“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
“This Is Sabotage, Plain And Simple”: The Unprecedented GOP Efforts To Undermine A Federal Law
Sen. Joe Manchin (D-W.Va.), who’s never been the Affordable Care Act’s biggest fan, appeared on MSNBC yesterday to join the critical chorus. In reference to the Obama administration, the conservative Democrat said, “The bottom line is that they messed up, they messed up royally. There’s no excuse for this.”
The administration’s missteps have been well documented, and officials have earned much of the criticism they’ve received. But to say there’s “no excuse” is to overlook Republican sabotage efforts that have made a real difference.
Todd Purdum recently made the case, for example, that “calculated sabotage by Republicans at every step” is a “less acknowledged cause” of the rollout’s troubles. Jamelle Bouie added this week, “If Republicans have shown anything over the last four years, it’s that they’ll do anything to stop the Affordable Care Act, even if it amounts to legislative sabotage.”
We’ve talked before about the scope of these unprecedented efforts to undermine a federal law, which include blocking necessary resources needed for implementation, public misinformation campaigns, discouraging public-private partnerships, blocking Medicaid expansion, blocking CMS nominees, refusing to create marketplaces, and prohibiting “Navigators” from doing their jobs. But the campaign is arguably intensifying now.
Dana Milbank reports on House Republican leaders who emerged from their weekly meeting yesterday and tried to scare the bejesus out of Americans.
The Republicans’ scary-movie strategy has some logic to it: If they can frighten young and healthy people from joining the health-care exchanges, the exchanges will become expensive and unmanageable. This is sabotage, plain and simple – much like the refusal by red-state governors to participate in setting up the exchanges in the first place.
The quotes from House GOP leaders are rather remarkable. Majority Leader Eric Cantor (R-Va.) said health care reform may lead to identity theft; Speaker John Boehner (R-Ohio) falsely claimed “premiums are going right through the roof”; Majority Whip Kevin McCarthy (R-Calif.) warned that consumers who visit healthcare.gov may become victims of fraud; and Caucus Chair Cathy McMorris Rodgers (R-Wash.) said vulnerable constituents may be put “on the casualty list.”
Milbank added, “Let’s hope the new health-care plans have generous coverage for anti-anxiety medication.”
Let’s not forget that the difference between a lie and a falsehood is intent – if you know the truth and say the opposite because your goal is deceit, you’re lying. And for the most part, congressional Republicans, whose interest in helping provide greater health security for Americans is easily trumped by their interested in destroying a Democratic law, have been reducing to lying.
But for saboteurs, honesty and serious policy debate are easily sacrificed for the larger goal. Indeed, they’re a small price to pay.
Also note, we’re looking at quite a one-two punch from the far-right – on the one hand we see the Koch brothers and their allies urge the uninsured to stay that way on purpose, in order to advance conservatives’ ideological goals, and on the other we see congressional Republicans try to terrify the public in the hopes that people who stand to benefit from “Obamacare” steer clear of the system.
President Obama added yesterday, during an interview with the Wall Street Journal, that if both parties were “invested in success,” the rollout wouldn’t have been quite so rocky. “One of the problems that we’ve had is that one side of Capitol Hill is invested in failure and that makes the kind of iterative process of fixing glitches as they come up and fine tuning the law more challenging,” he added.
There’s no denying that the dysfunctional health care website matters, and the administration’s missteps deserve criticism. But Republican sabotage matters, too.
Kevin Drum recently explained, “No federal program that I can remember faced quite the implacable hostility during its implementation that Obamacare has faced. This excuses neither the Obama administration’s poor decisions nor its timidity in the face of Republican attacks, but it certainly puts them in the proper perspective.”
By: Steve Benen, The Maddow Blog, November 20, 2013
“Separating Myth From Reality On Obamacare”: The Greatest Good For The Greatest Number, More People Are Better Off In The End
My heart sank when I got an email late last month from my friend Robert, who has been battling multiple sclerosis for the past decade. He wrote to tell me that he was among the many Americans who in recent weeks received letters from their insurance companies saying that their policies won’t be available next year.
Insurance companies are sending those letters primarily because the policies they will no longer offer don’t provide enough coverage — or have deductibles that are too high — to comply with the Affordable Care Act. In many cases, however, the policyholders getting those letters are simply victims of a business practice insurers have engaged in for years: discontinuing policies because they’re no longer sufficiently profitable.
Robert understandably was worried. Like most of us, he’d been seeing the news stories about people who had received similar letters and seemed to be resigned to having to pay more in premiums next year for comparable or even less coverage, thanks to Obamacare.
Considering his very serious and costly preexisting condition — his medications alone cost more than $5,000 a month — Robert was nervous as he started looking for a replacement policy. How much more would he have to pay to stay insured?
A couple of weeks went by. I assumed Robert, like many others, was still waiting for the Obama administration to fix Healthcare.gov so he could shop online for coverage. It turns out Robert wasn’t willing to just wait. He decided to call an insurance agent and talk to a real live human being about his options for next year.
He could barely believe what he heard: he could get better coverage than the policy being discontinued — and pay less — thanks to Obamacare.
“The overall cost of the plans I’m considering is cheaper than the plan I am currently paying for,” he wrote me this week. “My total cost for coverage now, including premiums and out of pocket costs, is about $9,800. Two of the plans I’m seriously considering for next year have total costs of $8,400. I’m shocked, but in a good way.”
So not only did Robert not experience the sticker shock he had been expecting, he will save $1,400 next year on health insurance.
The plan he is leaning toward — a top-of-the line “platinum” plan — will have a higher monthly premium, but he will still save on average about $117 a month because of the way his out-of-pocket costs will be calculated.
Robert is among many who are losing their current coverage but in the end will be better off. In fact, considering that many folks buying coverage on the individual market have at least one pre-existing condition — which insurers can no longer take into consideration when pricing their policies — it’s likely that more people will get more for their insurance buck next year than less.
In addition, most of the people who buy coverage through the new insurance marketplaces (as Robert will when the balky Healthcare.gov website is working more smoothly) will be eligible for tax credits and subsidies from the federal government that will lower their monthly and overall costs even more.
Robert knows that you can’t determine how much you’ll spend on coverage during a given year just by multiplying the monthly premium by 12. If you don’t take into consideration out-of-pocket costs and just pick the policy with the cheapest premium, you could wind up paying more overall than if you picked a plan with a slightly higher monthly premium.
Robert also will be able to spread the cost of his coverage more evenly over the year. Under his current plan, he had to have at least $5,000 in the bank at the beginning of every year when his policy renewed to cover the cost of his medications for just one month. Under the new plans he is considering for next year, his monthly out-of-pocket costs will range from $80 to $120 a month.
“It will be easier to manage paying for my drugs spread out over a period of 12 months instead of in one lump sum at the beginning of the year,” Robert told me.
Robert said the insurance agent told him his case is not unique, that a lot of the people she talks to who have been frightened by the media coverage are pleasantly surprised to learn that they will get better coverage for less money next year. Once the Healthcare.gov website is fixed, more people who have received letters from their insurance companies will get a similar pleasant surprise.
By: Wendell Potter, The Center for Public Integrity, November 12, 2013
“No Health Insurance, Just Drink”: Koch Brothers Generation Opportunity Campaign Against Obamacare Is Insanely Irresponsible
This is the strangest P.R. campaign yet against the Affordable Care Act. Generation Opportunity, the Koch-funded group behind the Creepy Uncle Sam ads, is throwing tailgate parties to “educate” young people about the exchanges. Read: To convince young people to forgo health insurance.
The group’s communication director, David Pasch, wrote an email to The Tampa Bay Times describing a drunken event at Saturday’s University of Miami-Virginia Tech football game:
“We rolled in with a fleet of Hummers, F-150’s and Suburbans, each vehicle equipped with an 8’ high balloon bouquet floating overhead. We hired a popular student DJ from UMiami (DJ Joey), set up OptOut cornhole sets, beer pong tables, bought 75 pizzas, and hired 8 ‘brand ambassadors’ aka models with bullhorns to help out.”
Mr. Pasch specified that “student activists,” rather than anyone employed directly by Generation Opportunity, “brought (lots of) beer and liquor for consumption by those 21 and over.”
As a sort of afterthought, he added, “Oh yeah, and we educated students about their healthcare options outside the expensive and creepy Obamacare exchanges.”
According to Think Progress, this isn’t a one-time thing: “The group is touring 20 different campuses this fall in a $750,000 effort to convince college students that they’re better off being uninsured than getting health coverage through Obamacare.”
That’s a lot of money for a campaign that’s not only insanely irresponsible, but also insanely dumb. Generation Opportunity is the old guy at a house party, convinced he can win the cool kids’ respect with booze.
By: Juliet Lapidos, Editors Blog, The New York Times, November 11, 2013
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