“A Closer Look At Those Falling Into The Wingnut Hole”: Nearly 80% Of People In The Health Care Coverage Gap Reside In The South
Yesterday the Kaiser Family Foundation released some badly needed data on the characteristics of Americans who fall into what I’ve dubbed the “wingnut hole,” and that others just call the Coverage Gap. These are the people too poor to qualify for Obamacare subsidies for purchasing insurance in the exchanges, but too “rich” to qualify for the Medicaid benefits the drafters of the ACA assumed they would get but that their state governments blocked once the Supreme Court let them make the choice. Here’s the Kaiser Family Foundation’s take on the problem:
Medicaid eligibility for adults in states not expanding their programs is quite limited—the median income limit for parents in 2014 will be 47% of poverty, or an annual income of about $9,200 a year for a family of three, and in nearly all states not expanding, childless adults will remain ineligible. Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults will fall into a “coverage gap” of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits…. Nationwide, nearly five million poor uninsured adults are in this situation.
Who are they? Well, they’re mostly southerners:
The nearly five million poor uninsured adults who will fall into the “coverage gap” are spread across the states not expanding their Medicaid programs but are concentrated in states with the largest uninsured populations…. More than a fifth of people in the coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility. Sixteen percent live in Florida, eight percent in Georgia, seven percent live in North Carolina, and six percent live in Pennsylvania. There are no uninsured adults in the coverage gap in Wisconsin because the state will provide Medicaid eligibility to adults up to the poverty level in 2014.
The geographic distribution of the population in the coverage gap reflects both population distribution and regional variation in state take-up of the ACA Medicaid expansion. As a whole, more people—and in particular more poor uninsured adults— reside in the South than in other regions. Further, the South has higher uninsured rates and more limited Medicaid eligibility than other regions. Southern states also have disproportionately opted not to expand their programs, and 11 of the 25 states not expanding Medicaid are in the South. These factors combined mean nearly 80% of people in the coverage gap reside in the South
They’re also hard to define by race or ethnicity:
The characteristics of the population that falls into the coverage gap largely mirror those of poor uninsured adults. For example, because racial/ethnic minorities are more likely than White non-Hispanics to lack insurance coverage and are more likely to live in families with low incomes, they are disproportionately represented among poor uninsured adults and among people in the coverage gap. Nationally, about half (47%) of uninsured adults in the coverage gap are White non-Hispanics, 21% are Hispanic, and 27% are Black (Figure 3).
And they’re often the people left behind in wave after wave of incremental reforms based on expanding Medicaid and S-CHIP benefits to kids and their parents.
The characteristics of people in the coverage gap also reflect Medicaid program rules in states not expanding their programs. Because non-disabled adults without dependent children are ineligible for Medicaid coverage in most states not expanding Medicaid, regardless of their income, adults without dependent children account for a disproportionate share of people in the coverage gap (76%)…. Still, nearly a quarter (24%) of people in the coverage gap are poor parents whose income places them above Medicaid eligibility levels. The parent status of people in the coverage gap varies by state….due to variation in current state eligibility.
What doesn’t vary state by state is how outrageous it is to exclude the people who by the accident of a court decision fall into the “wingnut gap” of benefits available to people just above them on the income scale. They are for the most part the “working poor,” people with part-time or small-business jobs that don’t come with private health insurance.
They are ineligible for publicly-financed coverage in their state, most do not have access to employer-based coverage through a job, and all have limited income available to purchase coverage on their own.
You can argue that these people are those most in need of the Affordable Care Act, yet most likely to be excluded from its benefits.
These are also people with an unusually large personal stake in the outcome of the 2014 elections–the kind of people conservatives are thinking of when they conclude Obamacare has created a “tipping point” wherein actual or potential beneficiaries of government programs are essentially being bribed into voting Democratic. But if there’s been any growing groundswell of political mobilization of people in the “wingnut hole,” it has been very quiet. So they will likely become objects of anti-redistribution propaganda from the Right without becoming subjects of any major Democratic comeback.
The latest hope for people in the “wingnut hole” has been enthusiasm for securing Medicaid expansion by very broad waivers allowing states to work their will on the Medicaid program as a whole. To be very blunt about it, such “deals” have tended towards broadening the base of people eligible for Medicaid while degrading its benefits, with the federal government paying almost all the cost of implementation and sharing the political risk that it might fail. The situation is a reminder that about a hundred fifty years after the end of the Civil War, southern states are still fighting the “Reconstruction” potential of federal funds to interfere with the region’s grim perpetuation of inequality.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 18, 2013
“Brazen Dishonesty”: California GOP ‘Reaches For The Bottom’
Health care policy can get confusing, even for policy experts who study the details for a living. It’s one of the reasons dishonesty in the political debate surrounding health care is so damaging – even the most well-intentioned people often don’t know how best to separate fact from fiction.
It’s why efforts from political officials – who know better – to deliberately confuse people are so disappointing. Michael Hiltzik reports:
Opponents of the Affordable Care Act never stop producing new tricks to undermine the reform’s effectiveness. But leave it to California Republicans to reach for the bottom. Their goal appears to be to discredit the act by highlighting its costs and penalties rather than its potential benefits.
The device chosen by the Assembly’s GOP caucus is a website at the address coveringcaliforniahealthcareca.com. If that sounds suspiciously like coveredca.com, which is the real website for the California insurance exchange, it may not be a coincidence.
In theory, this is a site created by California Republicans to serve as a “resource” for those looking for additional information. In practice, the site “is worse than useless” – it didn’t direct users to the in-state exchange marketplace, and includes demonstrable falsehoods intended to deceive the public.
Like what? The site includes the ridiculous notion that the Affordable Care Act increases the federal budget deficit, which is the exact opposite of reality. It also claims the IRS will use the law to target conservatives; it says the law will discourage private-sector hiring; and it even hints in the direction of the death-panel smear by raising the specter of “rationing” for the elderly.
All of these claims are wrong. All of them are presented, however, on a website that presents itself as objective and non-partisan.
Stepping back, dishonesty on this scale is certainly brazen, but it raises anew a lingering question: if the Affordable Care Act is so awful, and will be as horrific as critics claim, why do Republicans continue to feel the need to make stuff up? Shouldn’t reality be damaging enough?
By: Steve Benen, the Maddow Blog, December 4, 2013
“Like It Or Not, Obamacare Is Moving Forward”: For Certain People, This Isn’t As Good A Story As The Website’s Implosion Was
HealthCare.gov just tweeted that more than 375,000 had visited the refurbished federal website as of noon today. White House press secretary Jay Carney confirmed the figure shortly after.
So demand still appears to be there, despite weeks of deservedly awful press about the website and the law, and weeks of Republican claims that the law is so disastrously flawed that it cannot be rescued.
Along those lines, Kevin Drum captures what matters most about the news of the moment in one half a sentence:
if you need to buy health coverage via healthcare.gov, you can do it
This really is the rub. Sure, there will be continued problems. Charles Ornstein personally had a terrible experience. Sarah Kliff found the site is still not working for everybody. And the snafus at the back end may persist, too.
But the big picture is that far more people who need health insurance — whether they were bumped from plans or whether they were previously uninsured — will now be mostly able to go online, do some shopping, and buy health insurance. Before, they couldn’t.
This isn’t as good a story as the website’s implosion was, and if the site continues to function as expected, it will mostly stop getting media coverage. The press will move on to the next Obamacare disaster story, should it materialize: The “keep your doctor” saga, coming soon via Republican press release directly to reporters’ inboxes.
But the current fix has mostly tamped down concerns among Democratic lawmakers, and barring some truly catastrophic change, they just aren’t going to abandon the law in any meaningful sense. Meanwhile, demand looks likely to continue, even as insurance companies redouble their efforts to entice people on to the exchanges, which means enrollment will continue piling up, too.
Will it be enough? It’s too soon to say. Republican lawmakers and their voters have been 100 percent certain for some time now that Obamacare has already collapsed, but for everyone else, the law’s long term prospects will turn mostly on what that enrollment looks like over time. And for that, we’ll just have to wait.
By: Greg Sargent, The Washington Post, December 2, 2013
“Exploiting Consumers”: Republican Obamacare “Fix” Is Junk, Just Like The Junk Insurance Plans It Protects
In an effort to cynically score political points, the Republicans have taken up the cause of people who have received health insurance “cancellation” notices. The problem is that the Republicans aren’t helping these people, they are exploiting them. They’re peddling a “fix” that will stick consumers with lousy insurance policies, put the insurance companies back in charge of our health care and deceive people who deserve a straight answer about what’s going on with their health coverage.
If you’re one of the people who received a notice, it’s unsettling and confusing to say the least — and you don’t need a political party to play politics with your life. You need to know the truth and learn the available options.
People are receiving cancellation notices because they were sold health insurance policies that provide bare-bones coverage and expose them to financial ruin if they get sick or injured. Insurance companies sold these plans knowing full well that consumers could not keep them after the Affordable Care Act (ACA) standards are fully implemented on Jan. 1. The insurance companies didn’t tell their clients that they couldn’t keep the plans they sold them, and they certainly didn’t tell them that the plans were junk. Now the Republicans want to allow the industry to continue to sell these policies for another year in the name of letting people keep the plans “they like.” This is hypocrisy and politics at its worst, not to mention terrible policy.
There are roughly 15 million Americans who buy health plans in the individual market, and they represent 5 percent of people with private insurance. About half of them got cancellation notices, which naturally leaves people anxious to find out what they’ll do next year.
Instead of passing a law allowing insurers to keep selling bad policies that provide little for their premium money, we should tell people what their coverage options are and how much better they’ll do under the ACA. Because the enrollment web site HealthCare.gov has yet to work properly, most folks don’t realize they will save money and get better insurance if they shop in the new insurance marketplaces and take advantage of generous instant tax credits that will drastically cut their premiums.
People can save a lot of money when they buy their insurance through the online marketplaces: Seventeen million people will qualify for tax credits to reduce the cost of their insurance. As many as 7 million people may have no premium costs at all. Six of 10 uninsured Americans will pay $100 or less in monthly premiums. While it sucks to get canceled, the vast majority of those folks will see that getting coverage through the ACA marketplaces is a better deal.
The GOP-led legislation is bad public policy. It will disrupt the insurance market and make things worse now and in the future. You can’t mend our broken health insurance system if millions of people can opt out of participating in it. That’s how we got into this mess in the first place.
Allowing inferior insurance plans to exist alongside quality ACA policies will destroy the economic foundation of the law — the idea that financial risk must be spread and shared — and give our health care back to the insurance companies. Nothing could be worse for the health and the pocketbooks of everyday Americans.
For example, the Republican proposal would prompt younger, healthier people to opt out of enrolling in the marketplace plans, meaning the ACA policies will cover mostly older and sicker people who are more costly to insure. As a result, marketplace premiums would spike and millions of Americans would lose out on health coverage they can afford. People would be denied insurance or charged sharply higher premiums because of their medical history. Consumers would be at the mercy of the health insurance companies. That’s not why we enacted health reform. America reformed our health insurance system so everyone could have insurance with real benefits — not benefits that are only revealed to be phony in the middle of a medical crisis. We did it based on the simple principle that we all do better when we all do better.
The Republican bill would be a disaster for consumers. As we learned during the drive to pass the ACA, junk policies cause nothing but trouble. There are millions of stories of bankruptcy filings, homes and jobs lost, college educations abandoned and dreams deferred because someone with fake insurance got sick and was overwhelmed by medical bills. We can’t go back to those days.
The GOP is using overhyped cancellation stories as a pretext to destroy the ACA, a law they have attacked with a single-minded fervor never before seen in American politics. When the Republicans’ bill, H.R. 3350, reaches the floor, it will be the House GOP’s 46th vote to repeal Obamacare.
Any fixes to the Affordable Care Act should be judged by whether they help people and improve the law. The Republican-led proposal does neither.
By: Ethan Rome, HCAN Blog, November 14, 2013
“Another Media Black Eye”: John Boehner Inadvertently Exposes Sloppy Media Coverage Of Obamacare Costs
House Speaker John Boehner loves to tell stories about people getting a raw deal from Obamacare. This week, he decided to tell one about himself.
As you may recall, Obamacare treats members of Congress and their staff differently from other working Americans. Thanks to a provision added to the law by Charles Grassley, the Republican Senator from Iowa, certain Capitol Hill workers can’t get insurance like other federal employees—i.e., via the Federal Employees Health Benefits Plan. Instead, they must get coverage through one of the new Obamacare exchanges. For many, that means enrolling through the District of Columbia exchange.
This week, Boehner did just that. But, as his advisers later explained to media outlets, the Speaker had trouble. The website had technical problems, they said, and it took hours for Boehner to complete process. When he finally found a policy, he discovered it would cost a lot more. Politico got the full story, including a quote from Boehner spokesman Brendan Buck. “The Boehners are fortunate enough to be able to afford higher costs. But many Americans seeing their costs go up are not. It’s because of them that this law needs to go.” Soon it was all over social media.
But this story turns out to be a lot more complicated than either Boehner or the initial press accounts suggested. In fact, it’s an almost perfect example of how media coverage of Obamacare has failed to provide scrutiny, context or a sense of scale. For one thing, the circumstances of Boehner’s effort to use the D.C. website are a bit murky. Boehner had said he couldn’t get through to anybody on the Exchange’s help line. A spokesman for the exchange challenged that account, telling local NBC reporter Scott MacFarlane that a representative called Boehner’s office, only to be put on hold while patriotic music played in the background. After 35 minutes, according to this account, the representative hung up. It’s impossible to know which account is correct. But if the D.C. Exchange version is right, then, as Steve Benen observes, “Boehner complained about how long the process took, but when he got a call to complete the enrollment process, the Speaker kept the exchange rep on hold for over half an hour.”
In any event, the real issue here is what Boehner will pay for insurance next year—and what, if anything, that says about the law as a whole. It’s true that Boehner’s 2014 premiums will be higher than his 2013 premiums have been. But that’s because of a set of relatively unique factors. They’re a bit hard to explain: Michael Hiltzik of the Los Angeles Times has the full story if you want it. The simplistic version is that Boehner is paying more because he works on Capitol Hill and, at 64, he is relatively old. Unless you, too, work on Capitol Hill and are relatively old, his experience tells you very little about what will happen to you. Among other things, most large employers aren’t dropping coverage and sending their full-time workers into the exchanges. Only the U.S. Congress is—and that’s because of Grassley’s screwy amendment, which was, by all accounts, designed to embarrass the Democrats rather than become law.
Of course, the same factors that will mean higher premiums for older Capitol Hill workers will mean lower premiums for younger ones. An example of somebody benefitting from this dynamic is Drew Hammill, spokesman for House Democratic Leader Nancy Pelosi. Taking into account the employer contribution, he’ll be paying $88 a month for his insurance next year. This year he has paid $186. His story appeared in a Wall Street Journal article about the different heath insurance experiences for different workers on Capitol Hill. The article, by Louise Radofsky, was balanced and fair. It was also the exception. There have been plenty of stories focusing on the older workers paying more, but almost none about younger workers paying less. You could make a case for focusing on the former more heavily: Hardship is bigger news than unexpected good luck. But by such a lopsided margin? That’s hard to justify.
And that pattern, unfortunately, is one we’ve seen over and over in this debate. People giving up their current plans get tons of attention. People getting new coverage don’t. Those Americans paying higher premiums next year have been all over the media. Those Americans paying lower premiums haven’t. There are exceptions. In the L.A. Times, Hiltzik had a terrific article Tuesday about Californians gaining coverage and saving money through California’s exchange. But those articles are hard to find.
Obamacare is a complicated story to tell, with good news and bad news and plenty in between. The media should cover all of it. But for the last few weeks it has mostly told one side of the story—the side that Boehner and his allies want you to hear.
By: Jonathan Cohn, The New Republic, November 26, 2013
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