“Surprise, Surprise”: The Real Numbers On ‘The Obamacare Effect’ Are In, Now Let The Crow Eating Begin
After years of negative speculation on the part of the opponents of Obamacare, hard data is finally coming in with respect to the anticipated negative side-effects of the law.
The results are guaranteed to both surprise and depress those who have built their narrative around the effort to destroy the Affordable Care Act.
Let’s begin with the meme threatening that healthcare reform will lead to a serious decline in full-time employment as employers reduce workforce hours to below 30 per week in the effort to avoid their responsibility to provide health benefits to their employees.
It turns out that there has, in fact, been no such rush to reduce work hours. Indeed, numbers released last week reveal that precisely the opposite is taking place.
According to the Bureau of Labor Statistics (BLS), the number of part-time workers in the United States has fallen by 300,000 since March of 2010 when the Affordable Care Act was passed into law. What’s more, in the past year alone—the time period in which the nation was approaching the start date for Obamacare—full-time employment grew by over 2 million while part-time employment declined by 230,000.
And it gets even more interesting.
Despite the cries of anguish over the coming destruction of private sector work opportunities at the hands of Obamacare, it turns out that the only significant ‘cutter’ of work hours turns out to be in the public sector where cops, teachers, prison guards and the like are experiencing cuts in work time as cities, states and universities seek to avoid the obligations of the health reform law.
Correct me if I am wrong, but is it not the very same folks who strenuously oppose Obamacare who are constantly screaming for smaller government? Are these not the same people who have, for as many years as I can recall, been carping about swollen government payrolls?
But the false narrative that has been peddled to make us believe that the private sector can’t wait to lower our hours of employment turns out not to be the only false note being played by anti-Obamacare forces.
For months now, we have been pounded with the story of the millions of Americans who have lost their non-group, individual health insurance policy due to cancellations forced by Obamacare.
Yet, a new study just out by Lisa Clemons-Cope and Nathaniel Anderson of the Urban Institute tells a very different story.
How many times have readers, along with television and radio audiences, read or heard me point out that few ever expected to hang onto their individual insurance policy for longer than a year or two following date of purchase? Long before there was Obamacare, it was always clear that when someone purchased an individual health instance policy, it was pretty much a given that they would either be moving on to an employer provided group plan when they get a job or that their policy would respond to the ordinary, pre-Obamacare changes that occurred from year to year and result in the consumer having to purchasing a new plan after a short period of time.
Indeed, it was this very reality that made it clear to those who follow the health insurance industry that Obama’s “If you like your policy you can keep your policy” proclamation was a near impossibility for those participating in the individual marketplace. This simply wasn’t the way the individual market worked.
The Urban Institute study bears this out, noting that “the non-group market has historically been highly volatile, with just 17 percent retaining coverage for more than two years.”
While Obamacare foes have been quick to jump on this statistic when it comes to condemning the President for uttering his promise that you could keep your insurance if you are happy with your policy, the same people have somehow managed to miss the reality that a huge percentage of those who received cancellation notices last year were going to get that notice even if the Affordable Care Act had never existed.
But that is not all that critics have been missing as they’ve sought to exploit the supposed high number of cancellations they claim are due to Obamacare.
To find out just how many people have really been put into an insurance fix, the Urban Institute’s Health Reform Monitoring Survey, in December of 2013, asked people between the ages of 18 and 64 the following question:
“Did you receive a notice in the past few months from a health insurance company saying that your policy is cancelled or will no longer be offered at the end of 2013?”
The following bar published in Health Affairs provides the results—
Note that the number of people who saw their policy cancelled because it did not meet the Obamacare minimum requirements was 18.6 percent—dangerously close to the 17 percent of individual policyholders who were losing their individual market policies pre-Obamacare.
Also note that the 18.6 percent equates to roughly 2.6 million people whose plans were cancelled as a result of Obamacare—a number well below the estimates of 5 million or considerably more being tossed about by Obamacare opposition.
So, what happens to these folks who saw their health insurance policy cancelled?
According to the Urban Institute researchers :
“While our sample size of those with non-group health insurance who report that their plan was cancelled due to ACA compliance is small (N=123), we estimate that over half of this population is likely to be eligible for coverage assistance, mostly through Marketplace subsidies. Consistent with these findings, other work by Urban Institute researchers estimated that slightly more than half of adults with pre-reform, nongroup coverage would be eligible for Marketplace subsidies or Medicaid.”
So what does this data tell us?
As a result of at least half of those cancelled being able to either enroll in a Medicaid program or receive subsidies on the healthcare exchanges, many—if not most—will now find health care coverage at a price lower than previously paid while greatly improving the quality of coverage.
Still, roughly one million people will have to replace their cancelled policy with something that may cost them more. This is not a good thing but it is far, far less dramatic than what we’ve been hearing. It is also a part of the expected upheaval that has always—and will always—result from the passage of reforms designed to benefit the greatest number of people. Traditionally, those who are disadvantaged in this way find that things are sorted out in amendments to the initial legislation, amendments that can only result when Republicans in Congress stop playing politics and begin the serious work of making the law better for Americans.
There is another problem noted in the study—
Because of the amount of focus placed on scaring the you-know-what out of people when it comes to the alleged dire effects of Obamacare rather than educating them, people remain in the dark as to what is available on the exchanges or via the state Medicaid programs.
Per the Urban Institute study—
“Yet making the best enrollment choice may be difficult for consumers. HRMS findings show that many people are not aware of the new state Marketplaces, few know whether their state is expanding Medicaid, and many lack the confidence to enroll, make choices, and pay their premiums.”
Once again, politics trumps policy and the critical needs of those our elected officials are sworn to serve.
I highly encourage everyone—whether friend or foe of healthcare reform—to take a look at the study cited above and the BLS statistics. While most all would agree that there are some repairs that need to be made to the Affordable Care Act, workable fixes designed to benefit the public and improve American healthcare cannot happen so long as politicians, pundits and special interests are devoted to lying about what Obamacare means and what it does not mean to the American public.
Facts matter—even when they screw up an effective disinformation campaign.
UPDATE: Monday, 12:15pm EST:
The news just keeps on coming.
The Gallup-Healthways Well-Being Index is out this morning and reveals that 15.9 percent of American adults are now uninsured, down from 17.1 percent for the last three months of 2013 and has shown improvements in every major demographic group with the exception of Hispanics who did not advance.
That translates roughly to 3 million to 4 million people getting coverage who did not have it before.
According to Gallup, the number of Americans who still do not have health insurance coverage is on track to reach the lowest quarterly number since 2008.
This is one statistic that is going to be tough for Obamacare critics to overcome.
By: Rick Ungar, Op-Ed Contributor, Forbes, March 10, 2014
“The Hammock Fallacy”: Paul Ryan’s Poverty Report, Like His Famous Budget Plan, Is A Con Job
Hypocrisy is the tribute vice pays to virtue. So when you see something like the current scramble by Republicans to declare their deep concern for America’s poor, it’s a good sign, indicating a positive change in social norms. Goodbye, sneering at the 47 percent; hello, fake compassion.
And the big new poverty report from the House Budget Committee, led by Representative Paul Ryan, offers additional reasons for optimism. Mr. Ryan used to rely on “scholarship” from places like the Heritage Foundation. Remember when Heritage declared that the Ryan budget would reduce unemployment to a ludicrous 2.8 percent, then tried to cover its tracks? This time, however, Mr. Ryan is citing a lot of actual social science research.
Unfortunately, the research he cites doesn’t actually support his assertions. Even more important, his whole premise about why poverty persists is demonstrably wrong.
To understand where the new report is coming from, it helps to recall something Mr. Ryan said two years ago: “We don’t want to turn the safety net into a hammock that lulls able-bodied people to lives of dependency and complacency, that drains them of their will and their incentive to make the most of their lives.” There are actually two assertions here. First, antipoverty programs breed complacency; that is, they discourage work. Second, complacency — the failure of the poor to work as much as they should — is what perpetuates poverty.
The budget committee report is almost entirely concerned with the first assertion. It notes that there has been a large decline in labor force participation, and it claims that antipoverty programs, which reduce the incentive to work, are a major reason for this decline. Then come 200 pages of text and 683 footnotes, designed to create the impression that the scholarly research literature supports the report’s claims.
But it doesn’t. In some cases, Mr. Ryan and colleagues outright misstate what the research says, drawing outraged protests from a number of prominent scholars about the misrepresentation of their work. More often, however, the report engages in argument by innuendo. It makes an assertion about the bad effects of a program, then mentions a number of studies of that program, and thereby leaves the impression that those studies support its assertion, even though they don’t.
What does scholarly research on antipoverty programs actually say? We have quite good evidence on the effects of food stamps and Medicaid, which draw most of Mr. Ryan’s ire — and which his budgets propose slashing drastically. Food stamps, it seems, do lead to a reduction in work and working hours, but the effect is modest. Medicaid has little, if any, effect on work effort.
Over all, here’s the verdict of one comprehensive survey: “While there are significant behavioral side effects of many programs, their aggregate impact is very small.” In short, Mr. Ryan’s poverty report, like his famous budget plan, is a con job.
Now, you can still argue that making antipoverty programs much more generous would indeed reduce the incentive to work. If you look at cross-county comparisons, you find that low-income households in the United States, which does less to help the poor than any other major advanced nation, work much more than their counterparts abroad. So, yes, incentives do have some effect on work effort.
But why, exactly, should that be such a concern? Mr. Ryan would have us believe that the “hammock” created by the social safety net is the reason so many Americans remain trapped in poverty. But the evidence says nothing of the kind.
After all, if generous aid to the poor perpetuates poverty, the United States — which treats its poor far more harshly than other rich countries, and induces them to work much longer hours — should lead the West in social mobility, in the fraction of those born poor who work their way up the scale. In fact, it’s just the opposite: America has less social mobility than most other advanced countries.
And there’s no puzzle why: it’s hard for young people to get ahead when they suffer from poor nutrition, inadequate medical care, and lack of access to good education. The antipoverty programs that we have actually do a lot to help people rise. For example, Americans who received early access to food stamps were healthier and more productive in later life than those who didn’t. But we don’t do enough along these lines. The reason so many Americans remain trapped in poverty isn’t that the government helps them too much; it’s that it helps them too little.
Which brings us back to the hypocrisy issue. It is, in a way, nice to see the likes of Mr. Ryan at least talking about the need to help the poor. But somehow their notion of aiding the poor involves slashing benefits while cutting taxes on the rich. Funny how that works.
By: Paul Krugman, Op-Ed Columnist, The New York Times, March 6, 2014
“The GOP’s Health Crisis”: The Republican Party’s Worst Nightmare Is Coming True
Oh dear. The Republican Party’s worst nightmare is coming true. Obamacare is working.
The news that nearly 1.2 million people signed up last month for insurance through the Affordable Care Act exchanges is highly inconvenient for GOP candidates nationwide. It looks as if the party’s two-word strategy for the fall election — bash Obamacare — will need to be revised.
Wednesday’s status report on the health-insurance reforms was by far the best news for Democrats and the Obama administration since the program’s incompetent launch. January was the first month when new enrollments surpassed expectations, as the balky HealthCare.gov Web site began functioning more or less as intended.
Cumulatively, 3.3 million people had chosen insurance plans through the state and federal exchanges by the end of January. That is fewer than the administration had originally hoped but well above the predictions of critics who believed — or hoped — that the program would never succeed. The Congressional Budget Office projects that 6 million people will have chosen plans through Obamacare when the initial enrollment period ends March 31, down from a pre-launch estimate of 7 million. Not bad at all.
The numbers are even more encouraging when you look more closely. The proportion of young people — from 18 and 34 — who chose insurance plans through the exchanges increased slightly to 27 percent, compared with an average of 24 percent in previous months. This is important because premiums would have to rise if not enough young, healthy people enrolled.
The administration had hoped the percentage of young enrollees would reach about 40 percent. But the January figure — and the rising trend — should put to rest any notion that the whole program could go down the drain in an actuarial “death spiral.” Administration officials are convinced this won’t happen.
According to the January report, about 80 percent of those signing up for Obamacare are eligible for subsidies to help them pay for insurance. The administration believes, but does not have the data to prove, that most of the new enrollees were previously uninsured.
These figures do not include the additional people who have been determined newly eligible for insurance under the federal-state Medicaid program. Overall, the program appears to be doing exactly what it was designed to do: make health insurance accessible and affordable for those who truly need it.
The Affordable Care Act could be doing even more if Republican governors such as Rick Perry of Texas and Rick Scott of Florida were not doing all they could to sabotage the program. But even in states that refused to set up their own health-insurance exchanges or to expand Medicaid eligibility, growing numbers of the uninsured are obtaining coverage.
Politically, this is terrible news for Republicans who hoped that the botched Web site launch and President Obama’s misleading “you can keep your insurance” pledge would be the gifts that kept on giving.
Bashing Obamacare will always have resonance for the GOP’s conservative base. But if you’re trying to win the votes of independents, it’s more profitable to target a failed program than a successful one.
Critics will doubtless try to blame Obamacare for anything bad that happens to anyone’s health insurance before the November election. But all of this is just noise without the central narrative of a “failed program.”
Attack ads against vulnerable Democratic senators, such as Kay Hagan of North Carolina and Mary Landrieu of Louisiana, are already trying to paint Obamacare as a character defect — the president and his supporters “lied” when they said everyone could keep their insurance. The response from Democrats should be to shift the focus to the actual program and its impact. Imperiled incumbents can point to constituents who are benefiting from the Affordable Care Act in life-changing ways.
If you assume that Affordable Care Act enrollment remains on its current trajectory, the February numbers should look even better. Polls consistently show that even if voters have mixed views about the health-care reforms, most do not want to see them repealed. By the fall, the whole Obamacare-is-a-disaster line of attack could sound stale and irrelevant.
Republicans may even have to take the drastic step of saying what they advocate, rather than harping on what they oppose. Is there a GOP plan to cover those with preexisting conditions? To cover the working poor? Is expanding access to health insurance really such an awful thing?
Sorry, I didn’t catch what you said.
By: Eugene Robinson, Opinion Writer, The Washington Post, February 13, 2014
“Republican Alternative To Obamacare”: Pay More, Get Less, Put The Insurance Companies Back In Charge
Boy, can Democrats have fun with the new Republican alternative to Obamacare. It puts the health insurance companies back in charge and raises costs for almost all Americans. In particular, it substantially raises costs and threatens to cut coverage for the half of all Americans who get health insurance at work. Seniors, the group that Republicans have scared witless about Obamacare, would lose the real benefits they receive under Obamacare. The proposal from three Republican senators is a golden opportunity for Democrats to contrast the specific benefits of the Affordable Care Act (ACA) with what a repeal-and-replace agenda would really mean for Americans’ lives and health.
When it comes to the politics of health care reform, my first adage is “the solution is the problem.” That is because once you get past vague generalities, like lowering costs and making coverage available, to proposing specifics, people will look to see how the proposals impact them personally. This is why health reform is such a political nightmare. Unlike most public policy issues, the impact is very understandable and real.
With the ACA as the law of the land, in analyzing the Republican proposal we must compare its impact to the law it would repeal. The pre-ACA model of health insurance is irrelevant. Here is how the Republican plan would impact people, compared with the ACA:
People who get health insurance at work – bottom line: pay more for worse coverage.
Almost half of all Americans (48 percent), or 148 million people, obtain health insurance at work. The Republican plan would tax 35 percent of the average cost of health insurance benefits at work. This is a big tax increase on working people and is extraordinarily unpopular, as the Obama campaign used to devastating impact on John McCain. And while people would pay more, they would get less coverage, as the GOP plan would allow insurance companies to once again limit the amount of benefits they will pay out in one year and return to the day when employers could offer bare-bones plans.
While taxing health benefits would apply to all employer-provided coverage, the Republicans would give the 30 percent of people who work for businesses who employ fewer than 100 workers a tax credit. That might balance out the increased taxes for some people. However, doing so would create a huge set of economic distortions, as employers might seek to keep firm size under the 100-employee threshold.
Individuals who buy coverage on their own or who are uninsured – bottom line: insurance companies could again deny coverage for pre-existing conditions and offer bare-bones coverage, while the cost of decent coverage would go up for most people.
This is the group that the ACA is most aimed at helping, including the 5 percent of Americans who buy private health insurance and the 15 percent who are uninsured, totaling 64 million people. The ACA offers income-based subsidies to these people when they earn between 100 percent and 400 percent of the federal poverty level (FPL) and enrolls people under 133 percent of FPL in Medicaid, when states agree.
The Republican plan is toughest, in comparison with the ACA, on the lowest-income people and on the higher-income middle class, compared with Obamacare. But many families in between will do worse too.
The Republican plan would wipe out the expansion of Medicaid to people earning less than 133 percent of FPL, a provision the Supreme Court has made optional. It would cut back on Medicaid, ending the federal government’s offer to pay 90 percent of the cost of expanded coverage and replacing that with the federal government paying what it has paid historically, which is between half and three-quarters of the cost of Medicaid, with poorer states getting a bigger share. Crucially, the funding would only be for pregnant women, children and parents with dependent children who earn under the poverty level, as opposed to the ACA’s funding of all adults up to 133 percent of FPL. That means many fewer people covered and states getting less Medicaid money. Republican governors may not complain, but you can bet hospitals will. Adults without dependent children would not be covered by federal Medicaid, which means millions will stay uninsured or lose coverage they now have, unless states pay for coverage without federal support.
For individuals not covered by Medicaid or employees of firms with fewer than 100 workers, the Republican plan would replace the ACA’s sliding-scale subsidies, which now go to 400 percent of FPL, with a subsidy that is the same for everyone of the same age who is under 200 percent of FPL and lowersubsidies for people from 200 percent to 300 percent. In addition, the subsidies would be higher for older people than younger. The Republican plan also would take away the requirements that insurance plans offer decent benefits and free preventive care and charge women the same prices as men for coverage, along with every other consumer protection, with the exception of keeping in place no lifetime caps for covered benefits.
Comparing the value of the Republican plan subsidies vs. the ACA subsidies for the people who would still qualify depends on income, age, and family size. Generally, it appears that the Republican subsidies are much less than the ACA for people under 150 percent of the FPL ($35,000 for a family of four) and much less than the ACA for younger people, but more for older people. However, insurance rates for younger people would go down some at the expense of older people, who insurance companies could charge a lot more than under ACA. And families with incomes above $70,000 for a family of four would lose subsidies entirely.
Seniors and the disabled on Medicare – bottom line: seniors would pay more for prescription drugs and preventive care.
By repealing the ACA, the Republican plan would take away its two concrete benefits for seniors. One is that preventive care services are now free under Medicare (as they are under all insurance). The other is that the ACA is lowering drug prices for seniors by slowly closing the “donut hole,” under which seniors must pay the full cost of prescription drugs even though they are paying premiums for drug coverage. In other words, the Republican plan is simply bad news for seniors, the constituency that they have scared the most about Obamacare… groundlessly.
It is not surprising that Republicans have been reluctant to come up with a replacement for Obamacare. It’s much easier to throw darts – or bombs – at the ACA than to come up with a replacement that meets Republican ideological tenets of less regulation and less government. Any plan that meets the ideological test will be much worse for people in ways they can understand. It is our job to explain it to the public clearly: pay more, get less, put the insurance companies back in charge. This debate is not simply the political game Republicans want to make it. It is about our health and our lives.
By: Richard Kirsch, The National Memo, January 29, 2014
“Political Arsonist Condemns Partisan Fires”: When Mitch McConnell Looks At The Dysfunctional Senate, He Sees His Own Handiwork
Last week, Senate Minority Leader Mitch McConnell (R-Ky.) delivered a lengthy, beautifully written soliloquy on the once-great institution in which he serves. “What have we become?” McConnell asked. “I’m absolutely certain of one thing: the Senate can be better than it is,” he added. “We’ve gotten too comfortable with doing everything we do here through the prism of the next election, instead of the prism of duty. And everyone suffers as a result.”
The long-time Republican is apparently quite invested in his concerns over the demise of the Senate, publishing a piece in Politico on the subject.
When you look at the vote tallies for some of the more far-reaching legislation over the past century, for example, the Senate was broadly in agreement.
Medicare and Medicaid were both approved with the support of about half the members of the minority. The Voting Rights Act of 1965 passed with the votes of 30 out of 32 members of the Republican minority. Only six senators voted against the Social Security Act. Only eight voted against the Americans With Disabilities Act.
This is, oddly enough, practically identical to the kind of lament one might hear from a progressive Senate Democrat. Before the radicalization of Republican politics, bipartisan cooperation on major policies was common, and when centrist GOP lawmakers still existed, popular and even progressive legislation was approved with large majorities.
So why is McConnell echoing Democratic concerns? Because he’s convinced of his own misguided righteousness.
When Democrats couldn’t convince Republicans that [the Affordable Care Act] was worth supporting as written, they plowed ahead on their own and passed it on a party-line vote.
That’s why the chaos this law has visited on our country is not just tragic, it was entirely predictable. Chaos will always be the result if you approach legislation without regard for the views of the other side.
It’s at this point when knowledgeable readers, too well informed to fall for such a clumsy con, realized that McConnell is playing the public for fools. What we have is a political arsonist condemning partisan fires after he lit the match.
As Ed Kilgore, Greg Sargent, and others noted in response to McConnell’s breathtaking, almost nauseating, complaints about the Senate, the Minority Leader’s whining is not only hypocritical, it’s making a mockery of the very idea of self-awareness.
Medicare and Medicaid were approved with bipartisan support, but as GOP extremism becomes the new norm, McConnell and his party are eagerly trying to undermine both. The Voting Rights Act has enjoyed near-unanimous support, but it was Republican justices on the Supreme Court that gutted the law, and it’s Republican lawmakers who are now reluctant to repair it.
Social Security is a venerated American institution, which Republicans actively hope to replace with a privatization scheme. The Republican right to celebrate the Americans With Disabilities Act officially ended in December 2012.
Indeed, it’s not unreasonable to think all of these landmark legislative accomplishments – Medicare, Medicaid, VRA, Social Security, and the ADA – would not only face a Republican filibuster if brought to the floor for the first time today, they’d all fail in the GOP-led House.
“When you look at the vote tallies for some of the more far-reaching legislation over the past century, for example, the Senate was broadly in agreement”? That’s true. Then the Republican Party became radicalized and it stopped being true.
As for the Affordable Care Act, Democrats desperately tried to find Republican support for a policy built around Republican-friendly policies. No matter how much Dems pleaded with GOP officials to work in good faith towards a compromise, the more Republicans refused.
And it was McConnell who was candid enough to explain in 2010 how and why this happened.
“We worked very hard to keep our fingerprints off of these proposals,” McConnell says. “Because we thought – correctly, I think – that the only way the American people would know that a great debate was going on was if the measures were not bipartisan. When you hang the ‘bipartisan’ tag on something, the perception is that differences have been worked out, and there’s a broad agreement that that’s the way forward.”
Right. McConnell figured that if Republicans worked in good faith on a bipartisan health care bill, the public would assume it was a worthwhile idea. So McConnell insisted that his party oppose every effort at compromise, and slap away every outstretched hand, so that the GOP could condemn “Obamacare,” regardless of the merits.
In other words, even if Dems approached McConnell with a health care plan McConnell liked, he’d still reject it. To do otherwise would be to help Democrats, while denying the Minority Leader a chance to complain later.
Indeed, it’s this attitude that has served as a template for Republican obstructionism for five years. When McConnell looks at the dysfunctional Senate, what he sees is the result of his own handiwork – the ashes of the fire he started, then complained constantly as emergency crews struggled to put it out.
For the Minority Leader to ask, “What have we become?” is a good question. Perhaps McConnell can answer it after a long look in the mirror.
By: Steve Benen, The Madow Blog, January 14, 2014
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