“Obamacare Expansion In The Offing?”: Republicans Crying About People Losing Junk Insurance Should Expand The ACA
Every few days, a new poster child for the horror of Obamacare comes along, the person who just loves their insurance plan but has been told it’s being cancelled. Pretty much every time, their story turns out to be full of holes—the plan they’re on is junk insurance, they’d be able to get better and cheaper coverage through the exchanges, and so on (here’s the latest). But without a doubt, this small group of people (and not, say, the millions who are getting free or low-cost coverage for the first time) have become the momentary face of the Affordable Care Act, at least in the mainstream news media’s eyes.
So now the administration is scrambling to deal with this political problem, and here’s the latest twist:
The most popular idea for a fix on the Hill is legislation that would entitle someone who purchases health insurance coverage through the end of this year to keep that coverage. Other legislative responses may include extending the health exchange enrollment deadline or or delaying the penalty for not purchasing coverage.
Obama is also considering a different approach.
According to the administration source, the White House is “looking at an administrative fix for the population of people in the individual market who may have an increase in premiums, but don’t get subsidies.”
Such a fix would address the issue of “sticker shock” that has been popping up across the country, as individuals are losing their coverage and finding only higher-cost alternatives. Under the ACA, there are tax subsidies to help individuals and families with income between 133 percent and 400 percent above the poverty level purchase insurance. Those with incomes higher than 400 percent above poverty get no such assistance. The proposed administrative fix would address this group.
Allowing the junk insurance plans to continue is a terrible idea, no less terrible because it’s being pushed by some Democrats. But giving more subsidies? That’s got some promise. As a big-government liberal, I’m all for the government helping as many people as possible afford coverage. I’m also very skeptical that the administration can just take this move administratively without an act of Congress, but let’s talk about it. Since for the first time in history Republicans are suddenly so very concerned about people not being able to afford health insurance, perhaps they can be pressured into signing on with something that puts their money where their mouths are.
Fat chance, I know. But as long as we’re going to start proposing fixes, how about we let everyone who got a threatening letter from an insurance company buy in to Medicare? If Republicans are going to take the opportunity to demagogue the issue, why not take the opportunity to expand our extremely popular socialized medicine program?
By: Paul Waldman, Contributing Editor, The American Prospect, November 8, 2013
“Bringing Actual Facts To Bear”: The Truth Is, Obamacare Is Working
The Obamacare website might still not be working, but journalists are. All across the country, as Republicans try to highlight tragic tales of Americans losing their current health insurance and allegedly stuck with more expensive options, journalists are coming to the rescue. In case after case, journalists investigated these stories and called the policyholders and combed the insurance exchange websites to bring actual facts to bear in our public debate about Obamacare.
Here are just some of the mythical stories journalists have helped dispel — and the lessons we can learn from them about the reality of the Affordable Care Act:
Deborah Cavallaro was making the rounds on television complaining about how her current insurance plan was canceled under Obamacare. So Los Angeles Times columnist Michael Hiltzik talked to her. Her current plan cost $293 per month but had a deductible of $5,000 per year and out-of-pocket annual limits of $8,500. Also, the current plan covered just two doctor’s visits per year.
But in the California insurance exchange, which Hiltzik helped Cavallaro check, she could get a “silver” plan for $333 per month — $40 more than she’s currently paying. But the new plan has only a $2,000 deductible and maximum out-of-pocket expenses at $6,350. Plus all doctor visits would be covered. Hiltzik writes, “Is that better than her current plan? Yes, by a mile.”
Dianne Barrette also popped up on television on a CBS news report in which she lamented that her $54-per-month insurance plan had been canceled under Obamacare. But Nancy Metcalf at Consumer Reports investigated Barrette’s story and found that her current policy was a “textbook example of a junk plan that isn’t real health insurance at all.” According to Metcalf, if Barrette had ever tried to use her insurance for anything more than a sporadic doctor’s visit, “she would have ended up with tens or hundreds of thousands of dollars of medical debt.”
The plan, for instance, only pays for hospitalization in cases of “complications of pregnancy.” Instead, Metcalf found that Barrette could get a “silver” plan in the state insurance exchange for $165 per month that would actually cover Barrette in the case of any sort of serious or even moderate illness. Which is the very definition of insurance, isn’t it?
Edie Littlefield Sundby, a stage-four gallbladder cancer survivor, published an op-ed in the Wall Street Journal blaming the Affordable Care Act for her canceled insurance policy. In her essay, Littlefield wrote that because of Obamacare, “I have been forced to give up a world-class health plan.” But, according to Igor Volsky of Think Progress, Sundby’s insurer, United Healthcare, “dropped her coverage because they’ve struggled to compete in California’s individual health care market for years and didn’t want to pay for sicker patients like Sundby.”
Earlier this year, United, which has publicly supported the Affordable Care Act, announced that it would pull out of the individual market in California. A company representative said it withdrew because its individual plans have never had a huge presence in the state. According to United, and in compliance with state law, the company won’t be able to re-enter the California individual market until 2017.
By then though, competitors will get stuck with sicker patients like Sundby signing up in the first wave of Obamacare. This means that companies like United can cover cheaper patients if it decides to go back to the California individual insurance market.
According to a report by Dylan Scott at Talking Points Memo, a Seattle woman named Donna received a cancellation letter from her insurance company regarding her current plan. The letter steered Donna and her family into a more expensive option and said, “If you’re happy with this plan, do nothing.” The letter made no mention of the Washington State insurance exchange, where Donna could find plenty of other more affordable choices, because the company wanted a convenient excuse to jack up Donna’s rates.
Had Donna “done nothing,” she would have ended up spending about $1,000 more per month on insurance than the cost of insurance she ultimately chose through the Obamacare exchange. In fact, the practice of trying to mislead customers has become so widespread that Washington state regulators issued a consumer alert to customers.
This is just the tip of the iceberg. Republicans who have been desperate from the very beginning to destroy Obamacare at any cost, regardless of facts or the urgent health care crisis facing America, will continue to dig up stories of people supposedly harmed by the law. And journalists will hopefully continue to investigate these allegations, helping us all sort fact from fiction.
In the meantime, there’s a side benefit to all this: If you are one of the small fraction of Americans who currently relies on the individual insurance market and has seen your current policy canceled, call a journalist — like one of those in the stories above. Reporters all across the country are hungry for real-life stories about how Obamacare is working.
Plus, most reporters have access to high-speed Internet. If you can’t get through to the Obamacare exchange site, there’s a journalist standing by willing to help you navigate the exchange options and explore your pros and cons in terms of costs and benefits. The website might still be glitchy, but old-fashioned shoe-leather reporting is as reliable as ever.
By: Sally Kohn, Special To CNN, November 8, 2013
“The Obamacare Bait And Switch”: America’s Beloved Health Insurance Industry Demonstrates Why We Needed Reform All Along
So here’s my advice: If you’re somebody who’s smoking hot about the Big Lie of the Affordable Care Act — you know, how President Obama told everybody that if they liked their current health insurance policy they could keep it — do yourself a favor. Avoid the county fair midway.
Because if you go, you’re apt to encounter a quick-handed scoundrel running a shell game, and that boy will take your money. Doubtless Obama should have said almost everybody could keep their current plan, or that 95 percent could, but he apparently found that too, um, subtle for the campaign trail.
So now old Mitt “47-percent” Romney gets to call him a liar.
But while your attention’s fixed on the president’s “mendacity,” and “paternalism,” to quote one characteristically overwrought scribe, America’s beloved health insurance industry is demonstrating exactly why we needed reform all along. Certain companies are taking advantage of the political confusion to sell people in the “individual market” far more expensive plans than they need and blame “Obamacare.”
As usual, the nation’s esteemed political media have gone along for the ride. CBS News, rapidly morphing into Fox News Lite, presented the heartbreaking tale of one Diane Barrette, a 56 year-old Floridian who got a letter from her insurance company cancelling her $54 a month policy and offering a replacement for $591 a month—a lot of money to her.
CBS correspondent Jan Crawford, deemed smart enough to cover the U.S. Supreme Court, took Barrette’s story at face value. The idea that health insurance worth having could be purchased at a monthly cost of less than a steak dinner apparently failed to arouse her reporter’s curiosity.
Poor Barrette choked up telling CBS her story, leading to several appearances on Fox News itself.
Had CBS done elementary due diligence, they’d have learned why Ms. Barrette’s plan was so cheap. Reporters who did learned that among other shortcomings, it didn’t cover hospitalization. In reality, she had no health insurance at all. A serious accident or illness might have bankrupted her—precisely the kind of ripoff the Affordable Care Act makes illegal.
Also, Barrette was taking the insurance company’s word about the cost of a replacement policy. Writing for BillMoyers.com, Joshua Holland ran her numbers through Kaiser Permanente’s subsidy calculator. With assistance from Obamacare, she can have a real policy covering preventive care and hospitalization for an out-of-pocket cost of $97 monthly, or a more generous “Silver” level plan for $209.
Now she calls it “a blessing in disguise.”
In short, CBS News couldn’t have gotten the story more backward had they tried. For its part, NBC News featured Los Angeles real estate agent Deborah Cavallaro, whose similar experience led her to conclude that “there’s nothing affordable about the Affordable Care Act.”
However, LA Times columnist Michael Hiltzik found that Cavallaro had simply failed to consult Covered California, the state’s health plan exchange. When he did so, he quickly found that “better plans than she has now are available for her to purchase today, some of them for less money.”
No doubt some among the three to five percent of Americans whose individual health care policies have been cancelled are experiencing genuine sticker shock. However, nobody should take his insurance company’s word at face value without double-checking—a task admittedly made harder by Healthcare.gov’s website meltdown.
See, when you read a story about a couple like Dean and Mary Lou Griffin of Chadd’s Ford, PA, who told the Associated Press they’d expected to be able to keep the policy they bought three years ago, what reporters aren’t asking is where they’d gotten that idea.
From President Obama? Possibly.
More likely, however, from an insurance broker. See, all providers have known about new coverage standards ever since the Affordable Care Act passed in March 2010. Since then some have clearly been “churning” the market, offering low-risk, healthy customers bargain policies they knew perfectly well would no longer pass muster come January 1, 2014.
So now come the inevitable cancellation letters, and guess what? If they were lucky—and health-wise the Griffins have been fortunate—here comes the bad news. “We’re buying insurance that we will never use and can’t possibly ever benefit from,” Dean Griffin complains. “We’re basically passing on a benefit to other people who are not otherwise able to buy basic insurance.”
Two thoughts: One, don’t get cocky, you never know.
Two, boo-hoo-hoo. You can afford it.
Meanwhile, Dylan Scott at Talking Points Memo has documented companies sending “misleading letters to consumers, trying to lock them into…more expensive health insurance plans rather than let them shop for insurance and tax credits on the Obamacare marketplaces.” Authorities in four states have disciplined Humana affiliates for exactly that.
It’s a classic bait and switch: luring customers with unsustainably low rates, and then blaming the White House for their chicanery.
That’s basically why we needed Obamacare to begin with.
By: Gene Lyons, The National Memo, November 6, 2013
“Sanctifying Defenders Of The Status Quo”: The GOP’s Obsession With Rate Shock Victims
Last week, the Obamacare war room detected a twist in the national narrative that concerned them. The media’s obsessive focus on the failed website launch was beginning to give way to stories about individuals who found higher-than-expected prices on the exchanges. A memo instructed participants to prepare for such “media inquiries”: “The media attention will follow individuals to plan selection and their ultimate choices; and, in some cases, there will be fewer options than would be desired to promote consumer choice and an ideal shopping experience,” warned the memo. “Additionally, in some cases there will be relatively high-cost plans.”
CNN’s Jake Tapper obtained the memo. Here is how he described it: “Officials expressed concern that the next shoe to drop in the evolving story about the Affordable Care Act would be disappointment from consumers once they are able to get on the troubled Healthcare.gov website — disappointment because of sticker shock and limited choice.” Notice the crucial difference in framing. The memo simply acknowledged that in some cases — a caveat that appeared twice — consumers would have fewer options and higher prices than the administration would like. In CNN’s characterization, the caveat disappears altogether. Tapper portrays the problem as “disappointment from consumers,” writ large. The minority facing sticker shock has become a stand-in for the entire public.
This turns out to be a synecdoche for the entire Obamacare narrative now. The world of the Republican Party’s fever dreams has sprung to life in the mainstream media, where the Affordable Care Act now exists primarily as a series of cruel, oppressive acts of theft against innocent Americans. Here are CBS News, The Wall Street Journal, and the Washington Post chronicling the parade of horribles.
The stories often turn out to be either more complicated than initially depicted, or wildly overblown. But it is surely true that some people will find themselves worse off, at least immediately, under the new law. That their fate has blotted out everything else about the law explains why health-care reform is so maddeningly difficult to enact in the first place.
Everybody knows about the two main ways in which the American health-care system is awful: It’s the most expensive in the world, by far, and also the only advanced health-care system that denies basic care to many citizens. There’s also a third awful trait as well: The system is resistant to change. The very insecurity of American health care, the ever-present fear of finding one’s insurance lifeline snapped and plunging into the howling void of the 50 million uninsured, renders those with insurance understandably terrified of change.
The Affordable Care Act worked around the inherent change aversion of the system by leaving the vast majority of it in place. Insuring tens of millions of Americans costs money, and that money has to come from somewhere, but the law’s author’s carefully apportioned the burden in a relatively painless way. Some of the money comes from higher taxes on the rich — a source of anger and resentment on the right, though conservatives have shrewdly recognized that complaining about higher taxes on wealthy investors to pay for covering the uninsured is not a winning message. Some of it comes from reshuffling Medicare spending, so that the government essentially shifts funds from reimbursing hospitals for treating uninsured patients in emergency rooms to basic medical care, a clear positive-sum transfer.
And, yes, some of the cost is borne by the minority of healthy individuals paying higher premiums. (These individuals will, of course, go from Obamacare victims to Obamacare beneficiaries the moment anybody in their household develops a serious medical condition, in the same manner that fire insurance is a bad deal for people whose houses don’t burn.)
Why has their plight attained such singular prominence? Several factors have come together. The news media has a natural attraction to bad news over good. “Millions Set to Gain Low-Cost Insurance” is a less attractive story than “Florida Woman Facing Higher Costs.” Obama overstated the case when he repeatedly assured Americans that nobody would lose their current health-care plan. There’s also an economic bias at work. Victims of rate shock are middle-class, and their travails, in general, tend to attract far more lavish coverage than the problems of the poor. (Did you know that on November 1, millions of Americans suffered painful cuts to nutritional assistance? Not a single Sunday-morning talk-show mentioned it.)
The point here is not that Obamacare represents a perfectly optimal restructuring of the health-care system. Almost nobody would regard it as such. The point is that it represents the least-disruptive, least-painful way to clear the minimal threshold of any humane reform. The preferred alternatives of both right and left would impose an order of magnitude of more dislocation — creating not a few million “victims,” but tens of millions. What’s on display at the moment is a way of looking at the world that sanctifies defenders of the horrendous status quo and places all the burden upon those trying to change it.
By: Jonathan Chait, New York Magazine, November 5, 2013
“Intentionally Obscuring The Obvious”: Five Things Every American Needs To Know About Health Care Reform
“Discover the obvious,” Jonathan Cohn said on Monday.
Cohn is one of the nation’s foremost health care journalists and the keynote speaker of the journalism portion of “Hearsay or Fact: A Symposium on the Communication of the Affordable Care Act,” hosted by the Center for Healthcare Research and Transformation.
A senior editor at The New Republic and author of Sick: The Untold Story of America’s Health Care Crisis—and the People Who Pay the Price, Cohn decided to use his time to give five rules about reporting on the Affordable Care Act (ACA). His first rule was an admission that people who follow the everyday tribulations related to Obamacare — like wonks in every field — often assume they don’t need to report on “the obvious” and thus fail to report on the issues that matter most to the public.
He pointed to the success of fellow panelist Stephen Brill’s Time magazine cover story “Bitter Pill: Why Medical Bills Are Killing Us” that illuminated the outrageous variation in medical prices and profits from one hospital and one patient to the next, a well-known fact to experts that came as a shock to many Americans.
What’s obvious to everyone about the debate over Obamacare is that the public is confused. Nearly two-thirds of Americans didn’t know in late September that the health care exchanges were opening on October 1 and 67 percent of the uninsured said “they don’t have enough information about the law to know how it will impact their families,” according to the Kaiser Health Tracking Poll. The uninsured, of course, make up this law’s key demographic. They are the people this law is designed to help most, and their participation in the health care marketplaces will determine if the law is a success.
Why are people so confused? Much of what should be “obvious” has become obscured — intentionally.
Democrats passed the ACA with only Democratic votes — and Joe Lieberman. Republicans have responded with an unprecedented effort to scare voters, starve implementation and sabotage the law, an effort that helped doom the launch of Healthcare.gov, which the White House has to own as a greater act of self-sabotage than anything Republicans could have pulled off themselves.
The political battle over the law has overwhelmed any pertinent policy discussion. So it’s no wonder that people can’t even agree on the basic premises that made health reform necessary and an improvement over the current system, with 56 percent of Americans saying they’ve heard more about the politics and the controversies of the law than any discussion of its practical impact.
Here are five “obvious” premises that every American needs to understand so we can begin to have a rational debate on health care reform.
Before The ACA, America’s Health Care System Was Already ‘Socialized’
You should know by now that the United States spends more than any country on health care, even though approximately 50 million citizens have no insurance whatsoever. This is how we ended up with the 46th most efficient health care system in the world.
The Affordable Care Act attempts to fix this in a number of ways, including health care exchanges, subsidies, Medicaid expansion and regulation.
Since 2011, the government has set how much insurance companies have to spend on actual care – 80-85 percent depending on their size — and the minimum standard for the policies they can offer, among several other regulations. So even though private insurers remain in business and the government hasn’t taken control of the medical industry as it has in the United Kingdom, Republicans argue that it’s “a government takeover” of the health care system. Based on this standard, health care has been “taken over” by the government and even “socialized” for decades.
Since 1965, Americans over 65 and under the poverty level were guaranteed basic care, though it took until 1982 before the last state, Arizona, accepted Medicaid. This left America with a single-payer system, with a giant hole mostly made up of Americans under 65 with jobs, and their families.
In 1986, President Ronald Reagan signed a bill that tried to plug that hole — the Emergency Medical Treatment and Active Labor Act. This law states that any hospital that accepts any federal funds — which basically every hospital in America does — cannot turn away any patient, regardless of his or her ability to pay. As this bill provides no reimbursement for this care, the costs of those who can’t pay get passed on to those who can.
In 1996, Congress passed and President Clinton signed the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which mandated guaranteed renewability for all health insurance plans, requiring that an insurer has to offer you renewals of your policy without charging you any more based on any new information it has about your health.
These are three of the key “government takeovers” that helped lead to the broken health care system that we are now attempting to fix, while maintaining a private insurance industry.
The ACA clearly isn’t a one-size-fits-all solution, health economist Thomas Buchmueller pointed out at Monday’s symposium.
That would be a two-page bill that said, more or less, “Everyone is now on Medicare.”
Rich People Get Their Health Care Subsidized By Taxpayers
Single payer is a simple, proven system that would insure all Americans, save lives and cut costs. And it will likely never happen in America as long as the filibuster exists in the Senate. Still, liberals will not stop offering this ideal solution whenever Republicans complain about costs or cancellations.
The right has its own fantasy solution that is about as improbable as single payer: getting rid of the tax exclusion of premiums for employer-sponsored insurance.
As a result of an accident of history, employers and employees do not have to pay taxes on costs of health insurance policies.
Conservatives hate this. “We call the tax exclusion for ESI a tax ‘break,’ but when you think about it, it operates more like a tax hike,” writes the Cato Institute’s director of health policy Michael F. Cannon, another symposium participant. “It coerces workers into handing control over $11,000 of their earnings to their employers, who then choose the workers’ health plans for them.”
John McCain campaigned for president on ending this “tax break,” which costs taxpayers more than the costs of all the subsidies and Medicaid expansion in the ACA, according to symposium participant Dr. John Z. Ayanian. This will never happen because it would be far more disruptive than Medicare for All and — unlike effective single-payer systems around the globe — it has never been proven to work, anywhere.
As a result, taxpayers will continue to help subsidize takers like Ted Cruz, whose family’s $40,000-a-year insurance policy from Goldman Sachs entitles them to a subsidy large enough to put a family of four on Medicaid, though the Cruzes are clearly able to afford their own health insurance.
Republican Arguments Against Obamacare Are Opportunistic And Contradictory
Republicans fought the passage of the ACA by conjuring images of “death panels” pulling the plug on grandma and a “government takeover” that would destroy America.
The problem with these warnings was that approximately 80 percent of Americans get their health insurance through their employers. Most of these people haven’t and likely won’t notice much of a change in their coverage whatsoever, unless they’ve gone in for preventive or reproductive health care and discovered that they didn’t have to pay a co-pay for it.
That’s why Mitt Romney’s continual assertion that President Obama was embracing “European” solutions never made sense to most Americans.
Republicans didn’t seize on the president’s now-disproven promise “If you like your insurance, you can keep it” until late 2013, though it was clear that it never jibed with his other promise to make sure insurance policies met minimum standards.
Now their fixation on cancellation notices boxes them in, in two ways. First, it ignores that their plot to repeal Obamacare would result in as many as 137 million cancellation notices. Second, right-wing policy proposals would force cancellations that target far more than the estimated 5 percent of Americans who are having their plans changed by the ACA.
“Even if free-market health care reformers were able to pass the plan of their dreams — which would involve tweaking the tax code to end the bias in favor of employer-sponsored insurance — it would likely mean a lot of people would get dropped from their current plans,” the Washington Examiner’s Philip A. Klein notes.
The Republicans’ advantage is that they’re so stuck on the “repeal” part of “repeal and replace” that they’ve never actually passed an ACA replacement. Their rhetoric, and the fact that the only real conservative alternative to single payer requires an individual mandate, means any plan they pass would likely end up generating the same criticisms they’re lobbing at the ACA.
We Can’t Go Back To The Pre-Obamacare Health System
Dr. Ayanian pointed out that though the ACA may not be embraced by a majority of the American public, three key policies have: young people staying on their parents’ plans until age 26, closing the Medicare Part D prescription-drug donut hole, and the ending of concerns about pre-existing conditions.
The Republican Study Committee Obamacare replacement plan, which the House has not voted on, provided pre-existing conditions protections, but only for those who are already insured.
The Washington Post’s Jonathan Bernstein puts it simply — repeal “is dead”:
No one is ever going to kick young adults off their parents’ insurance (or change the law so that insurance companies are allowed to do it). No one is going to bring back the various limitations in pre-ACA insurance policies. Some trimming of the new Medicaid rolls might be possible. But no one — no politician who has to face reelection, at least – is going to just toss all those people off their insurance with nothing to replace it.
Beyond all this is simply the Humpty Dumpty-ness of the situation: The old system has been slowly pushed off the wall for three years now, and by this point it’s really beyond repair, whatever the merits or politics of the situation. Garance Franke-Ruta captured some of this in making the point that delaying things would be impractical at this point, but it really goes beyond that. Too many people have already done too many things to make a full reversal even remotely plausible.
Before the ACA became law, millions of Americans lost their insurance, rates were rising faster than the rate of inflation and the federal government was absorbing more and more health care costs. Repealing it would be a nightmare in that it would reveal a broken health care system badly in need of some type of fix.
Republicans Are Hurting Themselves, Their States And The Working Poor To ‘Punish’ Obama
Because the Supreme Court gave them the chance to do it, about two dozen — all Republican — states have completely rejected the Medicaid expansion in the ACA, even though the government will cover 100 percent of the costs of the expansion for the first three years. States could then opt out of the coverage or continue it with the feds’ contribution decreasing to 90 percent by 2020.
Medicaid expansion should be a huge transfer of wealth from rich blue states to poorer red states, as most of America’s public assistance programs are. Instead Texas, with the largest uninsured population in the nation, has rejected expansion, but will still contribute to helping to insure Californians.
By rejecting Medicaid expansion, just four states – Florida, Texas, Georgia, and North Carolina — will leave 5 million poor people with jobs uninsured. This will result in more emergency room visits that the uninsured cannot afford, and higher rates for the insured in those states.
By: Jason Sattler, The National Memo, November 5, 2013
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