“Surprise, Surprise”: The Real Numbers On ‘The Obamacare Effect’ Are In, Now Let The Crow Eating Begin
After years of negative speculation on the part of the opponents of Obamacare, hard data is finally coming in with respect to the anticipated negative side-effects of the law.
The results are guaranteed to both surprise and depress those who have built their narrative around the effort to destroy the Affordable Care Act.
Let’s begin with the meme threatening that healthcare reform will lead to a serious decline in full-time employment as employers reduce workforce hours to below 30 per week in the effort to avoid their responsibility to provide health benefits to their employees.
It turns out that there has, in fact, been no such rush to reduce work hours. Indeed, numbers released last week reveal that precisely the opposite is taking place.
According to the Bureau of Labor Statistics (BLS), the number of part-time workers in the United States has fallen by 300,000 since March of 2010 when the Affordable Care Act was passed into law. What’s more, in the past year alone—the time period in which the nation was approaching the start date for Obamacare—full-time employment grew by over 2 million while part-time employment declined by 230,000.
And it gets even more interesting.
Despite the cries of anguish over the coming destruction of private sector work opportunities at the hands of Obamacare, it turns out that the only significant ‘cutter’ of work hours turns out to be in the public sector where cops, teachers, prison guards and the like are experiencing cuts in work time as cities, states and universities seek to avoid the obligations of the health reform law.
Correct me if I am wrong, but is it not the very same folks who strenuously oppose Obamacare who are constantly screaming for smaller government? Are these not the same people who have, for as many years as I can recall, been carping about swollen government payrolls?
But the false narrative that has been peddled to make us believe that the private sector can’t wait to lower our hours of employment turns out not to be the only false note being played by anti-Obamacare forces.
For months now, we have been pounded with the story of the millions of Americans who have lost their non-group, individual health insurance policy due to cancellations forced by Obamacare.
Yet, a new study just out by Lisa Clemons-Cope and Nathaniel Anderson of the Urban Institute tells a very different story.
How many times have readers, along with television and radio audiences, read or heard me point out that few ever expected to hang onto their individual insurance policy for longer than a year or two following date of purchase? Long before there was Obamacare, it was always clear that when someone purchased an individual health instance policy, it was pretty much a given that they would either be moving on to an employer provided group plan when they get a job or that their policy would respond to the ordinary, pre-Obamacare changes that occurred from year to year and result in the consumer having to purchasing a new plan after a short period of time.
Indeed, it was this very reality that made it clear to those who follow the health insurance industry that Obama’s “If you like your policy you can keep your policy” proclamation was a near impossibility for those participating in the individual marketplace. This simply wasn’t the way the individual market worked.
The Urban Institute study bears this out, noting that “the non-group market has historically been highly volatile, with just 17 percent retaining coverage for more than two years.”
While Obamacare foes have been quick to jump on this statistic when it comes to condemning the President for uttering his promise that you could keep your insurance if you are happy with your policy, the same people have somehow managed to miss the reality that a huge percentage of those who received cancellation notices last year were going to get that notice even if the Affordable Care Act had never existed.
But that is not all that critics have been missing as they’ve sought to exploit the supposed high number of cancellations they claim are due to Obamacare.
To find out just how many people have really been put into an insurance fix, the Urban Institute’s Health Reform Monitoring Survey, in December of 2013, asked people between the ages of 18 and 64 the following question:
“Did you receive a notice in the past few months from a health insurance company saying that your policy is cancelled or will no longer be offered at the end of 2013?”
The following bar published in Health Affairs provides the results—
Note that the number of people who saw their policy cancelled because it did not meet the Obamacare minimum requirements was 18.6 percent—dangerously close to the 17 percent of individual policyholders who were losing their individual market policies pre-Obamacare.
Also note that the 18.6 percent equates to roughly 2.6 million people whose plans were cancelled as a result of Obamacare—a number well below the estimates of 5 million or considerably more being tossed about by Obamacare opposition.
So, what happens to these folks who saw their health insurance policy cancelled?
According to the Urban Institute researchers :
“While our sample size of those with non-group health insurance who report that their plan was cancelled due to ACA compliance is small (N=123), we estimate that over half of this population is likely to be eligible for coverage assistance, mostly through Marketplace subsidies. Consistent with these findings, other work by Urban Institute researchers estimated that slightly more than half of adults with pre-reform, nongroup coverage would be eligible for Marketplace subsidies or Medicaid.”
So what does this data tell us?
As a result of at least half of those cancelled being able to either enroll in a Medicaid program or receive subsidies on the healthcare exchanges, many—if not most—will now find health care coverage at a price lower than previously paid while greatly improving the quality of coverage.
Still, roughly one million people will have to replace their cancelled policy with something that may cost them more. This is not a good thing but it is far, far less dramatic than what we’ve been hearing. It is also a part of the expected upheaval that has always—and will always—result from the passage of reforms designed to benefit the greatest number of people. Traditionally, those who are disadvantaged in this way find that things are sorted out in amendments to the initial legislation, amendments that can only result when Republicans in Congress stop playing politics and begin the serious work of making the law better for Americans.
There is another problem noted in the study—
Because of the amount of focus placed on scaring the you-know-what out of people when it comes to the alleged dire effects of Obamacare rather than educating them, people remain in the dark as to what is available on the exchanges or via the state Medicaid programs.
Per the Urban Institute study—
“Yet making the best enrollment choice may be difficult for consumers. HRMS findings show that many people are not aware of the new state Marketplaces, few know whether their state is expanding Medicaid, and many lack the confidence to enroll, make choices, and pay their premiums.”
Once again, politics trumps policy and the critical needs of those our elected officials are sworn to serve.
I highly encourage everyone—whether friend or foe of healthcare reform—to take a look at the study cited above and the BLS statistics. While most all would agree that there are some repairs that need to be made to the Affordable Care Act, workable fixes designed to benefit the public and improve American healthcare cannot happen so long as politicians, pundits and special interests are devoted to lying about what Obamacare means and what it does not mean to the American public.
Facts matter—even when they screw up an effective disinformation campaign.
UPDATE: Monday, 12:15pm EST:
The news just keeps on coming.
The Gallup-Healthways Well-Being Index is out this morning and reveals that 15.9 percent of American adults are now uninsured, down from 17.1 percent for the last three months of 2013 and has shown improvements in every major demographic group with the exception of Hispanics who did not advance.
That translates roughly to 3 million to 4 million people getting coverage who did not have it before.
According to Gallup, the number of Americans who still do not have health insurance coverage is on track to reach the lowest quarterly number since 2008.
This is one statistic that is going to be tough for Obamacare critics to overcome.
By: Rick Ungar, Op-Ed Contributor, Forbes, March 10, 2014
“The Last Rural Abortion Clinics In Texas Just Shut Down”: Back-Alley Procedures Are About To Become A Lot More Common
Since November, the last abortion clinics in East Texas and the Rio Grande Valley, some of the poorest and most remote parts of the state, have been hanging on by their fingernails. The two clinics, both outposts of a network of abortion providers called Whole Woman’s Health, stayed open with slimmed-down staffs while their owner, Amy Hagstrom Miller, struggled to comply with the first chunk of HB2—the voluminous anti-choice law passed by the Texas legislature last summer—which requires abortion doctors to obtain admitting privileges at a local hospital. Today, after weeks of failed negotiations with nearby hospitals, Hagstrom Miller announced that both clinics are closing their doors.
The clinics in Beaumont, about an hour east of Houston, and McAllen, just north of the Mexico border in the Rio Grande Valley, were the last rural abortion providers left in Texas. Between July, when HB2 passed, and November, when the admitting privileges requirement went into effect, nearly half of the state’s 44 abortion clinics folded, unable to comply with the new rules. The health center in McAllen stopped offering abortions and pared down its staff, providing ultrasounds and counseling to the women who continued to walk in the door and helping them coordinate travel to the nearest clinic, two hours north in Corpus Christi. The Beaumont clinic survived this initial purge because one of its physicians had admitting privileges, but he’s in his seventies and wants to retire. His colleagues couldn’t get privileges in his stead, leaving the clinic in a precarious position.
“I had to come to terms with the fact that those clinics had no future,” Hagstrom Miller says. She might have kept looking for a way to keep them open, if she wasn’t facing a much bigger threat. In September, the rest of HB2 will go into effect, requiring all abortion providers to conform to the same standards as ambulatory surgical centers (ASCs), outpatient care units that offer more complicated procedures, usually involving high levels of anesthesia. Only one of Hagstrom Miller’s remaining three clinics, the Whole Woman’s Health in Fort Worth, qualifies as an ASC. Updating the other two clinics to comply with ASC regulations—which include wider hallways and specialized heating and cooling systems—could cost $6 million.
The Corpus Christi clinic (which isn’t one of Hagstrom Miller’s) also has until September to renovate. If that clinic closes, Rio Grande residents will have to embark on a five-hour trek to San Antonio. Women in Beaumont won’t have as far to drive, but they will have to make multiple trips. Under Texas law, women seeking an abortion must obtain a sonogram from the doctor who will be performing the procedure at least 24 hours ahead of time. If you live more than 100 miles from the clinic, you’re exempt from the law. Unfortunately for Beaumont women, their town is a mere 90 miles from the nearest abortion provider in Houston.
For many women, a long drive, an overnight stay, and a few days off work are a substantial burden, but not impossible. For the residents of the Rio Grande Valley, though, these new hurdles could make abortion as difficult to obtain as if it were illegal. McAllen is one of the poorest cities in the country, second only to Brownsville, another town nearby. Last fall, Sarah Posner documented some of the barriers that keep women in the Rio Grande from accessing basic reproductive healthcare like birth control. Unpaved roads, erratic electricity, and poor sanitation are common in the surrounding communities. Few of the Rio Grande’s residents have jobs with sick leave. By Hagstrom Miller’s estimate, around one-third of her patients are undocumented immigrants who can’t drive beyond the border checkpoints north of McAllen without risking deportation.
Rather than waiting for months to scrape together the money for the procedure and the trip—a Sisyphean task in itself, since the price for abortion skyrockets from as little as $300 in the first trimester to several thousand dollars by the end of the second—more women may take matters into their own hands. The Rio Grande Valley already has one of the highest rates of self-induced abortion in the country. A 2012 survey found that 12 percent of women in clinics near the Mexico border said they had attempted to end their pregnancy on their own before seeking professional help. “They’re getting drugs from Mexico, drinking teas, eating herbs, falling down the stairs on purpose or convincing their boyfriends to beat them up,” Hagstrom Miller says. “Any of those methods could be fatal.”
The problem is compounded by the Texas legislature’s decision, in 2011, to slash funding for family planning services. Dan Grossman, the vice president for research at Ibis Reproductive Health, a pro-choice think tank, has been investigating the effects of these cuts as co-principal investigator of the Texas Policy Evaluation Project at the University of Texas-Austin. In a 2012 survey of women seeking abortions, nearly half of the respondents said they hadn’t been able to obtain their preferred form of birth control in the past three months. “The cuts in family planning are leading to a rise in unintended pregnancy and an increased demand for abortion,” Grossman says. “More clinic closures means that women will have to wait longer to get the procedure, which means a higher risk of complications.”
In 2013, 38 percent of people living in the Rio Grande Valley were uninsured. When state-funded family planning clinics in the region folded, poor women lost their only source of affordable birth control. Now, some may be getting access to contraception once again, thanks to the rollout of Obamacare. But Texas’s refusal to participate in Medicaid expansion means that many Rio Grande residents will fall into the “coverage gap”—earning too much to be covered under Medicaid but too little to qualify for insurance tax credits—and won’t be able to get the no-cost birth control promised by the Affordable Care Act. Others are undocumented and unable to buy insurance on the exchanges.
Long wait times for appointments will undoubtedly become the norm. By next fall, when the ASC requirement kicks in, six clinics in major urban centers—Houston, Austin, San Antonio, Dallas, and Fort Worth—could be responsible for performing more than 70,000 abortions each year. Hagstrom Miller and others are fundraising to help poor women pay for transportation to these cities, but for many, a trip to Mexico to buy illegal abortion drugs might seem like a better bet.
By: Amelia Thompson-Deveaux, The American Prospect, March 6, 2014
“50th Time Is The Charm”: For House Republicans, The Affordable Care Act Is Not About Policy And Governing Isn’t Their Goal
Last week, after House Republicans announced an upcoming vote on undermining the Affordable Care Act, President Obama took some time to mock GOP lawmakers for their pointless hobby. “You know what they say: 50th time is the charm,” he joked at a DNC event. “Maybe when you hit your 50th repeal vote, you will win a prize. Maybe if you buy 50 repeal votes, you get one free. We get it. We understand. We get you don’t like it. I got it.”
But by all appearances, Republicans aren’t concerned about mockery. They’re proceeding today with their plan to go after the ACA’s individual mandate – again. By most counts, it will be the 50th time House Republicans have voted to gut some or all of the health care law since 2011, even though they fully realize their bill has no chance of being signed into law.
The House is set to vote Wednesday on a bill by Rep. Lynn Jenkins (R-KS) to effectively delay the individual mandate for one year by reducing the penalty in 2014 for not buying insurance from $95 to $0.
The Republican-led chamber passed a similar bill last July, capturing 22 Democratic votes. Now that it’s an election year, it’s plausible that a significant number of Democrats will defect, given the unpopularity of the individual mandate and the likelihood that Senate Democrats will throw the bill in the garbage once it arrives.
House Republicans are under no illusions about the legislation’s prospects, but governing isn’t the goal. This is about an election-year stunt intended to help GOP lawmakers feel better, maybe motivate the base a bit, and create the basis for some new attack ads against Democrats.
Whether or not one approves of this waste of time, it remains a ridiculous display.
For one thing, the effort itself would be a substantive disaster if the bill actually became law. Clearly the GOP is in its post-policy phase, so real-world implications are no longer considered before bills receive votes, but the Center on Budget and Policy Priorities published an analysis yesterday and found that the House’s proposal would increase the number of Americans without insurance and lead to higher health care premiums in the individual market. How do Republican leaders respond to revelations like these? They don’t – this isn’t about policy, so the implications are deemed irrelevant.
For another, this is quite a bit of effort over a policy Republicans supported up until a few years ago – the mandate used to be a key feature of GOP health care plans.
House Republicans could be using their time wisely right now. Maybe they could work on real legislation; maybe they could present their “Obamacare” alternative they’ve been promising for years.
But that just doesn’t seem to interest them. Americans are instead stuck watching their House of Representatives spin its wheels, picking up self-satisfying “message” bills.
By: Steve Benen, The Maddow Blog, March 5, 2014
“Just Die Already!”: GOP Would Bar Poor From Health Care Altogether
During a Republican primary debate in the last presidential election cycle, there was a dispiriting moment in which Tea Party audience members cheered at the idea that a comatose uninsured American — unable to afford health insurance — would be left to die. That infamous outburst, among others, has prompted GOP bigwigs to try to cut back on primary season debates, hoping to limit appearances that might expose the party’s baser impulses.
But that mean-spirited and contemptuous attitude toward the sick is alive and well in the Grand Old Party, as its maniacal (and futile) resistance to Obamacare has made clear. Now, one Republican politician is pushing that callousness to new lows: He wants to bar the uninsured from hospital emergency rooms.
Last week, Georgia Gov. Nathan Deal criticized a decades-old federal law that requires all hospitals that receive Medicare funds and have emergency facilities — and that’s most — to treat any patient who walks in needing care, regardless of his ability to pay. “It came as a result of bad facts,” Deal said, according to The Atlanta Journal-Constitution. “And we have a saying that bad facts make bad law.”
Deal says that many people use emergency rooms unnecessarily, and those patients inflate health care costs. He is factually correct. But there are other facts that undercut his arguments and reveal his hypocrisy.
First off, Deal is among those red-state Republicans who have vociferously opposed the Affordable Care Act, which makes health insurance available to hundreds of thousands of people who couldn’t otherwise afford it. If more people had health insurance policies that paid for doctors’ visits, fewer would use emergency rooms for routine complaints.
Second, Deal, like many Republican governors, has refused the Medicaid expansion made possible by Obamacare, even though the federal government would pick up 100 percent of the cost for the first three years and 90 percent until the year 2022. That expansion is the best chance many Georgians without means have for getting health insurance.
So, to sum up, Deal hates Obamacare and refuses its Medicaid expansion, which would keep the working poor out of emergency rooms. In addition, he wants to deny them access to emergency rooms unless they can pay. Really, governor? Don’t you insist that your values are “pro-life”?
It’s no wonder that GOP strategists shuddered when audience members responded so cruelly during the CNN/Tea Party Express debate in September 2011. It portrays the party as pitiless — a reputation unlikely to attract a majority of voters.
Quiet as it’s kept, most Americans support keeping Obamacare, despite the relentless pounding it has taken from Republicans. (And despite a website rollout that was infuriatingly incompetent.) A new poll by the Kaiser Family Foundation found that 56 percent of Americans favor keeping it in place, while just 31 percent want to repeal it. (Twelve percent want to replace it with a GOP plan.)
That’s likely because most voters, no matter their reservations about Obamacare, know that the Republican Party has no good solution for the millions of Americans who work every day but still don’t earn enough money to buy a health care plan. Americans have struggled with the nation’s dysfunctional health care “system,” and they know it’s overdue for an overhaul.
Meanwhile, as the midterm elections draw closer, the GOP struggles to come up with a plan that pretends to overhaul the health care system. Looking to avoid being painted as mere obstructions, House Republican honchos are working to draw their caucus together behind a bill that would replace Obamacare with a workable alternative.
But the most sincere plan so far — one offered by Sens. Richard Burr (R-NC), Tom Coburn (R-OK) and Orrin Hatch (R-UT) — would probably offer policies too skimpy to do any good once a policyholder gets sick.
Besides, even that replacement idea seems unlikely to draw broad support among the far-right Tea Partiers, who believe that allowing the uninsured poor to die is the appropriate government response to the health care crisis.
That’s a hulking bit of hypocrisy for a party that advertises itself as “pro-life.” Deal’s latest proposal is one more reminder of how little that label means.
By: Cynthia Tucker, The National Memo, March 1, 2014
“Show Me The Medicaid Money”: Buckle Up Republicans, Obamacare Is Here To Stay
Somewhat quietly, Obamacare enrollment hit 4 million this week. Now, it’s certainly true—as critics have noted—that enrollees aren’t the same thing as people who will continue to stay with their plan for a full year. If an enrollee encounters an unexpected expense of replacing a head gasket or something like that, he might skip a payment. But even so, 4 million’s a more-than-respectable number.
Also rather quietly this week, a new tracking poll from the Kaiser Family Foundation showed support for repeal of Obamacare down to 31 percent. As Jay Bookman noted in the Atlanta Journal-Constitution, overall the poll wasn’t something the president would exactly brag about, but it did represent noticeable change, especially among independents, 57 percent of whom now support the law.
That 31 percent number made me sit up straight for one reason. The percent of Americans who identify themselves as conservative is, lately, about 38 percent, says Gallup. So 31 percent is getting down there. And consider this: As of mid-December 2013, the percentage of Americans who favored repeal was 52.3 percent in a Real Clear Politics average of numerous polls. The Affordable Care Act may not be as popular as Twelve Years a Slave, but it’s not The Lone Ranger anymore either.
I would think there’s a direct correlation between these two sets of facts, no? The more people go to the web site and see that they can get insurance at a decent price (in most cases), the more they tell their co-workers and neighbors that doing so wasn’t the horror show they expected. The more people learn about some of the law’s benefits, the more opposition to it softens.
There are still a few more things the American people need to learn about the law, though, and it’s up to the Democrats to tell them, and I’m going to bang on about this until I see some action. As I wrote Wednesday, Governor Rick Perry has said no to $9 billion in free money. Texas is the largest state in the union that hasn’t accepted the Medicaid expansion money, so that’s the biggest figure, but the figures are significant in relation to the population and budget in every single state.
These figures are from a Commonwealth Foundation report from three months ago. Florida is saying no to $9.6 billion, Georgia to $4.9 billion, North Carolina to $5.7 billion. Wisconsin is passing on $1.75 billion, Virginia on $2.15 billion, and Pennsylvania on $5.5 billion (although Pennsylvania is considering the opt-in). And this report’s figure for Texas is actually $9.6 billion.
You know how states clamor for federal highway money? Well, as Commonwealth points out, in every one of these cases, the Medicaid money is more—at least double, typically, and sometimes far more—than what these states get in highway money. And yet they say they don’t want it. They say that over time, they’re going to be on the hook for vast expenditures they can’t afford, or they fret publicly that Washington might change the formula. They’re both bogus arguments.
The federal government is paying 100 percent of states’ expansion costs through 2016 and no less than 90 percent thereafter on a permanent basis. It’s a sweet deal. But okay, what about that (up to) 10 percent that states are going to have to start paying? Ten percent doesn’t sound like a lot, but in dollar terms, isn’t that real money?
The answer is, not really, in most cases. This gets complicated and involves a category of spending by the states for something called “uncompensated care,” which is just what it sounds like—health care provided for free to poor people. State and local governments typically pitch in now on uncompensated care. But as the Center on Budget and Policy Priorities explains in a 2012 report: “The Medicaid expansion will reduce state and local government costs for uncompensated care and other services they provide to the uninsured, which will offset at least some—and in a number of states, possibly all or more than all—of the modest increase in state Medicaid costs.” Overall, the health-care consulting firm The Lewin Group estimates a minimal increase in states’ spending obligations, around 1 or 2 percent, depending on the state.
As for the argument that some GOP governors make that they fear Washington might change the formula…well, that’s straight from Orwell or Kafka. That is: Barack Obama isn’t going to change any formula. President Hillary Clinton wouldn’t be changing any formula. A Democratically controlled Congress won’t be changing any formulas. Only Republican presidents and congresses would do that. In other words, these Republican governors are saying—yeah, the deal looks fine now, but my party might take over, and then I’d be really screwed!
The ACA is here to stay. It’s not going to be struck down. It’s not going to be repealed. That would require a Republican president and 60 GOP senators and a solid GOP House majority, and the odds are strongly against the emergence of such a confluence. It’s going to exist. And inevitably, it’s going to grow. And more and more people are going to get used to it and learn to live with it. And over time, the people in states like Texas and Georgia and Wisconsin are going to see that people in nearby states that took the money are in fact pretty happy with their situations.
It’s only a matter of time before these resistant governors and state legislatures start caving. Democrats have it in their power to help hasten that timetable by making this an issue. They have to have the courage not to wilt or get the vapors whenever a right-winger invokes the evil gummint or the hated Kenyan. Democrats say they’ve waited decades for this moment. Well, it’s here. Now’s not the time to run away from the fight.
By: Michael Tomasky, The Daily Beast, February 28, 2014
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