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“Enough Already”: The New York Times And The ACA, The Yuppie Whine-Athon Continues

I see the New York Times has published yet another article about very privileged people whining about the ACA.

In this case, said article features a couple making $100,000 a year who, under the ACA, will be paying $1,000 a month for health care. Take it away, Dean Baker:

Here they are with a front page story telling us about the tragic situation of the Chapmans, a New Hampshire couple making $100,000 a year who will have to spend $1,000 a month for insurance with Obamacare. This would come to 12 percent of their income. The piece tells readers:

“Experts consider health insurance unaffordable once it exceeds 10 percent of annual income.”

That’s interesting. If we go to the Kaiser Family Foundation website we find that the average employee contribution for an employer provided family plan is $4,240. The average employer contribution is $11,240. That gives us a total of $15,470. Most economists would say that we should treat the employers payment as a cost to the worker since in general employers are no more happy to pay money to health insurance companies than to their workers. If they didn’t pay this money as health insurance then they would be paying it to their workers in wages.

A couple of years ago, when my ex-husband and I were paying for health insurance under COBRA, we were shelling out something like $1,200 a month for just the two of us — and we were making far less than 100K a year. In fact, we were earning more like half that.

Enough already. In the real world we live in, $1,000 a month for good health insurance for two people in the top quintile of U.S. household income is pretty damn good. Upper middle class people, quitcher whining already — and New York Times, please stop enabling this nonsense.

 

By: Kathleen Geier, Washington Monthly Political Animal, December 21, 2013

December 22, 2013 Posted by | Affordable Care Act, Obamacare | , , , , , , | Leave a comment

“What Obamacare Death Spiral?”: So Sorry Republicans, The Rumors Have Been Greatly Exaggerated

Supporters of the Affordable Care Act have been terrified for months now that a combination of a botched online enrollment system, terrible press, and Republican sabotage could send the individual market part of the new system into the much-discussed “death spiral” where a disproportionately large population of older and sicker enrollees would produce very high premiums, which would in turn repel younger and healthier eligibles even more, creating a self-perpetuating disaster.

At Wonkblog today Sarah Kliff reports some research from the Kaiser Family Foundation indicating that fears of a “death spiral” are significantly overblown:

The rumors of an Obamacare death spiral have been greatly exaggerated. So say Larry Levitt, Gary Claxton and Anthony Damico, experts at the Kaiser Family Foundation who have put together a new brief analyzing what would happen if young adults snubbed the Affordable Care Act. Even if young people sign up at half the rate the administration hopes for, it would nudge premiums up only by a few percentage points, their report says.

“When you do the math, it matters, but not nearly as much as the conventional wisdom suggests,” Levitt says….

If young adults (those under 35) were 25 percent less likely than the rest of the population to sign up for Obamacare, they would represent 33 percent of exchange enrollees — rather than 40 percent. This means there would be fewer young people to subsidize older insurance subscribers. To make up that difference, the experts estimated, insurers would need to increase premiums by a terrifying … 1 percent. Yes, exactly 1 percent.

Levitt, Claxton and Damico also tested a scenario where young adults are half as likely as older shoppers to enroll. In that case, the younger enrollees would make up only a quarter of the exchange market. Premiums would fall 2.5 percent short of covering subscribers.

Wow. If these numbers are accurate, the widespread assumption (particularly among happy Republicans) that there’s nothing ahead for exchange enrollees beyond “sticker shock” forever could give way to the expectation that Obamacare will eventually be self-stabilizing, at least for most enrollees. That in turn would upset GOP calculations that they can perpetually benefit from Obamacare’s problems without coming up with their own credible “replacement” proposal (the ones we’ve seen so far, which rely on destructive gimmicks like interstate insurance sales and state-run high-risk pools, while vastly disrupting employer-based coverage, just aren’t credible once you get beyond the slogans).

A whole lot of GOP strategery for 2014 and 2016 depends on an Obamacare crash. They might want to start seriously considering a Plan B that isn’t even worse than the pre-Obamacare status quo ante.

 

By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 18, 2013

December 20, 2013 Posted by | Affordable Care Act, Health Reform | , , , , , , , | Leave a comment

“Unsatisfying To The Media And Republicans”: Surprise, Obamacare Now Projected To Cost Hundreds Of Billions Less Than Expected

Amidst the dark skies of the Healthcare.gov launch, some daylight may finally be emerging with respect to one of the critical goals of the Affordable Care Act—bending the cost curve of America’s expensive healthcare system.

According to a New York Times report out Tuesday, the Congressional Budget Office has quietly removed hundreds of billions of dollars from the projected costs of Obamacare, primarily the result of an anticipated decrease in the federal government’s contribution to the Medicaid expansion program along with the projected cost of the subsidy payments to those buying private insurance policies on the healthcare exchanges.

Why the good news?

The more favorable projections are the direct result of the slowing trend in the growth of healthcare spending over the past five years leading to a slowdown in rising costs. While, ten years ago, per-capita spending on healthcare had been growing by an average annual rate of 5 percent, that number was dramatically cut to 1.8 percent during the 2007-2010 period and reduced even further to 1.3 percent in the years following 2010.

Do we have Obamacare to thank for this highly successful “bending” of the cost curve?

Naturally, the answer depends upon who you ask as there simply is no definitive way of knowing—yet.

While most economist believe that the lion’s share of the reduction is due to the sluggish economy—making Americans far more careful when it comes to making decisions regarding when or if to spend money on medical care—others believe that some of the plans built into the ACA designed to get people to spend less may actually be working.

Among Obamacare inventions that do appear to be paying off in lower healthcare costs is the government’s refusal to pay hospitals more when patients are re-admitted within 30 days of their initial discharge. Additionally, new plan designs engineered to reward providers for quality of care rather than for quantity of care may well be paying off in terms of lowering the overall cost of care.

According to the Kaiser Family Foundation—widely regarded as an honest, non-partisan broker when it comes to healthcare issues and analysis—the declining increases in the cost of healthcare is 75 percent the result of economic factors and 25 percent a benefit of the cost cutting measures in the ACA that do, in fact, appear to be working.

Of course, the big question is whether or not these cost lowering provisions of Obamacare will continue to do the job once the economy regains its more typical trajectory.

There are reasons to be hopeful that healthcare spending can be held down once the economy kicks into higher gear.

For starters, while many Americans shopping for new health insurance policies may be decrying the higher deductibles they are discovering in the new offerings, higher deductibles should have a meaningful impact on the decisions people make when determining whether or not a visit to the doctor or agreeing to a given procedure is really necessary. While a $250 deductible will likely not cause a patient to ask how much a suggested CT Scan is going to cost, a $3,000-$5,000 deductible is far more likely to cause the patient to ask a few more questions and make more focused decisions when payment for the test is coming out-of-pocket.

Not surprisingly, there are no shortage of economists and pundits who believe that the ACA will prove inadequate to the task of controlling costs once the economy is in better shape.

Others are more hopeful, believing that the slowdown in costs are very much a result of hospitals and insurance companies understanding that something had to change given the unsustainable trends in rising costs. As a result of a desire to derail out-of-control costs before the costs derailed them, insurers and hospitals became involved in substantial systemic revisions designed to lower healthcare spending  even before the government required them to do so.

Discussing whether the current decreases can last when previous periods of cost-curve bending did not, Annie Lowrey writes in  her New York Times piece

“This time may be more durable. Insurance and hospital executives in Massachusetts, Illinois and California, among other places where reforms have gone the furthest, report a consensus that spending growth had become unsustainable, and that expectations that Washington would force changes to the system spurred them to make changes themselves.”

If this is true—and I believe the evidence reveals that it is—these self-imposed changes, in tandem with the changes brought about by elements of Obamacare that don’t receive nearly as much attention as the more hot button issues, may prove to provide lasting changes to the system; changes that will point our cost trajectory in the right direction.

Like most elements of the Affordable Care Act, these issues and results only go to prove that far more time is required before we can even begin to measure the real benefits or detriments of Obamacare.

While this reality may prove unsatisfying to the media, politicians and those in the public who are so emotionally committed to the failure and ultimate death of Obamacare—whether for political purposes or only so that the opponents can experience the satisfaction of having been right—anyone interested in realistic measurement of this dramatic change in our system better settle in for the long run.

It’s going to be awhile until we know how this story ends.

 

By: Rick Ungar, Op-Ed Contributor, Forbes, December 4, 2013

December 5, 2013 Posted by | Affordable Care Act, Media, Republicans | , , , , , , | Leave a comment

“You’re Not Invincible”: Young Adults Can’t Afford To Tune Out Obamacare Insurance Requirement

Before passage of the Affordable Care Act, becoming an adult meant getting kicked to the curb when it came to health coverage.

“Our gift when people turned 19 was to take away their health insurance,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. “Turn 19 and we kick them out.”

If you were in college, you could usually stay on your parents’ insurance until you turned 22. But until health-care reform came about, young adults who didn’t find jobs with health coverage or qualified for government insurance were often left uninsured and vulnerable to massive medical bills.

Now there’s a present awaiting young adults.

Thanks to the ACA, commonly referred to as Obamacare, you may now be able to get insurance or continue to be covered under a parent’s plan up to the age of 26. And this coverage is available even if you’re married, not living at home, attending school or are financially independent. Starting next year, young adults up to 26 can stay on their parents’ employer plan even if they have another offer of coverage through an employer.

The downside for some parents is that they might have to pay extra to keep young adult children covered. But at least they will have insurance.

And, in just a few weeks, a new marketplace will open at www.healthcare.gov, giving young adults, particularly those older than 26, another option for obtaining health insurance. Trust me, this is one shopping trip that you need to go on.

There is concern that not enough young healthy adults will buy insurance, which will help offset the cost of those who are older and sicker and will need a lot of health-care services. Some experts believe these concerns are overstated. They note that insurance plans in the new marketplace will cover a core set of benefits such as hospitalization, maternity and newborn care, mental health and substance-use disorder services, and prescription drugs.

With the help of trained personnel called navigators, insurance shoppers will be able to compare plans based on factors including price and benefits. They’ll also be able to determine if they qualify for subsidies to help pay for the coverage.

When you’re young and healthy, you may think you can put off getting insurance. Maybe money is tight and you figure this is something you can delay until you get older, like contributing to a retirement plan.

“Health insurance is something at the moment I feel I can’t afford,” said Josh Nece, 29, a restaurant server in Oakland, Calif.

Nece, who suffers from severe eczema, says with rent, transportation, student loan payments and other expenses, he couldn’t afford the cost of insurance on his own. But he needs insurance to help pay for the medication and doctor visits when his eczema breaks out. He says he often goes without treatment or medication because he can’t afford it.

He plans to check out the marketplace in his state. I’m going to follow up with him to see if he does.

“I’m pretty sure I’m going to get health insurance,” he says. “Going into my 30s, I know it’s one of the adult things I need to do.”

In June, Kaiser asked young adults whether they wanted and valued health insurance. The answer was a resounding yes, contrary to the conventional wisdom about young adults feeling they are invincible.

Still, for those who think they can wait, here’s something to ponder: A tumble off a skateboard could end up costing you $20,000, as it did for Pollitz’s 22-year-old son, who works part time in a day-care center.

“He hit a rock, and the skateboard slid under him,” she said. “He broke his wrist.”

Pollitz said the bill was a “teachable moment.” Thankfully, he was covered on his parents’ plan. Otherwise, “that would have been a financial catastrophe for him.”

It is stories like hers that make Pollitz passionate about getting out the word to young adults to get health insurance. Although most young adults already have coverage, more than 19 million lack basic health insurance. In 2011, 27.9 percent of Americans ages 19 to 25 were uninsured. About the same percentage in the 25-to-34 age bracket also didn’t have insurance, according to Kaiser.

Some young adults might not get health insurance because the penalty for not buying it isn’t stiff enough. If the government determines that you are in the financial position to pay for coverage and you don’t fall under an exemption, you’ll have to pay a penalty for being uninsured when you file your federal income tax. The penalty starts next year at $95 annually for an individual and can go up to $285 for a family, or 1 percent of a family’s household income, depending on which is higher.

I like to believe millennials are smart enough to recognize they can’t afford not to get health insurance. It’s a gift that can keep them not only healthy, but out of medical debt.

 

By: Michelle Singletary, Columnist, The Washington Post, September 13, 2013

September 16, 2013 Posted by | Affordable Care Act, Health Care | , , , , , , | Leave a comment

“The Wonk Gap”: The GOP’s Near Complete Lack Of Expertise On Anything Of Substance

On Saturday, Senator John Barrasso of Wyoming delivered the weekly Republican address. He ignored Syria, presumably because his party is deeply conflicted on the issue. (For the record, so am I.) Instead, he demanded repeal of the Affordable Care Act. “The health care law,” he declared, “has proven to be unpopular, unworkable and unaffordable,” and he predicted “sticker shock” in the months ahead.

So, another week, another denunciation of Obamacare. Who cares? But Mr. Barrasso’s remarks were actually interesting, although not in the way he intended. You see, all the recent news on health costs has been good. So Mr. Barrasso is predicting sticker shock precisely when serious fears of such a shock are fading fast. Why would he do that?

Well, one likely answer is that he hasn’t heard any of the good news. Think about it: Who would tell him?

My guess, in other words, was that Mr. Barrasso was inadvertently illustrating the widening “wonk gap” — the G.O.P.’s near-complete lack of expertise on anything substantive. Health care is the most prominent example, but the dumbing down extends across the spectrum, from budget issues to national security to poll analysis. Remember, Mitt Romney and much of his party went into Election Day expecting victory.

About health reform: Mr. Barrasso was wrong about everything, even the “unpopular” bit, as I’ll explain in a minute. Mainly, however, he was completely missing the story on affordability.

For the truth is that the good news on costs just keeps coming in. There has been a striking slowdown in overall health costs since the Affordable Care Act was enacted, with many experts giving the law at least partial credit. And we now have a good idea what insurance premiums will be once the law goes fully into effect; a comprehensive survey by the Kaiser Family Foundation finds that on average premiums will be significantly lower than those predicted by the Congressional Budget Office when the law was passed.

But do Republican politicians know any of this? Not if they’re listening to conservative “experts,” who have been offering a steady stream of misinformation. All those claims about sticker , for example, come from obviously misleading comparisons. For example, supposed experts compare average insurance rates under the new system, which will cover everyone, with the rates currently paid by a handful of young, healthy people for bare-bones insurance. And they conveniently ignore the subsidies many Americans will receive.

At the same time, in an echo of the Romney camp’s polling fantasies, other conservative “experts” are creating false impressions about public opinion. Just after Kaiser released a poll showing a strong majority — 57 percent — opposed to the idea of defunding health reform, the Heritage Foundation put out a poster claiming that 57 percent of Americans want reform defunded. Did the experts at Heritage simply read the numbers upside down? No, they claimed, they were referring to some other poll. Whatever really happened, the practical effect was to delude the right-wing faithful.

And the point is that episodes like this have become the rule, not the exception, on the right. How many Republicans know, for example, that government employment has declined, not risen, under President Obama? Certainly Senator Rand Paul was incredulous when I pointed this out to him on TV last fall. On the contrary, he insisted, “the size of growth of government is enormous under President Obama” — which was completely untrue but was presumably what his sources had told him, knowing that it was what he wanted to hear.

For that, surely, is what the wonk gap is all about. Political conservatism and serious policy analysis can coexist, and there was a time when they did. Back in the 1980s, after all, health experts at Heritage made a good-faith effort to devise a plan for universal health coverage — and what they came up with was the system now known as Obamacare.

But that was then. Modern conservatism has become a sort of cult, very much given to conspiracy theorizing when confronted with inconvenient facts. Liberal policies were supposed to cause hyperinflation, so low measured inflation must reflect statistical fraud; the threat of climate change implies the need for public action, so global warming must be a gigantic scientific hoax. Oh, and Mitt Romney would have won if only he had been a real conservative.

It’s all kind of funny, in a way. Unfortunately, however, this runaway cult controls the House, which gives it immense destructive power — the power, for example, to wreak havoc on the economy by refusing to raise the debt ceiling. And it’s disturbing to realize that this power rests in the hands of men who, thanks to the wonk gap, quite literally have no idea what they’re doing.

By: Paul Krugman, Op-Ed Columnist, The New York Times, September 8, 2013

September 9, 2013 Posted by | GOP, Politics | , , , , , , , | Leave a comment

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