“Obamacare’s Real Promise”: If You Lose Your Health-Care Plan, You Can Get A New One
The furor over “if you like your plan, you can keep it” touches on a deep fear in American life: That your health-care insurance can be taken from you. That fear is so powerful because it happens so often: Almost everyone in the country can lose their health insurance at any time, for all kinds of reasons — and every year, millions do.
If you’re one of the 149 million people who get health insurance through your employer, you can lose your plan if you get fired, or if the H.R. department decides to change plans, or if you have to move to a branch in another state.
If you’re one of the 51 million people who get Medicaid, you could lose your plan because your income rises and you’re no longer eligible or because your state cut its Medicaid budget and made you ineligible. You could lose it because you moved from Minnesota, where childless adults making less than 75 percent of the poverty line are eligible, to Texas, where there’s no coverage for childless adults.
If you’re one of the 15 million Americans who buys insurance on the individual market, you could lose your plan because your insurer decides to stop offering it or decides to jack up the price by 35 percent. And that’s assuming you’re one of the lucky people who weren’t denied coverage based on preexisting conditions in the first place.
Then, of course, there are the 50 million people who don’t have a plan in the first place. The vast majority of them desperately want health-care coverage. But it turns out that just because you want a plan doesn’t mean you can get one.
Virtually the only people whose health coverage is reasonably safe are those on fee-for-service Medicare and some forms of veterans insurance. And even there, enrollees are only safe until the day policymakers decide to change premiums or benefit packages.
President Obama’s critics are right: Obamacare doesn’t guarantee that everyone who likes their health insurance can keep it. In some cases, Obamacare is the reason people will lose health insurance they liked.
What Obamacare comes pretty close to guaranteeing, though, is that everyone who needs health insurance, or who wants health insurance, can get it.
It guarantees that if you lose the plan you liked — perhaps because you were fired from your job, or because you left your job to start a new business, or because your income made you ineligible for Medicaid — you’ll have a choice of new plans you can purchase, you’ll know that no insurer can turn you away, and you’ll be able to get financial help if you need it. In states that accept the Medicaid expansion, it guarantees that anyone who makes less than 133 percent of poverty can get fully subsidized insurance.
Health insurance isn’t such a fraught topic in countries such as Canada and France because people don’t live in constant fear of losing their ability to get routine medical care. A decade from now, that will be true in the U.S., too. But it’s not true yet, and paradoxically, that’s one reason health reform is so difficult. The status quo has left people rightly fearful, and when people are afraid, change is even scarier.
By: Ezra Klein, Wonkblog, The Washington Post, December 8, 2013
“Voters Wil Not Forget”: Opposition To Obamacare Will Come Back To Haunt Conservatives
It is truly amazing to me to read through the blogs, the press releases from the Republican anti-Obamacare war room, the phalanx of Koch-brothers’ sponsored think tanks and web sites – one message: FAILURE.
Let’s leave aside that their cagey rhetoric has shifted from “repeal” to “a fix,” but that their policy position remains the same: kill it. Republicans will continue their onslaught against the Affordable Care Act because they believe it is a political attack that will work for them and unite their party, at least in the short run.
They complain about the problems with the website, yet they love that it didn’t work well. They are euphoric when it fails. Do they want it to succeed? Heck no.
They offer up people who have had problems switching their health care plans, with big smiles on their faces. Another Congressional hearing is called for to condemn the ACA, according to the Republicans.
Peter Roff, one of my esteemed colleagues on this blog, publishes a list from the Heritage Foundation on why the ACA will fail (never mind that much of what Heritage called for is in the law, like the individual mandate).
But forget all that. I would cite much of this list as precisely why Obamacare will work (see Roff’s Heritage list here):
- The new plans available under the law will provide better coverage for a better price. This is not a broken promise by the president but the end result. Think about the benefits: no pre existing conditions; no canceling of your plan when you get sick; no caps on coverage; no huge costs for women over what men pay; keeping children on the plan until they are 26.
- There will be more options for consumers to choose from, not less. They won’t be forced into inferior plans.
- The new approach to Medicaid will allow people to shop for and purchase their plans, not arrive in emergency rooms often too late for help and with exorbitant costs. This will be a vast improvement on where we are now. Sadly, many Republican governors want to keep these people from getting insurance by rejecting federal funds to help with the Medicaid expansion.
- The ACA will lead to more stable families with better health care, not penalize people for success or getting married, as Heritage asserts.
- There will be better care for women, more coverage, and it won’t destroy our religious liberties. Pardon the sexism, but that is a “straw man.”
- Probably the most absurd claim from Heritage is that the ACA is a job killer. If we are providing health care to an additional 30-40 million Americans, it will create jobs in the health care field, not kill them. More doctors, more nurses, more ways to care for patients. Businesses will have more productive workers, fewer who are sick and out of work, and costs will decrease as more people are covered.
I do have one prediction for my friend Peter Roff and those Republicans who are staking the political future of their party on killing the ACA: When this succeeds, voters will not forget, and they will remember the horror stories of the old system. The more the focus is on patient care, better treatment through R&D, keeping people healthy, access for millions, the more that Democrats will benefit from the contrast. Republicans should be very careful not to argue too strongly for failure, it will come back to haunt them.
By: Peter Fenn, U. S. News and World Report, December 5, 2013
“Unsatisfying To The Media And Republicans”: Surprise, Obamacare Now Projected To Cost Hundreds Of Billions Less Than Expected
Amidst the dark skies of the Healthcare.gov launch, some daylight may finally be emerging with respect to one of the critical goals of the Affordable Care Act—bending the cost curve of America’s expensive healthcare system.
According to a New York Times report out Tuesday, the Congressional Budget Office has quietly removed hundreds of billions of dollars from the projected costs of Obamacare, primarily the result of an anticipated decrease in the federal government’s contribution to the Medicaid expansion program along with the projected cost of the subsidy payments to those buying private insurance policies on the healthcare exchanges.
Why the good news?
The more favorable projections are the direct result of the slowing trend in the growth of healthcare spending over the past five years leading to a slowdown in rising costs. While, ten years ago, per-capita spending on healthcare had been growing by an average annual rate of 5 percent, that number was dramatically cut to 1.8 percent during the 2007-2010 period and reduced even further to 1.3 percent in the years following 2010.
Do we have Obamacare to thank for this highly successful “bending” of the cost curve?
Naturally, the answer depends upon who you ask as there simply is no definitive way of knowing—yet.
While most economist believe that the lion’s share of the reduction is due to the sluggish economy—making Americans far more careful when it comes to making decisions regarding when or if to spend money on medical care—others believe that some of the plans built into the ACA designed to get people to spend less may actually be working.
Among Obamacare inventions that do appear to be paying off in lower healthcare costs is the government’s refusal to pay hospitals more when patients are re-admitted within 30 days of their initial discharge. Additionally, new plan designs engineered to reward providers for quality of care rather than for quantity of care may well be paying off in terms of lowering the overall cost of care.
According to the Kaiser Family Foundation—widely regarded as an honest, non-partisan broker when it comes to healthcare issues and analysis—the declining increases in the cost of healthcare is 75 percent the result of economic factors and 25 percent a benefit of the cost cutting measures in the ACA that do, in fact, appear to be working.
Of course, the big question is whether or not these cost lowering provisions of Obamacare will continue to do the job once the economy regains its more typical trajectory.
There are reasons to be hopeful that healthcare spending can be held down once the economy kicks into higher gear.
For starters, while many Americans shopping for new health insurance policies may be decrying the higher deductibles they are discovering in the new offerings, higher deductibles should have a meaningful impact on the decisions people make when determining whether or not a visit to the doctor or agreeing to a given procedure is really necessary. While a $250 deductible will likely not cause a patient to ask how much a suggested CT Scan is going to cost, a $3,000-$5,000 deductible is far more likely to cause the patient to ask a few more questions and make more focused decisions when payment for the test is coming out-of-pocket.
Not surprisingly, there are no shortage of economists and pundits who believe that the ACA will prove inadequate to the task of controlling costs once the economy is in better shape.
Others are more hopeful, believing that the slowdown in costs are very much a result of hospitals and insurance companies understanding that something had to change given the unsustainable trends in rising costs. As a result of a desire to derail out-of-control costs before the costs derailed them, insurers and hospitals became involved in substantial systemic revisions designed to lower healthcare spending even before the government required them to do so.
Discussing whether the current decreases can last when previous periods of cost-curve bending did not, Annie Lowrey writes in her New York Times piece—
“This time may be more durable. Insurance and hospital executives in Massachusetts, Illinois and California, among other places where reforms have gone the furthest, report a consensus that spending growth had become unsustainable, and that expectations that Washington would force changes to the system spurred them to make changes themselves.”
If this is true—and I believe the evidence reveals that it is—these self-imposed changes, in tandem with the changes brought about by elements of Obamacare that don’t receive nearly as much attention as the more hot button issues, may prove to provide lasting changes to the system; changes that will point our cost trajectory in the right direction.
Like most elements of the Affordable Care Act, these issues and results only go to prove that far more time is required before we can even begin to measure the real benefits or detriments of Obamacare.
While this reality may prove unsatisfying to the media, politicians and those in the public who are so emotionally committed to the failure and ultimate death of Obamacare—whether for political purposes or only so that the opponents can experience the satisfaction of having been right—anyone interested in realistic measurement of this dramatic change in our system better settle in for the long run.
It’s going to be awhile until we know how this story ends.
By: Rick Ungar, Op-Ed Contributor, Forbes, December 4, 2013
“Coverage That Is Surprisingly Affordable”: As Glitches Fade, Obamacare Approval Will Rise
The latest polls on Obamacare are bleak. A Kaiser Family Foundation survey found that almost half of those questioned last week had an unfavorable opinion of the law. Just a third had a favorable opinion, even less than the 40 percent support for the law in the Nov. 14 Gallup poll.
But those poll numbers will change as more people like Bob Freukes of St. Louis and Donna Smith of Denver are finally able to shop for coverage on the new health insurance websites — and find coverage that is surprisingly affordable.
Considering all the negative stories about the malfunctioning HealthCare.gov website and policy cancellations folks have been receiving, the steep decline in support for Obamacare shouldn’t surprise anyone.
But in the very week that poll numbers reached an all-time low, people who had tried for more than a month to enroll online in a health plan were finally able to do so.
Just minutes after the administration’s tech surge team said 90 percent of applicants were now able to enroll online, I started getting emails from people eager to share their success stories.
“My wife and I are both self-employed small sole proprietors,” wrote Freukes, a photographer. “This will be the first time in our married lives we will have health insurance.”
Freukes said that over the course of the past year, he and his wife — married 30 years and are now in their fifties — rarely went to the doctor because of the expense.
“We paid for doctor visits, prescriptions, eye glasses and everything else out of [our] own pockets, always knowing we were one major illness away from bankruptcy.
“We tried to find an affordable policy, but the going rate for my wife and me was roughly $900-$1,400 dollars a month with deductibles in the $5,000 range.” Considering that their combined annual income is often no more than $25,000, health insurance was out of the question.
Not only will they finally have coverage starting January 1, it will cost the Freukes less than they had expected because of the federal tax credits available to low- and middle-income individuals who buy coverage on the state exchanges. In fact, with the tax credits, the Freukes will not have to pay monthly premiums at all.
“I sat rubbing my eyes in amazement as the website did the math. Our portion of the premium for both plans was ZERO. No cost to us at all. I was stunned.”
Donna Smith wasn’t that fortunate, but she at long last will be able to get a comprehensive policy that she can afford.
Like Bob Freukes, it took Smith weeks of effort before she was finally able to enroll in a plan. Her delay, though, was caused by a different, though no less frustrating quirk in the system. Colorado is one of 13 states and the District of Columbia operating their own exchanges, which generally have experienced fewer problems than the federal website, where residents of most states have been sent. Several thousand people were able to begin the application process in Colorado but they had to wait — and wait and wait — while state officials checked to see if the applicants were eligible for Medicaid.
Smith knew her income was too high to qualify for Medicaid, but she nevertheless had to fill out an extensive questionnaire and was put in what she described as a “bureaucratic black hole” for 37 days. It was an agonizing wait for Smith, a cancer survivor who — along with husband Larry — had to file for bankruptcy several years ago because of medical debt. If her name sounds familiar, by the way, it might be because you’ve seen her in the movies. When she wrote filmmaker Michael Moore about her plight, he included her in the 2007 documentary, SiCKO. Since then she has been an active supporter of health care reform.
After she finally got the Medicaid denial she was expecting, Smith called Connect for Health Colorado — the name of the state exchange — and worked with an employee to complete her application.
“If people can get through the Medicaid process, I think they’ll be pleasantly surprised,” said Smith, who has been paying $875 a month for an individual policy. Beginning next year, she will be covered in a better plan, but it will cost her only $450 a month after factoring in a $72 federal tax credit.
As happy as she was to discover she will soon have affordable coverage —and that it can’t be canceled if her cancer returns, thanks to Obamacare — she still believes a single-payer, Medicare-for-all type system would be better.
She has a point. The Affordable Care Act is far from perfect. But in the coming months and years, millions of us who have been unable to find affordable coverage will at long last be insured. Poll numbers will eventually reflect that.
By: Wendell Potter, The Center for Public Integrity, November 25, 2013
“The Impoverished Republican Poverty Agenda”: Republicans Don’t Know Where They Are Headed Or What They Can Sell
What are Republicans for? We know they are against health-care reform. They voted en masse against it, shut down the government to stop it and have voted nearly 50 times to defund it. We know they are against government spending. They’ve voted for House Budget Committee Chairman Paul Ryan’s draconian budgets, which would slash spending so deeply that even some Republicans are in increasingly open revolt. But those budgets don’t go anywhere. So what do Republicans propose that actually addresses the challenges facing the nation or its people?
Republican leaders are clearly concerned that their policy house is largely vacant. In his dissection of the lost 2012 campaign, Republican National Committee Chair Reince Priebus noted that Republicans suffer a “major deficiency” – the “perception that the GOP does not care about people.” He urged a renewed effort to become “the champion of those who seek to climb the economic ladder.”
All that advice was lost in the anti-Obama venom that unifies Republicans. But after the government shutdown sent Republican poll numbers plummeting to new depths, a new effort – or at least a new public relations push – has been launched. The early reports make the administration’s botched health-care takeoff look smooth by comparison.
Politico noted that Republicans trooping into House Majority Leader Eric Cantor’s office received a paper titled “Agenda 2014.” The paper was blank. As of now, Politico reported, details are scant, but Republicans seem to be focused more on identifying the problems than the solutions. “The beginning should always be what are the problems we’re trying to fix,” said Republican policy chair James Lankford (Okla). Or as a GOP aide involved in the planning sessions was quoted: “Cantor wants to take us in a new direction, which is good. The problem is that we don’t know where we are headed, and we don’t know what we can sell to our members.”
Luckily, Cantor isn’t the only game in town. The Post published an adoring article on Ryan, Mitt Romney’s former running mate. The Post reported that Ryan and his staff have been “quietly” visiting “inner-city neighborhoods” and conservative think tanks, looking for creative ways to address poverty that can replace the “bureaucratic top-down anti-poverty programs” that Ryan’s budget would gut.
But the new ideas can’t include any new taxes or new spending – Ryan is staunchly against both. That doesn’t leave much. According to The Post, “his idea of a war on poverty so far relies heavily on promoting volunteerism and encouraging work through existing federal programs, including the tax code.” He’s repackaging private-school vouchers. And Ryan assumes that charity might take the place of the food stamps he’s cutting. “You cure poverty eye to eye, soul to soul,” he told a Heritage Foundation forum. “Spiritual redemption: That’s what saves people.” Prayer is good, but when it comes to public policies, as The Post story concluded, “Ryan’s speeches have been light on specifics.”
Some of those “specifics” are being offered by the tea party. Ryan and Cantor may be casting about for ways to look compassionate, but the tea party remains on the hunt. Politico detailed that Rep. Tim Heulskamp (Kan.) and a group of conservatives are gearing up for yet another assault on health-care reform. Assuming that the budget negotiations don’t reach an agreement by the December deadline, Congress will have to pass a continuing resolution by mid-January to keep the government open and funded. Huelskamp and his allies think that’s a perfect time to cut $20 billion out of Medicaid and transfer it to the Pentagon. That would eliminate Medicaid expansion – the one part of Obamacare that is working well – and placate Republicans worried about the cuts the military faces next year.
Cut health protection for the working poor and give the money to a Pentagon that is the largest center of waste, fraud and abuse in the federal government? Or slash food stamps while fending off every effort to close the tax dodges that allow companies like General Electric to avoid paying any taxes? The Republican “war on poverty” looks a lot like a war on the poor. It will take a lot of charity and volunteers and a lot more than “messaging” and “rebranding” to erase that indelible “deficiency.”
By: Katrina vandel Heuvel, Opinion Writer, The Washington Post, November 26, 2013
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