“Something To Celebrate”: Affordable Care Act Gives Workers Freedom, Republicans Enraged
Since I wrote about postal banking this morning, I’ve decided to continue the day’s shameless, lowest-common-denominator clickbaiting by talking about a new Congressional Budget Office report and the Affordable Care Act. Hang on to your hats.
With all the hype of a new Beyonce album, the CBO dropped its latest report on government finances and other related topics, which includes the news that the deficit has dropped to its lowest level since Barack Obama took office. This may prove inconvenient for Republicans still invested in fomenting deficit panic, but they’ll be helped by the fact that most Americans actually believe the deficit has gone up in the Obama years. According to a new poll from the Huffington Post, not only do 54 percent of people think so, but 85 percent (!) of Republicans think so.
In any case, the part of the CBO’s report that’s getting more attention is their projection that as a result of the ACA, the labor force will be reduced by 2 million in 2017, rising to 2.5 million in 2024. Unsurprisingly, Republicans rushed to the trumpets to shout that “Obamacare is going to cost 2.5 million jobs!!!” even though that’s not actually what the CBO said. Even news organizations who ought to know better made the mistake; earlier today, a headline at the Washington Post‘s web site read, “CBO: Health Law to Mean 2 Million Fewer Jobs” (it has since been corrected to read, “CBO: Health Law to Mean 2 Million Fewer Workers”).
The important thing to understand about the reduction in the labor force is that this is exactly what was supposed to happen. When you eliminate “job lock,” where people who’d like to leave their jobs can’t because if they do they won’t have health insurance, a certain number of people are going to take advantage of their newfound mobility. In some cases you might be able to construe it as a loss to the economy, say if a productive full-time worker cuts back to part time because she can. But in many cases it’s something to celebrate: an American exercising their freedom.
Imagine, for instance, a couple. The wife is a lawyer in private practice; the husband is an accountant at a large firm. Since she’s a cancer survivor, he has stayed at his job for the health insurance it provides, because if he didn’t they wouldn’t have been able to get coverage, what with her pre-existing condition. But now, he can make a different choice. And it happens that her business is doing pretty well, and he’d rather stay home with the kids and work on his novel than be an accountant. So he has the freedom to quit his job, and they can still get covered. When he does so, he’s no longer in the labor force. But that doesn’t mean there’s one fewer job in the economy. His firm will just hire someone else.
That isn’t to say there will be zero net loss to the economy; without his income, the couple will probably spend less. But their children may also grow up happier and more well-adjusted, and who knows, he might write the next great young-adult dystopian fight-to-the-death trilogy with the extra time he has between 9 and 3 every day. These are good things.
That’s just one kind of person who leaves the labor force because of the ACA; there will also be lots of people who leave jobs to start their own businesses, and some who decide to retire early because now they can. If people are making those decisions freely—just like people have the freedom to do in every other advanced economy in the world—it would be crazy to think of it as something to be lamented.
By: Paul Waldman, Contributing Editor, The American Prospect, February 4, 2014
“Obamacare Is Not A Job Killer”: How Critics Are Misreading A New Government Report
The Congressional Budget Office today released the latest update of its projections for the economy and the budget, including Obamacare. And a fair reading would be that not a ton has changed since last time. CBO now expects the law will lead to 25 million people getting health insurance, while some 31 million people will remain uninsured. It will require a lot of new government spending but, because of offsetting revenue and cuts to other programs, it will actually reduce the deficit.
But CBO revised one finding and, all day long, critics have been seizing on the revision as proof that the law is a boondoggle.
The real story, as usual, is a lot more complicated.
The projection is about how the Affordable Care Act will affect labor output—that is, the number of hours Americans work every year. From the get-go, CBO assumed that Obamacare would slightly reduce labor output, relative to what it might have been without the law in place. Why? The CBO gave a bunch of different reasons.
For one thing, CBO reasoned, the financial assistance Obamacare provides depends on income. The more money you make, the less assistance you get. CBO argued that this would discourage some workers from putting in more hours, since the reward for working harder would be more income but less assistance on health insurance. In addition, CBO noted, historically some people have taken or held on to jobs exclusively to get health insurance. Obamacare makes it possible to get coverage without a job. As a result, CBO predicted, some of these people would stop working—or, at least, work fewer hours.
These weren’t the only ways that Obamacare will affect jobs, according to the CBO. And sometimes Obamacare will lead to people working more hours—for example, by giving people with chronic medical problems more freedom to switch jobs or start their own firms.
Overall, the CBO had said previously, Obamacare’s net effect would be a reduction in total labor compensation of about 0.5 percent. Now, citing new research on the effects of taxes, CBO is predicting that the net effect will eventually be twice as large—a full 1 percent reduction in compensation, or the rough equivalent of what we’d expect if two million fewer people were in full-time jobs.
That sounds like a big deal—and Obamacare critics certainly treated it like one. Here’s the conservative publication Newsmax: “Simply put, the new analysis from the nonpartisan agency suggests the 2010 Affordable Care Act is driving businesses and people to choose government-sponsored benefits rather than work.” Here’s Republican Congressman Tom Price: “This independent analysis by the Congressional Budget Office confirms that Obamacare will destroy economic opportunity and with it financial security for many American families.” And here’s a spokesman for the National Republican Congressional Committee: “There is no way to spin this. Because of #ObamaCare, there will be 2.5 million less jobs in our economy.” (If you want more quotes, Glenn Kessler and Greg Sargent of the Washington Post have nice roundups—and some good analysis of their own.)
But CBO didn’t actually say Obamacare would lead to 2 million fewer jobs. It said that Obamacare would lead to the “equivalent” of 2 million fewer jobs. In reality, CBO expects a much larger group of people to reduce their hours by a much smaller amount. Only a relative few will stop working altogether.
More important, CBO says, most of the people working fewer hours will be choosing to do so. And that’s a very different story from the one Obamacare critics are telling. Some of the people cutting back hours will be working parents who decide they can afford to put in a little less time with their co-workers and a little more time with their kids. Some will be early sixty-somethings who will retire before they reach 65, rather than clinging to low-paying jobs just to get health benefits. “This is what we want in a fair society,” says Jonathan Gruber, the MIT economist and Obamacare architect. “We don’t want to enslave the old and sick to their jobs out of some sense of meanness. If they are dying to quit/retire, then let them. That’s a good thing, not a bad thing.”
Of course, some able-bodied Americans will cut back on hours for reasons that conservatives, in particular, might not like. To put it crudely, they’ll work fewer hours simply simply because they don’t feel like working so hard. But whether or not that’s so problematic, it’s also the inevitable by-product of any program that makes assistance conditional on income. The Earned Income Tax Credit works that way. So do food stamps and Medicaid.
And so, by the way, would the new health care proposal from three Republican senators, which makes subsidies available to people with incomes at 299 percent of the poverty line but not those with incomes at 300 percent. The only question with programs like these is how big the disincentive to work is—and whom, exactly, it affects. The only alternatives are to give help to everybody (which requires much more government spending) or to give help to nobody (which leaves many more people struggling).
Ironically, the CBO report included two other findings that should, if anything, make most people more optimistic about Obamacare’s future. First, the CBO found that the law will reduce the deficit by a little more than initial projections suggested. Second, it found that the now-infamous “risk corridor” program, in which government and insurers share gains and losses, will result in net payments from insurers to the government, rather than the other way. (Jonathan Chait has the details on that drama.)
The change in projected deficits isn’t very large and the risk corridor prediction comes with more uncertainty than usual, so you wouldn’t want to bet a lot of money on either prediction coming true. But both findings call into more serious doubt two of the Republicans’ favorite talking points—that Obamacare will drive up the deficit and that, because of the risk corridor program, it’s a “taxpayer bailout” of insurers. As of today, those claims look even weaker than they did before.
Will Republicans stop making these arguments? Or will they at least acknowledge some uncertainty about them? Nope. And that’s a prediction in which you can feel very confident.
By: Jonathan Cohn, The New Republic, February 4, 2014
“Bette In Spokane”: Consumers Hear More About The Horror Stories Than The Follow-Up Reports Proving The Horror Stories Wrong
For the last several months, conservative opponents of the Affordable Care Act, including congressional Republicans, have encouraged Americans to contact the GOP with “Obamacare horror stories.” The more the right can highlight those adversely affected by the law, the argument goes, the more ACA critics can undermine public support for reform.
To that end, Rep. Cathy McMorris Rodgers (R-Wash.), the House Republican Conference chair, used her party’s official response to the State of the Union to highlight a woman in her home state who, she claimed, was better off before the law.
“Not long ago, I got a letter from Bette in Spokane, who had hoped the president’s health care law would save her money, but found out instead her premiums were going up nearly $700 a month…. No, we shouldn’t go back to the way things were, but this law is not working.”
Almost immediately, red flags went up among those who follow the health care debate closely. And for good reason: over the last several months, Republicans and their allies have put a spotlight on quite a few “Obamacare victims,” but the stories invariably fell apart after modest scrutiny.
With this in mind, it was only natural to wonder about the circumstances surrounding “Bette in Spokane,” who presumably represented the single best piece of anecdotal evidence McMorris Rodgers could find as part of her ACA indictment. Fortunately, we now have a better sense of the relevant details, which, like so many “Obamacare horror stories,” don’t help the Republicans’ case at all.
The local newspaper, the Spokesman-Review, tracked down Bette Grenier, who wrote the letter used in McMorris Rodgers’ remarks.
[T]he “nearly $700 per month” increase in her premium that McMorris Rodgers cited in Tuesday night’s GOP response to the State of the Union address was based on one of the pricier options, a $1,200-a-month replacement plan that was pitched by Asuris Northwest to Grenier and her husband, Don.
The carrier also offered a less expensive, $1,052-per-month option in lieu of their soon-to-be-discontinued catastrophic coverage plan. And, Grenier acknowledged the couple probably could have shaved another $100 a month off the replacement policy costs by purchasing them from the state’s online portal, the Health Plan Finder website, but they chose to avoid the government health exchanges.
In a familiar situation, the horror story isn’t as horrible as we’d been led to believe. In this case, “Bette in Spokane” didn’t have a health care plan so much as she had insurance that covered catastrophic coverage – and nothing else – with a $10,000 deductible.
Because the law transitions consumers from these bare-bones plans to actual coverage – plans that offer meaningful health care security – she had to choose real insurance. For reasons that are unclear, “Bette in Spokane” refused to check the exchange marketplace to see if she could find a good deal and instead chose an expensive plan from her existing insurer.
Also note, it’s not too late for “Bette in Spokane” – the state insurance commissioner said his office can help her and her family review the available options.
In the official Republican Party’s SOTU response, all of these relevant details were ignored. Viewers were led to believe the law forced higher premiums on this consumer as part of some kind of inherent flaw in the system, but that’s not at all what happened in reality.
And circling back to the last time we talked about a story like this, it’s worth emphasizing that there are Americans who’ve been adversely affected by health care reform. In a nation of 314 million people, it will be possible to find some who didn’t benefit as much as everyone else. In fact, it’s inevitable.
But in the rush to condemn the law, the public has been confronted repeatedly with anecdotal evidence that’s completely fallen apart. Worse, consumers invariably hear more about the horror stories than the follow-up reports proving the horror stories wrong.
If the Affordable Care Act were really as awful as the right claims, shouldn’t it be easier to find genuine examples of Obamacare’s “losers”?
By: Steve Benen, The Maddow Blog, January 31, 2014
“Obamacare And Emergency Rooms, A Bit Of Perspective Needed”: Oregon Study Doesn’t Undermine Affordable Care Act Claims
Headlines based on a study of emergency room visits by a few thousand Oregon Medicaid beneficiaries undoubtedly gave the Obama administration heartburn last week. Although the study predated the Medicaid expansion authorized by the Affordable Care Act — which began in some states on January 1 — many who wrote about the Oregon study jumped to the conclusion that the millions of newly enrolled Medicaid beneficiaries would make greater — not less — use of the ER for routine care.
I may be going out on a limb, but I for one don’t buy the idea that the Oregon study means emergency rooms are going to get even more crowded. And that’s because more Americans will finally have insurance.
Reform advocates have long suggested that getting folks out of the ranks of the uninsured should cut down on visits to the ER for noncritical medical care. Many people who lack coverage don’t have a primary care physician and all too often make trips to the ER when their illness or injury could have been treated more appropriately and inexpensively in a clinic or doctor’s office.
The Oregon study, which was published in the journal Science, would seem to disprove that theory.
In 2008, two years before the ACA was enacted, Oregon increased the number of Medicare beneficiaries in a novel way: by lottery. Many Oregonians who had been on a waiting list for the state’s Medicaid program got lucky when their names were drawn and they were added to the rolls.
The researchers who wrote the Science article studied the emergency room use of about 25,000 of the successful and unsuccessful lottery participants and found that those who won coverage actually made more trips to the ER over 18 months than those whose names were not drawn.
Headline writers were quick to draw their conclusions: Obamacare would not reduce unnecessary ER visits.
“Emergency Visits Seen Increasing with Health Law,” read the headline above the New York Times story last Thursday.
“Obamacare Medicaid Expansion to Worsen Hospital ER Burden,” said Bloomberg.
And Forbes gave us this: “New Oregon Data: Expanding Medicaid Increases Usage of Emergency Rooms, Undermining Central Rational for Obamacare.”
“For years,” wrote Forbes columnist Avik Roy, “it has been the number one talking point of Obamacare supporters. People who are uninsured end up getting costly care from hospitals’ emergency rooms. ‘Those of us with health insurance are also paying a hidden and growing tax for those without it — about $1,000 per year that pays for [the uninsureds’] emergency room and charitable care,’ said President Obama in 2009. Obamacare, the President told us, would solve that problem by covering the uninsured, thereby driving premiums down. A new study, published in the journal Science, definitively reaches the opposite conclusion.”
There is more than a bit of twisted logic in that paragraph. It is true that those of us with insurance pay considerably more for it because those who don’t have it often can’t pay for their ER care. That’s because the hospital shifts the cost of that “uncompensated care” to its insured customers. Researchers have estimated that people with insurance pay $1,000 more a year for it than they would if this cost shifting didn’t have to occur.
Bringing uninsured people into coverage eliminates much of that cost shifting. And that’s a good thing, considering that the vast majority of Americans with health coverage — even after the Medicaid expansion — get it through private insurance companies, either at work or on their own.
The actual increase in the number of visits per person among the newly insured in Oregon via the Medicaid lottery was 0.41. In other words, each new enrollee made 0.41 visits more on average during the 18 months than the 1.02 ER visits made by those who remained uninsured.
When you look at it from the perspective of those numbers, and the actual amount Oregon spent per person, as University of Chicago health policy expert Harold Pollack did in a healthinsurance.org post, this is far from a “sky is falling” disaster in the making. And it is actually reducing the cost shifting.
Also, as Pollack pointed out, “the emergency departments will be reliably paid for care they provide … (With coverage expansion) providers don’t have to fear the burdens or uncompensated care, and…they don’t need to cruelly pursue low-income patients over bad debts.
It’s also important to keep in mind that private insurers now manage most of the states’ Medicaid populations, and they will be vigilant in their efforts to steer their new Medicaid enrollees away from the ERs and to more appropriate and cost-effective settings. WellPoint subsidiary Amerigroup described in a recent policy brief, for example, how its efforts to reduce primary care-treatable ER visits among Medicaid beneficiaries resulted in a savings of more than 50 percent.
Rather than rushing to conclusions, let’s see how the Medicaid expansion under Obamacare actually plays out in the years ahead.
By: Wendell Potter, The Center for Public Integrity, January 6, 2014
“A Gaping Wound In The Republican Psyche”: Obamacare Is No Longer Doomed, It Will Become A Scandal
Obamacare — actual, real, Obamacare, with doctors and cards and everything — has been operational for nearly a week now. It has been … extremely boring. It does not look like Stalinist collectivization. There aren’t even any beheadings. It looks like regular medical insurance, except several million more people now have it than before.
How conservatives will respond next to this mundane new world has become the subject of combative speculation. Greg Sargent predicts Republicans will soon come to terms with the law and begin negotiating for incremental improvements. On the right, Conn Carroll angrily replies that the law’s demise remains “inevitable” and liberals will turn against the law, citing Michael Moore as a harbinger of pro-single-payer liberals who will help Republicans dismantle Obamacare, somehow.
I predict a slightly different outcome than either. Obamacare will neither collapse, nor will Republicans accept its legitimacy, but the nature of their opposition will instead slowly morph. Gleeful predictions of imminent collapse will give way to bitter recriminations at the nefarious tactics used to make the law work. Obamacare will cease to be the something certain to destroy Obama and become something Obama has gotten away with.
In recent weeks, it has begun to dawn on some conservatives that the actuarial death spiral they confidently predicted for years — in which the young and healthy shun the exchanges, leading to sicker and costlier patients and rising prices, in turn driving out the remaining healthy customers — may not actually transpire. It won’t for several reasons, one of them being a set of protections embedded in the law itself called risk corridors and reinsurance, which compensate insurance companies that wind up with a sicker customer base in the first three years of the law’s operation, thus preventing a death spiral.
Republicans, having just learned of these provisions, demand that they be abolished, to hasten the death spirals. Repentant immigration reformer Marco Rubio is at the forefront with a bill to strike them from the law. Obviously Obama would never sign such a bill, but Charles Krauthammer offers a solution: demand he sign it or else refuse to lift the debt ceiling. The program is “a huge government bailout,” argues Krauthammer. This is true in the sense that any cost overrun by a defense contractor is also a huge government bailout — which is to say, it’s not true.
But it feels true, and that is the important thing. The premise that Republicans will seek to alter Obamacare in conservative-friendly ways assumes that the policy design of health-care law is their primary motivating force. Everything about the history of Republican health-care thought suggests the opposite. Just five years ago, Mitt Romney was running on a platform of taking his Massachusetts plan, with its individual mandate, national, provoking only the mildest grumbling on the right.
Obamacare is a gaping wound in the Republican psyche, representing not only the rise of a majority moocher class but a potential symbol of a successful Obama presidency. Health-care reform, George F. Will has ludicrously if representatively declared, amounts to Obama’s “single” achievement. If it lives, it will vindicate his presidency as a liberal Reagan, rather than the reprise of Jimmy Carter (or George W. Bush) Republicans wish him to be.
If and when the law melds into the national fabric, the proximate Republican response will not be to adapt their policy ideas to it, but to denounce it as a kind of stolen law. You can see this spirit creeping out not only in Rubio’s proposal but elsewhere. Eleven Republican attorneys general have denounced Obama’s various administrative maneuvers to make the law functional as illegal. “It was powerful corporate America, with its influential lobbyists, that got an additional year to meet the insurance mandate — when individuals did not,” complains The Wall Street Journal columnist Kimberly Strassel, “It was the unions that got a reprieve from a health-insurance tax — when individuals and small businesses were left to pick up the tab.” The hapless Obamacare is slowly giving way to the devious Obamacare.
In the very long run, Obamacare may become a thing, like Social Security and Medicare, that Republicans initially predict will destroy the fabric of capitalism but eventually accept and then finally swear up and down they will not harm. In the shorter term, it will remain a bloody shirt. Obamacare will be Benghazi or the IRS scandal writ large.
By: Jonathan Chait, Daily Intelligencier, New York Magazine, January 5, 2014
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 