“About Those Canceled Plans”: When “Victims” Become Beneficiaries
When pressed for specifics, the Affordable Care Act’s detractors tend to focus on two main areas of concern: the website and the cancelation notices. The website is obviously important and administration officials are doing what they can. Maybe it’ll be fixed quickly, maybe it won’t – we’ll find out soon enough.
But the cancelation notices are a different kind of concern. As we’ve discussed, we’re talking about a very small percentage of the population that has coverage through the individual, non-group market and are now finding that their plans are being scrapped. When the House Republican “playbook” looks for people saying, “Because of Obamacare, I lost my insurance,” these are the folks they’re talking about.
But the story about these “victims” of reform is coming into sharper focus all the time.
Only a small sliver of the Americans who buy their own health insurance plans and may be seeing them canceled under Obamacare will pay higher premiums, according to an analysis released Thursday.
More than seven in 10 Americans who purchase health plans directly will get subsidies to help pay for coverage under the Affordable Care Act, according to the report by Families USA, a Washington-based organization that supports the health care reform law.
“It is important to keep a perspective about the small portion of the population that might be adversely affected,” said Ron Pollack, executive director of Families USA. “That number is a tiny fraction of the 65 million non-elderly people with pre-existing health conditions who will gain new protections through the Affordable Care Act. It is also a small fraction of the tens of millions of uninsured Americans who can also get help.”
Let’s put this another way. A tiny percentage of consumers will receive cancelation notices, and of them, more than 70% will get new, more secure coverage that ends up costing them less.
They’re not, in other words, victims. They’re beneficiaries.
In fairness, many of them won’t know this for a while because they can’t yet go to healthcare.gov and see how much they’ll benefit, but we’re talking about the health care system itself – for all the talk about the cancelations, by a 2-to-1 margin, these folks are going to be better off, including receiving subsidies through the Affordable Care Act.
In reference to the remaining folks who’ll pay more, Pollack told the Huffington Post, “That’s approximately 1.5 million people, and that’s not trivial and I don’t in any way suggest that we shouldn’t be concerned about that group. But … the number of people at risk of this becoming a problem is considerably smaller than the tens of millions of people who are going to get substantial help.”
And here’s the larger question: if the evidence had pointed in the other direction, and 71% of these folks were poised to pay more, not less, would the story have gotten more attention? Would the coverage be dominated by “More bad news for Obamacare”?
This week, after years in which Obamacare critics said the law would fail to control costs, we saw remarkable evidence that the law is succeeding in controlling costs. Didn’t hear much about that? Neither did I.
I’m starting to get the sense that there’s an approved narrative – the Affordable Care Act is failing and is in deep trouble – and developments that point in the opposite direction are filtered out, while developments that reinforce the thesis are trumpeted.
The debate is often confusing enough, but this isn’t helping.
By: Steve Benen, The Maddow Blog, November 22, 2013
“A Right Wing Non-Plan”: Ted Cruz Reveals He’s A Thin-Skinned Wuss, Hypocrite And Policy Lightweight
Sen. Ted Cruz pretends to be a tough guy, but mostly he spends his time trashing Democrats in front of adoring right-wing crowds and conservative journalists. On Wednesday he sat down with CNN’s Chris Cuomo – you didn’t expect him to go to MSNBC, did you? – and showed himself to be incredibly thin-skinned when pressed just a little on how he would replace the Affordable Care Act he wants to repeal. It was an interesting window on Cruz’s temperament as well as his cynical, threadbare “policy” agenda.
Cuomo asked Cruz how he would replace the law he inveighs against, and as usual, Cruz dodged the question and kept on inveighing instead. Cuomo followed up. “You don’t think that you have a responsibility as a U.S. senator to do better than that, in terms of offering a solution for what to do next?” he asked.
And Cruz shot back: “Well, I appreciate your trying to lecture me in the morning.”
Cuomo didn’t leave it there.
“No, no, no, not at all, Senator. I’m worried, same as you, anybody who looks at the situation has worries.”
So Cruz tried to turn the tables. “If you’re worried, did you speak out for the 5 million people who have lost their health insurance?”
Cuomo had an answer: “Absolutely — we’ve been covering it doggedly. The problem is, I don’t have the power to fix it. You do. That’s what a U.S. senator does, is you sponsor law. You know this. It’s not a lecture, it’s a concern; I’m asking, what are you going to do about it?”
Apparently Cruz isn’t used to being grilled. Cuomo got him to share what passes for an answer from conservatives these days: “Let people purchase health insurance across state lines.”
Wow. That’s what Princeton and Harvard Law degrees get you: a warmed-over right wing non-plan that’s been around forever. As Ezra Klein reported back in 2010, the Congressional Budget Office looked at it in 2005 and found it didn’t reduce the number of uninsured and would only save the federal government $12 billion over the next eight years. (By contrast, the CBO says the ACA will reduce the deficit by $41 billion in 2013 alone.)
The CBO also found that allowing people to buy insurance plans across state lines would “make insurance more expensive for the sick and cheaper for the healthy, and lead to more healthy people with insurance and fewer sick people with insurance.” Other than that, it’s a terrific idea.
Of course, insurers like Cruz’s non-plan because it would mean a boon for the states that provide the least regulation and thus encourage the “cheapest” but least protective insurance policies. Rather than insuring states’ rights and competition, which conservatives pretend to like, it would, in effect, create a national insurance-regulation standard, as states then raced to the bottom to compete. Of course, a state’s “rights” usually diminish, for conservatives, whenever that state decides to give its citizens more power and its corporations less.
So in just one morning, Ted Cruz was revealed as a wuss, a hypocrite and a policy lightweight. The last one doesn’t matter on the right, but the first two won’t wear well in a presidential race. Kudos to Cuomo for not accepting Tea Party platitudes as a substitute for governing proposals.
By: Joan Walsh, Editor at Large, Salon, November 20, 2013
“Blaming Obamacare Is A Smokescreen”: Sorting Out The Real Reasons Why Insurers Cancel Health Insurance Policies
Now that President Obama has said it’s OK with him if insurance companies keep their policyholders in health plans that don’t meet the standards established by the Affordable Care Act, at least for another year, the big question is whether insurers will take him up on the offer.
The answer: it depends.
Some insurance executives will view the offer as one they can’t turn down. Even though Karen Ignagni, president of America’s Health Insurance Plans, the industry’s big PR and lobbying group, had nothing good to say about Obama’s proposal, keep in mind that she doesn’t run an insurance company. While industry executives look to her to comment on what politicians do, they make their own decisions when it comes to their companies’ bottom lines.
Here’s what Ignagni was quoted as saying in a FOX News story Friday:
“The only reason consumers are getting notices about their current coverage changing is because the ACA (Affordable Care Act) requires all polices to cover a broad range of benefits that go beyond what many people choose to purchase today.”
Not so fast. There are other reasons some folks are being told they’ll have to change health plans next year. Many of them are having to switch plans not because of Obamacare but because their insurance companies want to move them into policies with higher profit margins.
Insurance companies have been sending similar notices to their customers for years. My son Alex — and thousands of other customers of a Blue Cross plan in Pennsylvania — got such a notice four years ago, months before Congress passed the health reform law.
Why? The insurer wanted to move those policyholders out of a plan with a reasonable $500 annual deductible and into one with a deductible ten times that amount. To accomplish that, Blue Cross notified its policyholders that their health plan would not be available in 2010. Their options were to switch to the high-deductible policy, which would still cost them a couple of dollars more each month, or to another plan with that reasonable $500 deductible. If they chose the latter, their monthly premiums would increase 65 percent.
Notices like the one Alex got have provided a mechanism for insurers to implement a years-long industry strategy of shifting more and more of the cost of medical care to their policyholders. And that strategy will continue until every last one of us is in a high-deductible plan.
Some of you are likely old enough to remember the days before managed care when almost all Americans with private health insurance were in indemnity plans. In an old-fashioned indemnity plan, the insurer didn’t constrain us in a limited network of doctors and hospitals and didn’t call the shots about whether a knee replacement or liver transplant your doctor recommended was really necessary.
Those days are long gone. Everybody eventually got notices that those plans were being discontinued. They were replaced by HMOs and PPOs with limited provider networks and armies of utilization review nurses and medical directors who decided if you would get coverage for your new knee or new liver.
In most cases, it was our employers who killed off the indemnity plans in favor of managed care. But eventually, HMOs and PPOs also fell out of favor. The managed care backlash of the late 1990s forced insurers to abandon some of their utilization review practices and to add more doctors and hospitals to their skinny networks. That led to shrinking profit margins — and to the latest silver bullet from the insurance industry: high-deductible plans.
Before Obama signed the Affordable Care Act, insurance companies already were making rapid progress in implementing their business plans of “migrating” their customers from traditional managed care plans to so-called “consumer-directed” plans, the industry euphemism for high-deductible policies. At the same time they’ve been requiring us to pay more out of our own pockets for care, they’ve also been implementing a strategy of reducing benefits. Investors and Wall Street financial analysts refer to these common industry practices as “benefit buydowns.” That’s another euphemism, by the way.
I myself — and thousands of my fellow Cigna employees — were notified several years ago, long before I left my job, that our HMOs and PPOs were being discontinued. Yep, we got notices in the mail. If we wanted to stay in a Cigna-subsidized health plan, we would have to switch to a high-deductible plan. The same thing has happened to tens of millions of other Americans in recent years.
Yet if you relied on the Washington media for your news and information about health care, you’d think that insurance companies would never have considered sending policy discontinuation notices to their policyholders until forced to do so by Obamacare.
The truth: they have always done this when profits were at stake.
Which is why some insurers will be happy as clams to be able to keep their policyholders in plans that don’t meet the ACA’s standards. Many of those plans — especially the junk insurance plans many folks are in — are exceedingly profitable.
For people who are in those plans who have complained about their discontinuation notices, I hope they will shop around. Chances are, they’ll be able to get much better coverage at a better price. Thanks to the Affordable Care Act.
By: Wendell Potter, The Center for Public Integrity, November 18, 2013
“Things Are Neither Perfect Nor Disastrous”: Obamacare Panic To Enter Even Stupider New Phase
No, Democrats are not abandoning it en masse, and no, it isn’t going to be repealed.
I want to follow up on what I wrote Friday about those who are deciding that because of a) web site problems and b) the largely manufactured controversy over people who have one private insurance plan but now face the unfathomable horror of moving to a different private insurance plan, the Affordable Care Act is an unrecoverable disaster that has destroyed Barack Obama’s second term. I’m sensing that this is about to move into a new phase of inane speculation that we should think about before it starts.
I’ll just use one article as an example. This morning, under the headline “Why Obamacare Is On Life Support,” Josh Kraushaar of the National Journal all but declares that the law is about to be repealed. “Unless the HealthCare.gov website miraculously gets fixed by next month,” he writes, “there’s a growing likelihood that over time, enough Democrats may join Republicans to decide to start over and scrap the whole complex health care enterprise.” That’s so blindingly stupid I’m almost not sure where to start, but let’s give it is a shot. First, would it really be “miraculous” if Healthcare.gov got fixed by next month? It’s a website. Yes, a complicated one, and yes, one that had many problems. But it isn’t as though those problems are somehow beyond the ken of human ingenuity to solve, requiring heavenly intervention. The administration isn’t trying to achieve faster-than-light transport or make us all immortal. It’s a website. It may not be perfect, but it’ll work.
Kraushaar then goes through some counting of vulnerable Democratic seats in both houses to argue that it’s a real possibility that a repeal of the entire ACA could not only pass, but pass with a wide enough margin to override a veto from the President. His main evidence is the 39 House Democrats who voted last week for a symbolic Republican proposal to undo some of the individual-market reforms; he thinks the number for full repeal of the ACA will be even greater. But that’s completely backwards. It would take some kind of as-yet-unforeseen utter catastrophe to transform even those votes into a vote for full repeal. As Jonathan Bernstein says, “There’s an enormous difference between playing along on a symbolic vote and abandoning a policy Democrats are stuck with, like it or not.” Not even House Democrats from swing districts are dumb enough to think that voting to repeal the law would serve their political interests, despite Kraushaar’s bizarre and demonstrably false assertion that already, “Even [the ACA’s] most ardent supporters are running for the hills.”
If you’re going to start speculating about repeal, you have to confront what’s going to happen six weeks from now, on January 1. Let’s have a little reminder:
- Millions of people will begin getting coverage through Medicaid. Repeal would mean kicking these people off their insurance.
- Millions of people will begin getting subsidies to pay for private insurance. Repeal would mean taking away their subsidies, making it unaffordable for them to get insurance.
- Denials for pre-existing conditions will be officially over. Repeal would mean that once again, insurers could deny people coverage if they’ve ever been sick.
- Annual limits on coverage will be outlawed. Repeal would mean that people will once again start being forced to pay huge medical bills, in many cases forcing them into bankruptcy, if they have a serious illness or accident.
And that’s not to mention the parts of the bill that have already gone into effect, like “rescission” becoming illegal, children not being allowed to be denied coverage for pre-existing conditions, or young people being allowed to stay on their parents’ insurance until they’re 26. You think some news stories about people in the individual market having to pay more for a new insurance plan tug at lawmakers’ heartstrings? Wait until you see the stories about the 5-year-old girl with leukemia who’ll get kicked off her coverage if Republicans in Congress have their way. Right now we’re talking about a few people who are supposedly the “losers” in the ACA, but the most they’ve lost is some money they’ll have to pay for a more comprehensive plan. If you repeal the law, the country would be overflowing with people whose losses are genuinely catastrophic.
January 1 is the end of any talk of repeal, and Republicans know it—as many of them have been saying all along, once you start giving people benefits, it’s all but impossible to take them away. That doesn’t mean there isn’t still work to do, and it doesn’t mean there aren’t things that could go wrong. Nor does it mean there might not be piecemeal fixes to one or another provision debated in the future; there almost certainly will be. But unless you think that in the next six weeks Republicans are going to manage to put together a two-thirds majority in both houses of Congress to repeal the ACA—something you’d have to be nuts to believe—it’s never going to happen.
I realize that there’s an impulse as a reporter or a pundit to cast everything in the most dramatic terms possible. “Things are neither perfect nor disastrous” is a much less interesting assertion to make than “Everything has changed! Earth-shattering developments are afoot!” But that happens to be the truth.
By: Paul Waldman, Contributing Editor, The American Prospect, November 18, 2013
“Such Noble Sentiments”: Why Republicans Suddenly Care, Deeply, About All Those Canceled Health Policies
Amid the current national uproar over the troubles of the Affordable Care Act, it is almost uplifting to hear the deep concern expressed by politicians, pundits, lobbyists, and corporate leaders over cancellation of existing health insurance policies. They empathize loudly with the millions of potential victims, whose plight infuriates these worthy observers. They fill hours of television and pages of print with expressions of outrage.
Suddenly everyone in Washington is intensely concerned about Americans who are losing their health insurance.
The outpouring of noble sentiment would be laudable — indeed, long overdue — if only there was any reason to believe these protestations are sincere. Sadly, the evidence points in the opposite direction, for a single obvious reason: Millions of people in this country have been losing health insurance for many years, resulting in untold thousands of serious illnesses, bankruptcies, and early deaths – but until insurance cancellations became a political embarrassment for Barack Obama, the usual right-wing reaction was silence. (Except for that awkward and revealing outburst during the Republican debates of 2012, when a live audience howled its approval for the “let him die” plan.)
For anybody who ever honestly cared about people losing their health coverage – for instance, President Obama or his Democratic predecessor Bill Clinton – the depressing statistical reality has long been plain. Every day of every year, thousands of people leave the rolls of the private insurance industry in this country, almost never voluntarily.
People often forfeit insurance after losing a job, which happened to millions during the Great Recession. At the recession’s height, when the Tea Party Republicans were fighting to kill Obamacare in the cradle, more than 44,000 people were losing their health coverage every week. In May 2009, the policy journal Health Affairs published a projection that nearly 7 million Americans would lose coverage by the end of 2010.
People also lose insurance because their insurance company doesn’t want to pay the cost of a grave illness (having gorged on costly premiums for years), which has happened to many thousands more. The most recent congressional report on the subject found that three major insurance companies had saved at least $300 million through “rescission” of policies held by 20,000 seriously ill clients, while their profits mounted.
Or people lose insurance because the cost rises and they can no longer afford it, which happens routinely to nearly half the population at some point during every decade. A report released by the Treasury four years ago found that “nearly half of non-elderly Americans” had lived without health coverage at some point between 1997 and 2006, a period of relative prosperity and high employment.
The consequence, as everybody ought to know by now, is that upward of 45 million Americans have gone without health insurance at any given moment since 2007. And the further consequence is that many of those uninsured – men, women, and children — go without needed health care, leading to untold suffering and premature deaths for as many as 45,000 annually, perhaps more.
But such dismal facts have never seemed to trouble the Republicans who are screaming so loudly now about the terrible toll of Obamacare. The perennial GOP attitude was set forth by neoconservative eminence Bill Kristol back in 1993, when the prime objective was to kill the nascent Clinton health plan. “There is no health care crisis,” Kristol famously declared, and for him — then a well-paid flack in the Murdoch empire — that was true enough.
After two decades of medical costs skyrocketing above inflation, threatening fiscal and economic ruin, while millions went without insurance, such smug right-wing complacency remains largely intact. The only “health care crisis” ever feared by Republicans like Kristol is the prospect that reform will help Americans – as Obamacare is already doing, despite their worst efforts.
Let’s hope that the president’s team swiftly solves the inherent problems of providing universal coverage through private insurers. It is certainly possible, if never optimal, as Massachusetts and other states seeking to advance that goal are already proving.
And meanwhile, let’s please have no illusions about this momentary flurry of concern on the right over insurance lost. It would disappear instantly and permanently — if only Obamacare could be repealed.
By: Joe Conason, Featured Post, The National Memo, November 15, 2013
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