By: Jay Inslee, Steve Beshear and Dannel P. Malloy, Opinion Pages, The Washington Post, Published: November 17, 2013: Jay Inslee, a Democrat, is governor of Washington. Steve Beshear, a Democrat, is governor of Kentucky. Dannel P. Malloy, a Democrat, is governor of Connecticut.
“California, Here We Come?”: If Obamacare Can Work For 38 Million People In California, It Can Work For America
It goes without saying that the rollout of Obamacare was an epic disaster. But what kind of disaster was it? Was it a failure of management, messing up the initial implementation of a fundamentally sound policy? Or was it a demonstration that the Affordable Care Act is inherently unworkable?
We know what each side of the partisan divide wants you to believe. The Obama administration is telling the public that everything will eventually be fixed, and urging Congressional Democrats to keep their nerve. Republicans, on the other hand, are declaring the program an irredeemable failure, which must be scrapped and replaced with … well, they don’t really want to replace it with anything.
At a time like this, you really want a controlled experiment. What would happen if we unveiled a program that looked like Obamacare, in a place that looked like America, but with competent project management that produced a working website?
Well, your wish is granted. Ladies and gentlemen, I give you California.
Now, California isn’t the only place where Obamacare is looking pretty good. A number of states that are running their own online health exchanges instead of relying on HealthCare.gov are doing well. Kentucky’s Kynect is a huge success; so is Access Health CT in Connecticut. New York is doing O.K. And we shouldn’t forget that Massachusetts has had an Obamacare-like program since 2006, put into effect by a guy named Mitt Romney.
California is, however, an especially useful test case. First of all, it’s huge: if a system can work for 38 million people, it can work for America as a whole. Also, it’s hard to argue that California has had any special advantages other than that of having a government that actually wants to help the uninsured. When Massachusetts put Romneycare into effect, it already had a relatively low number of uninsured residents. California, however, came into health reform with 22 percent of its nonelderly population uninsured, compared with a national average of 18 percent.
Finally, the California authorities have been especially forthcoming with data tracking the progress of enrollment. And the numbers are increasingly encouraging.
For one thing, enrollment is surging. At this point, more than 10,000 applications are being completed per day, putting the state well on track to meet its overall targets for 2014 coverage. Just imagine, by the way, how different press coverage would be right now if Obama officials had produced a comparable success, and around 100,000 people a day were signing up nationwide.
Equally important is the information on who is enrolling. To work as planned, health reform has to produce a balanced risk pool — that is, it must sign up young, healthy Americans as well as their older, less healthy compatriots. And so far, so good: in October, 22.5 percent of California enrollees were between the ages of 18 and 34, slightly above that group’s share of the population.
What we have in California, then, is a proof of concept. Yes, Obamacare is workable — in fact, done right, it works just fine.
The bad news, of course, is that most Americans aren’t lucky enough to live in states in which Obamacare has, in fact, been done right. They’re stuck either with HealthCare.gov or with one of the state exchanges, like Oregon’s, that have similar or worse problems. Will they ever get to experience successful health reform?
The answer is, probably yes. There won’t be a moment when the clouds suddenly lift, but the exchanges are gradually getting better — a point inadvertently illustrated a few days ago by John Boehner, the speaker of the House. Mr. Boehner staged a publicity stunt in which he tried to sign up on the D.C. health exchange, then triumphantly posted an entry on his blog declaring that he had been unsuccessful. At the bottom of his post, however, is a postscript admitting that the health exchange had called back “a few hours later,” and that he is now enrolled.
And maybe the transaction would have proceeded faster if Mr. Boehner’s office hadn’t, according to the D.C. exchange, put its agent — who was calling to help finish the enrollment — on hold for 35 minutes, listening to “lots of patriotic hold music.”
There will also probably be growing use of workarounds — for example, encouraging people to go directly to insurers. This will temporarily defeat one of the purposes of the exchanges, which was to make price comparisons easy, but it will be good enough as a short-term patch. And one shouldn’t forget that the insurance industry has a big financial stake in the success of Obamacare, and will soon be pitching in with big efforts to sign people up.
Again, Obamacare’s rollout was a disaster. But in California we can see what health reform will look like, beyond the glitches. And it’s going to work.
By: Paul Krugman, Op-Ed Columnist, The New York Times, November 24, 2013
“How We Got Obamacare To Work”: We Urge Congress To Get Out Of The Way And Support Efforts To Make Health-Care Reform Work
In our states — Washington, Kentucky and Connecticut — the Affordable Care Act, or “Obamacare,” is working. Tens of thousands of our residents have enrolled in affordable health-care coverage. Many of them could not get insurance before the law was enacted.
People keep asking us why our states have been successful. Here’s a hint: It’s not about our Web sites.
Sure, having functioning Web sites for our health-care exchanges makes the job of meeting the enormous demand for affordable coverage much easier, but each of our state Web sites has had its share of technical glitches. As we have demonstrated on a near-daily basis, Web sites can continually be improved to meet consumers’ needs.
The Affordable Care Act has been successful in our states because our political and community leaders grasped the importance of expanding health-care coverage and have avoided the temptation to use health-care reform as a political football.
In Washington, the legislature authorized Medicaid expansion with overwhelmingly bipartisan votes in the House and Senate this summer because legislators understood that it could help create more than 10,000 jobs, save more than $300 million for the state in the first 18 months, and, most important, provide several hundred thousand uninsured Washingtonians with health coverage.
In Kentucky, two independent studies showed that the Bluegrass State couldn’t afford not to expand Medicaid. Expansion offered huge savings in the state budget and is expected to create 17,000 jobs.
In Connecticut, more than 50 percent of enrollment in the state exchange, Access Health CT, is for private health insurance. The Connecticut exchange has a customer satisfaction level of 96.5 percent, according to a survey of users in October, with more than 82 percent of enrollees either “extremely likely” or “very likely” to recommend the exchange to a colleague or friend.
In our states, elected leaders have decided to put people, not politics, first.
President Obama announced an administrative change last week that would allow insurance companies to continue offering existing plans to those who want to keep them. It is up to state insurance commissioners to determine how and whether this option works for their states, and individual states will come to different conclusions.
What we all agree with completely, though, is the president’s insistence that our country cannot go back to the dark days before health-care reform, when people were regularly dropped from coverage, and those with “bare bones” plans ended up in medical bankruptcy when serious illness struck, many times because their insurance didn’t cover much of anything.
Thanks to health-care reform and the robust exchanges in our states, people are getting better coverage at a better price.
One such person is Brad Camp, a small-business owner in Kingston, Wash., who received a cancellation notice in September from his insurance carrier. He went to the state exchange, the Washington Healthplanfinder, and for close to the same premium his family was paying before got upfront coverage for doctor’s office visits and prescription drug , vision and dental coverage. His family was able to keep the same insurance carrier and doctors and qualified for tax credits to help cover the cost.
Since Howard Stovall opened his sign and graphics business in Lexington, Ky., in 1998, he has paid half the cost of health insurance for his eight employees. With the help of Stovall’s longtime insurance agent and Kentucky’s health exchange, Kynect, Stovall’s employees are saving 5 percent to 40 percent each on new health insurance plans with better benefits. Stovall can afford to provide additional employee benefits, including full disability coverage and part of the cost of vision and dental plans, while still saving the business 50 percent compared with the old plans.
In Connecticut, Anne Masterson was able to reduce her monthly premiums from $965 to $313 for similar coverage, including a $145 tax credit. Masterson is able to use her annual premium savings of $8,000 to pay bills or save for retirement.
These sorts of stories could be happening in every state if politicians would quit rooting for failure and directly undermining implementation of the Affordable Care Act — and, instead, put their constituents first. Health reform is working for the people of Washington, Kentucky and Connecticut because elected leaders on both sides of the aisle came together to do what is right for their residents.
We urge Congress to get out of the way and to support efforts to make health-care reform work for everyone. We urge our fellow governors, most especially those in states that refused to expand Medicaid, to make health-care reform work for their people too.
“What A Shocker”: Obamacare Is Working Best In States That Aren’t Trying To Sabotage It
The disappointing Affordable Care Act (ACA) numbers the Department of Health and Human Services (HHS) released on Wednesday revealed that the law is working best in the states that are — shockingly — implementing the law as it was designed.
Of the 106,185 people who have completed an application for health insurance, nearly 75 percent came from 14 states and the District of Columbia that both set up their own exchanges and expanded Medicaid.
Unsurprisingly, California and New York combined for the bulk of the enrollments, 51,769. But the most promising news from the Golden State wasn’t even included in this report.
Peter Lee, the executive director of Covered California, reported Wednesday that as of Tuesday, 60,000 Californians had signed up for insurance. Signups have increased to a rate of almost 2,500 enrollees per day in November. At that pace, the state could be expected to enroll 402,500 people by March 31 but Lee says that he expects to hit a goal of 500,000 to 700,000 people by then, which means he expects the pace to pick up by at least 640 people a day to over 3,000 enrollees.
Lee’s optimism is linked to more than the enrollment numbers. It seems California’s consumers are happy with the state’s website.
“Overall, nearly 70 percent of consumers who completed the survey found the application process easy to complete, and 88 percent of customers visiting CoveredCA.com found the information needed to choose a health plan that was right for them,” Covered California reported in a statement released Wednesday, giving Republicans another reason to hope that California isn’t a bellwether for the rest of the nation.
Red Kentucky is the only state in the union that voted for Mitt Romney and set up its own exchange, thanks in large part to Democratic governor Steve Beshear. The state’s site signed up a total of 32,485 Kentuckians, with 5,586 enrolling in private plans, in its first month of operation. This reduces the state’s uninsured population —estimated at 640,000 — by just over 5 percent.
Of course, it’s not hard for the states to look impressive next to the federal number that is anemically low. And not all the states that set up their own exchanges have succeeded. Oregon’s marketplace is so flawed, they didn’t even have numbers to report for October.
Implementing health care reform was never supposed to be easy.
“It’s like fixing an airplane while it’s in flight, if there is something terribly wrong with the plane,” said Timothy Jost, a health law professor at Washington & Lee University and an expert on the ACA.
And that’s without the unprecedented campaign of sabotage the right has waged. But the obstruction that has threatened the law most has been the combination of a mostly unforced error — Healthcare.gov’s disastrous launch — and Republican states refusing to launch their own exchanges. While the right is thrilled they’ve assisted in this catastrophe, it was the ancillary result of another sabotage strategy that was either masterminded or enthusiastically encouraged by Michael Cannon.
Who?
“Cannon is a health care policy expert at the libertarian Cato Institute,” reports The New Republic‘s Alec MacGillis. “He is also an avowed opponent of the Affordable Care Act, and has for several years now been embarked on a legal crusade that, while a ways from triumphing, may have inadvertently played an outsized role in suppressing the number of states setting up their own exchanges, thereby greatly confounding the law’s implementation.”
Cannon believes he has found a loophole in the law that could end up undoing it in any state that didn’t set up an exchange. With that in mind, he helped successfully convince every state with a Republican governor to reject their right to build their own site.
By opting out, states made the success of the president’s signature legislative accomplishment dependent on one single portal that needed to reach its tentacles into three dozen complex insurance markets at one time.
That — it turns out — is a lot more complicated than the administration expected it to be.
The best state numbers show that the ACA can be implemented with participation rates that are in at least in the same ballpark as Massachusetts’ Romneycare or Medicare Part D.
And there were some other numbers in the HHS report that bode well for reform.
HHS reports that 26,876,527 different users accessed the site and 3,158,436 calls were made to its center. A total of 1,477,853 applications processed to the point of where eligibility could be determined. This shows that the demand for what the marketplace is offering definitely exists.
Clearly and undeniably, the fate of the law now depends most on one thing.
“The October report is clearly disappointing,” Timothy Jost wrote in his blog. ”But the really important reports will be the December report, which will tell us how many will be enrolled for coverage that begins in January, and the March report, which will tell us how many will be enrolled for 2014. If healthcare.gov is up and running by December, there is every reason to believe those reports will be much more promising.”
By: Jason Sattler, The National Memo, November 14, 2013
“The Kicking Mules Vs The Lying Turtle”: The GOP Civil War Is Now Basically Between Mitch McConnell And The Tea Party
There will not be another government shutdown, says Senate Minority Leader Mitch McConnell (R-KY).
“It was a strategy that I said both publicly and privately could not work, and did not work,” McConnell told The Wall Street Journal‘s Peggy Noonan.
“All it succeeded in doing was taking attention off of Obamacare for 16 days,” he added. “And scaring the public and tanking our brand—our party brand. One of my favorite old Kentucky sayings is that there’s no education in the second kick of a mule. It ain’t gonna happen again.”
This sounds as if he’s vowing to compromise when the resolution funding the government and the debt ceiling issue come up again early in 2014.
And to the Tea Party, that only means one thing: Treason!
The leader knows what the Tea Party thinks of him and he’s ready to take them on, along with his Tea Party challenger, Matt Bevin.
“They’ve been told the reason we can’t get to better outcomes than we’ve gotten is not because the Democrats control the Senate and the White House but because Republicans have been insufficiently feisty,” he told Noonan. “Well, that’s just not true, and I think that the folks that I have difficulty with are the leaders of some of these groups who basically mislead them for profit. . . . They raise money . . . take their cut and spend it.”
And in case that wasn’t clear enough, he called out the Senate Conservatives Fund, one of the key supporters behind Senator Ted Cruz (R-TX) and the plot to defund Obamacare that forced the shutdown.
“That’s the one I’m prepared to be specific about,” he said, adding that the group “has elected more Democrats than the Democratic Senatorial Committee over the last three cycles.”
Tea Party hero Erick Erickson responded to McConnell’s comments on Friday with “Question for Mitch McConnell: Will Any Reporter Ask It?”
The Red State editor-in-chief states that “the Senate Conservatives Fund has only helped nominate two Tea Party candidates, who went on to lose the general election.” In contrast, he points out, “On the other hand, Mitch McConnell supported Rick Berg, Denny Rehberg, Carly Fiorina, Linda McMahon, George Allen, and Tommy Thompson. All lost to Democrats.”
This leads to Erickson’s question: “So some enterprising reporter should ask Mitch McConnell this question: Given that the Senate Conservatives Fund has a better record than Mitch McConnell of getting Republicans elected to the Senate, shouldn’t he be supporting Matt Bevin?”
McConnell has successfully been able to persuade Ted Cruz to stay out of primaries. But the Tea Party, Erickson and the Senate Conservatives Fund are going all in. We’ll see who gets shut down this time.
By: Jason Sattler, The National Memo, November 8, 2013
“Standing With Mitch”: Is Rand Paul A Secret RINO?
Rand Paul (R-KY) was one of the 18 senators who voted against the deal brokered between Senate Majority Leader Harry Reid (R-NV) and Senate Minority Leader Mitch McConnell (R-KY) that ended the government shutdown and raised the debt limit — but that deal would likely never have happened if not for Paul’s alliance with McConnell.
Less than four years ago, Paul easily defeated Secretary of State Trey Grayson, McConnell’s choice to replace Senator Jim Bunning, in a GOP primary. The minority leader quickly moved to make amends with Paul as the Tea Party favorite cruised to a win in the general election.
Since 2010, the two men have formed a relationship of equals that’s worked to the advantage of both. “You know, I think when we call people a ‘mentor,’ I think that overstates,” Paul said when asked about the nature of their bond earlier this year. “We are colleagues, and I do respect him.”
McConnell backed Paul’s “drone” filibuster of future CIA director John Brennan. Paul has not only endorsed McConnell’s re-election, he’s lent out his campaign manager Jesse Benton to the senator. A hot mic caught the two senators discussing tactics for how to avoid blame for the government shutdown.
It’s impossible to imagine McConnell being able to swoop in at the last moment to negotiate a deal if he weren’t leading his primary opponent — Tea Partier Matt Bevin — by as much as 40 percent. And it’s impossible to imagine McConnell crushing a hardline opponent so handily if Paul had decided to back said hardline opponent.
In the wake of the McConnell-Reid compromise, Speaker John Boehner (R-OH) has gotten most of the grief from the Tea Party. You can get a sampling of the vile things he’s being called on his Facebook page from this Tea Party Insult Generator. The Speaker is much more deserving of grief because he let the shutdown happen and refused to even hold a vote on the “clean” continuing resolution that McConnell let pass the Senate.
However, Sarah Palin said on Thursday that she’s ready to fight in Kentucky in order to “shake things up in 2014.”
McConnell has already said there will not be another shutdown over Obamacare. He also refused to comment on the ascent of Senator Ted Cruz (R-TX). To those who have embraced the junior senator from Texas as the new leader of the conservative movement, this makes the minority leader a member of the “Surrender Caucus.”
It used to be a big deal when a former member of a national Republican ticket threatened to support a primary challenge to the GOP’s leader in the Senate. But that was back when Republican congressmen didn’t accuse former GOP standard-bearers of being in league with al Qaeda.
Palin’s threat would be a much bigger problem for the senator if Rand Paul weren’t standing with Mitch. And if you’re wondering where Paul’s loyalty is coming from, ask the man both men have employed — Jesse Benton. If he doesn’t know he’s being recorded, Benton might tell you, “I’m sorta holdin’ my nose for two years, cause what we’re doin’ here is going to be a big benefit for Rand in ’16…”
By: Jason Sattler, The National Memo, October 17, 2013
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