“Like It Or Not, Obamacare Is Moving Forward”: For Certain People, This Isn’t As Good A Story As The Website’s Implosion Was
HealthCare.gov just tweeted that more than 375,000 had visited the refurbished federal website as of noon today. White House press secretary Jay Carney confirmed the figure shortly after.
So demand still appears to be there, despite weeks of deservedly awful press about the website and the law, and weeks of Republican claims that the law is so disastrously flawed that it cannot be rescued.
Along those lines, Kevin Drum captures what matters most about the news of the moment in one half a sentence:
if you need to buy health coverage via healthcare.gov, you can do it
This really is the rub. Sure, there will be continued problems. Charles Ornstein personally had a terrible experience. Sarah Kliff found the site is still not working for everybody. And the snafus at the back end may persist, too.
But the big picture is that far more people who need health insurance — whether they were bumped from plans or whether they were previously uninsured — will now be mostly able to go online, do some shopping, and buy health insurance. Before, they couldn’t.
This isn’t as good a story as the website’s implosion was, and if the site continues to function as expected, it will mostly stop getting media coverage. The press will move on to the next Obamacare disaster story, should it materialize: The “keep your doctor” saga, coming soon via Republican press release directly to reporters’ inboxes.
But the current fix has mostly tamped down concerns among Democratic lawmakers, and barring some truly catastrophic change, they just aren’t going to abandon the law in any meaningful sense. Meanwhile, demand looks likely to continue, even as insurance companies redouble their efforts to entice people on to the exchanges, which means enrollment will continue piling up, too.
Will it be enough? It’s too soon to say. Republican lawmakers and their voters have been 100 percent certain for some time now that Obamacare has already collapsed, but for everyone else, the law’s long term prospects will turn mostly on what that enrollment looks like over time. And for that, we’ll just have to wait.
By: Greg Sargent, The Washington Post, December 2, 2013
“Coverage That Is Surprisingly Affordable”: As Glitches Fade, Obamacare Approval Will Rise
The latest polls on Obamacare are bleak. A Kaiser Family Foundation survey found that almost half of those questioned last week had an unfavorable opinion of the law. Just a third had a favorable opinion, even less than the 40 percent support for the law in the Nov. 14 Gallup poll.
But those poll numbers will change as more people like Bob Freukes of St. Louis and Donna Smith of Denver are finally able to shop for coverage on the new health insurance websites — and find coverage that is surprisingly affordable.
Considering all the negative stories about the malfunctioning HealthCare.gov website and policy cancellations folks have been receiving, the steep decline in support for Obamacare shouldn’t surprise anyone.
But in the very week that poll numbers reached an all-time low, people who had tried for more than a month to enroll online in a health plan were finally able to do so.
Just minutes after the administration’s tech surge team said 90 percent of applicants were now able to enroll online, I started getting emails from people eager to share their success stories.
“My wife and I are both self-employed small sole proprietors,” wrote Freukes, a photographer. “This will be the first time in our married lives we will have health insurance.”
Freukes said that over the course of the past year, he and his wife — married 30 years and are now in their fifties — rarely went to the doctor because of the expense.
“We paid for doctor visits, prescriptions, eye glasses and everything else out of [our] own pockets, always knowing we were one major illness away from bankruptcy.
“We tried to find an affordable policy, but the going rate for my wife and me was roughly $900-$1,400 dollars a month with deductibles in the $5,000 range.” Considering that their combined annual income is often no more than $25,000, health insurance was out of the question.
Not only will they finally have coverage starting January 1, it will cost the Freukes less than they had expected because of the federal tax credits available to low- and middle-income individuals who buy coverage on the state exchanges. In fact, with the tax credits, the Freukes will not have to pay monthly premiums at all.
“I sat rubbing my eyes in amazement as the website did the math. Our portion of the premium for both plans was ZERO. No cost to us at all. I was stunned.”
Donna Smith wasn’t that fortunate, but she at long last will be able to get a comprehensive policy that she can afford.
Like Bob Freukes, it took Smith weeks of effort before she was finally able to enroll in a plan. Her delay, though, was caused by a different, though no less frustrating quirk in the system. Colorado is one of 13 states and the District of Columbia operating their own exchanges, which generally have experienced fewer problems than the federal website, where residents of most states have been sent. Several thousand people were able to begin the application process in Colorado but they had to wait — and wait and wait — while state officials checked to see if the applicants were eligible for Medicaid.
Smith knew her income was too high to qualify for Medicaid, but she nevertheless had to fill out an extensive questionnaire and was put in what she described as a “bureaucratic black hole” for 37 days. It was an agonizing wait for Smith, a cancer survivor who — along with husband Larry — had to file for bankruptcy several years ago because of medical debt. If her name sounds familiar, by the way, it might be because you’ve seen her in the movies. When she wrote filmmaker Michael Moore about her plight, he included her in the 2007 documentary, SiCKO. Since then she has been an active supporter of health care reform.
After she finally got the Medicaid denial she was expecting, Smith called Connect for Health Colorado — the name of the state exchange — and worked with an employee to complete her application.
“If people can get through the Medicaid process, I think they’ll be pleasantly surprised,” said Smith, who has been paying $875 a month for an individual policy. Beginning next year, she will be covered in a better plan, but it will cost her only $450 a month after factoring in a $72 federal tax credit.
As happy as she was to discover she will soon have affordable coverage —and that it can’t be canceled if her cancer returns, thanks to Obamacare — she still believes a single-payer, Medicare-for-all type system would be better.
She has a point. The Affordable Care Act is far from perfect. But in the coming months and years, millions of us who have been unable to find affordable coverage will at long last be insured. Poll numbers will eventually reflect that.
By: Wendell Potter, The Center for Public Integrity, November 25, 2013
“Obamacare, A Question Of Morality”: Indifference To The Needs Of Others Is, Indeed, Immoral
There was a lot of bloviating about the Affordable Care Act on the talk shows last weekend. The Obamacare critics’ chief focus was the open-enrollment fiasco, the un-kept presidential promise and the millions of cancellation notices. Overlaying the palaver was the unrestrained glee of health-reform opponents.
The same weekend, in a section of our nation’s capital where pompous politicians and self-important opinion-makers seldom venture, the Affordable Care Act was the subject of thanks and praise at the First Baptist Church at Randolph Street and New Hampshire Avenue NW.
The talk-show criticism and the pulpit defense crystallized the Obamacare debate. Drawn into sharp relief is the struggle taking place in this country between doing what is right and good and an unashamed indulgence in the immorality of indifference.
The issue couldn’t be put more simply.
Forty-nine million Americans do not have health insurance. For many of them, the ability to deal with their illnesses and injuries depends on their ability to pay. Lacking the money, some of them just go without the care they need. Better to put food on the table for the kids than to check out that awful pain in the gut. Can’t afford to do both.
Which helps explain why the Affordable Care Act is viewed more kindly by the congregation at First Baptist Church, located a few miles from the shadow of the Capitol, than by those within the governmental structure.
First Baptist celebrates its 150th anniversary this year, having been founded in Southwest Washington by freed slaves in 1863 .
The church’s broad ministry includes parts of the city where good health care is an unaffordable luxury.
The Rev. Frank D. Tucker, who has been First Baptist’s pastor for nearly 38 years, used Sunday morning’s service to address Obamacare in terms its critics do not.
He announced that First Baptist, working with the city’s health-care exchange, DC Health Link, would host a health insurance enrollment fair on Saturday. He issued an emotional call to his congregation, young and old, to enroll in the program, resorting to language associated with the battle to win the right to vote.
Tucker noted the decades of unsuccessful efforts by several presidents to extend medical care to all Americans, including those living in dire circumstances beyond their control. Not sugar-coating the problems that President Obama has encountered in bringing about health-care reform, Tucker hammered at the obligation of the uninsured to enroll in the insurance program that Obama and other health-reform advocates have worked so hard to create. The Obama administration and its congressional supporters, Tucker observed, have been opposed every step of the way, taking a beating from people in Congress and around the country. Don’t let their sacrifices be in vain by sitting on your hands, he contended. Get enrolled, he declared.
And Tucker wasn’t even Sunday morning’s featured speaker. That honor fell to William P. DeVeaux, the presiding bishop of the African Methodist Episcopal Church’s second district, which covers the nation’s capital. DeVeaux’s presence, however, made Tucker’s appeal more compelling because DeVeaux’s message drew heavily on the scriptural command to serve others. It reinforced Tucker’s appeal to give all Americans the health security they deserve.
Tucker, DeVeaux and other members of the cloth are those whom the opponents of health-care reform are up against.
Gaining access to no-cost preventive services to stay healthy, which Obamacare provides, is not a sign of indifference. Neither is giving senior citizens discounts on their prescription drugs, or allowing young adults to get health insurance on their parents’ plan, or ending insurance company abuses. Those steps represent the caring actions of government.
In his apostolic exhortation this week, Pope Francis said he begged “the Lord to grant us more politicians who are genuinely disturbed by the state of society, the people, the lives of the poor!” Referring to the “excluded and marginalized,” the pontiff said that “it is vital that government leaders . . . take heed and broaden their horizons, working to ensure that all citizens have dignified work, education and healthcare.”
That, too, is where the health-reform resisters come up short. Their horizons are too narrow to notice or care about people who lead lives stunted by lack of opportunity. Stunted lives leave the critics unmoved.
And that’s why, when the bloviators take to the airways, preachers like the Rev. Tucker, Bishop DeVeaux and Pope Francis take to the pulpit.
They know that indifference to the needs of others is, indeed, immoral.
By: Colbert I. King, Opinion Writer, The Washington Post, November 29, 2013
“Are The Obamacare Clouds Breaking?”: Love It Or Hate It, Obamacare Is Here To Stay
This morning, I was listening to NPR—because yeah, I’m an effete pointy-headed liberal and that’s how I roll—and I heard a story about people in California who got insurance cancellation notices, but then wound up getting better coverage and couldn’t be happier about it. And the other day there was this story in The Washington Post about droves of poor people in rural Kentucky getting insurance for the first time in their lives—free, through Medicaid—because of the Affordable Care Act. In other words, after spending weeks telling the tales of people losing their health coverage (who in truth could get other health coverage), the media are finally putting at least some attention on the people who are benefiting from the ACA.
And encouraging news seems to be breaking out all over. Ezra Klein and Evan Soltas ask, “Is Obamacare Turning the Corner?”, noting that Healthcare.gov seems to be working pretty well, at least on the front end. States with well-functioning web sites like New York and California are meeting or exceeding their enrollment targets. Steve Benen concurs on the corner-turning interpretation. Kevin Drum argues that “Getting Obamacare to the end zone wasn’t easy, and Obama almost fumbled the ball at the one-yard line, but he’s finally won. There’s nothing left for conservatives to do. Love it or hate it, Obamacare is here to stay.”
That isn’t to say that there aren’t lots of problems left to be sorted out. Nor is it to say that the media are done with Obamacare “horror” stories. For instance, last night, NBC News aired this story about employers moving to more modest plans to avoid the “Cadillac tax” on high-cost health plans, complete with disgruntled employees. The piece didn’t bother to explore why an employer might choose a plan for 2014 based on a tax that doesn’t take effect until 2018, other than including a quote from a health-industry consultant claiming that employers “are going to have to get ready for it now,” which makes no sense at all. Think there might be a story there about companies making a decision to scale back benefits and save money but just blaming it on Obamacare? Maybe?
Anyhow, it does appear that we’re starting to edge toward a more balanced media discussion of the successes and failures of this law. I’ll stick to the prediction I’ve made for some time, that the law will be fine. When that December 1 deadline for fixing the website comes, reporters will find that it’s not perfect, but it’s pretty good. In the medium term, the law will do a lot of good for a lot of people, but it won’t transform America into a health care paradise, nor will it drag us into a nightmare of communist oppression. It will have problems, most of which will get sorted out. And the political impact? That will probably be something of a wash as well. Republicans will still be able to go to their conservative constituents and say, “I fought against Obamacare!” as proof of their right-wing bona fides. Democrats will still be able to go to their constituents and say they made it so nobody would get rejected for insurance because of a pre-existing condition. Eventually, Republicans will find something else to shout about.
And who knows, maybe these kinds of problems getting fixed will create a new narrative of success around the ACA: Despite terrible obstacles and mistakes, the administration found its way and delivered for the American people, redeeming liberalism in the process! Weirder things have happened.
By: Paul Waldman, Contributing Editor, The American Prospect, November 26, 2013
“A Reminder Of The Essential Truth”: You Might Lose Your Doctor, But Don’t Blame Obamacare
Obamacare critics on the right think they have a new issue. They are calling it “provider shock.” Thanks to the new health care law, these conservatives say, insurance companies are limiting beneficiaries to small groups of doctors and hospitals. As a result, people who depend on these professionals and institutions will have to seek treatment elsewhere—and, inevitably, get substandard care.
When conservatives make these arguments, I imagine they have in mind stories like this one, from the Los Angeles Times:
In a major shift in health-care benefits likely to be followed by others, PacifiCare Health Systems Inc. today will unveil an HMO that will limit members’ choices to a relatively small network of doctors and hospitals. … members who enroll in the plan, called Value Network, will have available to them about one-third of the hospitals and one-half of the doctors of a standard HMO. Altogether, there are 300 hospitals and 250 medical groups in California. Value Network members who use providers outside the slimmed-down network generally will have to foot the bills.
If you’re a fellow health policy geek, then you may have guessed the punch line. This article isn’t from 2013. It’s from 2002. And it’s a reminder of the essential truth here. Insurance companies have been using limited provider networks for a long time. It’s how they conducted business before Obamacare came along and, for better or worse, it’s how they’ll conduct business now that Obamacare is law.
Maybe a little history would put this issue in its proper context. Once upon a time, most insurance carriers would pay for care provided by pretty much any person or facility with a license. But that got expensive and, by the 1980s, insurers responded by reducing what they would pay for services—and then limiting beneficiaries to networks of doctors and hospitals willing to accept these lower fees.
The change was not particularly popular. At the time, Americans were not accustomed to such restrictions on where they got their medical care. In response to the consumer and political backlash—a backlash that providers happily supported—insurers started offering plans with looser restrictions. Mostly these were preferred provider organizations (PPOs), which allowed beneficiaries to seek care out of network as long as they were willing to pay more for each visit and service. But provider restrictions never went away entirely and frequently negotiations over the terms led to very public disputes, as Paul Fronstin, from the Employment Benefit Research Institute, pointed out via e-mail:
There have been numerous stories over the last decade of usually health plans dropping a large provider group because the provider group wouldn’t accept the rates, or less-usually a provider group walking away from a health plan because it didn’t like the terms. Often the two would come to terms after some period of continued negotiation once the contract expired and the news hit the fan, so to speak.
More recently insurers have shown renewed interest in tighter networks, sometimes through what’s known as “tiered network” plans that operate as a sort of hybrid between HMOs and PPOs. (These plans allow people to get care out of network, but only at much higher out-of-pocket costs than more traditional PPOs would require.) And it appears the Obamacare exchanges have lots of these plans.
While I haven’t seen definitive nationwide data, a report from the Center for Healthcare Transformation and Research found that, on Michigan’s new exchange, the majority of options are “limited or network plans.” In California, where narrow networks have gotten a great deal of media attention, the plans Blue Shield is offering will allow access to just 36 percent of the physicians available in Blue Cross employer plans, according to the L.A. Times. And when McKinsey and Company surveyed 16 state exchanges earlier in the year, it found that about half the plans had narrow networks, according to an article in Modern Healthcare magazine.
But Obamacare’s relationship to this trend is more complicated than it might seem. On the one hand, the law has introduced volatility into the insurance market, potentially emboldening insurers who were contemplating tightening networks already. As Karen Pollitz, a senior fellow at the Kaiser Family Foundation, explained via e-mail:
Without question, some insurers took this opportunity—when things are changing and so the old ways of doing business could be shaken up—to offer new, tighter, cheaper network designs. And probably without a clear idea as to what impact it might have on patients. Also without question, some hospitals and doctor groups took this opportunity to take a tougher bargaining stance and demand higher payments from insurers to join their networks, betting the insurers couldn’t live without them, and the insurers called their bluff. It’s not obvious providers knew clearly what the patient impact would be, either.
With Obamacare, and its requirement of selling policies to anybody willing to buy them, insurers also worry about adverse selection. Previously, they were willing to offer plans without provider restrictions, but only to people unlikely to use either outpatient or inpatient services much. Now insurers have to sell plans to anybody, regardless of pre-existing conditions or risk of illness. In other words, they can’t restrict wide-open access to the people least likely to use it. Faced with this reality, some insurers are bound to raise premiums for those plans—or to stop offering them altogether. That’s why some people who buy these plans now would have to pay more for them next year. (Basically, this is just another form of rate shock, about which you’ve read so much already.)
Still, according to nearly every source inside and outside the industry I’ve consulted, the primary reason carriers are offering so many small-network plans in the exchanges is that they believe consumers want them. Their marketing research suggests that, when forced to choose between paying higher premiums for wider networks or lower premiums for narrower networks, the majority of people will go for the cheaper insurance. The one survey I’ve seen on this question, by Morning Consult, suggests the carriers may be right: In that survey, nearly 60 percent of respondents said they’d opt for plans with fewer provider choices if it meant saving on premiums.
Larry Levitt, senior vice president of the Kaiser Family Foundation, summarizes the situation this way:
The main way insurers control costs is by negotiating and selectively contracting with doctors and hospitals. That’s been the case for decades. The only real connection to the Affordable Care Act is that the health reform law is making insurers compete for customers more aggressively.
As it happens, the narrower networks might be a good fit for many consumers, both financially and medically. Totally lost in this debate is the fact that many experts believe our health care system pays the providers of medical care way too much money. That’s particularly true of hospitals, whose obtuse and frequently unjustified prices were the subject of Steve Brill’s celebrated Time magazine article earlier this year. Sometimes high prices correlate with high quality, but sometimes they don’t. And particularly when it comes to more routine care, a community hospital is not just adequate but maybe even preferable to a teaching hospital that specializes in the hardest-to-treat cases.
Of course, the converse is also true. A few people have those hardest-to-treat cases. They are the ones who are better off at a place like Cedars-Sinai or the Mayo Clinic—or who need to maintain long-term relationships with professionals, rather than switching every time plans alter their networks. They are also the people whom, ideally, health insurance should do the most to assist.
But it’s not as if most people in this situation have unfettered access to such doctors and hospitals today. And Obamacare has provisions designed to help them. Most of the exchanges seem to include more traditional PPOs. They are expensive, but they are available to anybody—including people who, because of pre-existing conditions, previously had absolutely no way to buy them. (There are also subsidies that some people can use to offset the cost.) In addition, the Affordable Care Act has a “network adequacy” requirement that, in theory, requires all plans to include hospitals that provide specialty services like pediatric cancer treatment. The law even creates an external appeals process, through which people with private insurance can seek medically appropriate care they believe their carriers cannot (or will not) provide.
There’s a good case for strengthening these two provisions, which are relatively weak, or for taking other steps to help people who depend upon the most advanced hospitals and/or a set of familiar providers. The federal government could, for example, offer more financial incentives for the creation of Accountable Care Organizations, which are closed-network groups of providers designed to deliver the same kind of high-quality, low-cost care you find today at places like Kaiser Permanente, Geisinger Health System, and Group Health of Puget Sound. More states could set hospital rates, as Maryland already does, effectively taking price negotiation out of the market and subjecting it instead to regulation. Or there’s the most radical solution of all: Simply junking private insurance and creating a single-payer system, which would operate more or less like Medicare and would, in practice, mean access to most physicians and virtually every hospital.
None of these things are likely to happen anytime soon. They involve greater government regulation of health insurance, which would be fine with most Obamacare supporters but anathema to the law’s critics. That’s one irony of this latest controversy, as Jonathan Chait pointed out on Monday. Market forces, not government, and the main reason insurers are introducing tighter networks. Yet the people objecting to the result are the same ones who say they love markets.
By: Jonathan Cohn, The New Republic, November 26, 2013
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