“Plan Versus No Plan”: Virginia’s Gubernatorial Race Is A Referendum On ObamaCare, And The GOP Is Going To Lose
Republican Ken Cuccinelli became a national conservative star as Virginia’s attorney general by leading the legal fight to declare the Affordable Care Act unconstitutional all the way to the Supreme Court. Now he’s running for governor, and he’s making health care the defining issue of his campaign.
As the federal rollout continues to be plagued by website problems and renewed criticism over discontinued low-coverage individual plans, Cuccinelli told his supporters Monday, “We need people to know Nov 5th in Virginia is a referendum on ObamaCare.” His latest ad slams Democratic opponent Terry McAuliffe for wanting to “EXPAND OBAMACARE,” and closes by saying “to stop ObamaCare and higher taxes, there’s only one choice.” Outside conservative groups are also running ads excoriating McAuliffe as a supporter of ObamaCare.
Virginia voters appear to agree with Cuccinelli that health care is one of the most important issues of the campaign. The Washington Post poll conducted October 24-27 asked likely voters how important eight different issues were to determining their vote. Along with job creation and education, health care tied for first, with 72 percent saying those issues were “very important.”
And yet, in that same poll, Cuccinelli is losing by 12 points.
In fact, Cuccinelli is losing in every single poll that’s been taken in this race save for one in early July, suggesting that his defeat is a near-certainty.
Republicans are clinging to a bit of hope after a Quinnipiac poll released this week showed him only down by 4 points. But that poll only shows a minor tightening — within the margin-of-error — relative to the previous Quinnipiac poll from earlier in the month. Further, both Quinnipiac and the Washington Post polls peg Cuccinelli’s level of support around a meager 40 percent. And both polls show a third-party candidate in the race drawing support away from both major party candidates, which suggests if the also-ran fades in the stretch it won’t upend the stable trajectory of the race to date. (The Huffington Post synthesis of all the polls to date estimates McAuliffe’s lead to be a healthy eight points.)
Why isn’t health care helping Cuccinelli in the swing state of Virginia, despite all the very real problems ObamaCare has been facing this month? After all, the candidates’ positions on health care couldn’t make the choice any clearer. Cuccinelli wants the law repealed. McAuliffe says “it’s time to implement the law” by accepting federal money so the state can expand Medicaid coverage for the working poor, and having Virginia establish its own health insurance exchange.
The simplest answer is: McAuliffe’s position is shared by a whole lot of Virginians.
A plurality of 49 percent supported ObamaCare in a different Quinnipiac poll taken October 2-8. Voters said McAuliffe would do a “better job” on health care by a nine-point margin over Cuccinelli.
Of course, now that the shutdown is over and the program’s rollout is suffering significant flak, you might expect those numbers to worsen for McAuliffe. But this week’s Washington Post poll finds voters now trust McAuliffe to do a “better job” on health care by a whopping 21-point margin.
There is another plausible reason: Republicans still refuse to bolster their criticism of ObamaCare with serious policy alternatives.
Despite Cuccinelli’s insistence that the election is a referendum on ObamaCare, his website fails to include a page dedicated to what he would do about health care. Instead, he buries a few paragraphs on health care on his overall “Issues” page, which offers several conservative buzzwords but no actual policy specifics. Meanwhile, McAuliffe spells out his health care agenda in a seven-page white paper.
Plan beats no plan.
Despite all the troubles the Obama administration has had in getting ObamaCare off the ground, what’s been clear all month is this: Whatever misgivings and uncertainties persist, millions of people are going to Healthcare.gov and want the new system to work. But only Democrats, and a very small number of Republican governors, are showing a commitment to making the system work.
This should be a wake-up call to Republicans who thought the shaky Affordable Care Act rollout would shred belief in governmental competence, undermine liberalism, justify conservative obsession with repeal, and infuse Republicans with fresh momentum.
Because as this Virginia race shows, without plausible Republican policy alternatives, Democrats will able to ride out the inevitable hiccups that come with implementing new government programs and avoid any mass anti-government backlash. Simply hating on ObamaCare has not, is not, and will not be a potent political weapon.
By: Bill Scher, The Week, October 31, 2013
“Getting Better Coverage”: Obamacare “Sticker Shock”? What Under-Insured Think They Have Versus What They Actually Have
In a comment on resurgent talk of “sticker shock” for premiums on insurance bought through the Obamacare exchanges, Kevin Drum makes two points that are important to keep in mind. The first is that the number of people likely to see a major increase in net insurance costs–in excess of the subsidies they may qualify for–is not as large as you might think:
This probably doesn’t describe a huge demographic—people who are just barely above the subsidy threshold and currently have individual coverage and are young enough to see premium increases—but there’s no question they exist.
Those who do fit into this relatively narrow band of people will typically get better coverage for their additional dollars, but they may not appreciate it just yet. Kevin points to a woman quoted in an L.A. Times article on “sticker shock” as illustrative:
“Fullerton resident Jennifer Harris thought she had a great deal, paying $98 a month for an individual plan through Health Net Inc. She got a rude surprise this month when the company said it would cancel her policy at the end of this year. Her current plan does not conform with the new federal rules, which require more generous levels of coverage.
“Now Harris, a self-employed lawyer, must shop for replacement insurance. The cheapest plan she has found will cost her $238 a month. She and her husband don’t qualify for federal premium subsidies because they earn too much money, about $80,000 a year combined.
“‘It doesn’t seem right to make the middle class pay so much more in order to give health insurance to everybody else,” said Harris, who is three months pregnant. “This increase is simply not affordable.'”
I don’t know for sure how this plays out in the real world, but I’d be shocked if Harris’s $98 plan covers expenses related to pregnancy. If it does, the out-of-pocket max is probably astronomical. A bronze plan under Obamacare is still no picnic, but I’m willing to bet it covers a whole lot more of Harris’s maternity expenses than her current plan. In other words, there’s a pretty good chance that she’ll make up for her extra annual expense of $1,700 by sometime around, oh, April or so.
And even if she doesn’t, she now has insurance that will protect her from unforeseen medical conditions and out-of-pocket expenses even if they don’t occur. It is sometimes forgotten that every kind of insurance involves the potential of “excessive” premiums if you get lucky and don’t need it.
But more basically, the politics of Obamacare will indeed be affected by the attitudes of people who do or don’t view their enhanced insurance as having value, and do or don’t think they’re just shelling out dollars to “give health insurance to everybody else.”
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, October 28, 2013
“Obamacare Death Spirals”: The Latest Prediction Of Doom Hits The Conservative Blogosphere
A new meme has arrived on the scene from the voices and pens of the anti-Obamacare devotees who remain more committed to frightening than informing when it comes to healthcare reform.
It’s the Obamacare “death spiral”— and it’s coming to a conservative blog near you.
Through a series of articles already going viral—thanks to a piece published on National Review Online and one by my Forbes colleague, Dr. Scott Gottlieb –we learn that the threat of impending doom ‘du jour’ comes via an allegation that, due to the poor launch of the healthcare.gov website, younger and healthier participants will now be more likely to stay away than sign up.
This, the falsely fearful argue, will result in an insurance pool jammed with older and sicker people without the required participation of younger and healthier Americans needed to balance the pools.
The result of such an event?
As insurance companies are forced to pay out more claims —due to their older and sicker participant base—without sufficient premium income from younger and healthier people less likely to call upon the insurer to pay for medical care, the insurance company is forced to raise their premium costs so they don’t loose money. As this problem builds upon itself year after year, it becomes, as it is termed in the insurance industry, a ‘death spiral’ as, sooner or later, the insurers are forced out of business when the premium costs get too high to be affordable by much of anyone.
Clearly, the authors suffer from a lack of understanding of human behavior—particularly when it comes to young people who are not given to dealing with these sort of issues until the deadline approaches…meaning we really don’t yet know anything about the potential success or failure of the insurance pools available on the health care exchanges.
If you doubt this, you might want to review what took place with the forerunner of Obamacare—Romneycare.
According to Jonathan Gruber, one of the key architects of the Massachusetts health care exchange—a program that the overwhelming majority of Massachusetts residents favor and support—and one of nation’s leading experts on all things Obamacare, “Massachusetts launched its health insurance program at the beginning of 2007 but enrollment didn’t fully flesh out for a year. In fact, it was less than 6% of the year’s total by the end of the second month. (emphasis added)”
In other words, people of all ages tend to wait until the deadline is upon them before coming to grips with an obligation like purchasing health insurance. But if you have kids, you know that younger people are even more likely to delay matters such as this.
Yet, here we have the opponents of the Affordable Care Act, ready to declare the entire program DOA based on a prediction of ultimate demise via the ‘death spiral’—and all because the slow start of the federally operated state healthcare exchanges are precluding younger and healthier prospective participants from signing up during the initial weeks of availability.
Even stranger, Dr. Gottlieb argues that, as a result of the failures of the federal website launch and the negative cascading effect he suggests will likely follow, more people will be driven out of the exchanges due to higher premiums in future years. In its place, Gottlieb proposes, these people will turn to “off-exchange” policies, purchased by going directly to an insurance company, broker, etc. for policies that are not offered on the exchange.
Gottlieb writes—
“Over time, conforming and non-conforming insurance policies sold entirely outside the exchanges could look increasingly attractive to consumers; even accounting for the subsidies many people would get for staying inside the exchanges.”
Why would they do this? Because, Dr. Gottlieb suggests, the off-exchange policies will be cheaper.
Setting aside that I have no idea what Gottlieb is referring to when he speaks of “non-conforming” insurance policies as every individual insurance policy, whether available on the exchange or not, must, for all practical purposes, meet the basic benefits requirements set forth in the Affordable Care Act, I can’t quite fathom why buying less expensive insurance off the exchanges would be a bad thing.
There is a tendency among those dedicated to burying healthcare reform to miss the point when it comes to the objectives of Obamacare. They spend so much time working out how to creatively attack the law that they simply cannot recall why we needed healthcare reform in the first place.
At its core, the law is designed to do three things—get insurance company abuses under control, make healthcare coverage more readily available to virtually all Americans and institute a series of experiments designed to bend the cost curve in healthcare delivery.
This being the case, why would anyone care whether you buy your insurance coverage off-exchange or on-exchange, so long as you obtain healthcare coverage? What’s more, the individual mandate does not require that you shop on the exchanges—it only requires you to purchase a qualifying policy.
The healthcare exchanges are designed to create competition among insurance companies. Should it not work, and Dr. Gottlieb is correct that the events occurring on the exchange will produce lower costs of an off-exchange policy—even for those who qualify for subsidies which are only available on the exchange—then we will have learned that the exchanges did not create the intended competition.
But, if Gottlieb is right and people can buy a cheaper policy that meets the requirements of the ACA off-exchange, then the objective of the law will be accomplished.
The bottom line here is that, by any reasonable and rational metric, it is far too early to know whether or not the insurance programs offered on the healthcare exchanges will manage to maintain the balance required of sick versus healthy and old versus young. In the final analysis, the doomsayers may turn out to be right. Maybe it just won’t work.
Or, maybe it will.
This is something we will simply not know for quite a few years.
Therefore, where exactly is the benefit of predicting a dire result at this stage of the game based on no available evidence whatsoever? Can there be any possible use of this information aside from giving political opponents some newly minted ammunition? Will the knowledge that insurance policies offered on the exchanges could experience a death spiral—a possibility that has existed for health insurers since the dawn of the industry—do anything to improve the odds of success?
If there is anything we can be sure of, it is that there will be a great many surprises along the way as we make these major adjustments to our healthcare system—some that will be good and some that will not.
As for the suggestion that we are in some immediate crisis because the healthcare.gov website has not yet worked as required, Jonathan Gruber, again, provides a reasonable and rational explanation of what is really happening and what it means.
USA Today reports that Gruber describes the current situation as “DEFCON 1″—a political problem, but probably not a problem yet for the marketplace.
If healthcare.gov is not running by Thanksgiving, it would be “DEFCON 2″, a real problem because people want to get insurance by January, but it’s not a crisis.
The crisis, according to Gruber, arrives if people cannot get insurance until March of 2014.
Gruber added that, in Massachusetts, officials were not focused on how well enrollment went on a day-to-day basis. They looked at the long-term potential, and expected that people would sign up in time to avoid the penalty.
Finally, Gruber noted, “I’m pretty confident they’ll have it up and going by Thanksgiving.”
So, how about we leave the death spiral stuff in the back room until the moment comes to actually haul it out and parade it around?
After all, at the rate Obamacare opponents are tossing out and using up their theories of pending disaster, they will soon run through their play book and have nothing left in their quiver.
Wouldn’t that be a shame?
By: Rick Ungar, Op-Ed Contributor, Forbes, October 28, 2013
“Lousy Medicaid Arguments”: Deeply Revealing, More Evidence Of The Right’s Intellectual Decline
For now, the big news about Obamacare is the debacle of HealthCare.gov, the Web portal through which Americans are supposed to buy insurance on the new health care exchanges. For now, at least, HealthCare.gov isn’t working for many users.
It’s important to realize, however, that this botch has nothing to do with the law’s substance, and will get fixed. After all, a number of states have successfully opened their own exchanges, doing for their residents exactly what the federal system is supposed to do everywhere else. Connecticut’s exchange is working fine, as is Kentucky’s. New York, after some early problems, seems to be getting there. So, a bit more slowly, does California.
In other words, the technical problems, while infuriating — heads should roll — will not, in the end, be the big story. The real threat remains the effort of conservative groups to sabotage reform, especially by blocking the expansion of Medicaid. This effort relies heavily on lobbying, lavishly bankrolled by the usual suspects, including the omnipresent Koch brothers. But it’s not just money: the right has also rolled out some really lousy arguments.
And I don’t just mean lousy as in “bad”; I also mean it in the original sense, “infested with lice.”
Before I get there, a word about something that, as far as we can tell, isn’t happening. Remember “rate shock”? A few months ago it was all the rage in right-wing circles, with supposed experts claiming that Americans were about to face huge premium increases.
It quickly became clear, however, that what these alleged experts were doing was comparing apples and oranges — and as Ezra Klein of The Washington Post pointed out, oranges that, in many cases, you can’t even buy. Specifically, they were comparing the premiums young, healthy men were paying before reform with the premiums everyone — including those who previously couldn’t get insurance because of pre-existing conditions — will pay under the new system. Oh, and they also weren’t taking into account the subsidies many Americans will receive, reducing their costs.
Now people are signing up for policies on state exchanges and, to a limited extent, on the federal exchange. Where are the cries of rate shock? Anecdotal evidence, which is all we have so far, says that people are by and large happily surprised by the low cost of their insurance. It was telling that when Fox News eagerly interviewed some middle-class Americans who said they had been hurt by the Affordable Care Act, it turned out that none of their guests had actually checked out their new options — they just knew health reform was terrible because Fox News told them so.
Now, about those lousy Medicaid arguments: Last year’s Supreme Court decision upholding the Affordable Care Act did strike down one provision, the one that would have forced all states to accept an expansion of Medicaid, the already-existing program of health insurance for the poor. States are now free to reject that expansion. Yet how can states justify turning down a federal offer to insure thousands of their citizens, one that would cost them nothing in the first year and only trivial amounts later? Sheer spite — the desire to sabotage anything with President Obama’s name on it — is the real reason, but doesn’t sound too good. So they need intellectual cover.
Enter the same experts, more or less, who warned about rate shock, to declare that Medicaid actually hurts its recipients. Their evidence? Medicaid patients tend to be sicker than the uninsured, and slower to recover from surgery.
O.K., you know what to do: Google “spurious correlation health.” You are immediately led to the tale of certain Pacific Islanders who long believed that having lice made you healthy, because they observed that people with lice were, typically, healthier than those without. They were, of course, mixing up cause and effect: lice tend to infest the healthy, so they were a consequence, not a cause, of good health.
The application to Medicaid should be obvious. Sick people are likely to have low incomes; more generally, low-income Americans who qualify for Medicaid just tend in general to have poor health. So pointing to a correlation between Medicaid and poor health as evidence that Medicaid actually hurts its recipients is as foolish as claiming that lice make you healthy. It is, as I said, a lousy argument.
And the reliance on such arguments is itself deeply revealing, because it illustrates the right’s intellectual decline. I mean, this is the best argument their so-called experts can come up with for their policy priorities?
Meanwhile, many states are still planning to reject the Medicaid expansion, denying essential health care to millions of needy Americans. And they have no good excuse for this act of cruelty.
By: Paul Krugman, Op-Ed Columnist, The New York Times, October 20, 2013
“Game Show Contestants”: Why Obamacare’s Critics Have To Brazenly Just Make Stuff Up
With the federal government re-opened, and the debt ceiling raised, the political world can slowly adjust to some semblance of normalcy – or at least as normal as the conditions were a few months ago.
At Fox News, that means a few specific things, including an effort to convince viewers that the shutdown’s effects on the U.S. economy weren’t that bad, followed by an effort to – I kid you not – focus on another round of Benghazi conspiracy theories.
But it also means reinvesting in the crusade against the Affordable Care Act. Eric Stern has a fascinating item in Salon this morning on one Fox segment in particular.
I happened to turn on the Hannity show on Fox News last Friday evening. “Average Americans are feeling the pain of Obamacare and the healthcare overhaul train wreck,” Hannity announced, “and six of them are here tonight to tell us their stories.” Three married couples were neatly arranged in his studio, the wives seated and the men standing behind them, like game show contestants.
As Hannity called on each of them, the guests recounted their “Obamacare” horror stories: canceled policies, premium hikes, restrictions on the freedom to see a doctor of their choice, financial burdens upon their small businesses and so on.
“These are the stories that the media refuses to cover,” Hannity interjected.
To his credit, Stern listened carefully to the couples’ stories, but noticed that they didn’t sound plausible. So he tracked each of the guests down to ask some follow-up questions.
First was a North Carolina couple that said the health care law is hurting their construction business, forcing them to keep their employees at part-time status. As it turns out, what they said on the air was simply made up.
Then there was a woman who was paying over $13,000 a year in premiums, who was recently told by her insurer that her plan was being terminated. This was proof, she told Hannity, that when Obama said consumers could keep their plans if they wanted, it wasn’t true. What she neglected to mention on the air is that, thanks to the law she opposes, she can sign up for coverage through an exchange and save several thousand dollars a year for better insurance.
Finally, there was a Tennessee couple who said they’re facing a rate increase of 50% to 75%. Asked if they’d shopped around in the new marketplace, the couple said they refuse, which is a shame – when Stern checked for them, he found a plan for them that would cut their health care costs by 63%.
So what are we left with? Three Fox News horror stories that really aren’t that horrible after all.
Whether Hannity knew his guests were pushing bogus, politically motivated stories is unclear – fair minded folks can draw their own conclusions – but a related concern has lingered for quite a while. If the dreaded “Obamacare” were really so awful, and is poised to hurt so many families, shouldn’t Fox and other opponents find it easier to find real anecdotal evidence?
In other words, Hannity would have us believe Obamacare victims are everywhere. If so, why can’t he find real ones to appear on his show? Why mislead the public so brazenly?
By: Steve Benen, The Maddow Blog, October 18, 2013
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