“More People Have Health Insurance”: Another Day, Another Sign That Obamacare Is Working
It’s impossible to say how big an impact the Affordable Care Act is having on the uninsured. But it’s getting impossible to deny that it’s having an impact at all.
The latest evidence comes from the Gallup organization, which surveys respondents about insurance status. According to Gallup, the percentage of adults without health insurance has been falling since the middle of last year. Now, Gallup says, it’s down to 15.6 percent. That’s the lowest rate that Gallup has recorded since late 2008.
These tracking surveys on the uninsured are far from precise. Among other things, people answering these surveys aren’t always sure of their own insurance status. Nobody should treat them as gospel.
But Gallup also found the most dramatic change in insurance status among low-income and minority populations, which would be consistent with implementation of a law that has its most dramatic impact on people with the least money. It’s also consistent with three other pieces of information
- Health Reform Monitoring Survey. In this survey, conducted by the Urban Institute and supported by the Robert Wood Johnson Foundation, the rate of uninsurance among non-elderly adults fell from 17.6 percent in the first quarter of 2013 to 15.2 percent in the first quarter of 2014.
- The Rand Corporation. According to reporting by Noam Levey of the Los Angeles Times, unpublished research from Rand suggests that the percentage of uninsured Americans fell from 20.9 in late 2013 to 16.6 percent in early 2014.
- Department of Health and Human Services. Late last week, HHS announced that enrollment in Medicaid and CHIP was 3 million higher than it had been in late 2013.
The Congressional Budget Office has projected that 13 million Americans will get health insurance because of Obamacare. Gallup’s numbers would correspond to a significantly smaller decline, although the numbers depend on what you choose as a starting point. Then again, Gallup’s numbers don’t account for the end of open enrollment—when, by all accounts, large numbers of people rushed to sign up for coverage. They also don’t account for a full year of enrollment in Medicaid and the Children’s Health Insurance Program, since people can sign up for those programs all year long.
In short, it seems pretty clear that, because of Obamacare, more people have health insurance. And, yes, that accounts for people who lost existing coverage because insurers cancelled old policies. The question is how big a difference the law is making. And it’s going to be a while before anybody knows.
By: Jonathan Cohn, The New Republic, April, 7, 2014
“Irrational Hatred Of Obamacare Is Hard To Fathom”: The GOP’s Relentless Opposition Has Been Puzzling
My friend Isatou has just received an invoice from Kaiser Permanente, testament to her new coverage through the Affordable Care Act — usually called “Obamacare.” She’s thrilled to finally have health insurance so she can get regular checkups, including dental care.
A reasonably healthy middle-aged woman, she knows she needs routine mammograms and screenings for maladies such as hypertension. But before Obamacare, she struggled to pay for those things. She once had to resort to the emergency room, which left her with a bill for nearly $20,000. (She settled the bill for far less, but it still left her deeply in debt.)
She is one of more than 7 million people who have signed up for health insurance through the ACA, stark evidence of the overwhelming market demand. Despite a badly bungled initial rollout, a multimillion-dollar conservative media campaign designed to discourage sign-ups, and a years-long Republican crusade against it (50 votes to change the law), millions got health insurance.
That hardly means Obamacare is a raging success. It’s much too early to know how it will affect health outcomes for the previously uninsured. But it’s abundantly clear that the ACA has already made great strides in improving access to health care. And that alone is quite an accomplishment.
Now, young adults can stay on their parents’ health insurance policies until they are 26 years old — a boon in an economy where many young folks are struggling to find decent jobs. Now, patients with previously diagnosed illnesses (“pre-existing conditions,” in insurance lingo) can’t be denied coverage. Now, the chronically ill don’t have to worry about hitting a lifetime cap that would deny them essential procedures or pharmaceuticals. Now, working folks who don’t get insurance through their employers can purchase affordable policies.
Factoring in the Medicaid expansion, the ACA has extended health care coverage to an additional 9.5 million people, according to the Los Angeles Times, which gathered data from national surveys. Needless to say, millions more would have been covered if so many Republican governors, mostly located in Southern states, had not callously refused to accept the Medicaid expansion despite the fact that it is largely paid through federal government funds.
The GOP’s relentless opposition has been puzzling. Republicans have resorted to extreme measures to try to derail Obamacare, including an implicit threat to prevent the National Football League from participating in a marketing campaign to encourage people to sign up.
Oh, did I mention 50 votes to repeal or alter the law?
Even acknowledging that our politics have become bitterly polarized, I don’t understand this one. Even taking into account the GOP’s irrational hatred for President Obama, I don’t get it. Even though I know that Republicans believe in less government, I don’t understand their approach to Obamacare.
First off, the ACA adheres to market-based ideas, many of which were first suggested by conservatives. Instead of a single-payer system like, say, Medicare, the ACA relies on private insurance companies. It adopts the individual mandate that was supported by many Republicans, including Newt Gingrich, back in the 1990s and later adopted by Mitt Romney in Massachusetts.
Second, Republicans are free to offer up a health care scheme that is more in keeping with conservative principles. But the “repeal and replace” mantra is rarely heard anymore since it has become increasingly clear that the GOP has no intention of coming up with a plan to replace Obamacare. While there are various counter-proposals floating about, none has garnered the support of a majority of Republicans in Congress.
Is the ACA perfect? Absolutely not. There is much in the law that needs to be worked on, refined, improved. But the GOP doesn’t seem interested in that. Instead, its members have taken to engaging in increasingly ridiculous criticisms, including the charge that the White House has made up the number of successful enrollees.
It’s strange. Could it be that Republicans are simply furious that millions of Americans like Isatou finally have health insurance?
By: Cynthia Tucker, Winner of the 2007 Pulitzer Prize for Commentary, is a Visiting Professor at the University of Georgia; Published in The National Memo, April 5, 2014
“Rube Goldberg Survives”: Face It Republicans, Health Reform Has Won
Holy seven million, Batman! The Affordable Care Act, a k a Obamacare, has made a stunning comeback from its shambolic start. As the March 31 deadline for 2014 coverage approached, there was a surge in applications at the “exchanges” — the special insurance marketplaces the law set up. And the original target of seven million signups, widely dismissed as unattainable, has been surpassed.
But what does it mean? That depends on whether you ask the law’s opponents or its supporters. You see, the opponents think that it means a lot, while the law’s supporters are being very cautious. And, in this one case, the enemies of health reform are right. This is a very big deal indeed.
Of course, you don’t find many Obamacare opponents admitting outright that 7.1 million and counting signups is a huge victory for reform. But their reaction to the results — It’s a fraud! They’re cooking the books! — tells the tale. Conservative thinking and Republican political strategy were based entirely on the assumption that it would always be October, that Obamacare’s rollout would be an unremitting tale of disaster. They have no idea what to do now that it’s turning into a success story.
So why are many reform supporters being diffident, telling us not to read too much into the figures? Well, at a technical level they’re right: The precise number of signups doesn’t matter much for the functioning of the law, and there may still be many problems despite the March surge. But I’d argue that they’re missing the forest for the trees.
The crucial thing to understand about the Affordable Care Act is that it’s a Rube Goldberg device, a complicated way to do something inherently simple. The biggest risk to reform has always been that the scheme would founder on its complexity. And now we know that this won’t happen.
Remember, giving everyone health insurance doesn’t have to be hard; you can just do it with a government-run program. Not only do many other advanced countries have “single-payer,” government-provided health insurance, but we ourselves have such a program — Medicare — for older Americans. If it had been politically possible, extending Medicare to everyone would have been technically easy.
But it wasn’t politically possible, for a couple of reasons. One was the power of the insurance industry, which couldn’t be cut out of the loop if you wanted health reform this decade. Another was the fact that the 170 million Americans receiving health insurance through employers are generally satisfied with their coverage, and any plan replacing that coverage with something new and unknown was a nonstarter.
So health reform had to be run largely through private insurers, and be an add-on to the existing system rather than a complete replacement. And, as a result, it had to be somewhat complex.
Now, the complexity shouldn’t be exaggerated: The basics of reform only take a few minutes to explain. And it has to be as complicated as it is. There’s a reason Republicans keep defaulting on their promise to propose an alternative to the Affordable Care Act: All the main elements of Obamacare, including the subsidies and the much-attacked individual mandate, are essential if you want to cover the uninsured.
Nonetheless, the Obama administration created a system in which people don’t simply receive a letter from the federal government saying “Congratulations, you are now covered.” Instead, people must go online or make a phone call and choose from a number of options, in which the cost of insurance depends on a calculation that includes varying subsidies, and so on. It’s a system in which many things can go wrong; the nightmare scenario has always been that conservatives would seize on technical problems to discredit health reform as a whole. And last fall that nightmare seemed to be coming true.
But the nightmare is over. It has long been clear, to anyone willing to study the issue, that the overall structure of Obamacare made sense given the political constraints. Now we know that the technical details can be managed, too. This thing is going to work.
And, yes, it’s also a big political victory for Democrats. They can point to a system that is already providing vital aid to millions of Americans, and Republicans — who were planning to run against a debacle — have nothing to offer in response. And I mean nothing. So far, not one of the supposed Obamacare horror stories featured in attack ads has stood up to scrutiny.
So my advice to reform supporters is, go ahead and celebrate. Oh, and feel free to ridicule right-wingers who confidently predicted doom.
Clearly, there’s a lot of work ahead, and we can count on the news media to play up every hitch and glitch as if it were an existential disaster. But Rube Goldberg has survived; health reform has won.
By: Paul Krugman, Op-Ed Columnist, The New York Times, April 3, 2014
“The Moment Of Truth”: The GOP Must Admit It Was Wrong On Obamacare
Is there any accountability in American politics for being completely wrong? Is there any cost to those who say things that turn out not to be true and then, when their fabrications or false predictions are exposed, calmly move on to concocting new claims as if they had never made the old ones?
The fact that the Affordable Care Act (ACA) hit its original goal this week of signing up more than 7 million people through its insurance exchanges ought to be a moment of truth — literally as well as figuratively. It ought to give everyone, particularly members of the news media, pause over how reckless the opponents of change have been in making instant judgments and outlandish charges.
When the health-care Web site went haywire last fall, conservatives were absolutely certain this technological failure meant that the entire reform effort was doomed. If you doubt this, try a Google search keyed to that period relating the word “doomed” to the health-care law.
It should be said that the general public was much wiser. A CNN poll in November that Post blogger Greg Sargent highlighted at the time found a majority (54 percent to 45 percent) saying that the problems facing the law “will eventually be solved.” Political moderates took this view by 55 percent to 43 percent, independents by 50 percent to 48 percent. Only Republicans — by a whopping 72 percent to 27 percent — and conservatives (by 66 percent to 33 percent) thought the law could never be fixed.
Their representatives in Washington, moderate conservatives as well as the tea party’s loyalists, followed the base’s lead. In mid-November, for example, Sen. Rob Portman (R-Ohio) told Fox News flatly that the law is “destined to fail,” “fundamentally flawed” and “not ready for prime time.” House Speaker John Boehner predicted dire outcomes before the Web site fiasco. He repeatedly insisted, as he did in July, that “even the Obama administration knows the ‘train wreck’ will only get worse.”
This attitude affected more neutral observers. Forbes magazine posted a piece on Nov. 22 under the headline: “What to do if and when Obamacare collapses.” The op-ed modestly acknowledged that “it’s too soon to write an epitaph for Obamacare,” but then barged forward, since “its crises are piling up so fast that one has to begin looking ahead.”
At this point, the etiquette of commentary typically requires a “to be sure” paragraph, as in: To be sure, the law could still face other problems, blah, blah, blah. But such paragraphs are timid and often insincere hedges. After all, every successful program, even well-established ones such as Medicare, Social Security and food stamps, confronts ongoing challenges.
So let’s say it out loud: The ACA is doing exactly what its supporters said it would do. It is getting health insurance to millions who didn’t have it before. (The Los Angeles Times pegged the number at 9.5 million at the beginning of the week.) And it’s working especially well in places such as Kentucky, where state officials threw themselves fully and competently behind the cause of signing up the uninsured. Those who want to repeal the law will have to admit that they are willing to deprive these people, or some large percentage of them, of insurance.
Too many conservatives would prefer not to say upfront what they really believe: They don’t want the federal government to spend the significant sums of money needed to get everyone covered. Admitting this can sound cruel, so they insist that their objections are to the ACA’s alleged unworkability, or to “a Washington takeover of the health system” (which makes you wonder what they think of Medicare, a far more centralized program). Or they peddle isolated horror stories that the fact-checkers usually discover are untrue or misleading.
Thus the moment of truth, about the facts and about our purposes.
From now on, will there be more healthy skepticism about conservative claims against the ACA? Given how many times the law’s enemies have said the sky was falling when it wasn’t, will there be tougher interrogation of their next round of apocalyptic predictions? Will their so-called alternatives be analyzed closely to see how many now-insured people would actually lose coverage under the “replacement” plans?
Perhaps more importantly, will we finally be honest about the real argument here: Do we or do we not want to put in the effort and money it takes to guarantee all Americans health insurance? If we do — and we should — let’s get on with doing it the best way we can.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, April 2, 2014
“Blood On GOP’s Hands”: How Many Would Be Covered Without Its Sabotage Plan?
The cynicism of the GOP’s anti-Obamacare strategy has been obvious forever, but some particular kinks in it only became clear as the enrollment deadline approached and it seemed the Obama administration would not just meet but beat its public-exchange enrollment target. Republicans went from shrieking about what an awful program it was to complaining that not enough people had signed up, and then, when the goal was met, complaining that not enough uninsured people had gotten coverage, and of course lying about that, too.
The lunacy of their complaint – “This program is a nightmare – but not enough people are being helped by it!” – is like the old joke about the kvetchy restaurant patron who complains the food is terrible, and the portions are too small. It would be funny if it weren’t sad.
I confess that the freakout over the federal exchange’s rocky start had me convinced the administration would miss its enrollment target. So hitting the seven million mark is cause for elation, but also anger: Imagine how many people might have enrolled if the entire Republican Party coast to coast hadn’t spent the last six months telling them not to?
Let’s take it further: Imagine if all 50 states had implemented their own exchanges, instead of just 17 of them. Imagine if all 50 states had expanded Medicaid, instead of just 27. Imagine if a well-funded noise machine, from Fox to Rush to the online swarm hadn’t publicized every glitch and every allegation of someone losing their insurance, often fabricating the problems, sometimes lying outright, while ignoring every positive story.
It’s absolutely true that this first enrollment period still leaves most of the uninsured without insurance. Still, at least 9.5 million of the uninsured now have care, thanks to the state and federal exchanges, Medicaid expansion and people buying coverage privately. (On Fox, Charles Krauthammer simply lied when he says it’s only 1 million.) It must be noted that states that built their own exchanges and expanded Medicaid did much better when it comes to covering the uninsured. The Los Angeles Times estimates that at least 27 percent of the newly insured were previously uninsured; in Kentucky, it’s 75 percent and in New York it’s 70 percent. If Republican governors and legislatures hadn’t sabotaged the program in roughly half the states, we would see numbers like that nationwide.
When you add in young people covered by their parents’ insurance and people with pre-existing conditions who can now get coverage, the number goes higher still. As President Obama noted in his Rose Garden victory lap, 100 million people have received free preventive care under new regulations for insurance plans. It’s no wonder that the latest Washington Post/ABC News poll showed approval of the Affordable Care Act topping disapproval for the first time ever, with approval jumping from 40 percent in November to 49 percent last week. Barring a major meltdown, those numbers are likely to climb too.
This is, of course, what the GOP feared – not that the plan would fail, but that it would work. Again, it’s not perfect – we still don’t know exactly who signed up, and whether the balance of young and old, sick and well will make plans affordable. But this enormous milestone should make Democrats smarter about how to make Republicans pay for their obstruction in 2014. The conventional wisdom is that Obamacare will be a millstone in the midterms, especially for red state Democrats, but conventional wisdom is often wrong.
Democrats should challenge Republicans to take away that free preventive care from 100 million Americans. Challenge them to transfer money from women back to men, by letting insurance companies once again charge women more, sometimes much more, for health insurance. Take insurance away from people with pre-existing conditions; kick young people off their parents’ plans. Roll back Medicaid expansion in the 27 states that participated. Go on and tell the American people you’re going to do that, Republicans. The midterms might not be the cakewalk you think.
By: Joan Walsh, Editor at Large, Salon, April 2, 2014
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