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“Eight Months Until The End Of Job Lock”: A Reminder About One Of The Best Things Obamacare Does

For years, even before Barack Obama was elected, one of the many complaints liberals (mostly) had about the current employer-based health insurance system was “job lock”—if you have insurance at your job, particularly if you or someone in your family has health issues, then you’re going to be hesitant to leave that job. You won’t start your own business, or join somebody else’s struggling startup (unless they provide insurance), and this constrains people’s opportunities and dampens the country’s entrepreneurial spirit.

That this occurs is intuitively obvious—you probably know someone who has experienced it, or have experienced it yourself. And today there’s an article in that pro-Democrat hippie rag The Wall Street Journal entitled “Will Health-Care Law Beget Entrepreneurs?” Amid the worrying about the implementation of Obamacare in January, and the quite reasonable concern that the news could be filled with stories of confusion, missteps, and dirtbags like that Papa John’s guy cutting employees’ hours rather than give them insurance, to avoid the horror of increasing the cost of a pizza by a dime,11This is important: when you hear a story about an employer who cut his employees’ hours so he wouldn’t have to abide by the law, what you’re reading about is a jerk who doesn’t want to offer his employees insurance, not some inevitable consequence of the law. That’s a choice he makes. And don’t forget too that the employer mandate only applies to companies with 50 or more employers, and 96 percent of them already offer health insurance, even without a mandate. it’s a reminder that there will probably be lots of stories like this one in the news too, stories about people whose lives have been changed for the better by the fact that Americans will have something they’ve never had before: health security.

So what kind of effect could the elimination of job lock have on the economy? That’s tough to say. The study referred to in the WSJ article finds that people are much more likely to start a business if they get their health insurance from their spouse’s job than if they get it from their own job; in the former case you’d still have insurance if you started a business, while in the latter case you’d lose it. In addition, and this is particularly interesting, even though you might think of 65-year-olds as looking forward to days of golf and eating dinner at 4 p.m., a large number of people seem to start businesses pretty much the minute they become eligible for Medicare. While it’s hard to get insurance in the current private market if you’re 44, it’s basically impossible if you’re 64.

So it seems that the fact that after January, job lock will be history means that more businesses will be started. How many more? Well, we don’t know yet, and it could depend in part on how affordable the insurance you can get through the exchanges is compared to what people are getting from their employers. And it will be hard to measure precisely how much more economic activity is generated by businesses that wouldn’t have otherwise been started. Obviously, some will succeed and more will fail.

Nevertheless, beyond additions to GDP, there’s something psychological that shouldn’t be discounted, touchy-feely though it might be. The end of job lock means the end of a certain kind of fear that all of us under the age of 65 live with to one degree or another. It’s the fear that leaving a job, voluntarily or otherwise, could become an utter financial calamity if we or one of our loved ones has a health problem. Even if you wish reform hadn’t been grafted on to the existing employer-based system (I’ll raise my hand on that one), ending that fear is huge; it’s one of the best things Obamacare does. Even if it’s difficult to communicate on a bumper sticker.

By: Paul Waldman, Contributing Editor, The American Prospect, May 9, 2013

May 10, 2013 Posted by | Affordable Care Act | , , , , , , , | Leave a comment

“Unconscionable But Irrelevant”: Florida GOP Legislature Puts Politics Over People

It seemed like a breakthrough moment. In late February, Florida Gov. Rick Scott (R), who had made hating “Obamacare” his raison d’etre, announced his support for the Medicaid expansion policy in the Affordable Care Act. The Republican governor said at the time, “I cannot, in good conscience, deny the uninsured access to care.”

It was an open question whether Scott’s principal concerns were with the uninsured or the state hospitals he’s been friendly with in the past, it was nevertheless welcome news for health care advocates. Florida’s governor, an unlikely ally, had cleared the way for bringing health care access to 1.3 million Americans, expanding the reach of Obamacare to new heights.

At least, we thought so at the time. What was unexpected was Rick Scott’s own legislative allies ignoring the governor’s wishes and punishing Florida on purpose.

Scott wouldn’t be the one to “deny Floridians” a part of the health care law — but the Florida legislature had other plans. Lawmakers adjourned Friday after passing a budget that does not include funding for a Medicaid expansion. Unless the Republican-controlled legislature comes back for a special session later this year — which some Democrats are calling for — Florida will not expand Medicaid in 2014.

In Florida, where one in five non-elderly residents lack insurance coverage, the consequences are especially large: An estimated 1.3 million Floridians were expected to gain coverage through the Medicaid expansion. About a quarter of those people — Floridians earning between 100 and 133 percent of the Federal Poverty Line — would still be eligible for tax subsidies on the health insurance exchange.

As we talked about in March, Scott isn’t the only Republican governor in this boat. In Ohio and Arizona, GOP state lawmakers remain reluctant to accept Medicaid expansion, regardless of its benefits, and regardless of the wishes of their Republican partner in the governor’s office.

But the move in Florida is especially jarring given the circumstances — the state has an enormous Medicaid-eligible population, and was poised to receive $66 billion in federal funds over the next decade. What’s more, Florida already has struggling public hospitals, which will now be in even worse shape.

A Democratic state senator called the Medicaid decision “unconscionable,” which is true, but apparently irrelevant to state GOP lawmakers.

By: Steve Benen, The Maddow Blog, May 6, 2013

May 8, 2013 Posted by | Affordable Care Act, Medicaid | , , , , , , , | Leave a comment

“Irrational Actors”: Republican State Legislators Shoot Selves In Foot, Help Citizens

One of the main features of the Affordable Care Act is the creation of 50 state-based health-insurance exchanges, online marketplaces where people and small businesses will be able to easily compare competing plans and select the one they prefer. If you’re buying insurance on the individual market after the beginning of 2014 (but not if you get your insurance through your employer like most people), your state’s exchange is where you’ll go. While the federal government establishes a baseline of requirements for what plans offered through the exchange must contain, each state will determine exactly how theirs will work.

But after the ACA was passed, and especially after the 2010 election where Republicans won huge gains at the state level, a lot of states run by Republicans refused to take any action to create their exchanges. Like a Catholic bishop looking at a package of birth-control pills, they retched and turned away, not wanting to sully their hands at all with involvement in President Obama’s freedom-destroying health-care plan. But the law also provides that if a state doesn’t get around to creating its exchange, then the federal government will just do it for them.

Which is why I’ve always found the actions of Republicans on this issue puzzling. They all say they hate the federal government, and states can do things better. But in this case, they’re letting the federal government take over. Which is probably a good thing.

Let’s say you live in Arkansas. Who would you trust to create an exchange that works well and empowers consumers: a state government run by Republicans who think any government involvement in health care is vile, or the Obama administration’s Department of Health and Human Services, which has a huge reputational stake in making the Affordable Care Act work as well as possible? Well, you’re in luck, because Arkansas has explicitly refused to create an exchange. Plenty of other states with Republican-controlled legislatures have simply dragged their feet in the hopes that either the Supreme Court will strike down the ACA when it hears the case later this year, or that a Republican will win the White House in November and successfully repeal the law (this is a list of where exchanges stand in each state, if you’re curious).

Conservative health-care wonks seem to be divided on the issue. Here’s one (h/t Sarah Kliff) making exactly the case that I made—if Republicans just ignore this, it’ll be turned over to an administration they hate (I just happen to think that’s a good thing, while he doesn’t). But here’s another testifying before the New Hampshire Legislature, telling them not to do anything and hope it just goes away.

This offers a reminder, in case you needed one, that elected officials are not always rational actors. They’ll even do things that undermine the principles they hold, for reasons of emotion or pique or false hope. In this case, that means a lot of people living in Republican-dominated states will probably have access to an exchange that works substantially better than whatever their state would have set up. So it’ll be a happy ending!

 

By: Paul Waldman, Contributing Editor, The American Prospect, March 14, 2012

March 15, 2012 Posted by | Affordable Care Act, Health Care, Ideology | , , , , , , | Leave a comment

   

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