“The GOP’s Hypocrisy On Obamacare”: Republicans Get The Vapors And Become Outraged About The Problems They Created
Last spring, the Senate Finance Committee held a hearing on implementation of the Affordable Care Act, otherwise known as Obamacare. Sen. Max Baucus, a Montana Democrat and the chairman of the committee, was not pleased with how things were going.
The Obama administration originally had asked for more than half a billion dollars to spend on public relations and outreach for the law. House Republicans had returned with an offer of nothing. That’s right: zero dollars. Without necessary funds, the Department of Health and Human Services worried it would not have the necessary money to pay for navigators to help people enroll in health care, for the technology needed to implement the exchanges and for the public relations campaign that was required to inform citizens about what the law actually did.
HHS Secretary Kathleen Sebelius made the controversial move of asking insurance companies and nonprofit organizations to donate money and help. Republicans were outraged. She asked for more money. She was refused.
Then, when she tried to move some money from the PR budget to replace cuts to other areas, Baucus became quite upset. He was concerned that if the administration did not do more to inform people about the law and get implementation going, there would be problems:
“A lot of people have no idea about all of this,” he said. “People just don’t know a lot about it, and the Kaiser poll pointed that out. I understand you’ve hired a contractor. I’m just worried that that’s gonna be money down the drain because contractors like to make money. … I just tell ya, I just see a huge train wreck coming down.”
As I’ve said before, it’s important to note that the “train wreck” Baucus was describing was a botched implementation because not enough was being done to make things go smoothly.
It wasn’t a description of the law itself but of what might occur if the government did not devote enough resources to making it work. Sebelius’ response was not surprising to those who were paying attention. She said that she was “incredibly disappointed” that all her requests for resources were being denied by Republicans.
That was then. Today, implementation has arrived, and if it’s not a train wreck, then it’s certainly close. The administration is still under fire because people cannot get the insurance they want through the exchanges. But while I will continue to point out the problems with implementation and fault the administration for mistakes they’ve made, how does one ignore the apparent hypocrisy from many politicians who are now “outraged” about the very problems they’ve helped to create.
Republicans refused to appropriate money needed to implement Obamacare. When Sebelius tried to shift money from other areas to help do what needed to be done, she was attacked by Senate Republicans. At every step, Republicans fought measures to get money to put towards implementation.
Is it really a surprise then that implementation hasn’t gone smoothly?
Federal legislators aren’t the only ones to blame. Let’s remember that original versions of the bill called for one big national exchange. This would have been much easier to implement. But conservatives declared that insurance should be left to the states and kept out of the hands of the federal government. So as a compromise (yes, those did occur), exchanges were made state-based instead of national.
As a precaution, the law stipulated that if states failed to do their duty and enact exchanges, the federal government would step in and pick up the slack. This was to prevent obstructionism from killing the law. Surprisingly, it was many of the same conservative states that demanded local control that refused to implement state-based exchanges, leaving the federal government to do it for them.
That made implementation much harder.
There have been books, webinars and meetings explaining how to sabotage the implementation of Obamacare. There have been campaigns trying to persuade young adults not to use the exchanges. It is, therefore, somewhat ironic that many of the same people who have been part of all of this obstructionism seem so “upset” by the fact that people can’t easily use the exchanges.
For goodness sake, the government was shut down just a few weeks ago because some of the same people who are now bemoaning poorly functioning websites were determined to see that not one dime went to Obamacare.
Lest you think I’m defending this month’s rollout, I encourage you to review my last article here. I still maintain that the administration has had a failure in management in overseeing and reporting on progress towards October 1. But I’m also sympathetic that they’ve had a hard job to do. I would like to see this go better. I’d like to see millions more get insurance. I’d like to see the law of the land function as well as it can, and if it doesn’t, I’d like to see Congress continue to amend it to make it work better. I’d like a better health care system.
What I cannot ignore, however, are the many people who actively worked to see implementation fail now get the vapors over its poor start. The truth is, they got what they wanted. A victory lap is somewhat warranted, not concern-trolling.
If, on the other hand, their concern is real, then I’m sure the administration would welcome their help in making things right.
By: Aaron Carroll, Director, Center for Health Policy and Professionalism Research, Indiana University School of Medicine, Special to CNN, 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
“An Obvious Agenda”: Misleading Information, Sloppy Media Coverage Are Confusing The Public About Obamacare
Not confused enough yet about how much health insurance might cost some of us next year when the consumer protections in Obamacare kick in? Just wait. It’s likely you’ll soon be far more confused — and alarmed — than you already are.
Take, as an example, the CNNMoney story from last week, headlined, “Where Obamacare premiums will soar.” The subhead was equally scary: “Get ready to shell out more money for individual health insurance under Obamacare … in some states, that is.”
The first thing you should keep in mind when you read such stories is that very few Americans will be affected by how much insurers will charge for the individual policies they’ll be selling in the online health insurance marketplaces beginning Oct. 1. The CNN story doesn’t mention, as it should have, that in a country of 315 million people, only 15 million — less than five percent of us — currently buy health insurance on our own through the so-called individual market because it’s not available to us through the workplace.
Although the CNN story focused exclusively on the individual market, nowhere in the story was it explained that, according to the U.S. Census Bureau, the vast majority of Americans — about 55 percent of us — are enrolled in health insurance plans sponsored by our employers. Another 32 percent of us are enrolled in Medicare, Medicaid and other public programs. That means that almost 9 out of 10 of us will not be affected at all by rates insurers will charge next year in the individual market.
The Americans who will be affected most by Obamacare are the millions who are uninsured because they either cannot buy coverage at any price today as a result of pre-existing conditions or they cannot afford what insurers are charging.
Although the CNN story didn’t mention that one of the main reasons for Obamacare was to make it possible for the uninsured to at long last buy affordable coverage, it is the uninsured who will be most directly affected by the reform law, and most likely to benefit. That’s because insurers next year will no longer be able to refuse to sell coverage to people who’ve been sick in the past. And because most people shopping for coverage on the online marketplaces will be eligible for federal subsidies to offset the cost of the premiums.
Not until deep in the CNN story are we informed that “Americans with incomes up to $45,960 for an individual and $94,200 for a family of four will be eligible for federal subsidies.” That’s a huge point to bury, especially considering that the median household income in this country is still just around $50,000. It’s just a small percentage of folks buying coverage through the online insurance marketplaces that will have to pay the full premium price on their own.
Below the headline of the CNN story was a startling graphic showing the states of Ohio and Florida with the numbers 41 percent and 35 percent right below them, leading one to believe that all residents of those states would see their health insurance premiums skyrocket.
As I did my own research of those claims, I found that not only did those numbers apply to just the individual market, but they did not take into account the subsidies that will be available. So not only will very few Ohioans and Floridians see their premiums increase by that much, many if not most will pay less than they do today thanks to the sliding-scale subsidies.
I also found that officials in those states were being disingenuous in the way they calculated their “Obamacare” figures. Ohio and Florida and many other states permit insurers to sell policies today that are so inadequate they will be outlawed beginning Jan. 1. The reason those kinds of policies are being outlawed is because, even though they are profitable for insurers that sell them, people who buy them often find out when it’s too late — after a serious illness or accident — that their policies are essentially worthless.
As The Miami Herald noted in a story about the projected rates announced recently by Florida’s Office of Insurance Regulation, the source for the CNN graphic, “The OIR compared ‘apples to oranges’ by failing to factor into its projections the fact that statewide averages for pre-Obamacare premiums included a wide variety of low-value plans — including plans with extremely limited benefits, such as no prescription drug coverage; and high-deductible plans, where the insured first must pay hefty out-of-pocket costs before the insurer begins to cover services.”
Considering all the intentionally misleading information we are being subjected to about Obamacare from politicians and special interests with an obvious agenda, it will be vitally important for reporters to be more responsible in their reporting. Sensational media stories with attention-grabbing headlines but inadequate analysis will only add to Americans’ confusion about a law that in reality will help the vast majority of us.
By: Wendell Potter, The Center for Public Integrity, Originally Published on August 12, 2013
“Self-Interested Plutocracy”: Desperate Republicans Are Terrified That Obamacare Will Succeed
Even acknowledging that our national politics have become increasingly contentious, here’s a development that is really odd: Two billionaire brothers are spending millions of dollars to try to persuade young Americans not to buy health insurance. What’s up with that?
The industrialist Koch brothers, David and Charles, are among the very richest Americans — indeed, among the very richest people on the planet. They are not merely members of the 1 percent; they’re in the topmost fraction of the 1 percent.
That means that they not only can afford to buy health insurance for themselves, but they can also buy physicians, hospitals, medical labs and pharmacies if they choose to do so. They have access to the very best medical care that money can buy — and, in America, that’s the difference between life and death.
But unlike, say, Bill Gates, the founder of Microsoft, the Koch brothers have not concerned themselves with trying to make life a bit more comfortable and pleasant for others. Oh, no. The Koch brothers are the very stereotype of the greedy and selfish hyper-rich, the poster boys for self-interested plutocracy. They want to control the country’s politics — no matter who gets hurt in their grab for power.
That’s why they’ve funded ultraconservative candidates and political causes over the past couple of decades. Their to-do list includes aiding the effort to torpedo the Patient Protection and Affordable Care Act, popularly known as Obamacare. Among the political groups they fund is an outfit called Generation Opportunity, which is running a creepy ad to persuade young women of a lie: that Obamacare comes between a patient and her physician.
The Koch brothers know that the new health care paradigm depends on enlisting healthy young adults — people who tend to take the risk that they don’t need health insurance — into the system. If they don’t sign up, the new exchanges won’t have enough vigorous and youthful Americans to help pay the way for the sick and frail. Insurance companies need to be able to spread the costs around so they don’t go bankrupt trying to care for the ailing.
But the Koch brothers, like most conservatives, want Obamacare to fail. They are not concerned that the new health care law, which would extend insurance to the vast majority for the first time in history, is a “government takeover” of medicine or a “jobs-killer” or a ruinous new entitlement. None of that is true. (See factcheck.org or PolitiFact.com for actual facts about Obamacare.)
Nope, the real concern of most conservatives is that Obamacare will work, proving popular over the long run. Think about it: If they are so certain that the law will collapse under its own weight, why not step aside and allow it to do so? Why do they need to try to defund it and create creepy ads trying to persuade young people not to buy in? Why did they warn the National Football League not to promote the new health care exchanges?
If Obamacare succeeds, the generations-long conservative war against activist government would have lost another major battle, and more voters would be persuaded to vote for progressives. That’s the reason conservatives went all-out to defeat President Clinton’s similar health care proposal during his first term.
As Weekly Standard editor William Kristol, then fresh off his stint as Vice President Dan Quayle’s chief of staff, wrote in 1993: “… the long-term political effects of a successful Clinton health care bill will … relegitimize middle-class dependence for ‘security’ on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests.”
There you have it. They don’t dare allow Obamacare to proceed unimpeded because Americans might come to like it and depend on it, as the elderly like and depend on Medicare. Indeed, conservatives, including Ronald Reagan, fought the creation of Medicare, claiming it was pure socialism.
Meanwhile, the Americans who would suffer most if Obamacare doesn’t succeed are those without health insurance or the promise of decent medical care. That includes the young adults who could be victims of terrible accidents or unforeseen diseases. Not that the Koch brothers care about them.
By: Cynthia Tucker, The National Memo, September 28, 2013
“Muddied Waters And Smokescreens”: These Six States Want To Allow Health Insurers To Deny Coverage To Sick People
Officials in Texas and five other GOP-led states are refusing to oversee even Obamacare’s most basic — and popular — consumer protections and insurance market reforms. That includes the law’s ban on denying coverage or charging more because of a pre-existing condition and discriminating against women on the basis of gender. The decision could present major hurdles to Americans who buy health insurance through federally-run marketplaces in the Lone Star State, Arizona, Alabama, Missouri, Oklahoma, and Wyoming.
A majority of states haven’t set up their own insurance marketplaces, opting to let the federal government set one up for them. But every one of those states (other than the six in question) have at least said they will police the insurers that sell plans on their federally-run marketplaces to make sure that they aren’t giving consumers short shrift. The Centers for Medicare and Medicaid Services (CMS) will instead be responsible for enforcing Obamacare’s insurance industry reforms and reviewing consumer complaints in the states refusing to do so on their own.
That could be confusing for Americans who are buying insurance for the first time through the marketplaces. For example, imagine you’re a relatively poor person with diabetes. Your income isn’t low enough to get you on Medicaid — but your employer doesn’t offer health benefits, and you’ve never qualified for insurance on the individual market because of your medical condition. On October 1st, you can go buy insurance with government subsidies for the first time on an Obamacare marketplace. But the plan you choose charges you a suspiciously high premium relative to your income. You suspect it’s because of your medical problem, which is clearly illegal under the reform law. But who do you complain to?
Usually the answer is your state’s insurance department. But the answer is CMS if you live in one of the six states that won’t enforce the consumer protections. Unfortunately, if you don’t know that, you could spend months oscillating between the state and federal government, trying to figure out if you’re getting hoodwinked by your insurance company. And in the meantime, the bills are piling up.
Those kinds of scenarios are the reason that health policy experts say insurance complaints are best handled by state agencies. Officials with the Texas Department of Insurance argue that they legally can’t enforce the regulations because they’ve ceded authority over the marketplace to the federal government, and Texas doesn’t have corresponding state laws holding insurers to the same standards as Obamacare. But Stacy Pogue of the Center for Public Policy Priorities tells the Texas Tribune that’s likely a smokescreen, since Texas has enforced plenty of other federal laws on a statewide level in the past.
Officials in the Lone Star State certainly haven’t been shy about their opposition to the health law. Gov. Rick Perry (R) dug in his heels against reform in 2012, saying he wouldn’t “be a part of expanding [the] socializing of our medicine.” More recently, Perry denied basic health benefits to 1.5 million of his state’s poorest residents by forgoing Obamacare’s Medicaid expansion. Evidently, that wasn’t going far enough.
National Republicans have also been stepping up their efforts to to undermine Obamacare. Reps. Tim Huelskamp (R-KS) and Jason Chaffetz (R-UT) are refusing to help their own constituents if they have questions about the health law, and the Tea Party-affiliated advocacy group FreedomWorks has been telling young Americans to forgo signing up for health coverage under Obamacare entirely.
By: Sy Mukhergee, Think Progress, August , 2013
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