“Peacemaking On Contraception”: An Olive Branch To The Catholic Church On Contraception Coverage
America’s Big Religious War ended on Friday. Or at least it ought to.
A little more than a year ago, the Obama administration set off a bitter and unnecessary clash with the Roman Catholic Church over rules mandating broad contraception coverage under the Affordable Care Act. The Department of Health and Human Services’ announcement of new regulations is a clear statement that President Obama never wanted this fight.
The decision, the administration’s second attempt at compromise, ought to be taken by the nation’s Catholic bishops as the victory it is. Many of the country’s most prominent prelates are inclined to do just that — even if the most conservative bishops seem to want to keep the battle raging.
But more importantly, the final HHS rules are the product of a genuine and heartfelt struggle over the meaning of religious liberty in a pluralistic society. The contraception dispute was difficult because legitimate claims and interests were in conflict.
The vast majority of Americans believe that health insurance should cover contraception. At the same time, the Catholic Church has a theological objection to contraception, even if most Catholics (including regular churchgoers) disagree with its position. The church insisted that its vast array of charitable, educational and medical institutions should be exempt from the contraception requirement.
The church made a mistake in arguing its case on the grounds of “religious liberty.” By inflating their legitimate desire for accommodation into a liberty claim, the bishops implied that the freedom not to pay for birth control rose to the same level as, say, the freedom to worship or to preach the faith. This led to wild rhetorical excesses, including a comparison of Obama to Hitler and Stalin by one bishop and an analogy between the president’s approach and the Soviet constitution by another.
But the church had good reason to object to the narrowness of the original HHS definition of what constituted a religious organization entitled to exemptions from the contraception requirement. If an organization did not have “the inculcation of religious values” as its purpose and did not employ or serve primarily those who shared the faith, it got no exclusion at all.
The problem is that the vast charitable work done by religious organizations to help millions, regardless of their faith, is manifestly inspired by religion. The church could not abide the implicit reduction of its role merely to private expressions of faith. Don’t most Americans devoutly wish that religious people will be moved by their beliefs to works of charity and justice?
The HHS rules announced Friday scrapped this troubling definition in favor of long-established language in the Internal Revenue Code. In an interview, HHS Secretary Kathleen Sebelius showed a becoming humility, and it would be nice if this rubbed off on her critics. However defensible the original rules might have been, she said, “they really caused more anxiety and conflict than was appropriate.”
“What we’ve learned,” she said, “is that there are issues to balance in this area. There were issues of religious freedom on two sides of the ledger” — the freedom of the religious institutions and the freedom of their employees who might not share their objections to contraception.
This is where the other accommodation kicked in: Many Catholic institutions self-insure. While the administration rightly wants broad contraception coverage to include hospital workers, teachers and others at religious institutions, it also seeks to keep religious organizations from having “to contract, arrange, pay or refer” for coverage “to which they object on religious grounds.”
Under the new rules, employees who want it will be able to get stand-alone coverage from a third party. Some of the costs will be covered by small offsets in the fees insurers will have to pay to participate in the new exchanges where their policies will be on sale. It’s an elegant fix.
There are two reasons for hope here, particularly for Catholic progressives. First, the administration recognized the problem it had created and resolved it. Vice President Biden played a key role here, keeping lines of communication with the church open.
Second, many bishops have come to realize that the appearance of a state of war with Obama not only troubled many of the faithful — Obama, after all, narrowly carried the Catholic vote — but also threatened to cast a church with strong commitments to immigrants, social justice and nonviolence as a partisan, even right-wing organization.
This war has been bad for everyone involved. Obama has moved to end it. Here’s a prayer that the bishops will also be instruments of peace.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, February 3, 2013
“Setting The Stage”: What The Health Law Will Bring In 2013
Most of the really big changes made by the 2010 health law don’t start for another year. That includes things like a ban on restricting pre-existing conditions, and required insurance coverage for most Americans. But Jan. 1, 2013, will nevertheless mark some major changes.
One of those changes that will affect everyone with private health insurance actually took effect last September. But most people won’t see it until they renew or apply for new health insurance. It’s called a summary of benefits and coverage. The idea is to help people actually understand what’s in their insurance policies.
“One of the big complaints of people in polls or focus groups is that they just … don’t understand either the coverage or the price,” said Jay Angoff, a former official at the U.S. Department of Health and Human Services who worked on implementing the health law.
But with the new document, he says, “there’s a standard format that allows people to compare benefits to make apples-to-apples comparisons, not just on price, but on benefits.”
Health plans will also have to provide consumers a glossary of insurance terms if they ask for it.
“It’s still harder than some people would want,” Angoff says. “It’s still a complicated area. But I think HHS has really done a very good job in making it as simple and as meaningful as possible.”
Later in 2013 will also bring a key launch date for the law, says Angoff: “Oct. 1, 2013, is when open enrollment begins.”
That’s when people can start signing up for their 2014 coverage through the new health exchanges, or marketplaces, that the states and federal government are creating. Angoff, who used to head the office that’s in charge of building those exchanges, says he’s confident that things will happen on time.
“HHS has met all statutory deadlines on this until this point, and I have confidence that HHS will continue to meet those deadlines,” he said.
But the majority of what happens on Jan. 1 is to pay for the changes in 2014. In other words, tax increases and cuts in tax deductions. For example, starting next year, people will only be able to put $2,500 pre-tax into Flexible Spending Accounts that they use to pay for items insurance doesn’t cover.
“For example if they buy eyeglasses, if they pay copays on drug benefits or to their physician, they can submit those claims and be reimbursed from the pretax dollars,” said Marilyn Moon of the American Institutes for Research.
Moon says that while the change may hurt some people with very high out-of-pocket spending not covered by insurance, lawmakers decided this was a fair way to raise some of the money needed to pay for the rest of the law.
“This is a benefit that largely accrues to higher-income individuals who can afford to set aside a certain amount of money every year, to pay towards their health care spending,” she said.
There’s another tax change coming next year for the wealthy. Individuals earning more than $200,000 a year and couples earning more than $250,000 will see a nearly 1 percentage point increase in their Medicare payroll tax. They’ll also have to pay a 3.8 percent Medicare tax on their non-wage income. Moon says that represents a big change.
“The payroll tax usually applies only to wages, and now this law will extend it to investment income as well,” she said.
Those who take deductions for medical expenses on their income taxes will also see a change starting in 2013. Right now, expenses in excess of 7.5 percent of adjusted gross income are deductible. That’s going up to 10 percent for all except the elderly.
It will affect some people who spend a lot on medical care, says Moon. But the new law should also reduce the number of people with those very large bills, “because if everyone has health insurance, many fewer people should have to pay large amounts out-of-pocket on health care. Ten percent will not affect very many people, one would hope, when they get better insurance coverage.”
Finally, there’s a key change made by the health law for 2013 that will affect only the poor. Starting Jan. 1, state Medicaid programs will be required to reimburse doctors who provide primary care at Medicare rates, which are substantially higher. The idea is to get more doctors into the Medicaid program, which will itself expand in 2014.
The Medicaid increase, however, is only for two years.
By:Julie Rovner, NPR, January 1, 2013
“Rejecting Their Own Ideas”: Republicans Are Creating Needless Difficulties For Themselves And The Country
We know that the House of Representatives has been unable to reach a sensible deal to avoid unnecessary fiscal trouble at the first of the year because of right-wing Republicans’ aversion to tax increases.
But there is another issue on which conservatives are creating needless difficulties for themselves and the country: It’s harder and harder for politicians on the right to think straight about health care.
Conservatives once genuinely interested in finding market-based ways for the government to expand health insurance coverage have, since the rise of Obamacare, made choices that are dysfunctional, even from their own perspective.
Start with the decision of the vast majority of Republican governors to refuse to set up the state insurance exchanges required under the law. The mechanisms would allow more than 20 million Americans to buy coverage. They were originally a conservative idea for large, trustworthy marketplaces where individuals and families could buy plans of their choice.
Many liberals preferred a national exchange, in which the federal government could institute strong rules to protect consumers and offer broader options. This was the path the House took, but the final Senate-passed law went with state-level exchanges in deference to Republican sensibilities.
To ensure that governors could not just prevent their residents from having access to the new marketplaces, the bill required the federal government to run them if states defaulted. So, irony of ironies, in declining to set up state exchanges, conservative governors are undermining states’ rights and giving liberals something far closer to the national system they hoped for. As Robert Laszewski, an industry critic of Obamacare, told The Post’s N.C. Aizenman, conservative governors are engaging in “cut-off-your-nose-to-spite-your-face” behavior.
This is one of many forms of conservative health-care unreason. The “fiscal cliff” debate has been distorted because the problems confronting federal finances are consistently misdescribed. We do not have “an entitlement problem.” We have a giant health-care cost problem.
Our major non-military fiscal challenges lie in Medicare and Medicaid. In principle, conservatives should seek to find ways of holding down health-care inflation in both the private and public sectors. In practice, they see most efforts to take on this issue system-wide as examples of big government run wild. They seem to have a vague idea that markets can yet solve a problem that markets have not been very good at solving.
The result is that conservatives would either let government get bigger, or they’d save money by throwing ever more risk onto individuals by undercutting core government guarantees.
Their most outrageous move was the big lie that the original health-care bill included “death panels.” This would have been laughable if it had not been so pernicious. The provision in question would simply have paid for consultations by terminally ill patients — if they wanted them — with their physicians on their best options for their care. Few things are more important to the future of health care than thinking straight about the costs and benefits (to patients and not just the system) of end-of-life treatments. For those of us who oppose physician-assisted suicide, it’s urgent to promote, rather than block, serious, moral and compassionate discussions of the difficult issues raised by high-tech medicine.
Or take the health-care law’s creation of the Independent Payment Advisory Board, known as IPAB. It’s a 15-member body charged with finding ways of cutting the costs of treatment under Medicare. Congress would have the final say, but through a fast-track process. Yet the ink was barely dry on Obama’s signature of the Affordable Care Act (ACA) when a group of Republican senators introduced what they called the Health Care Bureaucrats Elimination Act, to get rid of IPAB. Thus did an innovative effort to save money meet with a slap in the face. Conservatives barely acknowledge other cost-saving experiments in the ACA.
Is it any wonder that our fiscal politics are so dysfunctional? Yes, we liberals are very reluctant to cut access to various government health-insurance programs. With so many Americans still uninsured, we are wary of depriving more people of coverage. But we fully accept the need to contain government health spending.
Yet given the conservatives’ habit of walking away even from their own ideas (the exchanges, for example) and of rejecting progressive efforts to save money, is it any wonder that liberals suspect them of greater interest in dismantling programs than in making them more efficient? We won’t find genuine common ground on deficits until we resolve this dilemma.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, December 26, 2012
“Another Anti-Obamacare Headline”: Beware The Great Health Insurance Scam Of 2014
The anti-Obamacare world is atwitter over comments made last week by Aetna CEO, Mark Bertolini, who predicts that some insurance markets will “go up as much as much as 100 percent” when Obamacare takes hold in 2014—with the average increases running between 25 percent and 50 percent in the small group and individual segments of the business.
Mr. Bertolini has dubbed this phenomenon “premium shock”.
To be sure, this is a great headline for those who remain committed to defeating the Affordable Care Act with nothing better to suggest in its place. However, the facts reveal that Bertolini’s comments—while just maybe true for a very few participants buying coverage on the exchanges in the individual markets—are completely misleading with respect to the individual markets and likely completely untrue as applied to the small group market.
So, how is Mr. Bertolini arriving at his dire predictions?
Apparently, it’s all about (a) the new tax placed on health insurance company sales, (b) the community rating requirements that now prohibit older participants in a health insurance pool to be charged more than 3 times what is paid by younger members and (c) the new minimum standard of benefits that will need to be provided to those who purchase health coverage on the exchanges.
Pretty scary, yes?
The problem with Mr. Bertolini’s prediction is that it is completely and utterly at odds with not only the Congressional Budget Office (“CBO”) projections but with American Health Insurance Plans (AHIP) —the very lobbying organization that represents Aetna and was an active and hugely important supporter of Obamacare.
In 2009, the CBO projected that the Affordable Care Act will have little impact on small and large group policies. This is notable given the expectation that, by 2016, the small group market will represent 13 percent of the total insurance market while large groups will provide coverage for a full 70 percent of Americans with health insurance coverage. Do the math and you find that, according to the CBO, 83 percent of all covered Americans will experience little to no change in premium rates beyond normal increases that would occur had Obamacare never become the law of the land.
As for the individual markets, which will comprise 17 percent of the overall insurance market in 2016, premium rates are predicted to rise about 10 to 13 percent by 2016—considerably lower than the doubling Mr. Bertolini has suggested will take place in 2014.
What’s more, approximately half of those gaining coverage in the individual market will qualify for the government subsidies, thereby reducing the price of their insurance premiums below where they currently exist.
Of course, it is not uncommon for people to discount CBO projections and proclaim them to be biased when the projections fail to meet a desired political narrative.
So, let’s see what Aetna’s own trade association, AHIP, has to say.
A review of the AHIP website reveals that the sales tax imposed on the health insurance companies—and sure to be passed along to consumers—will account for a premium increase averaging 1.9 percent to 2.3 percent by 2014 and 2.8 percent to 3.7 percent by 2023.
Now, you may object to this potential increase—but it is a long way from the increases Mr. Bertolini is predicting.
On the subject of community rating—where insurance companies will now be prohibited from charging older participants in their health insurance pools as much as 10 times more than what they charge younger members even if the elder participants have no pre-existing health problems—AHIP indicates that limiting the rates for the older participants to only 3 times the rate charged the young will result in some younger insurance customers paying as much as 45 percent more in premium payments while older participants will pay 13 percent less.
No doubt, this is a large part of what Aetna’s Bertolini is relying on when trying to freak out the public.
The problem with Bertolini’s prediction is that even this large percentage increase, should it prove to be actuarially accurate, would not apply in the small and large group markets- it would apply only to a very limited number of people purchasing their health insurance on the exchanges who are (a) very young and (b) not qualified for subsidies.
The number is also misleading in its severity.
According to AHIP, the average premium paid by a 24 year old in the individual marketplace is $1200 a year. Using AHIP’s numbers, the price of making the cost of heath insurance more equitable for a 60 year old will potentially cost that 24 year old, on average, an extra $45 a month.
While I don’t mean to minimize this increase, as I recognize that every dollar counts when one is young and getting started, it is important to keep the actual price tag in perspective and weigh the equities when considering that those at the older age range have been overcharged for many years.
The reality is that the young have been paying unreasonably low premium rates for for a very long time—it being in the health insurance company’s profit interest to bring in as many young and healthy people as possible in the door by charging artificially low rates. The problem is that they make up for it by charging artificially high rates to the older people the insurance company would rather not have in the first place. What the ACA seeks to do is correct this situation so that 60 year olds are not precluded from gaining health insurance coverage by being priced out of the market.
Note that this problem could have been averted for younger Americans had we lowered the Medicare age to 55 however this was not acceptable to the Congressional GOP.
And that brings us to the topic of minimum benefits that must now be including in insurance policies offered on the health care exchanges, another area where large increases can be found in the effort to alarm the public.
According to AHIP, the additional costs attributable to health insurance companies actually having to provide a meaningful benefit ranges for as little as a tenth of a percentage point in Rhode Island to 33 percent in Maine where, apparently, health insurance policies do not provide much in the way of actual coverage. And, again, these numbers apply only to the individual marketplace on the exchange.
Thus, if you are one of the 8.5 percent of Americans who will be buying your coverage on the exchange in the state of Maine (making for a very, very tiny percentage) you may now have to pay more to actually get some health care coverage in exchange for what you pay.
So, what does all this tell us?
Gary Klaxon, Vice President of the Kaiser Family Foundation—one of the few health care think- tanks that just about everyone agrees is completely non-partisan and objective, had this to say about Mr. Bertolini’s predictions:
“That just seems silly. I can’t imagine anything going on in the small-group market that would change the average premium that much. On the individual market, there’s arguments for things changing, but those magnitudes seem high.”
Silly, indeed.
There is, of course, more to this than what the anti-Obamacare folks are choosing to report.
That would be the part where Bertolini noted in his ‘premium shock’ comments that this huge, one-time jump in premium rates to be expected in 2014 also includes increases in costs that would come even without the health care reform law.
Translation—health insurance companies have been trying to raise rates at a ridiculous pace ever since the word ‘Obamacare’ first entered the American lexicon, always seeking to blame these increases on the law even before the law became the law. So, when 2014 arrives, you can be certain that they will do everything in their power to grab as large an increase as they can get away with in order to preserve their profits.
Mr. Bertolini is merely laying the groundwork for that effort as Obamacare has provided the health insurance industry with a wonderful scapegoat, perfectly suited and even more perfectly timed to cover the inescapable truth of health insurance—it is a business model whose time has passed.
The sooner the American public realizes that private health insurance companies no longer work, the sooner we can get busy with the solutions that, while politically uncomfortable, can actually solve the nation’s health care challenges.
In the meantime, if you are a part of a large or small business health insurance group, there is no reason to expect that there should be significant—if any— increases in your premium charges in 2014. If you are an individual who will be shopping for health insurance on the exchanges, the 50 percent of you that will qualify for subsidies should experience premium costs at a lower rate than what you are currently paying, If you are in that other half, you may, indeed, see some increase in your rate—but nowhere near the ‘doubling’ the insurance industry would like you to believe is in your future.
By: Rick Ungar, Op-Ed Contributor, Forbes, December 20, 2012
“Saving Medicare From The GOP, Again”: Raising Medicare Age Won’t Save Money But Will Cost Lives
Raising taxes on the rich alone won’t close the deficit or erase the national debt, as Republicans superciliously inform us over and over again. But in their negotiations with the White House to avert the so-called fiscal cliff, Congressional Republicans seem obsessed with a change in Medicare eligibility whose budgetary impact (when compared with ending the Bush tax cuts for the wealthy) is truly negligible — but whose human toll would be immense.
That Republican imperative is to raise the Medicare eligibility age from 65 to 67.
Why do Speaker John Boehner and the Republican majority in the House so badly want to put Medicare out of reach of elders younger than 67? It will be costly to their most loyal voting constituency among older whites. And it won’t save much money, according to the nonpartisan Kaiser Family Foundation’s latest study – which shows that the estimated $148 billion in savings over ten years is largely offset by increased insurance costs, lost premiums, and higher subsidies that will be paid as a consequence. The Center on Budget and Policy Priorities offers an even more stringent analysis, which shows that raising the eligibility age in fact will result in total costs higher than the putative federal savings — which amount to around $50 billion over ten years. Contrast that with the savings achieved by ending the Bush tax cuts for the wealthy, which amounts to well over $1 trillion during the same period — and it becomes clear which party wants to reduce deficits.
Assuming that the savings are mostly mythical, the only sensible assumption is that Republican politicians and financiers simply hate Medicare, a highly successful and popular federal program that the right has been trying to destroy, with one tactic or another, ever since its establishment in 1965. They don’t really care whether their alleged solutions save money or improve efficiency. They want a privately-funded medical system that preserves profits rather than a system that improves and expands health care, as Medicare has done for almost half a century.
What the Republicans evidently desire most in their “reform” crusade is to exacerbate inequality among the elderly – because that is the only assured outcome of their plans.
The impact of raising the Medicare eligibility age by two years will fall most heavily upon older African-American and other minorities, as they are still known. The projected damage is summarized clearly in a chart posted on Monday by Sarah Kliff at the Washington Post’s Wonkblog. The number of uninsured among the elderly will be increased for all groups, but the greatest increase will be among minorities, who will also become more likely to postpone medical care because they lack coverage. The net effect of those changes, to project from what we already know about people who lack of insurance and postpone care, will be earlier deaths and much suffering.
Even more broadly, delaying eligibility is a direct assault on the standard of living of working-class Americans, especially those who have earned their way through physical labor. By age 65, people who have spent decades engaged in hard physical work – as firefighters, nurses, or other first responders, to consider the most obvious examples – are ready to stop working. Medicare is a critical element of their ability to retire, but Washington elites, especially on the right, are obtusely unsympathetic to their conditions.
It is up to the Democrats in Washington, especially President Obama, to protect Americans from such policy proposals, which are economically idiotic and socially inhumane. For there is one objective that the Republicans would certainly achieve if they induce the President to accept, or worse, propose, any such plan: They will discredit his second term before it has begun.
By: Joe Conason, The National Memo, December 11, 2012
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 