“Muddied Waters And Smokescreens”: These Six States Want To Allow Health Insurers To Deny Coverage To Sick People
Officials in Texas and five other GOP-led states are refusing to oversee even Obamacare’s most basic — and popular — consumer protections and insurance market reforms. That includes the law’s ban on denying coverage or charging more because of a pre-existing condition and discriminating against women on the basis of gender. The decision could present major hurdles to Americans who buy health insurance through federally-run marketplaces in the Lone Star State, Arizona, Alabama, Missouri, Oklahoma, and Wyoming.
A majority of states haven’t set up their own insurance marketplaces, opting to let the federal government set one up for them. But every one of those states (other than the six in question) have at least said they will police the insurers that sell plans on their federally-run marketplaces to make sure that they aren’t giving consumers short shrift. The Centers for Medicare and Medicaid Services (CMS) will instead be responsible for enforcing Obamacare’s insurance industry reforms and reviewing consumer complaints in the states refusing to do so on their own.
That could be confusing for Americans who are buying insurance for the first time through the marketplaces. For example, imagine you’re a relatively poor person with diabetes. Your income isn’t low enough to get you on Medicaid — but your employer doesn’t offer health benefits, and you’ve never qualified for insurance on the individual market because of your medical condition. On October 1st, you can go buy insurance with government subsidies for the first time on an Obamacare marketplace. But the plan you choose charges you a suspiciously high premium relative to your income. You suspect it’s because of your medical problem, which is clearly illegal under the reform law. But who do you complain to?
Usually the answer is your state’s insurance department. But the answer is CMS if you live in one of the six states that won’t enforce the consumer protections. Unfortunately, if you don’t know that, you could spend months oscillating between the state and federal government, trying to figure out if you’re getting hoodwinked by your insurance company. And in the meantime, the bills are piling up.
Those kinds of scenarios are the reason that health policy experts say insurance complaints are best handled by state agencies. Officials with the Texas Department of Insurance argue that they legally can’t enforce the regulations because they’ve ceded authority over the marketplace to the federal government, and Texas doesn’t have corresponding state laws holding insurers to the same standards as Obamacare. But Stacy Pogue of the Center for Public Policy Priorities tells the Texas Tribune that’s likely a smokescreen, since Texas has enforced plenty of other federal laws on a statewide level in the past.
Officials in the Lone Star State certainly haven’t been shy about their opposition to the health law. Gov. Rick Perry (R) dug in his heels against reform in 2012, saying he wouldn’t “be a part of expanding [the] socializing of our medicine.” More recently, Perry denied basic health benefits to 1.5 million of his state’s poorest residents by forgoing Obamacare’s Medicaid expansion. Evidently, that wasn’t going far enough.
National Republicans have also been stepping up their efforts to to undermine Obamacare. Reps. Tim Huelskamp (R-KS) and Jason Chaffetz (R-UT) are refusing to help their own constituents if they have questions about the health law, and the Tea Party-affiliated advocacy group FreedomWorks has been telling young Americans to forgo signing up for health coverage under Obamacare entirely.
By: Sy Mukhergee, Think Progress, August , 2013
“Lower Premiums Is A Big Effing Deal”: The House GOP’s Futile Poorly Timed Efforts To Gut Obamacare
Guess whose heath care premiums are poised to drop considerably?
House Speaker John Boehner’s (R-Ohio) timing could be better. Hoping to capitalize on the bad press surrounding delay in the implementation of the Affordable Care Act’s employer mandate provision (even though the move was substantively meaningless), House Republicans are set to move on their latest idea: a vote on delaying the individual mandate, too.
Politically, the move arguably makes some sense. Even though Republicans came up with the idea of the individual mandate, they’ve since turned it into one of the least popular provisions in “Obamacare.” By singling it out for a delay, GOP lawmakers bring attention to a controversial health care policy and put Democrats on the spot for defending it. Their bill won’t become law, of course — Republicans love symbolic, post-policy governing — but they might get a few attack ads out of this.
But substantively, there’s a problem. In fact, there’s more than one.
First, by going after the individual mandate, House Republicans are taking a bold stand in support of leaving 13.7 million Americans without any health care coverage at all.
Second, GOP lawmakers are also simultaneously (and admittedly) positioning themselves in support of a policy that leads to higher premiums and gaps for Americans with pre-existing conditions.
And third, Republican lawmakers are, for purely political reasons, obsessed with gutting federal health care law at the same time as new-but-inconvenient evidence emerges that the law is working extremely well.
Individuals buying health insurance on their own will see their premiums tumble next year in New York State as changes under the federal health care law take effect, state officials are to announce on Wednesday.
State insurance regulators say they have approved rates for 2014 that are at least 50 percent lower on average than those currently available in New York. Beginning in October, individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly. With federal subsidies, the cost will be even lower.
Supporters of the new health care law, the Affordable Care Act, credited the drop in rates to the online purchasing exchanges the law created, which they say are spurring competition among insurers that are anticipating an influx of new customers. The law requires that an exchange be started in every state.
If elected officials’ principal goal is to pursue policies that benefit the public, launching a crusade to sabotage the Affordable Care Act really doesn’t make any sense.
Skeptics have noted this morning that New York’s insurance market is uniquely messy, so the results aren’t representative of the impact we’ll see elsewhere. Perhaps. But Matt Yglesias argues persuasively that it’s “a big deal anyway.”
The first reason is that New York is a really big state. Its almost 20 million residents account for over 6 percent of the American population.[…]
But this is also important because there’s a lesson here. At various points, the Affordable Care Act’s critics in Congress have suggested that they might be interested in keeping the popular-sounding aspects of Obamacare — the community rating, the guaranteed issue — but just scrap all that unfortunate mandate talk and tax increases. The New York experience shows why that won’t work. That lesser plan is essentially what New York did some years back, and the consequences were enormous premium hikes as the state’s market was rocked by adverse selection. Affordable Care Act implementation, by adding the nasty elements back in, is fixing a huge problem that other states don’t suffer from but that would exist everywhere if Congress took the approach of just doing the easy parts.
In light of this, House Republicans are eager — desperate, even — to boast about their efforts to gut the law, no matter what it does to the uninsured and people with pre-existing conditions, and even though it does more of what we already know doesn’t work.
Before we move on, let’s also not forget that this isn’t limited to the Empire State. In California, exchanges are taking shape and premiums will be even lower than expected; insurers in Oregon are also lowering premiums; and health care expenditures overall are slowing, just as Obamacare was designed to accomplish.
Congressional Republicans and a few too many pundits want you to believe the implementation of the Affordable Care Act is a disaster. It’s not. They want you to believe gutting the law would make things better. It won’t.
By: Steve Benen, The Maddow Blog, July 17, 2013
“Affordable And Accessable”: The Shocking Truth About Obamacare’s Rate Shock
Imagine you went to Best Buy and found a great deal on a plasma television set. I want to be clear here: You didn’t find a great television set. This television set is actually a bit crummy. The picture is fuzzy. Consumer Reports says it breaks down a lot and it’s expensive to fix. But it’s really cheap. The price tag reads $109.
When you take it to the counter, the saleswoman tells you that the set will actually cost you $199. And count yourself lucky, she confides in a conspiratorial whisper. There are customers whom Best Buy won’t sell it to at any price. You ask her which customers those are. The ones who need the TV most, she replies.
So here’s the question: Does that television really cost $109?
Best Buy, of course, would never do this to you. If they say you can buy a television set for $109, you can buy it for $109. Plus, they’re handsome, and their customer service is great, and I hope they advertise in The Washington Post forevermore, amen.
But this is actually how the individual health-insurance market works. And understanding why is crucial to understanding a lot of what you’re going to read about health reform in the next year.
Last week, California released early information on the rates insurers intend to charge on the new insurance marketplaces — known as “exchanges” — that the state is setting up under Obamacare. They were far lower than anyone expected. Where analysts had anticipated average premiums of $400 to $500, insurers were actually charging $200 to $300. “This is a home run for consumers in every region of California,” crowed Peter Lee, director of the state’s exchanges.
The Affordable Care Act’s critics saw it differently. Avik Roy, a conservative health writer at Forbes, said Lee was being “misleading” and that “Obamacare, in fact, will increase individual-market premiums in California by as much as 146 percent.” Obamacare, he said, would trigger “rate shock,” the jolt people feel when they see higher rates. That doesn’t sound like a home run at all.
Who’s right? In typical columnist fashion, I’m not going to tell you just yet. But stick with me, and you’ll be able to parse the next year of confused and confusing Obamacare arguments with ease.
Here’s the first thing to know: We’re talking about a small fraction of the American health-care system. This isn’t about people on Medicare or Medicaid or employer-based insurance. It’s about people joining Obamacare’s insurance exchanges. That’s people who buy insurance on their own now, as well as some of the uninsured. In 2014, 7 million people, or 2.5 percent of the population, is expected to buy insurance through the exchanges. By 2023, that will rise to 24 million people, or 8 percent.
So we’re talking about a small portion of the market. Worse, we’re talking about that small portion of the market all wrong.
Roy got his 146 percent by heading to eHealthInsurance.com, running a search for insurance plans in California and comparing the cost of the cheapest plans to the cost of the plans being offered in the exchanges. That’s not just comparing apples to oranges. It’s comparing apples to oranges that the fruit guy may not even let you buy.
I ran the same search Roy did. I looked for insurance in Irvine, Calif. — my home town. The average monthly premiums of the five cheapest plans is $114. So I took the middle plan, HealthNet’s IFP PPO Value 4500. It’s got a $4,500 deductible, a $2,500 deductible for brand-name medications, huge co-pays and a little “bestseller” icon next to it. And it’s only $109 a month — if they’ll sell it to you for that price.
That’s the catch, and it’s a big one. Click to buy the plan and eventually you’ll have to answer pages and pages of questions about your health history. Ever had cancer? How about an ulcer? How about a headache? Do you feel sad when it rains? When it doesn’t rain? Is there a history of cardiovascular disease in your family? Have you ever known anyone who had the flu? The actual cost of the plan will depend on how you answer those questions.
According to HealthCare.gov, 14 percent of people who try to buy that plan are turned away outright. Another 12 percent are told they’ll have to pay more than $109. So a quarter of the people who try to buy this insurance product for $109 a month are told they can’t. Those are the people who need insurance most — they are sick, or were sick, or are likely to get sick. So, again, is $109 really the price of this plan?
Comparing the pre-underwriting price of this plan to those in Obamacare’s exchanges is ridiculous. The plans in Obamacare’s exchanges have to include those people. They can’t turn anyone away or jack up rates because of a history of arthritis or heart disease.
They also have to offer insurance that meets a certain minimum standard. Under Obamacare, for instance, the out-of-pocket limit for someone making 100 to 200 percent of the poverty line is $1,983. Under the Value 4500, you could spend up to $9,500 before the out-of-pocket limit kicked in. Obamacare also has subsidies for people making up to four times the poverty line. The poor pay next to nothing. The rich pay full freight.
“We as a society have never really said here’s what reasonable insurance is,” says Larry Levitt of the Kaiser Family Foundation. “It’s just been anything goes. For the first time they’re setting a minimum about what reasonable insurance should be.” They’re also setting a minimum about who should be able to get it, and at what cost. Now it really will work like Best Buy, where the price on the tag is the price everyone actually pays.
Some people will find the new rules make insurance more expensive. That’s in part because their health insurance was made cheap by turning away sick people. The new rules also won’t allow for as much discrimination based on age or gender. The flip side of that, of course, is that many will suddenly find their health insurance is much cheaper, or they will find that, for the first time, they’re not turned away when they try to buy health insurance.
That’s why the law is expected to insure almost 25 million people in the first decade: It makes health insurance affordable and accessible to millions who couldn’t get it before. To judge it from a baseline that leaves them out — a baseline that asks only what the wealthy and healthy will pay and ignores the benefits to the poor, the sick, the old, and women — well, that is a bit shocking.
By: Ezra Klein, Wonkblog, The Washington Post, June 1, 2013
“Mundane Posturing”: House GOP Kills Eric Cantor’s Ridiculous Health-Care Scheme
It looked like House Majority Leader Eric Cantor (R-Va.) had come up with a fairly clever scheme. Unfortunately for him, it died yesterday when his fellow House Republicans refused to go along.
The gambit was a little complicated, but in a nutshell, Cantor thought he’d come up with a way to severely undermine the Affordable Care Act — the House would pass a bill to strip federal funds from the Prevention and Public Health Fund, which helps states set up the exchanges that are needed to make the ACA work. The proposal would then divert that money into existing-but- underfunded high-risk pools for the uninsured — a favorite GOP health care policy — that help people with pre-existing conditions buy subsidized coverage.
For Cantor, the plan checked a lot of boxes. If the exchanges are gutted, implementing “Obamacare” would be nearly impossible. At the same time, voters were supposed to see this and say, “See? House Republicans really are interested in providing solutions to problems people face in the real world.” As a matter of public policy, this was an awful idea, but the whole endeavor was billed as an element in the party’s “rebranding” campaign.
So what happened? Cantor’s plan failed miserably because his own allies balked.
On Wednesday, Republican leaders abruptly shelved one of the centerpieces of Mr. Cantor’s “Making Life Work” agenda — a bill to extend insurance coverage to people with pre-existing medical conditions — in the face of a conservative revolt. […]
Items that Mr. Cantor had hoped would change the Republican Party’s look, if not its priorities, have been ignored, have been greeted with yawns or have only worsened Republican divisions.
Cantor expected Democratic opposition and he received it — House Dems immediately saw through the scheme and the White House issued a veto threat yesterday morning.
But that wasn’t the majority leader’s real problem. Rather, far-right lawmakers, activists, and organizations saw Cantor’s proposal as an effort to “fix” the Affordable Care Act by investing in high-risk pools for those with pre-existing conditions.
For the left, Cantor’s “Helping Sick Americans Now Act” was a wolf in sheep’s clothing. For the right, it was just a sheep to be slaughtered.
Republican leaders assumed that if they just explained the legislation to their own members — this was about cutting “Obamacare” off at the knees, not actually improving the law — they’d have enough support to pass the bill. But House Republicans wouldn’t listen, seeing this as a misguided effort to spend public funds in support of a provision within the health care law they’ve been told to despise.
The Club for Growth, the Heritage Foundation and tea party groups have urged Republican lawmakers to oppose the bill, which was authored by GOP Reps. Joe Pitts of Pennsylvania, Michael Burgess of Texas and Ann Wagner of Missouri. Club for Growth said it would include this vote in its annual rating of members of Congress.
Brent Bozell, a tea party leader, dubbed the bill “CantorCare” in a news release Tuesday.
Republican lawmakers privately fretted that the bill would bolster Obamacare, which the GOP has long tried to dismantle.
Cantor, humiliated, was forced to pull the bill from the floor, realizing it would lose if brought up for a vote. His office insisted that the proposal would be brought back after the leadership had more time to educate its caucus, but there’s no indication of when that might happen.
Remember, Cantor and his allies didn’t really expect this to become law; they only hoped to use this as a political scheme that made House Republicans look better. In practice, it had the opposite of the intended effect, and divided the caucus instead of uniting it.
This was, as NBC’s First Read put it, “mundane posturing,” which should have been easy for the far-right lawmakers, but which ended up backfiring.
By: Steve Benen, The Maddow Blog, April 25, 2013
“Doing Nothing Was Not An Option”: Obamacare Is Lowering Some Health Care Costs
The snippy tone of the letter from my health insurance company really threw me for a minute. Very officious, very much this-is-totally-not-our-fault-the-bad-government-made-us-do-it, the letter informed me that because of the Affordable Care Act, my premium might change. Under the law, as of this year, insurance carriers would no longer be allowed to differentiate (or discriminate) on the basis of gender, and this, I was informed in a letter dripping with derision, might end up affecting how much I have to pay for my individual insurance each month.
Well, it did. My premiums are now 7 percent lower than they were.
Yes, that’s lower. Despite the fact that foes of Obamacare are screaming about how the law will bankrupt families and small businesses (the impact on buyers of individual policies never seems to come up), despite all the pols showing that Americans are terrified that their health care costs will grow, my premium went down. This will not be true for everyone—it was women who were routinely charged more for insurance for no other reason than their gender. That includes, incidentally, the handful of states in which it was perfectly legal for insurance companies to deem victims of domestic violence as having a “pre-existing condition.” But it’s reason to believe that the worry—verging on hysteria—over the law might be a bit much.
Health care costs are absurdly high in this country, and they must be reined in. And it’s not because we have the best health care in the world; we don’t. If you need a heart transplant, yes, this is where you want to be. But for most of the health care most of us will need in our lives, we are simply not getting the bang for our buck.
Health care premiums may indeed go up for many people, but they were going up before Obamacare was passed. That was the point of trying to do health care reform. That was the point during the Nixon administration, when both parties worried about the social and financial impact of the uninsured. It was the point in 1992, when Bill Clinton was running for president, and at nearly every campaign stop, someone told a sad story of a child with leukemia, and an insurance company refusing to pay for the treatments, or of someone who got laid off and couldn’t get a job because he had a “pre-existing condition” the new employer would find too expensive to cover through its insurance. The problem has merely gotten worse every single time Congress and the White House built the momentum to do something and came close but ultimately failed.
Is Obamacare the cure? The reality is, three years after the law was passed, is that we simply don’t know. House Democratic Leader Nancy Pelosi was criticized for saying we don’t know what the law will do until it’s in place, but she was right. That’s true of a lot of sweeping legislation (No Child Left Behind being the best recent example). The idea is to give it a shot, and then tweak it where necessary.
One thing is clear—doing nothing, yet again, was not an option.
By: Susan Milligan, U. S. News and World Report, March 22, 2013
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