“At The Intersection Of Calendars And The ACA”: The Success Of The System Will Not Rise Or Fall Based On Monthly Tallies
The Affordable Care Act enrollment figures for February were released yesterday afternoon, and for the most part, the numbers looked pretty good for those hoping to see the U.S. system succeed.
But news consumers can be forgiven for thinking the opposite. The Hill ran this headline: “ObamaCare enrollments dip.” The Washington Post had a similar message: “Obamacare enrollment drops off in February.” The conservative Washington Examiner told readers: “Obamacare signups slow down in February.”
Sounds discouraging, doesn’t it? January’s enrollment totals were heartening, but if you just skimmed the headlines out of D.C., you’d think February represented a step backwards.
The months HHS has been using for tabulation don’t correspond precisely to the calendar, because of state reporting methods and where weekends fall. As it turns out, “February” is actually February 2 through March 1. That’s 28 days. “January” is actually December 29 through February 1. That’s 35 days. Plug in the numbers, and you’ll see the average daily enrollment for January was 32,744 and for February it was 33,673. As you can see in the graph, the pace actually increased a bit. Among the very few who noticed were Charles Gaba of ACASingups.net and Sy Mukherjee of ThinkProgress.
At a superficial level, the raw monthly totals offer a misleading picture. Someone sees 1.2 million sign-ups in January, followed by 943,000 in February. That looks like a drop.
Until we’re reminded that February is the shortest month.
Stepping back, it’s worth noting that these month-to-month totals are interesting, but their broader importance is limited. I always make a point to highlight the totals as a way of documenting ACA progress, and there’s a political salience as more Americans get invested – literally and figuratively – in the law’s future, but the success of the system will not rise or fall based on monthly tallies and the degree to which they meet preliminary projections.
As Rachel has noted on the show more than once, when a very similar system was established in Massachusetts eight years ago, officials worked under the assumption that enrollment would be slow at first and would then improve in time. In the very first month of the state’s open-enrollment period, a grand total of 123 residents of Massachusetts actually signed up.
And while that may sound like a disaster, no one much cared – in fact, no one even bothered to acknowledge the total at the time, and the figure was only dug up later.
The Affordable Care Act is following a similar trajectory. And since the Massachusetts system is working quite well, that’s probably a pretty good sign.
By most estimates, by the end of March, a little over 5 million consumers will have enrolled through exchange marketplaces, and a similar number will have gained coverage through Medicaid. That’s not quite what the CBO projected before the process began – whether the 7 million figure could have been reached if healthcare.gov worked from the outset we’ll never know – but it’s a perfectly fine number when it comes to sustainability.
Keep this in mind the next time you’re perusing the Beltway media’s headlines about the system’s progress.
By: Steve Benen, The Maddow Blog, March 12, 2014
“Punish Them At The Polls”: Michigan’s Sweeping “Rape Insurance” Law Goes Into Effect
A new Michigan law forcing individuals or businesses to purchase costly additional insurance to cover abortion care went into effect Thursday.
The law applies to private health plans in the state, including plans secured through the state health exchange and employer plans. If a person does not purchase the additional insurance, then they will be forced to pay out of pocket for the procedure if they need to access abortion care. As it stands, very few insurance plans cover abortion care; the new law will likely further drive down the already tiny fraction of abortions covered by health insurance in the state, potentially putting the procedure financially out of reach for many people.
There were approximately 23,000 abortions performed in Michigan last year, and barely 3 percent of them were covered by insurance.
As Jessica Valenti at the Nation rightly pointed out at the time the measure first passed the Republican-controlled Legislature, eliminating insurance coverage for abortion will have devastating consequences for all people who need abortion care, which is essential and basic medical care. There is no hierarchy of “good” abortions or “bad” abortions. But pro-choice lawmakers in Michigan and much of the national coverage has focused on what many see as the most extreme feature of the law — its lack of exceptions for survivors of rape or incest.
The lack of exceptions has led many to call the law “rape insurance.”
At the time of the vote, Senate Majority Leader Gretchen Whitmer, a Democrat, said she was raped as a college student and couldn’t imagine having to face the additional trauma of such a law had she gotten pregnant. She asked her “Republican colleagues to see the face of the women they’re hurting by their actions today.”
“Thank God I didn’t get pregnant as a result of my own attack,” she continued, “but I can’t even begin to imagine now having to think about the same thing happening to my own daughters.”
By: Katie McDonough, Assistant Editor, Salon, March 13, 2014
“Stand By It, Support It, Argue For It”: Democrats Should Run On Obamacare, Not Run From It
Alex Sink should have won the special congressional election in Florida yesterday. She had more money, she had a better resume and profile, and she was certainly a good candidate.
Florida’s 13th congressional district is a very competitive district that President Obama carried in both 2008 and 2012. True, it had been in Republican hands for a long time, but it was a good chance for the Democrats to pick up an open seat.
So, what went wrong? Hard to tell, of course, from inside the beltway, but let me offer up one thought. Sink tried to straddle health care and got caught in the middle.
As we all know, the notion that “I was for it before I was sort-of against it” does not sit well with voters. Certainly one could argue that the “fix what is wrong” strategy could work in 2014 for Democrats. But my fear is that what the voters hear is “I don’t really like Obamacare much because it may be hurting me politically.”
It is my strong belief that Democrats need to argue vociferously for the benefits of Obamacare. They need to tout what it will do for the country, for average Americans, for those without health insurance, for the economy, for keeping health care costs under control. If candidates believe they can distance themselves politically, especially after they voted in favor of it, they are making a tragic mistake. Own it. Don’t shy away from the important impact it is having now and will have in the future.
Sure, each race is different, each race will have its own dynamics, each race will have its own issues and differences among candidates. But if Democrats are hopelessly divided on health care, even at odds with themselves, they will not be able to stop the Republicans from hammering them.
By emphasizing the “mend it, don’t end it” strategy rather than the “here’s what it will do for you” strategy, Democrats are playing defense. Sure, they can use the Bill Clinton line, “We’ll be fixing it this year, will fix it next year and we’ll fix it the year after that,” but stand by it, support it, argue for it. This is the way Social Security worked and Medicare too — they were constantly amended and changed — but the end result is that they are among the most effective and popular programs ever enacted.
Gov. Mitt Romney tried to straddle the auto bailout, Republicans try obfuscating on women’s issues and Kerry tried to argue both sides of his Iraq vote. It’s hard to make those plays work.
On Obamacare, Democrats should argue strongly for it. Over the next eight months, Democrats should point to the number of people signing up, the care that people are receiving, the improvements in delivery and cost, and, most importantly, what it will accomplish in the future. Once Obamacare is fully operational, fewer people will be bankrupted by health care expenses, our populace will be healthier and the overall impact on the nation will be similar to Social Security and Medicare.
In short, if Democrats start now and double down on the issue, they will fare better in November than if they run and hide.
By: Peter Fenn, U. S. News and World Report, March 12, 2014
“50th Time Is The Charm”: For House Republicans, The Affordable Care Act Is Not About Policy And Governing Isn’t Their Goal
Last week, after House Republicans announced an upcoming vote on undermining the Affordable Care Act, President Obama took some time to mock GOP lawmakers for their pointless hobby. “You know what they say: 50th time is the charm,” he joked at a DNC event. “Maybe when you hit your 50th repeal vote, you will win a prize. Maybe if you buy 50 repeal votes, you get one free. We get it. We understand. We get you don’t like it. I got it.”
But by all appearances, Republicans aren’t concerned about mockery. They’re proceeding today with their plan to go after the ACA’s individual mandate – again. By most counts, it will be the 50th time House Republicans have voted to gut some or all of the health care law since 2011, even though they fully realize their bill has no chance of being signed into law.
The House is set to vote Wednesday on a bill by Rep. Lynn Jenkins (R-KS) to effectively delay the individual mandate for one year by reducing the penalty in 2014 for not buying insurance from $95 to $0.
The Republican-led chamber passed a similar bill last July, capturing 22 Democratic votes. Now that it’s an election year, it’s plausible that a significant number of Democrats will defect, given the unpopularity of the individual mandate and the likelihood that Senate Democrats will throw the bill in the garbage once it arrives.
House Republicans are under no illusions about the legislation’s prospects, but governing isn’t the goal. This is about an election-year stunt intended to help GOP lawmakers feel better, maybe motivate the base a bit, and create the basis for some new attack ads against Democrats.
Whether or not one approves of this waste of time, it remains a ridiculous display.
For one thing, the effort itself would be a substantive disaster if the bill actually became law. Clearly the GOP is in its post-policy phase, so real-world implications are no longer considered before bills receive votes, but the Center on Budget and Policy Priorities published an analysis yesterday and found that the House’s proposal would increase the number of Americans without insurance and lead to higher health care premiums in the individual market. How do Republican leaders respond to revelations like these? They don’t – this isn’t about policy, so the implications are deemed irrelevant.
For another, this is quite a bit of effort over a policy Republicans supported up until a few years ago – the mandate used to be a key feature of GOP health care plans.
House Republicans could be using their time wisely right now. Maybe they could work on real legislation; maybe they could present their “Obamacare” alternative they’ve been promising for years.
But that just doesn’t seem to interest them. Americans are instead stuck watching their House of Representatives spin its wheels, picking up self-satisfying “message” bills.
By: Steve Benen, The Maddow Blog, March 5, 2014
“Show Me The Medicaid Money”: Buckle Up Republicans, Obamacare Is Here To Stay
Somewhat quietly, Obamacare enrollment hit 4 million this week. Now, it’s certainly true—as critics have noted—that enrollees aren’t the same thing as people who will continue to stay with their plan for a full year. If an enrollee encounters an unexpected expense of replacing a head gasket or something like that, he might skip a payment. But even so, 4 million’s a more-than-respectable number.
Also rather quietly this week, a new tracking poll from the Kaiser Family Foundation showed support for repeal of Obamacare down to 31 percent. As Jay Bookman noted in the Atlanta Journal-Constitution, overall the poll wasn’t something the president would exactly brag about, but it did represent noticeable change, especially among independents, 57 percent of whom now support the law.
That 31 percent number made me sit up straight for one reason. The percent of Americans who identify themselves as conservative is, lately, about 38 percent, says Gallup. So 31 percent is getting down there. And consider this: As of mid-December 2013, the percentage of Americans who favored repeal was 52.3 percent in a Real Clear Politics average of numerous polls. The Affordable Care Act may not be as popular as Twelve Years a Slave, but it’s not The Lone Ranger anymore either.
I would think there’s a direct correlation between these two sets of facts, no? The more people go to the web site and see that they can get insurance at a decent price (in most cases), the more they tell their co-workers and neighbors that doing so wasn’t the horror show they expected. The more people learn about some of the law’s benefits, the more opposition to it softens.
There are still a few more things the American people need to learn about the law, though, and it’s up to the Democrats to tell them, and I’m going to bang on about this until I see some action. As I wrote Wednesday, Governor Rick Perry has said no to $9 billion in free money. Texas is the largest state in the union that hasn’t accepted the Medicaid expansion money, so that’s the biggest figure, but the figures are significant in relation to the population and budget in every single state.
These figures are from a Commonwealth Foundation report from three months ago. Florida is saying no to $9.6 billion, Georgia to $4.9 billion, North Carolina to $5.7 billion. Wisconsin is passing on $1.75 billion, Virginia on $2.15 billion, and Pennsylvania on $5.5 billion (although Pennsylvania is considering the opt-in). And this report’s figure for Texas is actually $9.6 billion.
You know how states clamor for federal highway money? Well, as Commonwealth points out, in every one of these cases, the Medicaid money is more—at least double, typically, and sometimes far more—than what these states get in highway money. And yet they say they don’t want it. They say that over time, they’re going to be on the hook for vast expenditures they can’t afford, or they fret publicly that Washington might change the formula. They’re both bogus arguments.
The federal government is paying 100 percent of states’ expansion costs through 2016 and no less than 90 percent thereafter on a permanent basis. It’s a sweet deal. But okay, what about that (up to) 10 percent that states are going to have to start paying? Ten percent doesn’t sound like a lot, but in dollar terms, isn’t that real money?
The answer is, not really, in most cases. This gets complicated and involves a category of spending by the states for something called “uncompensated care,” which is just what it sounds like—health care provided for free to poor people. State and local governments typically pitch in now on uncompensated care. But as the Center on Budget and Policy Priorities explains in a 2012 report: “The Medicaid expansion will reduce state and local government costs for uncompensated care and other services they provide to the uninsured, which will offset at least some—and in a number of states, possibly all or more than all—of the modest increase in state Medicaid costs.” Overall, the health-care consulting firm The Lewin Group estimates a minimal increase in states’ spending obligations, around 1 or 2 percent, depending on the state.
As for the argument that some GOP governors make that they fear Washington might change the formula…well, that’s straight from Orwell or Kafka. That is: Barack Obama isn’t going to change any formula. President Hillary Clinton wouldn’t be changing any formula. A Democratically controlled Congress won’t be changing any formulas. Only Republican presidents and congresses would do that. In other words, these Republican governors are saying—yeah, the deal looks fine now, but my party might take over, and then I’d be really screwed!
The ACA is here to stay. It’s not going to be struck down. It’s not going to be repealed. That would require a Republican president and 60 GOP senators and a solid GOP House majority, and the odds are strongly against the emergence of such a confluence. It’s going to exist. And inevitably, it’s going to grow. And more and more people are going to get used to it and learn to live with it. And over time, the people in states like Texas and Georgia and Wisconsin are going to see that people in nearby states that took the money are in fact pretty happy with their situations.
It’s only a matter of time before these resistant governors and state legislatures start caving. Democrats have it in their power to help hasten that timetable by making this an issue. They have to have the courage not to wilt or get the vapors whenever a right-winger invokes the evil gummint or the hated Kenyan. Democrats say they’ve waited decades for this moment. Well, it’s here. Now’s not the time to run away from the fight.
By: Michael Tomasky, The Daily Beast, February 28, 2014
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