“John Boehner’s Hypocritical Griping About The Obamacare Deadline Delay”: Conservatives’ Real Beef, That People Want To Sign Up
The Obama Administration has made another adjustment to the Affordable Care Act and the critics are making another fuss.
The adjustment, first reported (I think) by Amy Lotven for Inside Health Policy, is an extension of the open enrollment period for buying private insurance through the new Obamacare marketplaces. Officially, most people have until March 31 to sign up for a plan. (The exception are people who lose a job or have some other, similar life-altering experience. They can sign up throughout the year.) But on Wednesday, the administration announced that it will be offering some extra time to consumers who don’t finish their applications in time. They’ll be able to use the websites, just like they can now, only they’ll have to check a box attesting to the fact that they started the application process before April 1.
Exactly how many extra days will these folks get? And what’s to prevent somebody from lying—effectively taking advantage of the grace period to get insurance after the official deadline? On a predictably painful and frustrating conference call Wednesday, officials from the Department of Health and Human Services wouldn’t answer these questions directly. Obamacare critics, meanwhile, were quick to express their displeasure.”What the hell is this? A joke?” House Speaker John Boehner said at a press conference. “Another deadline made meaningless. If he hasn’t put enough loopholes in the law already, the administration is now resorting to an honor system to enforce it.”
Boehner appears to be right about the lack of enforcement. Nothing can stop people from gaming this new system. And establishing some kind of fixed date might be a good idea, as Philip Klein points out at the Washington Examiner, although in practice the insurers will basically do that on their own. (If they don’t get applications by the middle of the month, they won’t start coverage on May 1.) But even insurers are shrugging at this and it’s not clear why Boehner or anybody else should react differently.
There’s genuine reason to think that people who waited until the last minute to sign up really might have problems completing the process in time. Traffic to the online marketplaces has been increasing rapidly, with levels now rivaling the surge that took place in late December. On Tuesday, 1.2 million people visited healthcare.gov, according to officials. At some point, the congestion could trigger a built-in queuing system—making it difficult for last-minute applicants to finish enrollment by midnight on March 31. As administration officials pointed out, you don’t stop people from voting because they were standing in line when the polls closed. Or, to borrow a phrase I saw on twitter, you don’t kick somebody out of a restaurant because their dish wasn’t ready before closing time.
As for people gaming the system to buy themselves extra time, sure, it’s going to happen. But it’s unlikely to happen that frequently, certainly not enough to upset the actuarial balance of insurance plans. And it’s not like this is unprecedented. As Igor Volskly explained in an item for ThinkProgress, the Bush Administration did pretty much the same thing with Medicare Part D:
In May of 2006, just days before the end of open enrollment, President Bush took administrative action to waive “penalty fees for very low-income seniors and people with disabilities who sign up late” and allowed “the same impoverished beneficiaries to sign up for Medicare drug coverage until Dec. 31.” …
Like Obamacare, the launch of President George W. Bush’s prescription benefit plan was hampered by technical glitches, setbacks, and mass confusion. As the May 15 deadline for enrollment loomed, a bipartisan group of lawmakers advocacy organizations, and a surprising number of newspaper editorials, urged the administration to extend the enrollment period and protect seniors from the penalties associated with late enrollment.
Of course, the real issue here for conservatives isn’t this one delay. It’s all of the delays, plus all of the exceptions and waivers. And it’s totally reasonable to ask hard questions about these, particularly when it comes to the limits of presidential authority and the precedent it sets for the future. (I’m still waiting to hear from more lawyers on the constitutional issues.) But, for what it’s worth, the Affordable Care Act really did give HHS a huge amount of leeway over how to implement the law—and it did so for a very good reason. Given the inherent complexity of health care, there’s no way Congress could have figured out all of the details. It made sense to delegate that authority—to put in place new systems, but leave the nitty-gritty of regulations and transitions to the administration.
For each one of these extensions or delays, the ultimate question is whether they change the law’s ability to realize its basic goals—which, in this case, means encouraging people to buy new private health plans while maintaining a stable insurance market. Giving people a little extra time to enroll wouldn’t seem to impede this kind of progress. If anything, it would seem to enhance it. And maybe that’s what really bothers some of the law’s fiercer critics.
By: Jonathan Cohn, The New Republic, March 26, 2014
“Showing Why The Law Is Working”: The Koch Brothers Are Accidentally Advertising The Benefits Of Obamacare
Some new advertisements attacking the Affordable Care Act actually show why the law is working.
The ads are running in Colorado and Louisiana, two states where incumbent Democratic senators face difficult reelection fights. They come from Americans for Prosperity, the conservative organization backed by the Koch Brothers. And in the spots, a woman makes some fairly sweeping claims about how Obamacare is hurting average Americans: “Millions of people have lost their health insurance, millions of people can’t see their own doctors, and millions are paying more and getting less.”
The statements leave out critical context, as Politifact has observed. But the interesting thing about the ads is their style. The narrator isn’t claiming these things happened to her or, for that matter, to any particular person. It’s all very broad and unspecific.
That’s a change and it’s probably because so few “Obama-scare” stories have held up to media scrutiny. Remember “Bette in Spokane”? House Republicans claimed she had to pay twice as much for her new coverage. Reporter David Wasson, a local reporter with the Spokesman-Review, tracked her down and determined that Bette could actually save money if she bought Obamacare coverage on Washington state’s online marketplace. Then there was Whitney Johnson, a 26-year-old with multiple sclerosis, who claimed that she’d have to pay $1,000 a month for her new insurance in Texas. That didn’t sit quite right with journalist and policy expert Maggie Mahar. Mahar dug into the details and, in an article for healthinsurance.org, revealed that Johnson had actually found coverage for about $350 a month—what Johnson had been paying previously. Maybe the best-known story is the one of Julie Boonstra, a Michigan cancer patient who said that her new insurance policy was “unaffordable.” A series of reporters, first at the Washington Post and then at the Detroit News, determined that Boonstra is probably saving money because of Obamacare—all while keeping the physicians who provide her cancer care.
The conservatives’ struggle to find more airtight stories might seem mystifying, given that there’s no shortage of people with real and serious complaints about the Affordable Care Act. Quite a few Americans, probably numbering in the low millions, lost their old policies and are now paying more for replacements—usually because the old plans lacked benefits like maternity and mental health or because insurers can no longer avoid the sickest and most expensive beneficiaries. You’ve read about some of those people in these pages. These people are not happy and it’s easy to see why: The president and his allies promised that everybody who liked their olds plans could keep them. But, as Los Angeles Times columnist Michael Hiltzik has observed, these stories inevitably have a lot of nuance. These are people who, almost by definition, are healthy enough to have gotten cheap insurance before or make enough money that they don’t qualify for the Affordable Care Act’s insurance discounts. That makes their tales less dramatic.
A better subject for future conservative advertisements might be people with serious, even life-threatening diseases who need access to very specific specialists or hospitals—and are now having difficulty, because their new plans have very narrow networks of providers. But even these stories have mitigating circumstances that media attention would reveal. Most of these people can find their way to comparable, albeit different, doctors and hospitals—and at least some can keep the old ones if they’re able and willing to pay more for it. Also, this kind of thing was a problem long before Obamacare came along. And that’s not to mention the fact that, previously, many of these people lived in fear of losing their insurance altogether.
In short, these stories may generate sympathy but they are rarely the stuff of tragedy. And that’s because of the protections Obamacare provides—which is to say, the very things that Koch-funded right-wingers want to gut.
After all, it’s Obamacare that sets a minimum standard for insurance, so that all policies include comprehensive benefits and set limits on out-of-pocket spending. It’s Obamacare that puts coverage within financial reach of many more people than before, by offering those subsidies and then, for some people, reducing out-of-pocket expenses even more. In the old days, it wasn’t so hard to find tear-jerker anecdotes: People without insurance or with inadequate insurance were filing for bankruptcy, losing their homes, and missing out on essential medicine. Now those stories are less common and, for the most part, they are among people who had these same problems previously. Telling the stories of these people would be a rationale for expanding the Affordable Care Act, not repealing it.
At some point, conservatives will find some tragic stories that are real. It’s a big country, and a complex law, and there are bound to be a few people for whom the new changes work out really badly. But there are also good news stories—lots of them. And while those stories inevitably have complications of their own, some are pretty dramatic. Democrats may not have figured out the politics of Obamacare. But it looks increasingly like they got the policy right.
By: Jonathan Cohn, The New Republic, March 21, 2014
“The Real Truth About ObamaCare”: Conservatives Need To Help Fix It, Or Face Their Worst Nightmare!
Despite the worst roll-out conceivable, the Affordable Care Act seems to be working. With less than two weeks remaining before the March 31 deadline for coverage this year, five million people have already signed up. After decades of rising percentages of Americans’ lacking health insurance, the uninsured rate has dropped to its lowest levels since 2008.
Meanwhile, the rise in health care costs has slowed drastically. No one knows exactly why, but the new law may well be contributing to this slowdown by reducing Medicare overpayments to medical providers and private insurers, and creating incentives for hospitals and doctors to improve quality of care.
But a lot about the Affordable Care Act needs fixing — especially the widespread misinformation that continues to surround it. For example, a majority of business owners with fewer than 50 workers still think they’re required to offer insurance or pay a penalty. In fact, the law applies only to businesses with 50 or more employees who work more than 30 hours a week. And many companies with fewer than 25 workers still don’t realize that if they offer plans they can qualify for subsidies in the form of tax credits.
Many individuals remain confused and frightened. Forty-one percent of Americans who are still uninsured say they plan to remain that way. They believe it will be cheaper to pay a penalty than buy insurance. Many of these people are unaware of the subsidies available to them. Sign-ups have been particularly disappointing among Hispanics.
Some of this confusion has been deliberately sown by outside groups that, in the wake of the Supreme Court’s “Citizens United” decision, have been free to spend large amounts of money to undermine the law. For example, Gov. Rick Scott, Republican of Florida, told Fox News that the Affordable Care Act was “the biggest job killer ever,” citing a Florida company with 20 employees that expected to go out of business because it couldn’t afford coverage.
None of this is beyond repair, though. As more Americans sign up and see the benefits, others will take note and do the same.
The biggest problem on the horizon that may be beyond repair — because it reflects a core feature of the law — is the public’s understandable reluctance to be forced to buy insurance from private, for-profit insurers that aren’t under enough competitive pressure to keep premiums low.
But even here, remedies could evolve. States might use their state-run exchanges to funnel so many applicants to a single, low-cost insurer that the insurer becomes, in effect, a single payer. Vermont is already moving in this direction. In this way, the Affordable Care Act could become a back door to a single-payer system — every conservative’s worst nightmare.
By: Robert Reich, The Robert Reich Blog, March 22, 2014
“The Education Of Scott Brown”: A Slowly Dawning Lesson, Running Against An Abstraction Is Easy
Less than two years after losing his re-election bid in his home state, former Sen. Scott Brown (R-Mass.) is apparently trying again, this time running in New Hampshire – where’s he still learning quite a bit.
It’s not altogether clear why Brown is running in the Granite State, but his strategy has nevertheless taken shape: the Republican intends to hit the campaign trail complaining about the Affordable Care Act. It worked in one state in 2010, Brown figures, so maybe it’ll work in a different state in 2014.
With this in mind, Brown visited with state Rep. Herb Richardson (R-N.H.) and his wife over the weekend at the lawmaker’s home, where the Senate candidate called the ACA a “monstrosity.” Sam Stein flagged an account of the meeting from the local newspaper (pdf):
Richardson was injured on the job and was forced to live on his workers’ comp payments for an extended period of time, which ultimately cost the couple their house on Williams Street. The couple had to pay $1,100 a month if they wanted to maintain their health insurance coverage under the federal COBRA law.
Richardson said he only received some $2,000 a month in workers’ comp. payments, however, leaving little for them to live on. “Thank God for Obamacare!” his wife exclaimed.
Now, thanks to the subsidy for which they qualify, the Richardsons only pay $136 a month for health insurance that covers them both.
The state lawmaker added that the health care law, which Brown claims to abhor, has been a “financial lifesaver” for his family.
According to the local reporter, the former senator listened to the Richardsons’ perspective and then changed the subject.
Running against an abstraction is easy; running against a law that’s currently benefiting millions of families nationwide is a little trickier. That may slowly be dawning on Brown right about now.
Speaking of New Hampshire, Stein also had this report out of the Granite State the other day.
The former chair of the New Hampshire Republican Party will save $1,000 a month in premiums for his family’s health care package after signing up for a new policy through the Obamacare exchange.
But Fergus Cullen said the savings aren’t enough to turn him into a supporter of the new health care law.
Apparently, Cullen’s catastrophic-coverage plan was phased out under ACA guidelines, which forced the former state GOP chair to transition to a new plan – with no annual or lifetime caps, and which can’t be taken away if Cullen gets stick – that will save the Republican and his family $12,000 a year in premiums.
For his part, Cullen, concerned about out-of-pocket costs, says he still prefers his old plan and wrote about his experience in the Union Leader, acknowledging the trade-offs.
By: Steve Benen, The Maddow Blog, March 20, 2014
“Stripping Away The Rhetoric”: Rebuilding The American Dream, One Insurance Policy At A Time
The Republicans give lots of reasons for their opposition to the Affordable Care Act. Only two really matter.
One is politics. The other is money. More precisely, big-business money.
Like Social Security and Medicare, the expansion of health insurance coverage is making voters more predisposed to support the politicians that championed the law — and they’re all Democrats.
Meanwhile, the more Americans benefit from this new law, the more Republicans are being forced to modify and mellow their rejection of it.
Within a few years, it may become as politically suicidal to openly attack the Affordable Care Act as it would be to call for abolishing Medicare.
Of course, Republicans can’t say they oppose the reform law often called “Obamacare” because it boosts the Democratic Party’s prospects. So they say it violates states’ rights. They say it infringes on individual liberty. They say it hurts small businesses. They say it will cost Americans their jobs.
None of these charges is withstanding scrutiny.
The law was written with states in mind. That’s why states can build their own insurance exchanges. It doesn’t erode individual liberty. The Supreme Court said so. And while it will be some time before we know about the law’s full economic impact, the evidence so far suggests that it puts more money into the pockets of people who will spend it, according to a report by the Congressional Budget Office.
Wasn’t that the same report that said Obama’s expansion of health insurance coverage is killing jobs? Indeed, many news outlets reported exactly that. But that’s a misreading of the report.
The CBO found that some workers — mothers with small children, students, and those close to retirement — have voluntarily left the workplace, because they didn’t need a job to maintain access to quality health care anymore.
Once the Affordable Care Act began to take effect, these workers exercised their newfound economic freedom by choosing to quit. They’re now caring for their kids and grandchildren, focusing on their own education, simply opting to enjoy their golden years, or starting their own businesses.
That’s something to celebrate. The critique that the Affordable Care Act somehow reduces the incentive to work doesn’t stand up to scrutiny.
The voluntary exit of more than 2 million workers from the American labor force will benefit many people. These workers are free to follow their dreams. If they are providing care, they will ease our caregiving deficit. And other Americans seeking work may finally find a job.
At the same time, money saved on health care can be spent on things that small businesses sell. Yes, I know. Republicans claim higher wages are bad for small businesses, and because small businesses are the engine of the economy, Obama’s expansion of health insurance is a job-killer. That’s just wrong.
Wages aren’t the top concern of small businesses. Taxes and poor sales are. So with more money in more pockets, sales receipts should climb.
When you strip away the rhetoric and take a good hard look at what the Affordable Care Act actually does, it sure looks like the new law raises wages and increases workers’ bargaining power.
By: Jonathan Stoehr, Managing Editor, The Washington Spectator; The National Memo, March 17, 2014
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