“Becoming Increasingly Clear”: Despite What The Critics Say, Obamacare Is Working
Despite the treasured right-wing talking points, it’s increasingly clear that Obamacare is a success. Moreover, in places where Obamacare is not succeeding, it’s also clear that the right wing is to blame. Well, it’s clear to any who look at the state-by-state numbers of the newly insured. A whole lot of Americans will have to look, however, for the program’s success to redound to Democrats’ advantage.
Charles Gaba, an enterprising Web site designer, has taken it upon himself to track the number of Americans who have gained health insurance under the Affordable Care Act (ACA). Tallying those who have signed up on the state and federal exchanges (2.1 million), those who have obtained Medicaid coverage (4.4 million) and those who gained coverage through the law’s requirement that private plans allow parents to cover their children up to age 26 (3.1 million), he cites more than 9 million newly insured through Obamacare.
The meaning of that number is, to be sure, a little fuzzy. To begin, it’s a gross, not a net, increase. Some of the 2.1 million who purchased insurance on exchanges did so after their previous plans were altered or canceled. In some states, the increase in those insured through Medicaid does not distinguish between those not eligible previously and those who are simply renewing coverage.
All that said, whether the total is 9 million or 7 million, it’s a big number and it’s rising rapidly: December sign-ups far exceeded those in November, and the number is expected to continue growing through 2014.
Whether you can access the benefits of the ACA, however, depends on where you live. In states that set up their own exchanges and accepted federal funding for Medicaid expansion, the increase in the number of insured vastly exceeds that in states that declined to do either.
Theda Skocpol, a Harvard professor of government and sociology, has compared state totals of those who gained insurance through the exchanges and Medicaid with Congressional Budget Office projections of the number of enrollees in each state for the first year the ACA is in effect, as well as with the Kaiser Medicaid Commission’s projections of new Medicaid recipients in that first year.
In the three months since the exchanges opened, she wrote this week, the 14 states that established their own exchanges and accepted Medicaid funding reported increases amounting to 37.2 percent of the projected yearly exchange purchases and 42.9 percent of the projected Medicaid enrollments. In the 23 states that refused to establish insurance exchanges, refused to cooperate in making the federal Web site easily accessible and declined to expand Medicaid, exchange purchases were just 5.6 percent of the projected increase and Medicaid enrollments just 1.5 percent. (The 13 states that partially embraced the programs generally had increases lower than the 14 full implementers but higher than the 23 refusniks.)
Which is to say, the ACA is working as planned, perhaps a little better, in the states where governors and legislatures chose to implement it, such as California and New York. It is barely working in those states where governors and legislators have refused to implement it, such as Texas. Although the number of states declining any participation probably will diminish over time, as the tea party’s grip on the Republican Party wanes or as older white conservative voters die off, the resulting red-blue division between the states probably will be a feature of the nation’s political economy for some time.
Consider the implications: A larger share of Californians will be able to afford regular medical check-ups than Texans. A smaller share of Californians is likely to be bankrupted by the expense of major medical treatment than Texans. When the law’s tax penalties take effect, a smaller share of Californians will be subject to the penalties that come with the individual mandates than will Texans. In the coming years, a smaller share of California hospitals will face financial risk for indigent care than hospitals in Texas, where fewer of the sick and poor will be covered by Medicaid.
The conservative argument that the ACA is a disaster is true only when it’s a self-fulfilling prophecy: Most of the negative consequences that right-wingers have warned against have occurred only in those places where right-wingers have subverted implementation of the law. What supporters of the ACA must keep in mind, however, is that Americans who live in states where implementation has been stymied may continue to see the act as a failure and continue to blame President Obama and his party.
Only by publicizing the act’s manifest success in states where it has been implemented can supporters begin to change the public’s verdict.
By: Harold Meyerson, Opinion Writer, The Washington Post, January 8, 2014
“Can A Cure Be Found For Obamacare Brain Meltdown Syndrome?”: Putting The Lie To The Anti-ACA Talking Heads
As we launch into 2014, I must regrettably report that we have yet to develop a vaccine or cure that can assist those who have contracted the insidious Obamacare Brain Meltdown Syndrome (OBMS)–a tragic illness affecting roughly 50 percent of Americans who now lack all ability to review ACA data with any measure of balance and reason.
While we await the critically needed medical advances and discoveries that can bring relief to the afflicted—assuming such a program has not been ground into the dust as a result of sequestration cuts to medical research—we continue in the attempt to bring actual data to the attention of the long-suffering, in the hope that the rumors, half-truths and outright lies can be retired through the presentation of the facts.
One of the more pervasive rumors, half-truths and outright lies making the rounds these days is the meme that more people have lost their insurance as a result of Obamacare than have gained coverage thanks to healthcare reform.
As the story goes, some five million people have had their insurance cancelled because of the ACA while the numbers of those who have gained coverage currently stands somewhere around two million—and we don’t even know how many of those who have enlisted will actually bother to pay the first premium for their newly acquired insurance policy. Based on these numbers the math is simple—the law has hurt three million more than it has helped.
This line of reasoning makes for a terrific story as it is a tale both easy to understand and clear in its result.
The problem is, the story is clearly not true.
A report out this week from the Minority Staff of the House Committee on Energy and Commerce reveals that 99.8 percent of those who received an insurance cancellation can now either re-up their existing plans for another year, as a result of the changes made in recent weeks, or, alternatively, obtain a catastrophic coverage policy. As a result of these changes, the report finds that about 10,000 Americans —representing 0.2 percent of those who received cancellation notices—will actually find themselves without access to an affordable health insurance alternative.
That said, I recognize that the report was issued by the Democrats on the committee— making the study something less than the best possible authority for those suffering from OBMS. I also recognize that 10,000 people lacking the access they once had to affordable health care insurance are 10,000 people too many.
Accordingly, let’s just pretend that the Minority staff report never happened and that we are still working off the suggestion that five million people really have been left fully exposed as the metric that should be used for comparison.
With that as our comparison point, surely the argument suggesting that Obamacare has hurt more Americans than it has helped can be justified, yes?
Actually, no.
In fact, based on the hard data, we are now able to see that at least 9.4 million Americans have health insurance coverage as a result of Obamacare.
Let’s go to the numbers—
We know that approximately 2.1 million people have purchased a health insurance policy from either a health care exchange operated by the federal government or from one of the 14 state operated exchanges. Indeed, even the harshest ACA critics appear to have accepted this number—although they insist on noting that, somehow, many of these people went to the trouble of buying a policy but will refuse to pay the first premium by January 10th, as required.
While I don’t doubt that there will be a few purchasers who will fall into this category, it would require the most extreme case of Obamacare Brain Meltdown Syndrome to imagine that the number of those who went to the bother of signing up—but won’t pay up—will be statistically significant.
Next, I remind you that, as of November 30, 2013, 3.9 million new participants were enrolled in Medicaid as a result of the program’s expansion. These are 3.9 million who were not previously qualified. As reported by Michael Hiltzik over at the Los Angeles Times and Josh Marshall—using the data that has been compiled by Charles Gaba who has been carefully tracking the Obamacare math (I strongly recommend you review Mr. Gaba’s spreadsheet) since the beginning—the number of Medicaid sign-ups through the end of the year have now risen to a total of 4.3 million.
As you add up these numbers, you quickly arrive at 6.4 million Americans who now have insurance as a direct result of the ACA—a number, while in excess of the 5 million allegedly left without insurance coverage as a result of Obamacare, thereby disproving the meme—does not equal the 9.4 million Americans being served by Obamacare that I suggested earlier.
Clearly, this can only be the math of an Obama loving liberal, yes?
Or might you be missing something? Might that something be the roughly 3 million young Americans who have yet to reach 26 years of age who remain on their parents’ health insurance policy thanks to Obamacare?
Because this provision has been in effect for a few years, those afflicted with OBMS have managed to simply erase this number from their minds as if these young Americans either do not exist or simply do not “count”.
They very much do count as, prior to the ACA, these were precisely the people who were among the least likely to purchase a health insurance policy yet, thanks to the law, now have healthcare insurance. They are also the people who add the badly needed healthy participants to the insurance pools.
Add these people to the mix and you reach 9.4 million Americans with insurance as a result of the Affordable Care Act.
What’s more, the number is probably higher given that that we are not taking into consideration those who are purchasing their individual Obamacare policies off the exchanges by going to their insurance agent or directly to their insurance company. These are the folks who are not qualified for subsidies and, therefore, have no reason to deal directly with the exchange if they choose not to do so.
None of this data, by the way, proves that Obamacare is necessarily working. As I have long noted, success is far more tied to the composition of the insurance pools resulting from the ACA (the ratio of healthy to unhealthy) than it is tied to the raw number of sign-ups. This is data we do not yet have.
What this data does prove is that there are clearly far more Americans benefitting from Obamacare than those who are claimed to be losing coverage as a result of the law. The data also highlights that those with Obamacare Brain Meltdown Syndrome must fight through the fog that has descended upon them and try to face up to the actual numbers as, only then, can we continue a rational conversation about this law.
Until we find that cure for OBMS, we can only hope that those afflicted with this tragic illness will turn to that famous old saw that instructs, “then you will know the truth and the truth will set you free.”
By: Rick Ungar, Op-Ed Contributor, Forbes, January 4, 2014
“Where Beliefs Diverge”: The Issue That Turns Republicans Against Israel
America’s right believes that Israel can do no wrong when it’s building settlements in the occupied territories or trying to prevent a nuclear deal with Iran. But when it comes to social policies, fundamentalists ignore that Israel is far more progressive than the United States.
A new governmental panel is suggesting that the Jewish state pay for all abortions for women aged 20-33. Currently, abortions for medical reasons and for girls under the age of 18 are subsidized by the government.
“Unlike in the United States, abortion has never figured in the country’s political campaigns,” The Times of Israel’s Lamar Berman notes. “In fact, Israel does not even have an active anti-abortion movement.”
The Hyde Amendment makes it illegal for Medicaid to fund any abortions, except in the cases of rape, incest or a threat to the life of the mother. Several Republican state legislatures have passed laws that will require women to purchase an additional waiver to cover abortion.
Israel has a single-payer health care system, which helps keep costs low, as Mitt Romney noted during his visit to the country in 2012.
Christians like to play up their connection to the religious traditions of the Holy Land. But abortion is an issue where beliefs diverge.
“That Jewish law does not consider the fetus to be a legal person goes to the heart of why so-called ‘personhood’ amendments—laws that would declare a fertilized egg to be a person with rights—and other attempts by lawmakers and activists to afford fetuses equal protection rights have a constitutional problem,” Sarah Posner notes. “They reflect a particular religious view, one that is not, as Christian-right activists like to say about their beliefs on reproduction, a ‘Judeo-Christian’ one.”
As the far right has moved even further to the right on abortion — passing more restrictions in the last three years than in the decade before — it also has intensified its embrace of the Jewish state. Haaretz’s Chemi Shalev pointed out in 2011 that if President Obama treated Israel the way Ronald Reagan — who placed an embargo on arms sales to the state — did, he would be impeached.
The growing influence of the Christian Coalition following Pat Robertson’s galvanizing 1988 presidential campaign has shifted power to the evangelicals of the Republican Party and given rise to policies based on Christian Dispensationalism, which argues the Jews must return to Israel for the second coming of Jesus Christ to occur. Some Christians go further and argue that the conversion of the “chosen people” is necessary to bring about the rapture. George W. Bush recently raised funds for a group that is actively engaged in converting Jews.
The drastic dissonance between American fundamentalists and Israeli health experts — who would prefer to fund all abortions for all women but didn’t propose this for budgetary reasons — suggests that the right is willing to ignore differences of opinion on reproductive rights… when they’re focused on bringing about the end of the world.
By: Jason Sattler, Featured Post, The National Memo, January 2, 2014
“The Three Stages Of Obamacare Acceptance”: It’s Increasingly Difficult To See How Repeal Would Work, Even With Full GOP Control
Now that Obamacare is clearly moving forward, Republicans are adjusting to a new reality: it may no longer be a realistic option to simply wait until the law collapses under its own weight and vanishes entirely. GOP lawmakers are increasingly discussing a range of responses, from proposing profound changes to finally embracing a comprehensive alternative.
Which raises a question: Is it possible to envision a future in which Republicans and Democrats do enter into real negotiations over the future of the law and the health system, in which each side gets some changes it wants, in exchange for accepting some of the other’s proposed changes?
Yes, it is. But to get there, Republicans will first have to pass through what might be called the Three Stages of Obamacare Acceptance.
Right now, Republicans entertaining changes or alternatives are still proceeding from the premise that no outcome is acceptable unless it fatally cripples the law or eliminates it entirely. Republicans don’t believe the law can be fixed, since they think that even if it does work according to its own lights, it will still amount to a colossal policy failure. If Republicans want to hold that position indefinitely, there’s not much Dems can do about it.
But if Republicans do get to a point where crippling or eliminating the law is not the only acceptable outcome, there are scenarios under which they might negotiate for certain types of changes to the law, in exchange for changes Dems or liberals want.
Larry Levitt of the Kaiser Family Foundation laid out the types of incremental changes Republicans might pursue. He suggested Republicans might propose various ways of relaxing Obamacare’s regulations, in keeping with conservative policy ideas, that wouldn’t destroy the law. For instance, they could propose allowing insurance sales across state lines so competition drives down prices, something liberals might be willing to accept under certain circumstances if the law’s uniform federal minimum coverage standards are kept (which could theoretically prevent the “race to the bottom” liberals fear).
Or Republicans could propose to make tax deductions available to those over 400 percent of the poverty line who do not qualify for Obamacare subsidies, helping those who see premiums go up (which Republicans have turned into a major issue) and mitigating Obamacare’s redistributive elements a bit. Or Republicans could propose relaxing the limitations on age ratings, allowing insurance companies to charge more than the current three-to-one ratio the law mandates between older and younger people.
In exchange, liberals might ask for subsidies to be expanded to those who fall into the Medicaid gap — making too little to qualify for subsidies but too much to qualify for Medicaid in states that haven’t opted in to the expansion. Or they might ask for more in subsidies for those who currently qualify.
The point is, there are scenarios under which real negotiations over the future of the law could take place. But Republicans would have to be willing to accept something less than its complete destruction. (As Jonathan Bernstein has detailed, a general unwillingness by Republicans to try to get some of what they want on multiple issues has made the GOP into a kind of dysfunctional “post policy” opposition.)
Let’s be clear: It is certainly still possible that over the long term, Obamacare could fail, if, say, the demographic mix is bad, insurers pull out, and the exchanges collapse. If so, Republicans would theoretically be able to simply wait for the law to fall apart in a few years. But some experts are cautiously optimistic that the latest enrollment numbers suggest the law could be on track to work.
And that’s where the Three Stages of Obamacare Acceptance come in — presuming, again, that the law works at least moderately well over the long term:
* Stage One: A dim awareness that there might be some good elements in the law, and that the public might not support returning to the old system. GOP Rep. Jack Kingston, for instance, recently suggested that it might not be “responsible” to simply let the law fall apart, and that lawmakers should be open to anything in it that would help people get coverage. Kingston was immediately slapped down by his primary opponent and quickly reiterated his zeal to get rid of it entirely. Something similar happened to a GOP Senate candidate in Michigan.
* Stage Two: A genuine recognition that large numbers of people are already benefitting from the law, and that this reality needs to be reckoned with — such as by proposing alternatives or changes that purport to accomplish similar goals, even as the elimination or crippling of it remains a paramount aim. GOP Rep. Tom Price has proposed an alternative designed, in part, to cover people with preexisting conditions, but it would probably cover far fewer people, and Price continues to insist on Obamacare’s repeal, maintaining its demise is a certainty.
Meanwhile, Senator Ron Johnson has admitted that “we have to deal with the people who are currently covered under Obamacare,” and to do this, he has proposed keeping the exchanges while getting rid of the individual mandate. The latter, experts say, would fatally undermine the law, and as such this isn’t a serious proposal.
* Stage Three: Republicans accept Obamacare is likely here to stay, abandon the premise that the only acceptable outcome is crippling or eliminating the law, and negotiate to achieve incremental changes they want. This is the scenario outlined by Levitt above. It’s hard to know when this might happen in earnest – certainly not in 2014, and GOP presidential primary politics could also make this difficult next year. But you’re already seeing this a bit with GOP governors who are negotiating with the feds to create their own versions of the Medicaid expansion.
It’s always possible Republicans could win the presidency and both houses of Congress in 2016 and pass legislation repealing the law. And again, if the law fails over time, the above stages could be moot. But it’s increasingly difficult to see how repeal would work in practical terms, even with full GOP control. What’s more, as Jonathan Cohn has detailed, experts think early returns suggest the law is likely to work out. Which means you can begin to imagine Stage Three kicking in. At some point.
“If Republicans were to accept that the law is in place for the foreseeable future, then one could envision tweaks that could move it in a more conservative direction without undermining its goals, while also providing improvements to the law that liberals are looking for,” Levitt says.
By: Greg Sargent, The Plum Line, The Washington Post, January 2, 2014
“Happy New Year, Losers”: The “Supreme Court Gap” In Unversal Health-Care Coverage
Chief Justice Roberts wishes a Happy New Year to all those losers who will not get health care insurance, thanks to his clever reading of the Constitution. There are 4.8 million of these losers and 2.6 million of them are people of color, black and Hispanic mainly. Not that the Chief Justice and his right-wing colleagues on the Supreme Court would make racist distinctions. No, no, no. They assure us their decision is solely driven by a matter of high comstittional principle—States Rights.
The problem with these people is that they are low-income adults without dependent children—not quite poor enough to qualify for Medicaid nor old enough to qualify for Medicare. President Obama’s original legislation took care of them by expanding Medicaid coverage and putting up the federal money to pay for it. The Roberts decision insisted that state governmednts have a constitutional right to reject this financial aid from Washington. And twenty-five states took him up on the offer.
This odd failure will probably be blamed on Obama but should rightly be called the “Supreme Court gap” in unversal health-care coverage. Because these folks do not not quite earn enough to qualify for Obamacare’s tax credits to help people purchase health insurance. A report from the Kaiser Family Foundation outlined the consequences. “Most of these individuals have very limited coverage options and are likely to remain uninsured,” the foundation explained.
Of course, they could get a job that pays more. Or maybe get married and have children that would qualify them for Medicaid. State governments set many of the rules for Medicaid coverage and some conservatives think fedeal aid saps individual initiative and rewards indolence. It is not entirely a coincidence that many of these rejectionist states are the same states that defied the Supreme Court half a century ago and resisted racial integration and equal rights for minorities. Some of them are the very states that went to war to defend slavery. Republicans are sometimes called a “neo-confederate party.” After the Supreme Court gutted the voting-rights act, the neo-confederates were free to pass restrictive laws designed to shrink minority voting, and so they did.
The Kaiser Foundation doesn’t get into any of that but simply observed, “These continued coverage gaps will likely lead to widening racial and ethnic as well as geographic disparities in coverage and access.”
Don McCanne of Physicians for A National Health Program circulated the Kaiser report with this comment: “What a terrible way to start the first of the year of what is essentially the full implementation of the Affordable Care Act. It seems pretty obvious what our New Year’s resolution should be. Let’s bring health care to everyone through an improved and expanded Medicare for all.”
Democrats ought to call out Republicans on these questions. And citizens generally ought to call out the Roberts court. The Supremes have done quite a lot in the last fifteen years to mess up our already weakened democratic system. They stole the presidential election in 2000. They cut loose big money to swamp elections by destroying lawful restraints. They are trying step-by-step to restore hoary old legalisms that favor capital over labor, corporations over individuals. Shouldn’t we be talking about how to stop them?
By: Wiliam Greider, The Nation, December 31, 2013
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