“The Austerity Trap”: What Raising The Medicare Eligibility Age Really Means
After a campaign in which Republicans attempted to pillory Barack Obama for finding $716 billion in savings from Medicare (via cuts in payments to insurance companies and providers but not cuts to benefits), those same Republicans now seem to be demanding that Obama agree to cuts in Medicare benefits as the price of saving the country from the Austerity Trap, a.k.a. fiscal cliff. Oh, the irony! You’d almost think that they weren’t really the stalwart defenders of Medicare they pretended to be.
And there are some hints that the Obama administration is seriously considering agreeing to raise the Medicare eligibility age from 65 to 67 as part of this deal. It’s a dreadful idea, and as we discuss this possibility, there’s one really important thing to keep in mind: Medicare is the least expensive way to insure these people. Or anybody, for that matter. In all this talk of the bloated entitlement system, you’d be forgiven for thinking Medicare was some kind of inefficient, overpriced big government program. But the opposite is true, and that’s why raising the eligibility age is such a dreadful idea.
Raising the eligibility age saves very little money, on the order of a few billion dollars a year. That’s because the 65 and 66-year-olds will have to get insurance somewhere, and many of them are going to get it with the help of the federal government, either through Medicaid or through the insurance exchanges, where they’ll be eligible for subsidies. However, since many Republican-run states are refusing to expand Medicaid in accordance with the Affordable Care Act, lots of seniors who live in those states will just end up uninsured, which will end up leading to plenty of financial misery and more than a few premature deaths. Put this all together, and the Center on Budget and Policy Priorities estimates that while the federal government would save $5.7 billion a year from raising the eligibility age, costs would increase by more than twice in other parts of the system—for the seniors themselves, employers, other enrollees in exchanges who would pay higher premiums, and state governments.
What we’d be doing is taking people off Medicare, the most efficient and inexpensive option for them to have insurance, and putting them into the individual market, which works less well and costs more. When we start talking about this in more detail, that’s what Republicans should really be forced to address.
If you want more details on the implications of raising the eligibility age, you should be reading Jonathan Cohn and Sarah Kliff. But it’s important that we keep the big picture in view as the Austerity Trap deal takes shape. If anything, we should be putting more people on Medicare—that would save money and improve health in the system overall (you may recall that when the ACA was being debated one of the proposals was to allow people over 50 to buy in to Medicare, an idea we should bring back). There’s an argument being made that raising the eligibility age may not be a good idea, but the administration has to give Republicans something, and it’s not that big a deal. If that’s the case that wins the day, we should be clear about exactly what it means: a more expensive health care system, exactly the opposite of what everybody says they want.
By: Paul Waldman, Contributing Editor, The American Prospect, December 10, 2012
“Still Under Women’s Clothes”: Michigan Abortion Legislation Package Moves Forward
State lawmakers in Michigan are using their lame-duck session to pass a bundle of bills that would significantly restrict women’s ability to access and pay for abortions in the state.
The state Senate passed three bills on Thursday that would ban abortion coverage in state-based health insurance exchanges and all private insurance plans, and another bill that would allow employers and medical professionals to refuse to cover or provide health treatment to which they morally object. State lawmakers are also expected to pass a so-called omnibus bill on Thursday that would impose prohibitive building regulations on abortion clinics and ban the use of telemedicine to prescribe abortion medication.
“It feels like [state legislators] are completely tone-deaf to what Americans want in general, which is for legislators to pay attention to the economy, particularly in Michigan, and to women and their power to say, ‘This is what we want, and this is what we don’t want,'” Desiree Cooper, a spokeswoman for Planned Parenthood Advocates of Michigan, told The Huffington Post.
Senate Bills 612, 613 and 614, which passed along party lines in the State Senate on Thursday, will prevent all insurance plans in Michigan from covering abortion unless a woman would die without the procedure. The measures do not include exceptions for rape, incest or pregnancy complications that would jeopardize the mother’s health. Private insurance companies will be given the option to carry a separate abortion coverage policy that the woman would have to pay for in addition to her regular coverage.
Republicans said they support the bills because they allow people who morally object to abortion to ensure that their money doesn’t feed into a pool that pays for the procedure. Reproductive rights advocates argue that the bill is unreasonable, because insurance companies are not likely to offer that separate rider.
“It’s somewhat of a false promise,” said Meghan Groen, director of government relations for PPAM. “No insurance company currently offers a rider for abortion coverage, and no woman is going to purchase a separate rider for something she hasn’t planned. You’re talking about an unexpected pregnancy, or a fetal anomaly.”
State senators also passed a bill on Thursday by a vote of 26 to 12 that would allow employers, doctors, nurses and pharmacists to conscientiously object to providing or paying for certain medical services, including birth control and abortion. Senate Republicans argued that the bill protects religious freedom. The Detroit Free Press reports that one Republican doctor, state Sen. Roger Kahn (R-Saginaw), broke with his party to oppose the bill.
“I don’t know how this doesn’t violate the oath I took, when I promised to resuscitate someone with TB or treat someone with AIDS,” he said.
The House is expected to consider those bills next week. In the meantime, it is expected to pass an omnibus bill that would further restrict abortion access. House Bill 5711 would regulate abortion clinics as surgical centers by imposing strict physical building requirements on them, such as minimum doorway sizes and minimum square footage. The regulations could effectively shut down some clinics in the state.
The omnibus bill also includes a provision that ends telemedicine abortions, which are commonly used by women in rural and medically under-served areas of the state. According the Groen, 21 out of 83 counties in Michigan have no local OBGYN, so telemedicine allows doctors to prescribe medication abortions to women in early stages of their pregnancies through a phone or internet consultation. Michigan Gov. Rick Snyder (R) recently signed a bill that expands the use of telemedicine in other areas of health care.
State Sen. Coleman Young II (D-Detroit) sharply criticized his Republican colleagues on Thursday for pushing forward with the anti-abortion agenda. “Get the government from underneath women’s clothes,” he said. “We’ve already had this conversation. Obama won, Romney lost, get over it.”
By: Laura Bassett, The Huffington Post, December 6, 2012
“Blue Light Special”: Walmart To Pass More Of Its Costs On To Taxpayers
The nation’s largest private employer, Walmart, has announced that beginning in 2013 it will begin drastically reducing the number of new hires who receive health insurance coverage, according to The Huffington Post.
The retail giant surprised many by supporting the drive for universal health care in 2007 and then the employer mandate in 2009.
However, its planned policy of not offering new employees health insurance if their hours dip below 30 a week indicates that they intend to take advantage of Obamacare’s new obligation to provide coverage for those who cannot afford it. And with several Republican governors promising to deny the funds for Medicaid expansion, the new policy could lead to a swift increase in the uninsured.
In several states, Walmart tops the list of employers whose employees seek government-funded health care and food assistance for their families, forcing taxpayers to subsidize its low prices and low wages.
Former Secretary of Labor Robert Reich points out that despite the incredible wealth of Walmart’s primary stockholders, the Walton family, its employees earn wages that may not even keep them out of poverty.
“The average Walmart employee earns $8.81 an hour. A third of Walmart’s employees work less than 28 hours per week and don’t qualify for benefits,” Reich wrote in one of his recent columns encouraging the retail giant’s employees to organize. Across the country a small percentage of Walmart’s employees walked out on Black Friday, protesting the company’s alleged retaliation against workers who speak out for better working conditions.
“Organizing makes economic sense,” Reich wrote.
In 2006, Walmart responded to criticism by greatly expanding the number of employees to whom it offered health insurance. They reduced the number receiving coverage in 2011.
“This is another example of a tremendous government subsidy to Walmart via its workers,” Nelson Lichtenstein, director of the Center for the Study of Work, Labor and Democracy at the University of California, Santa Barbara told The Huffington Post.
This change in policy will push the number of employees without benefits closer to one half.
Critics have said that Walmart provides a huge benefit to poor consumers by multiplying the value of food stamps with its low prices. But to Doug Henwood, that argument misses the central problem with the impact that Walmart has had on our economy:
And, yeah, it’s nice that Walmart has been able to provide a working class facing at best stagnant wages with lots of cheap stuff, but Walmart has itself had no small effect on dragging average wages down. It’s not just that they’ve been an inspiring business model for the rest for corporate sector, impressed by the chain’s growth and profitability. That’s led to endless rounds of outsourcing and speedup. But also by lowering the cost of reproduction of the working class, to use the old language, they’ve made it easier for employers to keep a lid on wages.
Add into the equation that taxpayers are subsidizing the costs of these wages and you have a formula for a permanent underclass underwritten by a government that can do little else than providing basic health care and sustenance.
By: Jason Sattler, The National Memo, December 3, 2012
“It Doesn’t Have To Be This Way”: Walmart Plans To Deny Health Care Benefits To New Employees
Why the ACA can’t kick in soon enough, part the infinite: the Huffington Post is reporting that, according to a new policy that will take effect in January, Walmart will begin denying health insurance to new employees who work less than 30 hours a week. It will also reserve the right to cut health benefits for certain groups of current employees who work less than 30 hours. Walmart workers, like many retail employees, often have shifts and hours that vary from week to week, according to seasonal business cycles, so even workers who are currently working 30 hours or more could be affected.
Let’s not forget that Walmart is the nation’s largest private employer, so this change is hugely important. And it’s important not only in itself, but in the spillover effect it could have on the employment policies of comparable retailers.
The Huffington Post observes that the point of the new policy is to opportunistically take advantage of certain aspects of Obamacare:
Among the key features of Obamacare is an expansion of Medicaid, the taxpayer-financed health insurance program for poor people. Many of the Walmart workers who might be dropped from the company’s health care plans earn so little that they would qualify for the expanded Medicaid program, these experts said.
“Walmart is effectively shifting the costs of paying for its employees onto the federal government with this new plan, which is one of the problems with the way the law is structured,” said Ken Jacobs, chairman of the Labor Research Center at the University of California, Berkeley.
This is yet one more example of why last week’s historic worker protests against Walmart were so important. I’ll add this reminder: it doesn’t have to be this way. Some highly profitable players in the retail game which are comparable to Walmart, such as Costco, manage to treat their workers decently. The reason Walmart runs its business in such a reprehensible manner is because it actively chooses to do so.
By: Kathleen Grier, Washington Monthly Political Animal, December 2, 2012
“Medicaid On The Ballot”: Unfortunately Mr. Romney, A Lack Of Insurance Does Kill People
There’s a lot we don’t know about what Mitt Romney would do if he won. He refuses to say which tax loopholes he would close to make up for $5 trillion in tax cuts; his economic “plan” is an empty shell.
But one thing is clear: If he wins, Medicaid — which now covers more than 50 million Americans, and which President Obama would expand further as part of his health reform — will face savage cuts. Estimates suggest that a Romney victory would deny health insurance to about 45 million people who would have coverage if he lost, with two-thirds of that difference due to the assault on Medicaid.
So this election is, to an important degree, really about Medicaid. And this, in turn, means that you need to know something more about the program.
For while Medicaid is generally viewed as health care for the nonelderly poor, that’s only part of the story. And focusing solely on who Medicaid covers can obscure an equally important fact: Medicaid has been more successful at controlling costs than any other major part of the nation’s health care system.
So, about coverage: most Medicaid beneficiaries are indeed relatively young (because older people are covered by Medicare) and relatively poor (because eligibility for Medicaid, unlike Medicare, is determined by need). But more than nine million Americans benefit from both Medicare and Medicaid, and elderly or disabled beneficiaries account for the majority of Medicaid’s costs. And contrary to what you may have heard, the great majority of Medicaid beneficiaries are in working families.
For those who get coverage through the program, Medicaid is a much-needed form of financial aid. It is also, quite literally, a lifesaver. Mr. Romney has said that a lack of health insurance doesn’t kill people in America; oh yes, it does, and states that expand Medicaid coverage show striking drops in mortality.
So Medicaid does a vast amount of good. But at what cost? There’s a widespread perception, gleefully fed by right-wing politicians and propagandists, that Medicaid has “runaway” costs. But the truth is just the opposite. While costs grew rapidly in 2009-10, as a depressed economy made more Americans eligible for the program, the longer-term reality is that Medicaid is significantly better at controlling costs than the rest of our health care system.
How much better? According to the best available estimates, the average cost of health care for adult Medicaid recipients is about 20 percent less than it would be if they had private insurance. The gap for children is even larger.
And the gap has been widening over time: Medicaid costs have consistently risen a bit less rapidly than Medicare costs, and much less rapidly than premiums on private insurance.
How does Medicaid achieve these lower costs? Partly by having much lower administrative costs than private insurers. It’s always worth remembering that when it comes to health care, it’s the private sector, not government programs, that suffers from stifling, costly bureaucracy.
Also, Medicaid is much more effective at bargaining with the medical-industrial complex.
Consider, for example, drug prices. Last year a government study compared the prices that Medicaid paid for brand-name drugs with those paid by Medicare Part D — also a government program, but one run through private insurance companies, and explicitly forbidden from using its power in the market to bargain for lower prices. The conclusion: Medicaid pays almost a third less on average. That’s a lot of money.
Is Medicaid perfect? Of course not. Most notably, the hard bargain it drives with health providers means that quite a few doctors are reluctant to see Medicaid patients. Yet given the problems facing American health care — sharply rising costs and declining private-sector coverage — Medicaid has to be regarded as a highly successful program. It provides good if not great coverage to tens of millions of people who would otherwise be left out in the cold, and as I said, it does much right to keep costs down.
By any reasonable standard, this is a program that should be expanded, not slashed — and a major expansion of Medicaid is part of the Affordable Care Act.
Why, then, are Republicans so determined to do the reverse, and kill this success story? You know the answers. Partly it’s their general hostility to anything that helps the 47 percent — those Americans whom they consider moochers who need to be taught self-reliance. Partly it’s the fact that Medicaid’s success is a reproach to their antigovernment ideology.
The question — and it’s a question the American people will answer very soon — is whether they’ll get to indulge these prejudices at the expense of tens of millions of their fellow citizens.
By: Paul Krugman, Op-Ed Columnist, The New York Times, October 28, 2012
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