“Things Are Looking A Lot Better”: We Don’t Know If Obamacare Is Working Well, But We Know It’s Working
Obamacare got off to a lousy start. But things are looking a lot better now.
Nearly a million people signed up for private health plans via healthcare.gov in December, according to statistics the Obama Administration released on Sunday morning. That pushed the total number of sign-ups for the year to 1.1 million. Combined with the totals that states are likely to report by year’s end, it probably means more than 2 million people have signed up for private health insurance though the Affordable Care Act’s marketplaces. That doesn’t count several million who enrolled in Medicaid, the newly expanded federal-state program that provides insurance to low-income people.
The official enrollment number doesn’t tell us many things. It doesn’t tell us whether these people getting private (or public) coverage had insurance previously—or, if they had insurance, how much they were paying for it. It doesn’t tell us how many of these people have actually paid premiums, which is essential for coverage to take effect. It doesn’t tell us whether insurers have proper data on these people or what kind of access and protection the new coverage will give. It doesn’t tell us how many of the enrollees are in relatively good health or how many are in relatively poor health—or how that mix will affect insurance prices going forward.
In addition, the numbers do not appear to match the Administration’s own targets. According to internal projections, later reported by the Associated Press, officials expected more than 3.3 million enrollments by year’s end, with about 1.8 million of those coming through the federal website.
For all of those reasons, and a few others, it’s premature to say Obamacare is meeting expectations.
But those internal enrollment targets don’t include people who signed up for coverage directly through insurers. And while lower-than-predicted enrollment could be a sign consumers don’t like the new policies, they could also represent the lingering effects of the site’s technical problems. The internal projections were never particularly scientific: Administration officials extrapolated them from the Congressional Budget Office’s projection of overall private plan enrollment in 2014 (about 7 million) and with necessarily imperfect data from prior programs. “What’s important now is that the systems are mostly functioning so that anyone who wants to get coverage can,” says Larry Levitt, senior vice president at the Kaiser Family Foundation. “The outreach campaigns and advertising by insurers likely haven’t peaked yet, so I wouldn’t be at all surprised if enrollment in March is even bigger than December.”
MIT economist Jonathan Gruber, an architect of reforms, has a similarly nuanced take. “Given the technical problems at the start, and given that the important deadline is March 31, what matters right now is the trend in enrollment. In terms of overall enrollment, the trend looks quite good,” Gruber says. “What matters more is the mix in terms of the health of those enrolling, and we won’t have a clear answer on that until we see 2015 rates from insurers.”
While we wait to see more numbers—and parse the meaning of the numbers we have—we do know a few things for sure.
We know, first and foremost, that healthcare.gov is a (mostly) functioning website. This was no sure thing even a few weeks ago. At the end of November, when officials announced that they had met their goal of constructing a website that worked well for most customers, they were cautious to warn about future problems. Partly that was because their previous predictions of success proved so unbelievably wrong. And partly that was because they feared a late surge of customers would overwhelm the site’s capacity, threatening a whole new period of chaos. But the system held up just fine, as the high enrollment numbers indicate.
More important, we know that many of the people getting insurance are very, very happy to have it. In the fall, when insurers began sending notices of rate increases and plan cancellations, all we heard about was people unhappy with—and in many cases angry about—their new options. Now, however, we are increasingly hearing stories about people who are saving money and, in some cases, getting access to health care they’ve desperately needed for a long time.
Here two examples, culled from a new story by Lena Sun and Amy Goldstein in the Washington Post:
Adam Peterson’s life is about to change. For the first time in years, he is planning to do things he could not have imagined. He intends to have surgery to remove his gallbladder, an operation he needs to avoid another trip to the emergency room. And he’s looking forward to running a marathon in mid-January along the California coast without constant anxiety about what might happen if he gets injured.
These plans are possible, says Peterson, who turned 50 this year and co-manages a financial services firm in Champaign, Ill., because of a piece of plastic the size of a credit card that arrived in the mail the other day: a health insurance card. …
Dan Munstock knows this. A 62-year-old retiree in Greenville, Tenn., he hasn’t had insurance since he left his job as a crisis counselor in Miami six years ago. He lives on Social Security income of less than $15,000 a year. Although he does not know of any major ailments, he would like a checkup because, he said, “you can seem fine until the day you drop over with something.”
Like thousands of other Americans, Munstock ran into technical problems with the federal Web site before managing to pick a health plan Dec. 1. He qualified for a federal subsidy to help him afford the insurance, so he has to pay just $87.57 a month toward his premium. After his welcome packet from Blue Cross Blue Shield of Tennessee arrived in the mail, Munstock was so eager to finish the process of enrolling and getting an insurance card that he picked up the phone to pay the first premium instead of using the mail.
“It felt really good,” he said. Paying toward his own insurance, he said, gives him “a certain dignity,” a feeling that he is not “one of the takers.” The next day, he called the doctor’s office. His appointment for a physical is Jan. 2. …
Like the stories of rate hikes and plan cancellations, anecdotes of people gaining insurance or saving money will frequently prove more complicated than they seem at first blush. Some people will discover they owe more out-of-pocket costs than they imagined, because of high deductibles and co-payments. Some won’t be able to see the doctors they want, because plans have limited networks of providers. Some will haggle with insurers over particular bills or services. And that’s not to mention the many other trade-offs in the law—like higher taxes on the wealthy, cuts to various industry groups, higher premiums for some people buying their own coverage, and other steps that made possible the law’s expansion of health insurance.
But nobody ever promised that Obamacare would solve all of the health care system’s ills—or that it would come without costs of its own. The goal has always been to make insurance more widely available, so that more people had access to care and protection from crippling medical bills, while beginning the difficult work of reengineering medical care to make it more efficient. The new enrollment numbers should give us new reason to think it will.
By: Jonathan Cohn, The New Republic, December 29, 2013
“Paul Ryan Lectures The Pope”: After All, “The Guy” Is From Argentina And Doesn’t Understand Capitalism
When 1.3 million Americans lose their unemployment benefits on Saturday, they can thank Rep. Paul Ryan. He took the lead in negotiating a bipartisan budget deal with Democratic Sen. Patty Murray, and on behalf of his party, held the line against continuing extended unemployment benefits for the long-term jobless.
Sure, a lot of Republicans share blame with Ryan. But he deserves extra-special (negative) credit for the deal, because he has lately had the audacity to depict himself as the new face of “compassionate conservatism,” insisting Republicans must pay attention to the problems of the poor. Friends say the man who once worshipped Ayn Rand now takes Pope Francis as his moral role model. Except he can’t help treating his new role model with arrogance and contempt.
It’s true that while knuckle-draggers like Rush Limbaugh attack the pope as a Marxist, Ryan has praised him, which I guess takes a tiny bit of courage since normally Republicans don’t like to buck the leader of their party. “What I love about the pope is he is triggering the exact kind of dialogue we ought to be having,” Ryan told the Milwaukee Journal-Sentinel. “People need to get involved in their communities to make a difference, to fix problems soul to soul.”
But he couldn’t suppress either his right-wing politics or his supreme capacity for condescension for very long. “The guy is from Argentina, they haven’t had real capitalism in Argentina,” Ryan said (referring to the pope as “the guy” is a nice folksy touch.) “They have crony capitalism in Argentina. They don’t have a true free enterprise system.”
Beltway journalists would have us believe Ryan’s love for the guy from Argentina is triggering genuine new interest in helping the poor. “My bet is that he’s on Pope Francis’ team,” a former Romney-Ryan advisor told BuzzFeed’s McKay Coppins, for a worshipful Ryan profile headlined “Paul Ryan finds God.”
I admit, I have been immune to Ryan’s various efforts to brand himself as a bright and innovative Republican over the years – and I continue to be. Let’s recall: The guy who impressed Ezra Klein as a serious albeit deficit-obsessed budget wonk turned out to be terrible at math – his heralded “Roadmap,” the Ryan budget, busted out the deficit for years and didn’t balance the budget until 2040, thanks to its generous tax cuts for the wealthy and corporations.
Now we’re supposed to believe Ryan is going to deliver an anti-poverty agenda as soon as the spring. “This is my next ‘Roadmap,’” Ryan told an aide, according to Coppins. “I want to figure out a way for conservatives to come up with solutions to poverty. I have to do this.”
Excuse me if I remain a skeptic. Ryan’s prescription for the poor is, and always has been, a dose of discipline. Even in 2010, with unemployment in his own district hovering around 12 percent, he voted against extending unemployment benefits on the grounds that they’d increase the deficit – and then reversed himself when they were coupled with an extension of Bush tax cuts, which of course added far more to the deficit than extended benefits.
Ryan has always defended his stinginess on safety net issues as tough love for the poor, giving them “incentives” to take a job, any job, to support their families.
“We have an incentive-based system where people want to get up and make the most of their lives, for themselves and their kids,” he says. “We don’t want to turn this safety net into a hammock that ends up lulling people in their lives into dependency and complacency. That’s the big debate we’re having right now.”
I don’t think Pope Francis would call our threadbare safety net a hammock.
Today, Ryan’s guide on the road to a GOP poverty agenda is the same man who has guided generations of Republicans into political self-congratulation and little else: Bob Woodson, a conservative proponent of what used to be touted as “black capitalism.” Now 75, Woodson runs the Center for Neighborhood Enterprise, and he helped inspire the dead-end “enterprise zone” movement beloved by some Republicans back in the 1980s and ’90s. Enterprise zones, which lowered taxes and created other incentives for businesses to invest and hire in low-income neighborhoods, were championed by the late Rep. Jack Kemp, who is one of Ryan’s political mentors. They have repeatedly been found to have “negligible” effects on employment, earnings and business creation in urban neighborhoods.
But Woodson apparently finds Ryan a one-man enterprise zone for restoring his national profile. (He last made headlines for attacking African-American Democrats at the GOP’s 50th anniversary of the March on Washington commemoration, insisting they let black issues languish while gays and immigrants became priorities.) Woodson is the star of Coppins’s Ryan piece, vouching for the Republican’s “authenticity” on poverty issues.
“The criminal lifestyle makes you very discerning, and everywhere I’ve taken Paul, these very discerning people have given me a thumbs up,” Woodson told Coppins. “You can’t lip synch authenticity around people like that.”
But when asked what Ryan has done tangibly for the poor, the Republican came up with one word: neckties. Apparently, according to Woodson, Ryan sent neckties to a classroom of teenagers after one admired his while he was visiting. So where conservatives used to preach that the poor should lift themselves up by their bootstraps, their new anti-poverty agenda involves neckties.
In the spirit of the holiday season, I have to admit there’s something a little bit touching about Ryan’s insistence that the GOP needs an anti-poverty agenda. Honestly, Jack Kemp would be a welcome addition to the modern Republican Party, which prefers to demonize the poor rather than empathize.
But forgive me if I can’t entirely believe in Paul Ryan’s “authenticity” on these issues. A guy so prideful that he thinks he can lecture the pope about capitalism doesn’t strike me as capable of the humility required to rethink his political beliefs. I have no doubt Pope Francis would support extended unemployment benefits, and a host of other policies to make life easier for poor people and help them find genuine opportunity. I don’t think he’d be satisfied with sending them neckties.
By: Joan Walsh, Editor at Large, Salon, December 28, 2013
“Who Is For Growth And Job Creation And Who Isn’t”: The Biggest Thing Centrists Miss About The Inequality Debate
With the electoral victory of Bill de Blasio in New York City, an unabashed economic progressive, and the rising star of Elizabeth Warren, the issue of inequality has come to occupy center stage in lefty policy discussions. As Greg has been writing, it’s popular — something we see in reports today that Democrats are planning to use a near-certain GOP vote against a bill hiking the minimum wage against them in 2014.
But this has brought about a reaction from center-left types, who insist that the progressives have their priorities wrong. In the process, they mischaracterize the progressive view, and set up a false dichotomy between that and establishment positions. Progressives see inequality as a fundamental part of why our economy is not working as it once did, not a problem to be placed above job creation.
Bill Keller recently provided a representative sample:
The left-left sees economic inequality as mainly a problem of distribution — the accumulation of vast wealth that never really trickles down from on high. Their prescription is to tax the 1 percent and close corporate loopholes, using the new revenues to subsidize the needs of the poor and middle class…
The center-left — and that includes President Obama, most of the time — sees the problem and the solutions as more complicated. Yes, you want to provide greater security for those without independent means (see Obamacare), but you also need to create opportunity, which means, first and foremost, jobs. … The center-left … agrees on the menace of inequality, but places equal or greater emphasis on the fact that the economy is not growing the way it did for most of the last century.
First of all, this is a bit rich to hear from the center. The left has been howling about jobs and growth for five years now, for so long and so loud that our collective tonsils have about come unglued — and who were we arguing against? The centrists, who were a major bloc of support behind the premature turn to austerity back in 2010. Better late than never, I guess. Welcome to the party, guys!
In fact, this longstanding hair-on-fire panic about mass unemployment, which until now has been met with near-total indifference from the elite, is a big part of what motivates the inequality focus today. Because I have never met or even heard of someone concerned with inequality who is not also a fervent supporter of immediate monetary and fiscal stimulus to restore full employment as fast as possible. (That’s Item One in the inequality-reduction handbook!) The problem isn’t just mass unemployment — it’s the fact that we haven’t done anything about it since 2009. As Steve Randy Waldman has written, there are many economic strategies to create jobs now, of which we are trying none whatsoever. Inequality-driven discrepancies in political influence are a probable factor here.
What’s more, there is a compelling case that inequality is a major reason why our economy seems so prone to bubbles and why traditional policy remedies no longer have much purchase on job creation. A full recounting is beyond the scope of this post, but such arguments are worth taking seriously.
In any case, Keller is right to say that Republicans are now the major obstacle to any job creation agenda, so if centrists are now aboard the jobs train, I welcome them with open arms. They just shouldn’t kid themselves about who is for growth and job creation, and who isn’t.
By: Ryan Cooper, The Plum Line, The Washington Post, December 24, 2013
“During The Holidays, Remember Our Least”: Today We Have To Say “Thou Shalt Not” To An Economy Of Exclusion And Inequality
As we celebrate the holiday season, we are instructed by virtually all faiths to turn our thoughts to the “least of these.” January will mark the 50th anniversary of the War on Poverty, but most notable today is how impoverished our discussion of poverty is.
Political leaders in both parties pledge to save the “middle class,” because polls show that most Americans consider themselves part of the broad middle. Democrats tout their “middle out” economics against Republican “trickle-down” economics. Republicans claim to be fighting to save small businesses and middle-class homeowners from the rapacious demands of government. Very little attention is given to the poorest among us.
Perhaps that is because poverty scars this rich nation. A recent report by the United Nations Children’s Fund (Unicef) reveals that among 35 developed nations the United States ranks 34th in childhood poverty, above only Romania, a country several times less wealthy. Worse, we are also next to last in the depth of childhood poverty — the gap between average income of child’s family and that of poverty standard.
There is no argument about the facts. The poor were much more deprived when Lyndon Johnson declared his “war on poverty,” of course, but the percentage in poverty hasn’t changed much . Childhood poverty translates into poor health, poor education, and poor prospects. It isn’t an accident that the country frequently at the top of the international education rankings – Finland — also has the lowest levels of childhood poverty in that U.N. study.
So you’d think Washington would be focused on what to do to reduce the number of children in poverty, to address mass unemployment, declining wages, family distress. Instead, Washington has decided to administer a little “tough love.” Last month, Congress cut food stamps by an average of 7 percent for 48 million Americans . And this week 1.3 million jobless Americans will lose unemployment benefits , with as many as 5 million left in the cold over the course of the coming year .
In his recent “exhortation,” Pope Francis wrote starkly about the moral challenge of poverty:
“We can only praise the steps being taken to improve people’s welfare in areas such as health care, education and communications. At the same time, we have to remember that the majority of our contemporaries are barely living from day to day, with dire consequences. A number of diseases are spreading. The hearts of many people are gripped by fear and desperation, even in the so-called rich countries. . . .[Emphasis added.]
“Just as the commandment ‘Thou shalt not kill’ sets a clear limit in order to safeguard the value of human life, today we also have to say ‘thou shalt not’ to an economy of exclusion and inequality. Such an economy kills. How can it be that it is not a news item when an elderly homeless person dies of exposure but it is news when the stock market loses two points?”
Here, the Pope was standing firmly in the long tradition of the church’s concern for the poor, but among American conservatives, the response was hysteria. Rush Limbaugh accused him of peddling “pure Marxism.” Louis Woodhill in Forbes scorned him for “Papal Bull” that seemed “copied and pasted out of The Nation or Mother Jones.” (I take that as a compliment.) Rep. Paul Ryan (R-Wis.), a pious Catholic, was notably silent.
In a recent speech on inequality, President Obama insisted, “We are a better country than this,” and he made the case for government action. But his agenda was far less impressive than his rhetoric — including lower corporate tax rates, more trade accords, “streamlined” regulations, a “responsible budget” (meaning continued austerity).
The president touted his “race to the top” education program, when, in fact, schools in low-income districts have been forced to fire teachers, leaving classrooms far more crowded. He bragged on his college loan efforts even as reports showed students are graduating even deeper in debt. He did repeat his call for universal preschool and raising the minimum wage, but neither of these has been able even to receive a vote in the Republican-led House.
The reality is that government programs to lift the poor work. Johnson’s War on Poverty brought poverty down dramatically, but that war was lost to the war in Vietnam. Today, the United States does a much better job lifting poor children out of poverty than it did before Johnson pushed through Medicare and Medicaid expansions, child nutrition programs, subsidized school lunches and more. Even so, the United States still does far less than other developed countries. In 2010, for example, Dutch government programs reduced its poverty rate from 25 percent to 7.5 percent , while the United States only reduced its rate from 28 percent to 17 percent .
Two fundamental issues should be at the center of our debate. The first, posed by Pope Francis and Barack Obama, is what must be done to make the economy work for working people? The second is that posed by the president: Are we a better country than this? Do we want to be? We know what works. We can afford it, even more than other industrial countries. But are we prepared to do what needs to be done?
By: Katrina vanden Heuvel, Opinion Writer, The Washington Post, December 24, 2013
“The GOP’s Sad Scrooge Agenda”: A Real Anti-Poverty Agenda Involves Raising The Minimum Wage
It’s the most wonderful time of the year … unless your unemployment benefits are set to run out three days after Christmas. But there’s a little bit of holiday cheer for the long-term unemployed: Democrats are showing some new spine in fighting to help them.
For decades Democrats have had, at best, a stealth agenda when it comes to fighting poverty. After backing GOP-inspired welfare reform in 1996, most favored work-support programs taxpayers couldn’t necessarily see, like the Earned Income Tax Credit, and borrowed Republican rhetoric dividing the deserving from the undeserving poor. Expanding eligibility for food stamps and Medicaid was mainly defended in terms of an agenda to support the working — i.e. “deserving” — poor, and even for someone as ostensibly liberal as President Obama, deficit reduction has been a higher-profile priority than fighting income inequality throughout most of his five years in office, and the word “poverty” rarely crosses his lips at all.
That’s slowly been changing, for Obama and his party. Increasingly Democrats seem to believe poverty and income inequality are not only important issues morally, but politically. Now comes the liberal group Americans United for Change with polling, advertising and a political campaign designed to make sure Republicans suffer for their Scrooge agenda in 2014.
Polling by PPP finds that in four swing House districts currently held by Republicans, at least two-thirds of voters support continuing the expanded unemployment benefits that are set to expire Dec. 28, just three days after Christmas. Even in Speaker John Boehner’s district, 63 percent of voters want benefits extended, including 52 percent of Republicans.
But it’s not just PPP polling. A new Pew poll finds the public supports maintaining programs for the poor over deficit reduction 59-33; among independents it’s 53-38.
Of course, one of the tough things about being a progressive is that you can often find poll data supporting your policy agenda. And yet when push comes to shove in the only polls that matter, the ones that open on Election Day, economic fairness issues haven’t driven liberal voters quite the way social issues have turned out conservatives. Of course that’s because conservatives have had a head start organizing on issues like abortion and gun rights while liberals too often assume the obvious correctness of their world view will prevail over time.
But the fight over unemployment looks different. Americans United for Change, along with labor groups, plans an advertising and media push focused on vulnerable Republicans. Already, an effort to publicize the cost of cutting unemployment in those members’ home districts has paid off in remarkable local media coverage, as Greg Sargent laid out two weeks ago.
Senate Majority Leader Harry Reid has already announced that extending unemployment is at the top of his agenda when the Senate reconvenes in January. He’ll of course face pushback from the Tea Party caucus — Sen. Rand Paul continues to insist that extending unemployment is a “disservice” to the unemployed, as if he has any interest in policies that would actually be of “service” to them. Sen. Ted Cruz insists unemployment benefits “exacerbate” joblessness. But vulnerable and moderate Republicans in the House and Senate could conceivably surprise Paul and Cruz — they don’t want to find themselves in the unemployment line come 2015.
Still, it’s not time to celebrate just yet. Democrats weren’t tough enough to insist that an unemployment extension become part of the budget compromise. And there’s been little comparable innovative organizing around restoring food stamp cuts. Of course, a real anti-poverty agenda involves not just improving the safety net but raising the minimum wage, strengthening union rights, increasing spending on both preschool and higher education and restoring fairness and progressivity to the tax code. None of those things is going to happen with the current Congress.
But the Democrats’ new strength and political savvy on unemployment insurance is just more evidence that the party is no longer exclusively playing defense when it comes to an economic populist agenda. If progressives can demonstrate real political benefits to that agenda, expect cowardly Blue Dog Dems and even some Republicans to see the light.
Joan Walsh, Editor at Large, Salon, December 23, 2013
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