“The Human Consequences”: Cost Of The Medicaid Expansion Rejection In Lives As Well As Dollars
The more research that is done on the human toll of denying people health insurance, the easier it is to place a price in lives as well as dollars of decisions like that made by nearly half the states to reject the Medicaid expansion provided for in the Affordable Care Act. At Politico Magazine (in a piece given the wonderful, Celine-esque title, “Death on the Installment Plan”) Harold Pollack of the University of Chicago utilizes the findings of last week’s study on the lives saved by RomneyCare in Massachusetts to make some suggestions for those that might be saved by making Medicaid available to more non-elderly adults:
As a matter of fiscal policy, [rejecting the Medicaid expansion] makes little sense. The federal government would initially cover 100 percent of the costs. Its share will gradually drop to 90 percent over the coming years. Over the next decade, the federal government will cover more than 95 percent of the Medicaid expansion’s total cost. Edwin Park of the Center on Budget and Policy Priorities notes that the ACA raises state expenditures on Medicaid and the Children’s Health Insurance Program (CHIP) by only 1.6 percent, when compared with what expenditures would have been in the absence of health reform.
Even the above figures overstate states’ true fiscal burden, since these federal dollars would cover many services such as mental health care, public hospital services and services to the correctional population that would otherwise be supported by states and localities. Medicaid expansion is a significant economic stimulus to the states that have adopted it. Even in deeply conservative states such as Texas, the expansion is strongly supported by the medical community, hospitals, cities and localities and other key constituencies.
Texas and other huge states like Florida are leaving tens of billions of dollars on the table. When asked to give an accounting of themselves, officials offer flimsy justifications to evade two obvious realities: First, Republican politicians do not want to embrace the centerpiece domestic policy achievement of the Obama presidency. Second, many of these same politicians display conspicuously tepid concern for the wellbeing of the expansion’s most obvious beneficiaries: poor, nonwhite, politically marginal residents of their own states….
Nearly 5 million low-income Americans are income-eligible for Medicaid under the ACA, yet live in states that now reject the Medicaid expansion. Within this rather small but critical low-income population, that same one-per-830 estimate [made in the Massachusetts study] implies that almost 5,800 people will die every year as a result of being left uninsured. That’s only an estimate. It may overestimate—or underestimate—the true human consequences. In my view, there’s no escaping the fact that partisan opposition to the ACA is costing thousands of actual human lives every year.
That’s a hell of a toll for scoring an ideological point.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, May 12, 2014
“Stuck Between Obamacare And A Hard Place”: As A Massachusetts State Senator, Scott Brown Voted For Romneycare
Former Massachusetts Sen. Scott Brown will officially kick off his campaign to unseat New Hampshire Democratic Sen. Jeanne Shaheen tonight, as he attempts to return to the world’s greatest deliberative body (or something) after being ousted from his Bay State Senate seat by Democrat Elizabeth Warren two years ago. According to leaked excerpts of the speech he plans to deliver tonight, Brown will be campaigning against Obamacare, just as he did in 2010 when he won an upset in the race to succeed the late Sen. Edward Kennedy.
“Along with our money and our health plans, for a lot of us, it feels like we’re losing our liberty, too. Obamacare forces us to make a choice, live free or log on — and here in New Hampshire, we choose freedom,” Brown plans to say. (Get it? Because New Hampshire’s state motto is “live free or die.” But wait, if Obamacare is the major assault on freedom Republicans claim it is, do you have the choice to live free under it? Or is it just that “log on or die” didn’t send the right message? But I digress.)
There’s definitely a danger for Brown in taking this approach. Yes, the health care law has, according to a recent WMUR Granite State poll, a less than stellar approval rating in New Hampshire, with only 34 percent saying they approve of it while 53 percent say they oppose it. (Let’s add the caveat that the poll doesn’t say what portion of the opposition thinks the law goes too far and what portion thinks it doesn’t go far enough.) But Brown will have a hard time getting around the various problems other Republicans are running into when it comes to making Obamacare a focal point of a campaign.
For starters, the law may be unpopular in theory, but in practice, signups under Obamacare’s New Hampshire exchange have exceeded expectations. Does Brown have a plan for providing for those folks? Or how about the estimated 50,000 people who are going to receive health insurance under New Hampshire’s recently approved Medicaid expansion, which was made possible by Obamacare and on which Brown has thus far been mum? Those are real people who are experiencing real benefits from the law.
And therein lies the problem for Republicans, which Brown is eventually going to run into as well: Providing the benefits of Obamacare requires something that looks like Obamacare. Just look at this quote a Republican aide gave to Talking Points Memo’s Sahil Kapur (emphasis added):
As far as repeal and replace goes, the problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act. … To make something like that work, you have to move in the direction of the ACA. You have to have a participating mechanism, you have to have a mechanism to fund it, you have to have a mechanism to fix parts of the market.
And Brown knew this once upon a time. As my former colleague Igor Volsky noted, as a state senator Brown voted for the Massachusetts health reform law that looks a whole lot like Obamacare.
This is exactly why the long awaited Republican health care alternative never actually comes to fruition. (Sure, some individual lawmakers have proposed plans, but the party hasn’t coalesced around one bill.) To actually craft an alternative, the GOP would either have to admit that Obamacare is a pretty darn conservative measure or admit, like House Budget Committee Chairman Paul Ryan did the other day, that the popular provisions and benefits of Obamacare have to go away as well in order to enact a more Republican-y plan.
Will that latter approach work in still quite blue New Hampshire? Or will Brown try to get away with hand waving about an Obamacare alternative that will never materialize? Either way, spouting “live free or log on” will be no slam dunk.
By: Pat Garofalo, U. S. News and World Report, April 10, 2014
“Imminent ‘Death Spiral’ Premature, Over-Hyped”: Young People Are Just Procrastinating On ObamaCare
ObamaCare enrollees are, so far, generally older and therefore potentially less healthy than the general public. And on the flip side, only one-fourth of sign-ups are in the crucial 18-35 year-old age bracket, well below the administration’s roughly 40 percent target, according to new enrollment data released Monday.
Given the top-heavy enrollment figures, critics and skeptics are again raising a doomsday scenario in which an elderly pool of enrollees, without adequate subsidization from healthier, younger people, causes premiums to skyrocket so much the entire system crumbles.
“Hello, Death Spiral,” snarks a National Review headline.
Terrifying, right?
However, the administration expected that young people would procrastinate until the last minute, while older and sicker people would be more motivated to get coverage as soon as possible. People have until the end of March to sign up for ObamaCare before the individual mandate’s penalty kicks in, so assuming that works as something of a metaphorical term paper deadline, there could very well be a surge of young people into ObamaCare in the next couple of months.
Massachusetts’ experience implementing Romneycare in 2006 offers some historical precedent. As an analysis by MIT economics professor Jonathan Gruber shows, the percentage of Romneycare sign-ups in the 19-34 year-old bracket hovered in the low 20s for the first few months before gradually rising into the mid-30s range by the end of the year.
ObamaCare, likewise, saw an eight-fold increase in young adults enrolling in December compared to the two months prior, indicating that young people were indeed waiting until the last minute. Hence Aaron Smith, head of the nonprofit Young Invincibles, whose goal is getting uninsured young people enrolled, says the latest numbers show they “are on the right track.”
The White House is also planning to up its outreach to young people, including a National Youth Enrollment Day on February 15. That should help drive up youth enrollment above its current level.
And even if that effort fizzles, it’s still extremely unlikely the death spiral will materialize if the current enrollment demographics remain unchanged. A December report form the nonpartisan Kaiser Family Foundation concluded that “the financial consequences of lower enrollment among young adults are not as great as conventional wisdom might suggest.” Even in a worst-case scenario where young people comprise 25 percent of the overall pool, Kaiser estimated premiums would rise marginally, or “well below the level that would trigger a ‘death spiral.'”
There are two months of open enrollment left, so proclaiming dire predictions is a tad premature at this point. And even if the supposedly deadly enrollment demographics remain unchanged come April, and premiums go up, it almost certainly won’t imperil the law.
By: Jon Terbush, The Week, January 14, 2014
“Obamacare Death Spirals”: The Latest Prediction Of Doom Hits The Conservative Blogosphere
A new meme has arrived on the scene from the voices and pens of the anti-Obamacare devotees who remain more committed to frightening than informing when it comes to healthcare reform.
It’s the Obamacare “death spiral”— and it’s coming to a conservative blog near you.
Through a series of articles already going viral—thanks to a piece published on National Review Online and one by my Forbes colleague, Dr. Scott Gottlieb –we learn that the threat of impending doom ‘du jour’ comes via an allegation that, due to the poor launch of the healthcare.gov website, younger and healthier participants will now be more likely to stay away than sign up.
This, the falsely fearful argue, will result in an insurance pool jammed with older and sicker people without the required participation of younger and healthier Americans needed to balance the pools.
The result of such an event?
As insurance companies are forced to pay out more claims —due to their older and sicker participant base—without sufficient premium income from younger and healthier people less likely to call upon the insurer to pay for medical care, the insurance company is forced to raise their premium costs so they don’t loose money. As this problem builds upon itself year after year, it becomes, as it is termed in the insurance industry, a ‘death spiral’ as, sooner or later, the insurers are forced out of business when the premium costs get too high to be affordable by much of anyone.
Clearly, the authors suffer from a lack of understanding of human behavior—particularly when it comes to young people who are not given to dealing with these sort of issues until the deadline approaches…meaning we really don’t yet know anything about the potential success or failure of the insurance pools available on the health care exchanges.
If you doubt this, you might want to review what took place with the forerunner of Obamacare—Romneycare.
According to Jonathan Gruber, one of the key architects of the Massachusetts health care exchange—a program that the overwhelming majority of Massachusetts residents favor and support—and one of nation’s leading experts on all things Obamacare, “Massachusetts launched its health insurance program at the beginning of 2007 but enrollment didn’t fully flesh out for a year. In fact, it was less than 6% of the year’s total by the end of the second month. (emphasis added)”
In other words, people of all ages tend to wait until the deadline is upon them before coming to grips with an obligation like purchasing health insurance. But if you have kids, you know that younger people are even more likely to delay matters such as this.
Yet, here we have the opponents of the Affordable Care Act, ready to declare the entire program DOA based on a prediction of ultimate demise via the ‘death spiral’—and all because the slow start of the federally operated state healthcare exchanges are precluding younger and healthier prospective participants from signing up during the initial weeks of availability.
Even stranger, Dr. Gottlieb argues that, as a result of the failures of the federal website launch and the negative cascading effect he suggests will likely follow, more people will be driven out of the exchanges due to higher premiums in future years. In its place, Gottlieb proposes, these people will turn to “off-exchange” policies, purchased by going directly to an insurance company, broker, etc. for policies that are not offered on the exchange.
Gottlieb writes—
“Over time, conforming and non-conforming insurance policies sold entirely outside the exchanges could look increasingly attractive to consumers; even accounting for the subsidies many people would get for staying inside the exchanges.”
Why would they do this? Because, Dr. Gottlieb suggests, the off-exchange policies will be cheaper.
Setting aside that I have no idea what Gottlieb is referring to when he speaks of “non-conforming” insurance policies as every individual insurance policy, whether available on the exchange or not, must, for all practical purposes, meet the basic benefits requirements set forth in the Affordable Care Act, I can’t quite fathom why buying less expensive insurance off the exchanges would be a bad thing.
There is a tendency among those dedicated to burying healthcare reform to miss the point when it comes to the objectives of Obamacare. They spend so much time working out how to creatively attack the law that they simply cannot recall why we needed healthcare reform in the first place.
At its core, the law is designed to do three things—get insurance company abuses under control, make healthcare coverage more readily available to virtually all Americans and institute a series of experiments designed to bend the cost curve in healthcare delivery.
This being the case, why would anyone care whether you buy your insurance coverage off-exchange or on-exchange, so long as you obtain healthcare coverage? What’s more, the individual mandate does not require that you shop on the exchanges—it only requires you to purchase a qualifying policy.
The healthcare exchanges are designed to create competition among insurance companies. Should it not work, and Dr. Gottlieb is correct that the events occurring on the exchange will produce lower costs of an off-exchange policy—even for those who qualify for subsidies which are only available on the exchange—then we will have learned that the exchanges did not create the intended competition.
But, if Gottlieb is right and people can buy a cheaper policy that meets the requirements of the ACA off-exchange, then the objective of the law will be accomplished.
The bottom line here is that, by any reasonable and rational metric, it is far too early to know whether or not the insurance programs offered on the healthcare exchanges will manage to maintain the balance required of sick versus healthy and old versus young. In the final analysis, the doomsayers may turn out to be right. Maybe it just won’t work.
Or, maybe it will.
This is something we will simply not know for quite a few years.
Therefore, where exactly is the benefit of predicting a dire result at this stage of the game based on no available evidence whatsoever? Can there be any possible use of this information aside from giving political opponents some newly minted ammunition? Will the knowledge that insurance policies offered on the exchanges could experience a death spiral—a possibility that has existed for health insurers since the dawn of the industry—do anything to improve the odds of success?
If there is anything we can be sure of, it is that there will be a great many surprises along the way as we make these major adjustments to our healthcare system—some that will be good and some that will not.
As for the suggestion that we are in some immediate crisis because the healthcare.gov website has not yet worked as required, Jonathan Gruber, again, provides a reasonable and rational explanation of what is really happening and what it means.
USA Today reports that Gruber describes the current situation as “DEFCON 1″—a political problem, but probably not a problem yet for the marketplace.
If healthcare.gov is not running by Thanksgiving, it would be “DEFCON 2″, a real problem because people want to get insurance by January, but it’s not a crisis.
The crisis, according to Gruber, arrives if people cannot get insurance until March of 2014.
Gruber added that, in Massachusetts, officials were not focused on how well enrollment went on a day-to-day basis. They looked at the long-term potential, and expected that people would sign up in time to avoid the penalty.
Finally, Gruber noted, “I’m pretty confident they’ll have it up and going by Thanksgiving.”
So, how about we leave the death spiral stuff in the back room until the moment comes to actually haul it out and parade it around?
After all, at the rate Obamacare opponents are tossing out and using up their theories of pending disaster, they will soon run through their play book and have nothing left in their quiver.
Wouldn’t that be a shame?
By: Rick Ungar, Op-Ed Contributor, Forbes, October 28, 2013
“A Man Of No Convictions”: You Can Never Meet The Same Mitt Romney Twice
To a skeptic, the most remarkable aspect of Mitt Romney’s presidential campaign has been how so flexible a politician can represent so dogmatic a party. Contemporary Republicanism is ideological to its core. Everybody who watched the GOP primary debates between Mitt and the Seven Dwarves (or were there nine? I forget) understands that there’s a black-and-white party line on almost every imaginable topic from tax policy to global warming.
Romney, on the other hand, appears to have no firm convictions at all. How anybody purports to know what the GOP candidate actually thinks about any issue other than the size of his own offshore bank accounts beggars my poor imagination. That most Republicans have temporarily persuaded themselves to trust him reflects mainly their fear and loathing of President Obama.
Equally remarkable, however, is the way the Obama campaign has let Romney get away with it. How can his evasiveness not be an issue? For that matter, how can it not be THE issue? Early on, a strategic decision was apparently made to depict the GOP candidate as the “severely conservative” politician he affected to be during the Republican primaries.
Well, it ain’t working. So many and so various are the GOP candidate’s self-contradictions and reinventions that the proverbial “low information” citizens who appear to constitute much of the swing vote are pretty much free to imagine any Mitt Romney that strikes their fancy.
Maybe it’s unpatriotic to say so, but an awful lot of people who manage their personal affairs competently enough simply refuse to understand the most elementary facts when they’re part of a political argument.
Sometimes you have to tell them a story. It helps if that story connects to something close to home; something they’ve had to think about realistically in their own lives.
Such as, what happens if you lose your health insurance and then get sick? Millions live in fear of this every day.
CBS News’ Scott Pelley recently asked Romney a simple question on 60 Minutes: “Does the government have a responsibility to provide health care to the 50 million Americans who don’t have it today?”
“Well, we do provide care for people who don’t have insurance,” Romney allowed. “If someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.”
“That’s the most expensive way to do it,” Pelley observed. Indeed, government figures show the average emergency room visit costs $922, vs. $199 for a doctor’s office visit.
Nor is it free. People do know that. Under the Emergency Medical Treatment and Active Labor Act signed by President Reagan, hospitals must treat sick and injured patients regardless of their ability to pay. A civilized society can do no less; much less one that hopes to head off deadly epidemics.
But the law doesn’t say the hospital can’t perform what’s cynically called a “wallet biopsy” and send you a bill. Indeed, many states allow hospitals to hire collection agencies, garnish wages and seize assets in pursuit of payment. For this reason, many people stay away until they’re at death’s door.
Others abuse the privilege and stick the rest of us with the bill.
Back in 2006, the politician Bill Clinton calls “Moderate Mitt” recognized the problem. Hewrote a Wall Street Journal column objecting to the way deadbeats game the system.
“By law, emergency care cannot be withheld,” he wrote. “Why pay for something you can get free? Of course, while it may be free for them, everyone else ends up paying the bill, either in higher insurance premiums or taxes.”
Writing in Time, Kate Pickert catches Moderate Mitt as recently as 2008, explaining the conservative origins of “Romneycare” in Massachusetts.
“They shouldn’t be allowed just to show up at the hospital and say somebody else should pay for me, so we said no more free riders… We said if you can afford insurance, then either have the insurance or get a health savings account, pay your own way, but no more free ride… I think it’s the conservative approach—to make sure that people who can afford insurance are getting it at their expense, not at the expense of the taxpayers or the government. That, I consider a step towards socialism.”
Ah, but then came “Obamacare,” basically Romneycare with a less expensive per capita price tag. Yesterday’s conservative solution turned into today’s Bolshevism. Severely Conservative Mitt played along.
So what would Romney do if elected?
Who knows? To paraphrase the ancient Greek philosopher Heraclitus: You can never encounter the same Mitt Romney twice. Whatever he says today, he’ll say something different tomorrow.
Here’s the question President Obama should be asking: Would you buy a used health insurance policy from this man?
By: Gene Lyons, The National Memo, October 17, 2012
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