“Obamacare’s Real Promise”: If You Lose Your Health-Care Plan, You Can Get A New One
The furor over “if you like your plan, you can keep it” touches on a deep fear in American life: That your health-care insurance can be taken from you. That fear is so powerful because it happens so often: Almost everyone in the country can lose their health insurance at any time, for all kinds of reasons — and every year, millions do.
If you’re one of the 149 million people who get health insurance through your employer, you can lose your plan if you get fired, or if the H.R. department decides to change plans, or if you have to move to a branch in another state.
If you’re one of the 51 million people who get Medicaid, you could lose your plan because your income rises and you’re no longer eligible or because your state cut its Medicaid budget and made you ineligible. You could lose it because you moved from Minnesota, where childless adults making less than 75 percent of the poverty line are eligible, to Texas, where there’s no coverage for childless adults.
If you’re one of the 15 million Americans who buys insurance on the individual market, you could lose your plan because your insurer decides to stop offering it or decides to jack up the price by 35 percent. And that’s assuming you’re one of the lucky people who weren’t denied coverage based on preexisting conditions in the first place.
Then, of course, there are the 50 million people who don’t have a plan in the first place. The vast majority of them desperately want health-care coverage. But it turns out that just because you want a plan doesn’t mean you can get one.
Virtually the only people whose health coverage is reasonably safe are those on fee-for-service Medicare and some forms of veterans insurance. And even there, enrollees are only safe until the day policymakers decide to change premiums or benefit packages.
President Obama’s critics are right: Obamacare doesn’t guarantee that everyone who likes their health insurance can keep it. In some cases, Obamacare is the reason people will lose health insurance they liked.
What Obamacare comes pretty close to guaranteeing, though, is that everyone who needs health insurance, or who wants health insurance, can get it.
It guarantees that if you lose the plan you liked — perhaps because you were fired from your job, or because you left your job to start a new business, or because your income made you ineligible for Medicaid — you’ll have a choice of new plans you can purchase, you’ll know that no insurer can turn you away, and you’ll be able to get financial help if you need it. In states that accept the Medicaid expansion, it guarantees that anyone who makes less than 133 percent of poverty can get fully subsidized insurance.
Health insurance isn’t such a fraught topic in countries such as Canada and France because people don’t live in constant fear of losing their ability to get routine medical care. A decade from now, that will be true in the U.S., too. But it’s not true yet, and paradoxically, that’s one reason health reform is so difficult. The status quo has left people rightly fearful, and when people are afraid, change is even scarier.
By: Ezra Klein, Wonkblog, The Washington Post, December 8, 2013
“A Nightmare For John Boehner”: Why Obamacare Could Help The Democrats In 2014
If some Republicans are sounding just a little bit desperate right now, I think I know why. “Obamacare is not just a broken website,” House Speaker John Boehner sputtered the other day in retreat as it emerged that the website is now working well. “This bill is fundamentally flawed.” He sure hopes he’s right about that—and by the way, Mister, it’s a law, not a bill. But I bet late at night, when he’s having that last smoke and thinking back over his day, he fears that he’s wrong and that the central Republican…“idea,” if you want to call it that, of the last three years—get rid of Obamacare—is going to look awfully stupid to a majority of Americans eight or 10 months from now.
If you haven’t gone to HealthCare.gov just for kicks, I certainly recommend now that you do. Pretend that you’re from a state that didn’t create an exchange, if you aren’t, because if you’re from a state with its own exchange, you’ll just be kicked to the state website, and what you want to test here is the federal one. So just choose a yahoo state that didn’t play ball, where the law was mocked as just so much socialism.
I just did, for the first time in weeks, an hour before scribbling these sentences. I was amazed. It was lightning fast. Explanations were clear and straightforward. Instead of bureaucratese, I encountered something I didn’t expect at all: plain English!
And here’s the key thing. It gave me loads of choices. I pretended to be a 35-year-old man from Kansas with a spouse and child. Without even having to enter my fake income, the site delivered me in a split second to a page with loads of plan options.
Choice. That’s what America’s about. As I heard Sen. Joe Manchin (D-WV) say on Alex Wagner’s show a couple of weeks ago, we’re a nation of shoppers. It’s what we do best. Alas, he is correct. That’s what we want. From TVs to smartphones to flavors of potato chip that have been stretched to include ketchup and dill pickle (who eats those?), we believe that endless options are our right.
How many options? An amazing 42, to be precise. Forty-two plans! That might be more than the number of available potato-chip flavors in America. I would have to think it will shock people, in a highly positive way, to see they have so many choices. And most of all, it will feel…American. Something that offers a person 42 options ain’t socialism, as Americans know in their bones.
The plans ranged from $70 a month, which would have covered only me, to $742 a month for the Rolls-Royce family version, with $0 deductible and $6,500 out-of-pocket. It was an astonishing menu. And take it from a guy who just moved house and has been on the phone and online interminably with private-sector service-providers, mostly but hardly limited to the cable/Internet/phone company: This looked easy. The interface was great, really user-friendly, really clear.
Now, most of these plans weren’t cheap. Health insurance isn’t cheap. For example, a middle-of-the-pack silver plan looked like this: $472 a month; a $7,500 family deductible; a $12,700 out-of-pocket maximum. Those aren’t cheap. But a $10 copay for a doctor’s visit, $75 to see a specialist, and just $15 for a generic prescription. That’s not bad at all.
So yes, Mr. Speaker, it’s more than a website. It’s a chance for people who’ve eschewed insurance for years to buy it and take their kids to a doctor and even to a specialist when needed. Individuals will have to decide for themselves whether that buys them $5,664 in peace of mind (that’s $472 times 12), but I suspect a lot of people will decide that it sure does.
And this is where Republicans, if they’re looking around the corner, might be freaking out. They are going to emphasize the horror stories going forward, and those stories will exist. The Democrats will emphasize the violin stories, and they will exist, too.
But in between the decontextualized disasters and the stories with Hollywood endings will be millions of people to whom nothing particularly dramatic, but something very positive indeed, will have happened. They got insurance, or decent insurance, for the first time in their lives. They went and got their first physical in years. They had that bad back checked out finally. They took their child to an eye doctor and got her glasses. That’s not dramatic enough for a television ad, but any parent will understand that a child going from struggling with reading to being able to read easily at school is plenty dramatic.
I’ve known for a long time the Republicans were on the wrong side of history here. Forty-something million uninsured in this impossibly rich country, and they don’t want to do a thing about it. And don’t fall for their “plans.” They’re unworkable. They’re unworkable because the Republicans aren’t willing to spend the money that experts all say is required to make plans workable. And they aren’t willing to spend the money because spending money acknowledges the existence of a common purpose in this nation, and they certainly can’t acknowledge a common purpose, unless it’s war.
So while I’ve known they were on the wrong side of history, I have feared they were on the right side of the politics. Well, I’m starting to think otherwise. No American who has 42 choices is going to feel like the jackboot of the state is stomping on his neck. And sometime next year, the people in the states that didn’t take Medicaid money are going to start noticing something else: that in a lot of cases, they’re going to be paying more for the same plan that a person in a participating state is paying. How’s that going to go down, Rick Perry?
Mr. Speaker, light up another one. It’s going to be a long night.
By: Michael Tomasky, The Daily Beast, December 5, 2013
“Overheated, Half-Baked Advice”: No, Obama Doesn’t Have To Fire Everybody In The White House
In the wake of the disastrous rollout of HealthCare.gov, President Obama’s inner circle is taking a pounding.
Several anonymous Democrats recently dumped on Obama’s White House political aides in the pages of The Hill newspaper, suggesting they should be fired for dropping the ball on their boss’s top domestic priority.
Ron Fournier took a more direct approach. In a National Journal piece titled “Fire Your Team, Mr. President,” Fournier argued that Obama will never regain his standing with the public unless he overhauls his staff “so thoroughly that the new blood imposes change on how he manages the federal bureaucracy and leads.”
The “off with their heads” approach is just the latest manifestation of longstanding criticism that Obama’s group of advisers is far too insular, which in this case resulted in utter embarrassment for the administration.
But this overheated advice is half-baked for a few reasons.
Yes, the HealthCare.gov rollout is a headache for the White House, but early problems are typical of new government programs. In particular, ObamaCare’s hiccups are reminiscent of Social Security’s at the beginning. The eventual government audits may find instances of individual incompetence, but even if so, there likely won’t be evidence of a systemwide governmental breakdown warranting mass firings.
In fact, the Obama administration has a rather impressive managerial history, pulling off an $800 billion stimulus free of graft and boondoggles, executing the auto industry bailout, and providing scientific expertise to stop the BP underwater oil gusher. Any assessment of the Obama administration’s competence should factor in all it has done before demanding across-the-board career sacrifices.
Furthermore, panic firings breed more panic. Jimmy Carter learned this the hard way in 1979. Suffering from low approval ratings and a sputtering agenda, Carter sparked a fresh wave of support and renewed grassroots spirit with his daring “Crisis of Confidence” speech. But a few days later, he snuffed out his own momentum by demanding the resignation of his entire cabinet.
One Carter-era reporter recently told Politico, “Wholesale sacking of cabinet officers usually comes off as desperation,” and fed the perception of Carter as a “floundering leader.”
Contrast that to Franklin Roosevelt, who was suffering his lowest approval ratings in 1939 as fears circulated that the Social Security Board had failed to collect necessary wage data from employers and would be unable to cut millions of checks. Did FDR start firing people left and right? Nope. As his top Social Security man recounted decades later, “He wasn’t interested in it. He was bored stiff. I couldn’t have kept him interested in any of my woes. He laughed them off.”
Some people today say Roosevelt was a pretty good leader.
By: Bill Scher, The Week, December 5, 2013
“Brazen Dishonesty”: California GOP ‘Reaches For The Bottom’
Health care policy can get confusing, even for policy experts who study the details for a living. It’s one of the reasons dishonesty in the political debate surrounding health care is so damaging – even the most well-intentioned people often don’t know how best to separate fact from fiction.
It’s why efforts from political officials – who know better – to deliberately confuse people are so disappointing. Michael Hiltzik reports:
Opponents of the Affordable Care Act never stop producing new tricks to undermine the reform’s effectiveness. But leave it to California Republicans to reach for the bottom. Their goal appears to be to discredit the act by highlighting its costs and penalties rather than its potential benefits.
The device chosen by the Assembly’s GOP caucus is a website at the address coveringcaliforniahealthcareca.com. If that sounds suspiciously like coveredca.com, which is the real website for the California insurance exchange, it may not be a coincidence.
In theory, this is a site created by California Republicans to serve as a “resource” for those looking for additional information. In practice, the site “is worse than useless” – it didn’t direct users to the in-state exchange marketplace, and includes demonstrable falsehoods intended to deceive the public.
Like what? The site includes the ridiculous notion that the Affordable Care Act increases the federal budget deficit, which is the exact opposite of reality. It also claims the IRS will use the law to target conservatives; it says the law will discourage private-sector hiring; and it even hints in the direction of the death-panel smear by raising the specter of “rationing” for the elderly.
All of these claims are wrong. All of them are presented, however, on a website that presents itself as objective and non-partisan.
Stepping back, dishonesty on this scale is certainly brazen, but it raises anew a lingering question: if the Affordable Care Act is so awful, and will be as horrific as critics claim, why do Republicans continue to feel the need to make stuff up? Shouldn’t reality be damaging enough?
By: Steve Benen, the Maddow Blog, December 4, 2013
“$2,229.11 For Three Stitches?”: We Don’t Have To Wonder What The Unfettered Market In Health Care Produces, We’ve Been Living It
Twenty years ago I had my first knee surgery, after tearing some cartilage while skying for a thunderous dunk on the basketball court (or it might have been just falling backward while getting faked out on defense—who remembers the details?). Although I had insurance, I was responsible for a substantial copay, and I vividly recall the one item that stood out among the dozens on the bill. For the two steri-strips that covered an incision—tiny pieces of tape that even today cost about 20 cents retail, and which hospitals buy in bulk so surely cost them just a couple of pennies—I and my insurance company were charged $11, or $5.50 per strip. A miniscule amount in a five-figure bill, but it struck me as the most absurd, since it represented a markup of approximately 10,000 percent, if not more. More recently, I was getting some physical therapy for the same knee, and in what turned out to be a session that wasn’t covered by my insurance, a therapist put a piece of kinesio tape around my kneecap. The retail price for that length of tape is around 40 cents (though again, they buy it in bulk so it’s probably a quarter of that); and there was the therapist’s time to retrieve, cut, and apply the tape, which took about 60 seconds all told. Total tape charge: $75.
My experience is not at all uncommon, as an excellent piece in today’s New York Times explains. The article discusses things like people getting charged thousands of dollars to have a couple of stitches put on a finger, or my personal favorite, the $137 charge for an IV bag that costs the hospital one dollar. There are a number of reasons why they can get away with this, including the fact that nobody tells you what the charges are going to be before you’re treated, and the fact that information is diluted through the insurance system.
But since we’re now talking about what government is and isn’t capable of handling when it comes to health care, allow me to repeat something I’ve argued elsewhere: The government didn’t give us this kind of price-gouging, just like the government didn’t give us 50 million uninsured Americans. Nor did the government give us lifetime and yearly caps on coverage. Nor did the government give us now-outlawed “rescission,” in which your insurer cancels your coverage because you got sick. Nor did the government gave us denials for pre-existing conditions. You know what gave us all that? The free market. Government can certainly cause problems, but just about all the major reasons our health-care system is so expensive and serves so many people so poorly (or not at all) are the result of the free market.
Or more specifically, the health-care market, which is so different from other kinds of markets. The unique features of health care are what makes a far higher level of government involvement than exists in the markets for wristwatches or shoes necessary. If we don’t want to have a system that costs so much more than every other one in the world while giving us crappy results, then we’re just going to have to accept that. In other industrialized countries, the government says, “We can’t sustain a system in which an MRI costs $1,200. So an MRI is going to cost $300.” And guess what? The MRI manufacturers and the hospitals accommodate themselves to that reality, and not only do they manage to survive, but people still get MRIs when they need them.
If maintaining the ability of certain people to suck as much profits from the health-care system as possible is your highest value, you find that unacceptable. But if having a system that serves everyone, maximizes health, and is affordable rank higher for you than making sure there are hospital systems with 28 different executives pulling down salaries of over $1 million a year, you have to make a different choice.
And let’s be clear about this: what conservatives are arguing for is the maintenance of the status quo that gives us the $2,229.11 hospital charge for putting in three stitches. It was their devotion to the primacy of market freedom in health care that put us where we are now. When the government doesn’t work properly, by, say, making a terrible website that took months to fix, the answer is to make it work better. Because we don’t have to wonder whether the alternative is worse. We’ve been living it.
By: Paul Waldman, Contributing Editor, The American Prospect, December 3, 2013
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