doesn’t exist. GOP lawmakers didn’t see the old system – the bankruptcies, the uninsured rates, the deaths, Americans paying more for less – as a problem requiring a solution, which is precisely why they haven’t invested time and energy in writing a detailed reform blueprint.
Ryan seems to think this time will be different.
By: Steve Benen, The Maddow Blog, December 4, 2015
“The Equivalent Of Thinking The Iraq War Would Be A Cakewalk”: Why The GOP Presidential Candidates Can’t Reform Health Care
In the last few days, Scott Walker and Marco Rubio released health care plans, and other Republican candidates are sure to follow soon. Most will probably be pretty similar, even if some are more fully fleshed out than others.
But they’ll all share one feature, the thing that tells you that they aren’t even remotely serious about this issue: they will take as their starting point that the entire Affordable Care Act should be repealed.
I say that that shows they aren’t serious not because I think the ACA has done a great deal of good, though I do think that. I say it because it shows that they’re completely unwilling to grapple with both the health care system as it exists today, and how incredibly disruptive the wholesale changes they’re proposing would be. Walker’s plan even says, “unlike the disruption caused by ObamaCare, my plan would allow for a smooth, easy transition into a better health care system.” This is the health care equivalent of thinking the Iraq War would be a cakewalk.
The reality is that repealing the ACA now that it has been implemented would mean a complete and utter transformation of American health care. Republicans have often lamented that the law was so terribly long and included many different rules and regulations — yet now they act as though the law amounts to just a couple of rules here and there that can therefore be tossed out without too much trouble. But they were right the first time: the law is indeed complex, and has brought hundreds of changes big and small to American health care, not just in how people get insurance but in how Medicare and Medicaid work, how doctors and hospitals are paid, and in all sorts of other areas.
The ACA established health care exchanges. It brought millions of people into Medicaid, it closed the Medicare prescription drug “doughnut hole.” It gave subsidies to small businesses. It funded pilot projects to explore new means of providing and paying for care, it imposed new regulations on insurance companies. It created new wellness and preventive care programs, it provided new funding for community health centers. It did all that, and much more. You can argue that each one of these was a good or a bad idea, but you can’t pretend that unwinding them all would be anything resembling a “smooth, easy transition.”
We know why every Republican health care plan has to start with repealing the ACA: politics. Republicans have spent the last five years telling their constituents that they’re going to repeal it any day now, and they’ve held over 50 repeal votes in Congress. They’ve refused to admit that a word of it has any merit, even as they try to incorporate some of its more popular reforms (like protections for people with pre-existing conditions) into their own plans. So they’ve backed themselves into a corner where whatever any Republican offers has to start with repeal.
Which is why all their plans, the ones that have been released and the ones yet to come, are absurdly unrealistic. They pretend that it will be no problem to completely transform the American health care system — and there will be no losers in such a transformation, only winners — which shows that they have no intention of actually doing so. In fact, I’d go so far as to say that if a Republican gets elected next November, he’ll be relieved when his health care plan dies in Congress.
Let’s contrast that with how Democrats acted in 2008, when there was a vigorous debate in the presidential primary over health care. The three leading candidates, Barack Obama, Hillary Clinton, and John Edwards, all had very similar plans, similar because they reflected the Democratic consensus on health care reform that had evolved in the decade and a half since Bill Clinton’s reform effort failed. One major disagreement was over whether there had to be an individual mandate — Clinton’s plan had one, and Obama’s didn’t — but when he took office, Obama accepted that the mandate was necessary to make the entire plan work. It wasn’t a fantasy plan that just pandered to liberal hopes, it was something that could actually pass and be implemented.
Whenever liberals told Obama that a single-payer health plan would be far superior to what he was proposing, he would respond that if we were starting from scratch, that would probably be true. But, he’d say, we aren’t starting from scratch, so the ACA has to accommodate itself to the health care system that already exists. The result was a gigantic kludge, new complexity layered on top of an already complex system in an attempt to solve its varied shortcomings. Like all kludges, it seemed like the realistic option given the situation we confronted, but it left us with something that was far from perfect.
A Republican who actually wanted to pass real health care reform would have to approach the problem the same way: by saying that for better or worse, the Affordable Care Act has already affected the system in profound ways, so any realistic plan has to understand what those changes are, and find the most efficient way to keep the ones that are working and change the ones that aren’t. That doesn’t mean that repeal is impossible, just that it would be a spectacular upheaval, one that I promise you Republicans have no genuine appetite for. Remember all the screaming and shouting they did over the people on the individual market whose previous plans didn’t qualify under the new regulations, and who had to shop for new plans? Multiply that by ten or twenty times, because that’s how many people would likely lose their existing coverage if you repealed the ACA in one fell swoop.
And that would be only the beginning. So when any Republican candidate says he or she has a plan to reform health care, take a close look. If it starts with repealing the ACA — and it will — then you’ll know it isn’t serious and it’s never going to happen.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The PlumLine, The Washington Post, August 20, 2015
“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
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