“Old Time Crackpot Patriarchy”: Behind The Right’s Crazy Crusade To Make Women Pay More For Health Insurance
In a sane world, when Rep. Renee Ellmers asked rhetorically last week “Has a man ever delivered a baby?” she would have been arguing not against, but for the Affordable Care Act’s requirement that men and women pay the same insurance premiums. After all, the special physical burdens borne solely by women to ensure the life and health of the next generation obviously benefit both genders, right? Healthy men today can thank their mothers for eating well and getting good prenatal care; likewise fathers are grateful to the mothers of their children for the same. (Michael Hiltzik runs down the case for sharing those costs publicly here.)
But no, Ellmers asked that question of Health and Human Services Secretary Kathleen Sebelius in order to rail against the ACA’s equal premium requirement. She thought it was a clever “gotcha” moment, designed to show the craziness of requiring all insurance policies to cover maternity care and contraception without a co-pay. (The doofuses at Breitbart agreed, declaring “Ellmers brings her A game.”) Amazingly, Ellmers chairs the House GOP’s “women’s policy committee” – so how could she be so tone-deaf in attacking the way the ACA helps that increasingly elusive GOP constituency, female voters?
Because the right-wing base of the modern Republican Party is dedicated to restoring men as the head of the household, and the nuclear, husband-headed family as the principle social unit. From Rick Santorum railing against contraception and preaching the nuclear family as the answer to poverty in last year’s GOP presidential primary, to Rafael Cruz Sr. telling an audience that “God commands us men to teach your wife, to teach your children—to be the spiritual leader of your family,” today’s right-wing Republicans are increasingly comfortable with open displays of old-time crackpot patriarchy. This week Sen. Ted Cruz Jr. courts the right-wing preachers of the South Carolina Renewal Project, which is thought to be a key stop on his way to the GOP nomination in that early-primary state.
Let’s face it: The only way charging women more for health insurance and healthcare makes sense is if they have a partner who either shares that burden or shoulders it entirely. As in … a husband. Then it’s clear that the male of the species is doing his part to keep the species healthy and reproducing itself. A woman who doesn’t have a husband to play that role? Well, there shouldn’t be women like that – and certainly if there are, they shouldn’t be having children anyway, or even having sex, so they don’t need maternity care or contraception.
That’s the only way I can explain the GOP’s willingness to openly endorse an enormous transfer of wealth from women back to men by not only advocating the repeal of the ACA but specifically railing against its equal-premium provisions. But don’t worry, gals: You’ll get that wealth back once you get yourself a man!
I got a glimpse of this mind-set from an otherwise open-minded Republican, former RNC chair Michael Steele, last year, when he argued against the ACA’s contraception without a co-pay provision on “Hardball.” As Steele told me:
The problem is that you have effectively absolved the male of any responsibility in the relationship with this woman, whether it’s a sexual nature or beyond that. It’s not just about giving women access to contraception. It’s about the responsible behavior that goes with that access. It’s nice for Barack Obama to tell women, ‘I got your back. Here, have a pill.’ Men have a responsibility here … It’s this other piece that doesn’t get talked about in terms of the responsibility of fathers, or potential fathers, in this relationship.
I tried to reassure Steele that men could continue to be responsible to the women in their lives, even if they got contraception without a co-pay, but he wasn’t having it. I saw the uneasiness with female autonomy that’s at the heart of modern Republicanism, even if Steele himself handles that anxiety better than folks on the far right.
The father of the man who led the crusade to shut down the government over Obamacare, Rafael Cruz Sr., is quite clear about his belief that women must be subservient to men. As David Corn revealed in Mother Jones, Cruz told an Irving, Texas, mega-church last year:
As God commands us men to teach your wife, to teach your children—to be the spiritual leader of your family—you’re acting as a priest. Now, unfortunately, unfortunately, in too many Christian homes, the role of the priest is assumed by the wife. Why? Because the man had abdicated his responsibility as priest to his family…So the wife has taken up that banner, but that’s not her responsibility. And if I’m stepping on toes, just say, ‘Ouch.’
Ouch. I’m waiting for mainstream reporters to ask Cruz whether he shares his father’s beliefs – including his claim that President Obama should “go back to Kenya.” Rafael Cruz is a leading surrogate for his son, and has played a core role in his political rise. I don’t think it’s unfair to ask how much their views overlap, especially as Cruz courts the extremists in the South Carolina Renewal Project.
Right now those extremists matter more to key GOP leaders than ordinary women do. But if Ken Cuccinelli loses the Virginia governor’s race to Democrat Terry McAuliffe, as polls indicate is likely, he’ll do so because of the women’s vote. Republicans can’t win women because they’re still fighting a culture war to restore men to their “rightful” place as the head of the family and society. They’re profoundly uncomfortable with women’s autonomy – and that makes women voters increasingly uncomfortable voting Republican. Making Renee Ellmers the face of the backlash won’t help.
But I don’t expect a Cuccinelli loss to sober up the GOP either. Already right-wingers are telling reporters that McAuliffe is winning because the stridently antiabortion lieutenant governor didn’t campaign hard enough on culture-war issues. Antiabortion activist Marjorie Dannenfelser, who leads the Susan B. Anthony List, told Politico that Cuccinelli bowed to a GOP establishment-mandated “jobs, economy, that’s all that matters script.” Dannenfelser says “that script didn’t work in the presidential with [Mitt] Romney, who is not viewed as conservative as Ken is, and it has been problematic in this gubernatorial race. Sometimes, when it gets to social policy, everyone gets in the fetal position on the Republican side.”
Democrats have to hope the GOP listens to Dannenfelser heading into the 2014 midterms.
By: Joan Walsh, Editor at Large, Salon, November 5, 2013
“A Range Of Options And A Very Good Deal”: Under The Affordable Care Act, Millions Eligible For Free Policies
Millions of people could qualify for federal subsidies that will pay the entire monthly cost of some health care plans being offered in the online marketplaces set up under President Obama’s health care law, a surprising figure that has not garnered much attention, in part because the zero-premium plans come with serious trade-offs.
Three independent estimates by Wall Street analysts and a consulting firm say up to seven million people could qualify for the plans, but federal officials and insurers are reluctant to push them too hard because they are concerned about encouraging people to sign up for something that might ultimately not fit their needs.
The bulk of these plans are so-called bronze policies, the least expensive available. They require people to pay the most in out-of-pocket costs, for doctor visits and other benefits like hospital stays.
Supporters of the Affordable Care Act say that the availability of free-premium plans — as well as inexpensive policies that cover more — shows that it is achieving its goal of making health insurance widely available. A large number of those who qualify have incomes that fall just above the threshold for Medicaid, the government program for the poor, according to an analysis by the consulting firm McKinsey and Company.
The latest analysis was conducted by McKinsey’s Center for U.S. Health System Reform, whose independent research has been cited by the federal government and others.
“The whole point of the law was not only to cover the uninsured, but so people didn’t have to make choices between food or drugs, or going to the doctor or dentist,” said Karen Davis, a health policy expert at the Johns Hopkins Bloomberg School of Public Health. “It’s what it is designed to do.”
Many insurers tried to price their least expensive plans so they would become free or nearly free with the addition of subsidies that are set based on a person’s income and the cost of a midlevel, or silver, plan.
Independence Blue Cross in Philadelphia has four plans that are free to some customers. But the company, along with other insurers, has been careful not to publicize its free coverage for fear of alienating customers who will need to pay more.
“We’re not advertising zero dollar,” said Brian Lobley, a senior vice president at Independence Blue Cross. But the company is promoting monthly premiums in the $20 to $30 range, he said.
The Obama administration has also stressed affordability over coverage with no monthly charge, frequently saying that the cost of coverage will be less than a monthly cellphone bill for many consumers. Officials at the Department of Health and Human Services would not comment on the McKinsey analysis, saying in a statement that the goal of the health law was to provide a range of options for people with differing needs and budgets.
The analysis found that five million to six million people who are uninsured will qualify for subsidies that will be greater than the cost of the cheapest bronze or silver plan. A million more people with individual insurance could also be eligible, according to McKinsey, although estimates of the size of the market for private individual insurance vary widely. None of the people in the analysis qualify for Medicaid.
The availability of zero-premium plans may make the deal especially enticing to the healthy young people the marketplace needs to succeed, said Mark V. Pauly, a professor of health care management at the University of Pennsylvania’s Wharton School. “This is such a good deal that you’d have to believe you were immortal not to really pick it up,” he said.
Although they vary in their design, bronze plans generally cover about 60 percent of a person’s medical costs. All plans, including bronze, must cover standard benefits like prescription drugs, maternity care and mental health treatment.
The availability of the zero-premium plans varies across the country. McKinsey found that about 40 percent of the uninsured in Missouri will be able to select a no-cost bronze plan, for example, compared with 2 percent of the uninsured in New Jersey.
Its estimate, based on an analysis of premiums for plans offered in the marketplaces in all 50 states and the District of Columbia, is in line with two other estimates, by Credit Suisse and Morgan Stanley.
The McKinsey researchers also found that about half of the people eligible for zero-premium plans were under 39 and uninsured. The Obama administration has been emphasizing the affordability of its plans for young people, a critical group because their participation in the marketplaces will help keep overall premiums low.
It is impossible to know who will actually sign up, and whether they will choose a zero-premium plan.
For many people, paying slightly more for a silver plan may be a much better option, experts said. Ninety percent of those who will have the option of buying the no-cost plans make less than 250 percent of the federal poverty level, which is $28,725 for an individual, and $58,875 for a family of four. People earning below those thresholds are eligible for the most generous assistance, but only if they choose a silver plan.
About a million of those who will qualify for free coverage will be able to buy a silver plan for no monthly cost. McKinsey, which is releasing a report about the new insurance marketplaces, estimates that the cost of silver plans for the people who qualify for a zero-premium bronze plan will range from $40 to $50 a month.
“They may be getting zero premiums, but they’re also leaving a lot of money on the table if they don’t enroll in a silver-level plan,” said Sabrina Corlette, a professor at Georgetown University’s Health Policy Institute.
All plans, including bronze policies, limit annual out-of-pocket costs to $6,350 for individuals and $12,700 for families. But insurers and advocates said out-of-pocket costs — even those under that limit — can be daunting to people with low incomes.
For Mark and Elisabeth Horst, both artists in Albuquerque, the risks of signing up for a bronze plan were outweighed by the prospect of getting it free. The Horsts, who make $24,000 a year between them, qualified for $612 in monthly subsidies, but the cost of a bronze plan was $581 a month.
“We’re in good health,” Mr. Horst said.
Besides, he said, they can always switch to a better plan next year. “At this point, it’s a little bit of a gamble.”
Not everyone selects the cheapest option. Dante Olivia Smith, a lighting designer from Manhattan, learned that federal subsidies would allow her to buy a bronze plan for $24 a month.
“It was astounding,” she said. “I almost started crying, and called my mom.”
In the end, however, she went with a silver plan for $91 a month that included dental and vision coverage. Ms. Smith, who is 30, said she opted for the more comprehensive plan because of her work, which requires her to climb ladders and use power tools.
“If I had a different job, for 24 dollars a month I would have been like ‘Woo-hoo!’ ” she said. “But the reality is, I know what my risks are in my life.”
By: Reed Abelson and Katie Thomas, The New York Times, November 3, 2013
“Obamacare Witch Hunt”: Republican Halloween Witch Trials About Obamacare Avoid The Facts
Watch out for the hobgoblins! The knives are out. The hearings are on. The charges are flying. Obamacare is on the hot seat … again!
The sad result is that as we get these unconfirmed anecdotes, these stories about problems with insurance companies, these people who face hardship supposedly because of Obamacare, few Republicans think back to pre-2010. Then the costs of health care were skyrocketing – from $1,000 per person in 1980 to about $3,000 in 1990 to $4,000 in 2000 to nearly $8,000 before the Affordable Care Act was passed. The next highest nation for cost: Norway at $5,352.
According to the Commonwealth Fund, 49.9 million Americans were without health insurance in 2009, up 13 million from 2000. Houston, we have a problem.
And remember the stories of pre-existing conditions? Getting kicked off your health insurance or unable to get coverage? How about caps on your care? Or huge deductibles, especially for women? Horror story after horror story.
The facts are clear: 17 million Americans had pre-existing conditions; 34 percent lacked coverage for mental health; 62 percent lacked maternity coverage.
How soon we forget the problems that the ACA was written to solve. Right now, only 5 percent of Americans are covered by individual plans – if you had your plan prior to 2010, you are grandfathered in and can keep it. If the insurance companies want to kick you off they have to alter your plan, but they can no longer kick you off because of a pre-existing condition or because you cost them too much.
Most of these individual plans are renewed yearly and, according to current figures, 48 percent of those with individual plans would get a tax credit under the Affordable Care Act. The average “rebate” would be $5,500, not exactly chump change. Nearly half of those who believe they are suffering sticker shock from their insurance companies would get better coverage for less money.
So, before more and more people are dragged up before Republican-led congressional committees and berated, maybe it is time to get the facts. Maybe it is also time to work to fix what problems may exist and to offer solutions and not engage in more Salem-like witch trials just before Halloween.
By: Peter Fenn, U. S. News and World Report, October 30, 2013
“Purposeful Lying”: Time To Investigate Those Health Insurance Company Letters
As a follow-up to this post, I want to talk about the thing that spawns some of these phony Obamacare victim stories: the letters that insurers are sending to people in the individual market. People all over the country are getting these letters, which say “We’re cancelling your current policy because of the new health-care law. Here’s another policy you can get for much more money.” Reporters are doing stories about these people and their terrifying letters without bothering to check what other insurance options are available to them.
There’s something fishy going on here, not just from the reporters, but from the insurance companies. It’s time somebody did a detailed investigation of these letters to find out just what they’re telling their customers. Because they could have told them, “As a result of the new health-care law, your plan, StrawberryCare, has now been changed to include more benefits. The premium is going up, just as your premium has gone up every year since forever.” But instead, they’re just eliminating those plans entirely and offering people new plans. If the woman I discussed from that NBC story is any indication, what the insurance company is offering is something much more expensive, even though they might have something cheaper available. They may be taking the opportunity to try to shunt people into higher-priced plans. It’s as though you get a letter from your car dealer saying, “That 2010 Toyota Corolla you’re leasing has been recalled. We can supply you with a Toyota Avalon for twice the price.” They’re not telling you that you can also get a 2013 Toyota Corolla for something like what you’re paying now.
I’m not sure that’s what’s happening, and it may be happening only with some insurers but not others. But with hundreds of thousands of these letters going out and frightening people into thinking they have no choice but to sign up for a much more expensive plan, it’s definitely something someone should look into. Like, say, giant news organizations with lots of money and resources.
Now, it should be said that when President Obama said during the debate over the Affordable Care Act in Congress that if you like your health coverage you can keep it, he was only half right. The reason he repeated it so many times was that he and his advisors firmly believed that one of the main reasons Bill Clinton’s health-care reform failed was that it changed things too much for too many, and people fear change. In Clinton’s plan, pretty much everybody not on Medicare or Medicaid would have had to go into a new insurance plan. That those plans might be better than what they had didn’t matter; the idea frightened people. So the Obama administration took pains to emphasize that the government would not require anyone to change their insurance. That didn’t mean they were guaranteeing that no insurance company would ever make changes to anyone’s plan, because insurance companies do that all the time. But the law wouldn’t mandate that, say, you leave Aetna and join Blue Cross.
The more complex reality is that because the law imposed new requirements on insurers for what they have to cover and what they can charge, the insurers were inevitably going to make changes to their existing plans in response. And yes, that means many people’s insurance is going to change. In most cases it will change for the better, and the effect all this is going to have on premiums is yet to be seen. But it sure looks like insurance companies are trying to make sure anyone who’s displeased aims their ire at the government, and if they can get people to buy a more expensive product along the way, they’ll be happy to do that.
By: Paul Waldman, Contributing Editor, The American Prospect, October 29, 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
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