“Forget The Conventional Wisdom”: What Florida Really Tells Us About Obamacare
Was it really Obamacare that sunk Sink? I mean of course Alex Sink, the Democratic Florida congressional candidate who lost to Republican David Jolly on Tuesday. After the results were announced, Washington’s conventional wisdom congealed immediately: This was all about Obamacare, and it’s going to doom the Democrats come November.
Not so fast, says Geoff Garin, the pollster who did Sink’s polling in the race. Garin argues in a memo he released the day of the voting that “the issue ultimately provided more of a lift than a drag to her campaign.” He followed up by telling me yesterday: “She would have done worse if she’d neglected to hit back and engage the issue.” There’s a lesson in there for Democrats as they march toward November.
Garin put two key questions to the district’s voters. The first paraphrased the criticisms of Sink on Obamacare: Sink supports this law that will take away $716 billion from Medicare, and that caused 300,000 Floridians to lose their coverage and 2,500 patients at a district cancer center to have to change doctors. The second paraphrased criticisms of Jolly’s health-care position: He wants to totally repeal the law instead of fix it, a position that would let insurers again discriminate against the already ill and charge women more than they charge men for coverage. Repeal would also cut expanded prescription-drug coverage for Medicare recipients.
Respondents were asked to say whether this information gave them “very major doubts” about the candidates, “fairly major” doubts, “just some” doubts, or “no real” doubts. Results: While 43 percent now entertained very major doubts about Sink, 50 percent said they had very major doubts about Jolly. And 35 percent had no real doubts about Sink while only 26 percent had no real doubts about Jolly.
If that polling is accurate, then “more lift than drag” is accurate and fair. Guy Molyneux, a partner of Garin’s who oversaw some Obamacare polling for a couple of unions in January, echoed the point that there are at least three things Democrats can say about the law and the Republicans’ repeal zeal that poll really well. People broadly understand, Molyneux told me, that the law protects against discrimination based on pre-existing conditions, and they approve of that strongly. They also know that insurers can no longer drop sick people on whim, and they like that. And they’re getting to know that the law prevents insurers from charging women more than men, and they like that, too; even men.
There’s one more thing that people don’t yet know very well, but the polling indicates that it could be a strong debating point, too: Under the law, insurers have to publicly justify any rate increases greater than 10 percent. This is called rate review, and it and the medical-loss ratio provisions of the law (explained here) are the two main planks that guard against willy-nilly rate hikes. A Heath and Human Services study from last September found that nearly 7 million citizens had saved more than $1 billion because of rate review, and moreover, that insurance companies were seeking increases of 10 percent far less frequently than before the law because of the added oversight.
Since everybody and his brother assumes that the Affordable Care Act is going to increase their rates, seems to me it’d be awfully useful for the Democrats to develop a sharp talking point or two explaining to people that the law actually helps prevent crazy premium increases.
This all makes the Obamacare story a lot more complicated than “disaster for Dems.” It just doesn’t have to be. Republicans know this, too. Why are they, or some of them, suddenly talking about replacing the law? Precisely to try to insulate themselves from the effective Democratic attack that they’d give carte blanche to insurance companies to go back to their old ways.
It’s worth dwelling on this for a paragraph—it’s important to understand. It was in the spring of 2010 that the GOP unveiled “repeal and replace.” They stuck with that through the election. Then, once they’d retaken the House, they dropped “replace” and went for “repeal” only. Now that a midterm election is coming again, though, they’re starting to put “replace” back in their rhetoric. But it’s as hollow this time as it was then. “Our challenge,” Molyneux told me, “is to show that there’s nothing behind the curtain there.”
Lord knows, the Democrats have more problems than health care staring them in the face for the fall. The turnout question is the biggest one, although they say they’re making efforts this time that have no precedent in a midterm election. And Obama’s bad approval numbers—worse still in many of the states with high-profile Senate contests—are a huge factor. “If Obama’s still at 41 percent in mid-October, we’re in a world of hurt,” Molyneux says. And finally, but far from least, the economy. An awful, awful number from this week’s NBC/Wall Street Journal poll: Fully 57 percent of those surveyed said they think we’re still in a recession.
So yeah, there’s a lot for Democrats to worry about. But in most of the contested states—not Louisiana, probably not Arkansas, but the others—they can make Obamacare a net wash if they can be clear about the implications of “repeal” and call out their GOP opponents on “replace.” And maybe as a bonus show they have some fight in them, and give those unmotivated young and Latino voters some good reasons to go to the polls.
By: Michael Tomasky, The Daily Beast, March 14, 2014
“They’ll Never Rally Behind A Single Plan”: The GOP’s Push To Replace ObamaCare Is Cynical And Doomed
On Friday, House Majority Leader Eric Cantor (R-Va.) is gathering key members of his caucus to work toward coming up with a single, official Republican alternative to the Democrats’ Affordable Care Act (ACA), or ObamaCare. Republican lawmakers have several competing bills to work with, and putting the party’s weight behind one plan or piece of legislation would be great for the country: Finally, America could have a real discussion about the best way to reform America’s health care insurance system.
But an official Republican health care plan would also be great for Democrats — which is reason No. 1 Republicans aren’t going to actually rally behind a single plan.
They will, of course, make a public effort. “GOP leaders have been clear that ahead of the 2014 elections, the conference wants to show what it is for, not simply what it is against,” says Daniel Newhauser at Roll Call. “Similarly, they want to show that they are not in favor of simply returning to the old health care system, which is viewed unfavorably by the electorate.” But any viable plan needs 218 votes from the fractured GOP caucus.
Cantor and his fellow House Republicans have at least three separate House bills to consider — from Reps. Tom Price (R-Ga.), Paul Broun (R-Ga.), and Phil Roe (R-Tenn.) — and a plan from Sens. Tom Coburn (R-Okla.), Richard Burr (R-N.C.), and Orrin Hatch (R-Utah) that was unveiled to much fanfare in January. There’s also a bill, from Rep. Todd Young (R-Ind.), that would raise ObamaCare’s definition of full-time employment to 40 hours a week, from 30. And a George W. Bush administration economist named Edward Lazear is pushing what he calls BushCare.
As they sort through these plans, what criteria will they use? If they can agree on one proposal, says Roll Call‘s Newhauser, it’s “likely to include poll-tested measures that have broad agreement in the GOP conference, including allowing the purchase of health insurance across state lines, allowing insurance portability between jobs, expanding access to health savings accounts, and limiting medical malpractice lawsuits.”
Another way of putting that: Republicans are looking for popular talking points that sound different enough from ObamaCare to win support from the more conservative factions of the GOP caucus. The problem, as The Washington Post notes, is that “there are only so many ways to preserve the patient protections that the ACA offers, which Republicans say they want to keep, while maintaining a private insurance market and assisting those who can’t afford coverage.”
Once Republicans hold up a specific plan, the Congressional Budget Office gets to issue its verdict and the public gets to weigh the proposals not just against ObamaCare but also the GOP’s attacks against ObamaCare.
The CBO analysis for Rep. Young’s bill to raise full-time employment to 40 hours, for example, found that the bill would raise the federal deficit by $74 billion while reducing the number of people getting employer-sponsored health insurance by about a million; about half of those people would go on Medicaid or other public programs, the other half would be uninsured.
It’s not clear the other Republican proposals would be popular in practice, either. Some of them, as the Washington Post editors note, would be better than ObamaCare at holding down health care costs and incentivizing people to buy private health insurance. But they are more disruptive to the status quo — especially post-ObamaCare — and almost all of them would be ripe for articles about sick people losing coverage or watching their health insurance costs skyrocket.
All of the GOP alternative plans, in other words, have their own drawbacks. Some people will lose, and some people will win. They would reduce the role of the federal government in most cases, but increase the power of insurance companies. Many of the policies are really interesting. Here are some examples of the big ideas from the GOP plans:
Cap or end employer tax breaks for providing health insurance: The idea here is that the insurance market is distorted by the tax incentives for employers to offering their workers insurance. It’s a fair point. But capping the tax breaks, as Coburn-Burr-Hatch does, or eliminating them would almost certainly cause employers to drop their plans. Almost 60 percent of Americans get their health insurance through work.
Provide tax breaks for individuals to buy their own insurance: With no employer-offered health plans, individuals and families would buy their own insurance on the open market. The Coburn-Burr-Hatch plan, for example, offers age-adjusted tax credits to people at up to 300 percent of the federal poverty line: Individuals 18 to 34 would get $1,560 a year, while those 50 to 64 would get $3,720 a year (families would get more than double those figures). Lazear’s BushCare would give all Americans with any type of health insurance $7,500 a year in tax breaks, or $15,000 for families; if people opted to buy low-cost, low-coverage insurance, they’d pocket the difference.
Allow insurance to be sold across state lines: This is a perennial GOP proposal to lower health insurance costs. The idea is that if insurers could sell the same policies to any state, regardless of that state’s own insurance regulations, it would increase market competition and drive down prices. A 2005 CBO report estimated those savings to consumers at about 5 percent overall, with the savings skewed toward the young and healthy; the old and sick would pay more. Enacting this option would require scrapping the minimum standards required for all plans under ObamaCare — a selling point for conservatives who argue we use too much health care, anyway.
“The fact that Republicans are coalescing around healthcare reform plans of their own could be very bad news for ObamaCare,” says Sally C. Pipes at Forbes. “Once voters see that the Republican alternative adds up to sensible and affordable health care, ObamaCare’s days will be numbered.”
But the opposite is almost certainly true. And House Republicans know that.
The GOP has gotten a lot of mileage out of its push to repeal ObamaCare — with a big assist, since October, from the Obama administration — but now the law is signing up real people (four million and counting) for real insurance policies. Republicans have to do better than provide plausible-sounding alternatives. They have to come up with a plan that Americans will think is much better than ObamaCare, and worth the disruption of overhauling the health care system again.
Here’s the bottom line: If reforming America’s health care system to provide near-universal affordable coverage were easy, it would have been done 60 years ago — or at any point since. Several Democratic presidents had tried and failed before President Obama. If Republicans had wanted to take their own bite at the apple, they had plenty of chances, too.
This isn’t spitballing. If Republicans want to be relevant voices in the health care debate, they have to come up with something. They should come up with a plan they can try to sell to America.
“One of the unseemly aspects of the last four-plus months is watching some on the right root for ObamaCare to fail,” says Forbes‘ Avik Roy, one of ObamaCare’s wonkiest critics. Among some conservatives, “there has been a kind of intellectual laziness, a belief that there’s no need for critics to come up with better reforms, because Obamacare will ‘collapse under its own weight,’ relieving them of that responsibility.” But it’s clear now that’s not going to happen, he adds. “And that makes the development of a credible, market-oriented health-reform agenda more urgent than ever.”
Well, don’t hold your breath.
The Affordable Care Act was written and enacted by Democrats — with a few exceptions — and that’s one of its main weaknesses: If Republicans had helped shape and pass the law, they probably wouldn’t have spent the last four years attacking and undermining it. They now have at least 10 months left to criticize the law without having to take any serious action to replace it. Don’t expect them to squander the opportunity.
By: Peter Weber, The Week, February 26, 2014
“The Insurance Company Bailout That Republicans Love”: The GOP Has Found A Way To Be Even More Hypocritical Than Before
Remember when Republicans found insurance company bailouts outrageous? Good, because the Republicans don’t.
On Friday, the Obama Administration announced proposed payment rates for Medicare Advantage plans, the private insurance option within Medicare. The federal government pays insurers a fixed fee for each senior they enroll. The program’s goal is to provide seniors with more options and, ideally, foster competition that will lead to better management of care both within the traditional program and for those who get private insruance instead. But, for a long time, experts have said the federal government is actually paying the insurers too much—in other words, more than it costs to provide the same coverage through traditional Medicare.
In the late 1990s, when the program was known as “Medicare+Choice,” the Clinton Administration attempted to rectify this by reducing insurer fees. But experts subsequently found the government was still paying the plans too much, so the Obama Administration and its allies included additional Medicare Advantage cuts in the Affordable Care Act—leaving discretion over the exact rates to the Department of Health and Human Services and its actuaries. On Friday, HHS revealed its calculations for next year’s rates, based in part on projections for how health care spending for the country as a whole is changing.
The payment formula is complicated and even now, with a weekend to digest the announcement, analysts aren’t entirely sure how insurers would react and what that would mean for seniors in the plans. (As Phil Galewitz of Kaiser Health News reports, many independent experts seem to think the effects would be pretty minimal.) But insurers, who say better benefits account for whatever extra funds they get, have warned that cuts of virtually any magnitude will force insurers to offer less generous benefits, charge higher premiums, or withdraw from the program altogether—as some of them did in the late 1990s, following those cuts the Clinton Administration implemented. The insurers are lobbying the administration to use its discretion to reduce the cuts or, ideally, eliminate them altogether. If you live in Washington and have seen those ubiquitous “Seniors are Watching” advertisements on billboards and buses, you have some idea of how strongly the insurers feel about this.
But insurers aren’t the only ones making a fuss. Republicans are too—and they have been for a while. As you may recall, Republicans pounced on the new Medicare Advantage cuts as proof that Obamacare was bad for seniors—in the 2010 midterms and then, again, in the 2012 presidential election. It was pure political gold, since seniors (particularly white seniors) were among those most skeptical of Obama and his health care law in the first place. Of course, House Republicans voted for the very same cuts when Paul Ryan’s budgets had them. But that didn’t stop Republicans from attacking the cuts then—and it’s not stopping them now. “ObamaCare has already caused millions to lose the healthcare plans they liked, and now it is directly harming seniors who rely on the care they have through Medicare Advantage,” Eric Cantor, the House Majority Leader, said on Friday. “Our nation’s grandparents should not have to wake up tomorrow worried they no longer can access the care they want because of Obamacare.”
With this latest salvo, however, Republicans have actually found a way to be more hypocritical than before. For the last few weeks, Republicans and their allies have been in high dudgeon about Obamacare’s so-called risk corridor program, in which the federal government will subsidize insurers that take heavy losses for the next three years. Republicans and their allies have decried risk corridors as a “taxpayer bailout” of the insurers. But the policy justification for risk corridors is straightforward and, even to some conservatives, incontrovertible: They will ease the transition to a newly regulated insurance market, so that it’s possible to provide universal coverage through a system of private plans. And unlike the additional Medicare Advantage payments, the risk corridor program might actually end up being a net boon to the taxpayers, since the government also shares in unexpected insurer gains. (The Congressional Budget Office has actually predicted as much, though, as with many such projections, there’s a lot of uncertainty there.)
Maybe Republicans think that’s insufficient reason to pay the Obamacare insurers money—fine. But then how can they simultaneously insist government keep paying higher fees to Medicare insurers, given the case for them is a lot more dubious?
Congressional Democrats haven’t exactly covered themselves in glory over this issue. New York Senator Charles Schumer was among the Democrats who signed a bipartisan letter to HHS, urging the administration not to harm beneficiaries with payment reductions, though the senators stopped short of calling for outright reversal of the cuts. But the current Republican position makes no sense whatsoever, unless the GOP’s real priorities are (a) opposing anything the Obama Administration supports (b) sucking money away from the traditional, government-run Medicare program (c) stopping programs and spending that benefits the non-elderly uninsured. Readers can decide for themselves which of those explanations make the most sense—or whether, perhaps, it’s all of the above.
By: Jonathan Cohn, The New Republic, Fenbruary 24, 2014
“Republicans Are Losing All Credibility On ObamaCare”: At Some Point, Voters Are Going To Stop Paying Attention To Their Scare Tactics
Even before President Obama signed the Affordable Care Act into law, GOP critics assailed it as a socialist, job-killing overreach indicative of a government run amok. In the years since, we’ve seen no shortage of scare-mongering and hand-wringing about how the law would harm Americans and bring the republic to an ignominious end.
Yet as ObamaCare gradually went into effect, reality began to undercut the thrust of that argument. Remember those terrifying death panels Sarah Palin warned us about? And over the past few months in particular, facts have shot down a handful of the more apocalyptic claims about the law.
In the most recent instance, a report last week from the Congressional Budget Office estimated that ObamaCare would trim the labor force by 2 million full-time jobs by 2017, and by 2.5 million come 2024. Critics seized on that as proof that the law would indeed spook businesses and stifle job growth.
What the report actually showed, though, was not a dearth of jobs, but a dearth of labor. Incentives in ObamaCare that make insurance cheaper and easier to obtain, the report suggested, would encourage some people to retire earlier or work less, thus shrinking the labor pool.
With spin and misinformation flying about, the CBO on Monday made that point clear.
“Because the longer-term reduction in work is expected to come almost entirely from a decline in the amount of labor that workers choose to supply in response to the changes in their incentives, we do not think it is accurate to say that the reduction stems from people “losing” their jobs,” CBO head Doug Elmendorf wrote.
So much for that talking point.
The same CBO report also undercut another meme on the right, that ObamaCare contains a big bailout for insurance companies.
The scuttlebutt involves the risk corridors built into the law, which cap how much insurance companies can make or lose in their first three years on the exchange marketplace. (You can read a more thorough explanation on risk corridors here.) Since taxpayers could theoretically be on the hook for covering the losses of flopping companies, a cadre of Republicans, led by Sen. Marco Rubio (R-Fla.), labeled the provision a “bailout” and vowed to repeal it.
As it turns out, the CBO found that insurance companies would receive $8 billion — but pay back double to the government. In other words, the supposed bailout — which was really just standard actuarial practice to begin with, and not a literal bailout — would actually save the government billions of dollars.
Then there’s the zombie claim that lawmakers and their staffs are exempt from ObamaCare. Last month, Sen. Ron Johnson (R-Wis.) said he was filing suit over that boondoggle, arguing the administration had “exceeded its legal authority” in “arranging for me and other members of Congress and their staffs to receive benefits intentionally ruled out by” ObamaCare.
In truth, the law does offer a unique subsidy to Capitol Hill employees to offset the cost of obtaining insurance through the exchanges. But lawmakers and staffers only qualified for that subsidy because the law, via an attempted GOP poison pill amendment, stripped them of federally subsidized coverage and forced them onto the exchanges in the first place. Even National Review thoroughly debunked the exemption claim.
Republicans also warned that Healthcare.gov’s early glitches exposed the entire law as an unworkable train wreck. Writing in The Hill, Rep. Bill Johnson (R-Ohio) called the problems “catastrophic,” and likened the site to cooked eggs: “You see, you can’t recook eggs!”
Following a massive IT effort though, the site is now running much smoother, and enrollments are surging as a result.
That brings up another ObamaCare bogeyman: the dreaded death spiral.
ObamaCare needs a bunch of young enrollees to offset the cost of enrolling older folks. If not enough young people sign up, premiums for everyone else could spike and the system could crash.
Yet despite the best efforts from some on the right to convince young adults not to enroll — one ad campaign featured a creepy Uncle Sam sexually assaulting young patients — the death spiral, too, was more myth than reality.
Enrollment among young adults has indeed been lower than the administration’s target, but it’s expected to surge as the enrollment deadline nears. And even if the current demographic breakdown remains unchanged, an analysis from the Kaiser Family Foundation determined the consequences “are not as great as conventional wisdom might suggest.” In a worst-case scenario, the report found, the effect on premiums from an unbalanced pool of enrollees would still be “well below the level that would trigger a ‘death spiral.'”
Phew. That’s a lot of debunked arguments. Next thing you know, critics will be trying to falsely claim the law won’t help enough people get coverage. Oh, wait.
Now, the GOP was right to be skeptical of Obama’s claim that everyone could keep their health insurance under ObamaCare. That turned out to not be the case.
But the party’s overall success rate on loaded ObamaCare allegations is terrible, and is only getting worse. The danger is that at some point, voters are going to stop paying attention.
By: Jon Terbush, The Week, February 11, 2014
“Delusions Of Failure”: How Republicans Are Deceiving Voters And Deceiving Themselves
The Republican response to the State of the Union was delivered by Cathy McMorris Rodgers, Republican representative from Washington — and it was remarkable for its lack of content. A bit of uplifting personal biography, a check list of good things her party wants to happen with no hint of how it plans to make them happen.
The closest she came to substance was when she described a constituent, “Bette in Spokane,” who supposedly faced a $700-a-month premium hike after her policy was canceled. “This law is not working,” intoned Ms. McMorris Rodgers. And right there we see a perfect illustration of just how Republicans are trying to deceive voters — and are, in the process, deceiving themselves.
I’ll get back to “Bette in Spokane” in a minute, but first, is Obamacare “not working”?
Everyone knows about the disastrous rollout, but that was months ago. Since then, health reform has been steadily making up lost ground. At this point enrollments in the health exchanges are only about a million below Congressional Budget Office projections, and rising faster than projected. So a best guess is that by the time 2014 enrollment closes on March 31, there will be more than six million Americans signed up through the exchanges, versus seven million projected. Sign-ups might even meet the projection.
But isn’t Obamacare in a “death spiral,” in which only the old and sick are signing up, so that premiums will soon soar? Not according to the people who should know — the insurance companies. True, one company, Humana, says that the risk pool is worse than it expected. But others, including WellPoint and Aetna, are optimistic (which isn’t a contradiction: different companies could be having different experiences). And the Kaiser Family Foundation, which has run the numbers, finds that even a bad risk pool would have only a minor effect on premiums.
Now, some, perhaps many, of those signing up on the exchanges aren’t newly insured; they’re replacing their existing policies, either voluntarily or because those policies didn’t meet the law’s standards. But those standards are there for a reason — the same reason health insurance is now mandatory. Health reform won’t work if people go uninsured, then sign up when they get sick. It also can’t work if currently healthy people only buy fig-leaf insurance, which offers hardly any coverage.
And what this means, in turn, is that while we don’t know yet how many people will be newly insured under reform, we do know that even those who already had insurance are, on average, getting much better insurance. Since the goal of health reform was to make Americans more secure — to reduce their risk of being unable to afford needed health care, or of facing financial ruin if they get sick — the law is doing its job.
Which brings me back to Bette in Spokane.
Bette’s tale had policy wonks scratching their heads; it was hard to see, given what we know about premiums and how the health law works, how anyone could face that large a rate increase. Sure enough, when a local newspaper, The Spokesman-Review, contacted Bette Grenier, it discovered that the real story was very different from the image Ms. McMorris Rodgers conveyed. First of all, she was comparing her previous policy with one of the pricier alternatives her insurance company was offering — and she refused to look for cheaper alternatives on the Washington insurance exchange, declaring, “I wouldn’t go on that Obama website.”
Even more important, all Ms. Grenier and her husband had before was a minimalist insurance plan, with a $10,000 deductible, offering very little financial protection. So yes, the new law requires that they spend more, but they would get far better coverage in return.
So was this the best story Ms. McMorris Rodgers could come up with? The answer, probably, is yes, since just about every tale of health reform horror the G.O.P. has tried to peddle has similarly fallen apart once the details were revealed. The truth is that the campaign against Obamacare relies on misleading stories at best, and often on outright deceit.
Who pays the price for this deceit? In many cases, American families. Although health care enrollment is actually going pretty well at this point, thousands and maybe millions of Americans have failed to sign up for coverage because they believe the false horror stories they keep hearing.
But conservative politicians aren’t just deceiving their constituents; they’re also deceiving themselves. Right now, Republican political strategy seems to be to stall on every issue, and reap the rewards from Obamacare’s inevitable collapse. Well, Obamacare isn’t collapsing — it’s recovering pretty well from a terrible start. And by the time that reality sinks in on the right, health reform will be irreversible.
By: Paul Krugman, Op-Ed Columnist, The New York Times, February 2, 2014
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