“Feigning Outrage”: The GOP’s Health Reform Playbook
The last thing Republicans want right now is to repeal the Affordable Care Act.
They may claim it is destroying the country, but they need it, and desperately, to rebuild their party. They even have a detailed playbook to exploit it, outlining how and when to stage attacks against Democrats who support it in order to inflict maximum damage in the months before the 2014 midterm elections.
As Jonathan Weisman and Sheryl Gay Stolberg reported in this morning’s Times, House Republicans have been organizing their strategy behind closed doors for the last month. They began by capitalizing on the gifts given them by the White House in the form of the malfunctioning health care website and President Obama’s false promise that no one need lose an insurance policy. Then they moved on to claims that personal data is insecure on the insurance exchanges.
Next, according to the playbook, will come criticism of premium price hikes, and breast-beating about changes to Medicare Advantage plans, as well as the possibility that people will lose their doctors under some policies.
Republicans will also hold hearings, and come armed with anecdotes from outraged citizens who suddenly find their new health insurance options aren’t perfect.
Reform has given new life to a party that was in the depths after the shutdown debacle just last month.
This deep concern about Americans’ access to quality insurance is entirely new and utterly insincere, of course. Nearly one in 10 people on Medicare — 4 million people — are dissatisfied with that program, according to surveys, but you don’t hear their complaints broadcast at hearings or at Republican news conferences. In 2010, long before the health reform law took effect, 20 percent of people on employer-based insurance expressed dissatisfaction with their plans, as did a third of people on the individual market. They complained about high deductibles and constrained networks of doctors and hospitals, just as many of them will under the new system. And they complained about cancelled policies.
Republicans never cared about those concerns before the Affordable Care Act came around, and they don’t really care now, even though they’re doing a great job of feigning outrage. They’re simply using these grievances, magnified by anecdotal media coverage, to batter Democrats who are still standing up for the president’s program.
Some of those Democrats are fighting back. They’re pointing out, as the White House did yesterday, that the growth in health care costs is slowing significantly. They’re trying to highlight people who are saving money on their new policies, or who can buy insurance even if they are sick. And they will try to broadcast the voices of the previously uninsured, who have never appeared in a Republican diatribe and never will.
But the most attention, as always, will be paid to the shrillest critics. Just remember, as their attacks pick up in volume in the months to come, that they were prepared long in advance, as cheap as canned laughter.
By: David Firestone, Editors Blog, The New York Times, November 21, 2013
“Can We Please Get A Grip?”: Having The Backbone To Set Minimum Standards For Health Insurance
Democrats are showing once again they have the backbones of banana slugs.
The Affordable Care Act was meant to hold insurers to a higher standards. So it stands to reason that some insurers will have to cancel their lousy sub-standard policies.
But spineless Democrats (including my old boss Bill Clinton) are caving in to the Republican-fueled outrage that the President “misled” Americans into thinking they could keep their old lousy policies — and are now urging the White House to forget the new standards and let people keep what they had before.
And some congressional Republicans are all too eager to join them, and allow insurers to offer whatever crap they were offering before — exposing families to more than $12,700 in out-of-pocket expenses, canceling policies of people who get seriously sick, failing to cover prescription drugs, and so on.
Can we please get a grip? Whenever industry standards are lifted — a higher minimum wage, safer workplaces, non-toxic foods and drugs, safer cars — people no longer have the “freedom” to contract for the sub-standard goods and services.
But that freedom is usually a mirage because big businesses have most of the power and average people don’t have much of a choice. This has been especially the case with health insurance, which is why minimum standards here are essential.
Yes, the President might have spelled this out a bit more clearly beforehand, explaining that 95 percent of us aren’t in the private insurance market to begin with and won’t be affected, and that most of the 2 percent who lose their lousy policies and have to take better and more expensive ones will be subsidized.
But right now the President needs all the political support he can muster to hold insurers’ feet to the fire. Democrats should stand firm for a change.
By: Robert Reich, The Robert Reich Blog, November 15, 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
“Why Isn’t Everyone More Worried About Me?”: Maybe The Most Ridiculous Obamacare “Victim” Story Yet
Apparently, there was a meeting of the editors at The New York Times op-ed page in which someone said, “You know how every time someone does a story about one of these Obamacare ‘victims’ whose insurance companies are cancelling their plans, it turns out they could do really well on the exchange, but no one bothers to check? We should get one of them to write an op-ed, but not bother to ask what options they’ll have.” And then someone else responded, “Right, don’t bother with the fact-checking. But we need a new twist. What if we find someone who’ll complain that the problem with Obamacare is that other people care too much about poor people and the uninsured, while what they ought to be doing is spending more time liking her Facebook post about her possibly increased premiums?” The editors looked at each other and said, “That’s gold. Gold!”
And this was the result. Written by Lori Gottlieb, a Los Angeles psychotherapist and author, it relates how she got a cancellation letter from Anthem Blue Cross and was offered a plan for $5,400 more a year, then had a frustrating phone call with the company. Did she go to the California health exchange and find out what sorts of deals would be available to her? Apparently not. She took Anthem at their word—you can always trust insurance companies, after all!—then took to Facebook, where she “vented about the call and wrote that the president should be protecting the middle class, not making our lives substantially harder.”
And here’s where our story takes a shocking turn. Instead of expressing what she felt was the appropriate sympathy, those 1,037 people on Facebook she thought were her friends but turned out just to be “friends” had the nerve to point out that the Affordable Care Act will help millions of previously uninsured and uninsurable people get coverage. Gottlieb was disgusted with these people she termed the “smug insureds.” And none of them even “liked” her post!
Like Bridget Jones’s “smug marrieds,” the “smug insureds” — friends who were covered through their own or spouses’ employers or who were grandfathered into their plans — asked why I didn’t “just” switch all of our long-term doctors, suck it up and pay an extra $200 a month for a restrictive network on the exchange, or marry the guy I’m dating. How romantic: “I didn’t marry you just to save money, honey. I married you for your provider network.”
Along with the smug insureds, President Obama doesn’t care much about the relatively small percentage of us with canceled coverage and no viable replacement. He keeps apologizing while maintaining that it’s for the good of the country, a vast improvement “over all.”
And the “over all” might agree. But the self-employed middle class is being sacrificed at the altar of politically correct rhetoric, with nobody helping to ensure our health, fiscal or otherwise, because it’s trendy to cheer for the underdog. Embracing the noble cause is all very well — as long as yours isn’t the “fortunate” family that loses its access to comprehensive, affordable health care while the rest of the nation gets it.
The truly noble act here is being performed by my friend Nicole, who keeps posting Obamacare fiasco stories on my Facebook page, despite being conspicuously ignored, except for my single “like.” It’s the lone “like” that falls in the forest, the click nobody wants to hear.
How terribly smug, to think that the fate of millions of poor people who will now get insurance is as important as the suffering of this one person who might have to pay more for comprehensive coverage, and also happens to have access to The New York Times where she can air her grievances! If only it weren’t so “trendy to cheer for the underdog.”
It’s one thing to feel your own problems more acutely than those of other people, even millions of other people, even many whose problems make yours look trivial by comparison. We all do that, and we could barely function if we didn’t. It’s quite another thing to expect that other people will see your problems as more important than those of millions. I sprained my ankle a few weeks ago, and I’ll admit that in the time since I’ve given more thought to my ankle’s recovery than I have to the 660,000 people who die every year from malaria. But if I asked you why you aren’t thinking more about my ankle than you are about malaria, you’d wonder if it was my brain that I had sprained.
I imagine that after her disappointment at the response to her Facebook post, Gottlieb will be even more disappointed with the response to her op-ed explaining her disappointment with the response to her Facebook post. So if she wants to feel better, the first thing she ought to do is go to the exchange and she what her options are. There’s almost certainly something better than the plan her insurance company is trying to get her to buy. And then she can go to Facebook and ask her “friends” to celebrate her good fortune.
By: Paul Waldman, Contributing Editor, The American Prospect, November 11, 2013
“What Really Matters”: Don’t Knock Obamacare Until You Try It
There has been a steady drumbeat of news stories about health insurance companies informing customers that their policies will be dropped or that they will face steep rate increases due to requirements of the Affordable Care Act.
This has opened the door to fair criticisms that President Obama wrongly stated that people would be able to keep their current insurance policies if they are happy with them, as this isn’t necessarily the case. However, the real question for individuals facing rate hikes or dropped coverage is whether there are insurance options provided through the exchanges, mandated by the new law, that these people would actual prefer, thanks to some combination of lower prices and more generous benefits. Obamacare might cause some to lose their current policy, but it also might provide them with options they would prefer. That is what really matters.
People should remember that the program provides subsidies for lower income individuals and families. At least in states that have accepted the very generous federal contribution, Obamacare also expands access to Medicaid. For many people who currently lack insurance, a group of people who tend to be poorer, Obamacare insurance policies will be free or relatively cheap.
The initial implementation of Obamacare has not gone smoothly. The key problem is website difficulties faced by people who are attempting to see just how much a plan will cost them, and whose attempts to actually sign up for a policy have been thwarted. We will see if these problems are fixed in a timely fashion, and whether other serious problems crop up.
But the program, as designed, is intended to lower prices for the vast majority of people on the individual insurance market, as well as to open it up to people who previously have been denied affordable coverage because of pre-existing medical conditions. Optimistically, increased competition could even lower prices for employer-based health plans.
Admittedly, such optimistic predictions might not come to pass. Over the next several months we will get a better idea of how many people manage to enroll, whether their coverage is adequate, and whether their overall medical costs, including premiums and out of pocket costs, fall. We might ultimately declare Obamacare a failure, and if that happens we should figure out a better way to expand access to affordable health insurance and care.
Despite the rhetoric from many conservatives, Obamacare isn’t the way most self-described liberals would reform our health care system. It is needlessly complicated, not guaranteed to reduce overall medical costs significantly and its subsidies, while significant, are too stingy. People with lower middle class incomes will still likely find the premiums to be a budgetary strain. At the very least, liberals would have included a government run “public option,” a Medicare-like program that would have competed with the private insurance.
But problems aside, people who are currently navigating the private insurance market –both those without health insurance currently and those who might be receiving scary policy and price change letters from their current insurance companies — should make sure to see just what their Obamacare options are. They might be pleasantly surprised.
By: Duncan Black, USA Today, November 5, 2013
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