“Obamacare’s Real Promise”: If You Lose Your Health-Care Plan, You Can Get A New One
The furor over “if you like your plan, you can keep it” touches on a deep fear in American life: That your health-care insurance can be taken from you. That fear is so powerful because it happens so often: Almost everyone in the country can lose their health insurance at any time, for all kinds of reasons — and every year, millions do.
If you’re one of the 149 million people who get health insurance through your employer, you can lose your plan if you get fired, or if the H.R. department decides to change plans, or if you have to move to a branch in another state.
If you’re one of the 51 million people who get Medicaid, you could lose your plan because your income rises and you’re no longer eligible or because your state cut its Medicaid budget and made you ineligible. You could lose it because you moved from Minnesota, where childless adults making less than 75 percent of the poverty line are eligible, to Texas, where there’s no coverage for childless adults.
If you’re one of the 15 million Americans who buys insurance on the individual market, you could lose your plan because your insurer decides to stop offering it or decides to jack up the price by 35 percent. And that’s assuming you’re one of the lucky people who weren’t denied coverage based on preexisting conditions in the first place.
Then, of course, there are the 50 million people who don’t have a plan in the first place. The vast majority of them desperately want health-care coverage. But it turns out that just because you want a plan doesn’t mean you can get one.
Virtually the only people whose health coverage is reasonably safe are those on fee-for-service Medicare and some forms of veterans insurance. And even there, enrollees are only safe until the day policymakers decide to change premiums or benefit packages.
President Obama’s critics are right: Obamacare doesn’t guarantee that everyone who likes their health insurance can keep it. In some cases, Obamacare is the reason people will lose health insurance they liked.
What Obamacare comes pretty close to guaranteeing, though, is that everyone who needs health insurance, or who wants health insurance, can get it.
It guarantees that if you lose the plan you liked — perhaps because you were fired from your job, or because you left your job to start a new business, or because your income made you ineligible for Medicaid — you’ll have a choice of new plans you can purchase, you’ll know that no insurer can turn you away, and you’ll be able to get financial help if you need it. In states that accept the Medicaid expansion, it guarantees that anyone who makes less than 133 percent of poverty can get fully subsidized insurance.
Health insurance isn’t such a fraught topic in countries such as Canada and France because people don’t live in constant fear of losing their ability to get routine medical care. A decade from now, that will be true in the U.S., too. But it’s not true yet, and paradoxically, that’s one reason health reform is so difficult. The status quo has left people rightly fearful, and when people are afraid, change is even scarier.
By: Ezra Klein, Wonkblog, The Washington Post, December 8, 2013
“A Nightmare For John Boehner”: Why Obamacare Could Help The Democrats In 2014
If some Republicans are sounding just a little bit desperate right now, I think I know why. “Obamacare is not just a broken website,” House Speaker John Boehner sputtered the other day in retreat as it emerged that the website is now working well. “This bill is fundamentally flawed.” He sure hopes he’s right about that—and by the way, Mister, it’s a law, not a bill. But I bet late at night, when he’s having that last smoke and thinking back over his day, he fears that he’s wrong and that the central Republican…“idea,” if you want to call it that, of the last three years—get rid of Obamacare—is going to look awfully stupid to a majority of Americans eight or 10 months from now.
If you haven’t gone to HealthCare.gov just for kicks, I certainly recommend now that you do. Pretend that you’re from a state that didn’t create an exchange, if you aren’t, because if you’re from a state with its own exchange, you’ll just be kicked to the state website, and what you want to test here is the federal one. So just choose a yahoo state that didn’t play ball, where the law was mocked as just so much socialism.
I just did, for the first time in weeks, an hour before scribbling these sentences. I was amazed. It was lightning fast. Explanations were clear and straightforward. Instead of bureaucratese, I encountered something I didn’t expect at all: plain English!
And here’s the key thing. It gave me loads of choices. I pretended to be a 35-year-old man from Kansas with a spouse and child. Without even having to enter my fake income, the site delivered me in a split second to a page with loads of plan options.
Choice. That’s what America’s about. As I heard Sen. Joe Manchin (D-WV) say on Alex Wagner’s show a couple of weeks ago, we’re a nation of shoppers. It’s what we do best. Alas, he is correct. That’s what we want. From TVs to smartphones to flavors of potato chip that have been stretched to include ketchup and dill pickle (who eats those?), we believe that endless options are our right.
How many options? An amazing 42, to be precise. Forty-two plans! That might be more than the number of available potato-chip flavors in America. I would have to think it will shock people, in a highly positive way, to see they have so many choices. And most of all, it will feel…American. Something that offers a person 42 options ain’t socialism, as Americans know in their bones.
The plans ranged from $70 a month, which would have covered only me, to $742 a month for the Rolls-Royce family version, with $0 deductible and $6,500 out-of-pocket. It was an astonishing menu. And take it from a guy who just moved house and has been on the phone and online interminably with private-sector service-providers, mostly but hardly limited to the cable/Internet/phone company: This looked easy. The interface was great, really user-friendly, really clear.
Now, most of these plans weren’t cheap. Health insurance isn’t cheap. For example, a middle-of-the-pack silver plan looked like this: $472 a month; a $7,500 family deductible; a $12,700 out-of-pocket maximum. Those aren’t cheap. But a $10 copay for a doctor’s visit, $75 to see a specialist, and just $15 for a generic prescription. That’s not bad at all.
So yes, Mr. Speaker, it’s more than a website. It’s a chance for people who’ve eschewed insurance for years to buy it and take their kids to a doctor and even to a specialist when needed. Individuals will have to decide for themselves whether that buys them $5,664 in peace of mind (that’s $472 times 12), but I suspect a lot of people will decide that it sure does.
And this is where Republicans, if they’re looking around the corner, might be freaking out. They are going to emphasize the horror stories going forward, and those stories will exist. The Democrats will emphasize the violin stories, and they will exist, too.
But in between the decontextualized disasters and the stories with Hollywood endings will be millions of people to whom nothing particularly dramatic, but something very positive indeed, will have happened. They got insurance, or decent insurance, for the first time in their lives. They went and got their first physical in years. They had that bad back checked out finally. They took their child to an eye doctor and got her glasses. That’s not dramatic enough for a television ad, but any parent will understand that a child going from struggling with reading to being able to read easily at school is plenty dramatic.
I’ve known for a long time the Republicans were on the wrong side of history here. Forty-something million uninsured in this impossibly rich country, and they don’t want to do a thing about it. And don’t fall for their “plans.” They’re unworkable. They’re unworkable because the Republicans aren’t willing to spend the money that experts all say is required to make plans workable. And they aren’t willing to spend the money because spending money acknowledges the existence of a common purpose in this nation, and they certainly can’t acknowledge a common purpose, unless it’s war.
So while I’ve known they were on the wrong side of history, I have feared they were on the right side of the politics. Well, I’m starting to think otherwise. No American who has 42 choices is going to feel like the jackboot of the state is stomping on his neck. And sometime next year, the people in the states that didn’t take Medicaid money are going to start noticing something else: that in a lot of cases, they’re going to be paying more for the same plan that a person in a participating state is paying. How’s that going to go down, Rick Perry?
Mr. Speaker, light up another one. It’s going to be a long night.
By: Michael Tomasky, The Daily Beast, December 5, 2013
“We Are All Fragile Beings”: Obamacare Saved My Family From Financial Ruin
House Speaker John Boehner and his tea party friends shut down the U.S. government because of people like me. I am the mother of an insurance hog, someone who could have blown through his lifetime limit of health coverage by the time he was 14. My son has managed to survive despite seemingly insurmountable challenges, and he wears his preexisting condition like a Super Bowl ring.
Mason, now 16, was probably born with his brain tumor. We discovered it six years ago. Biopsies showed a slow-growing mass, which was the good news. The bad news was that the tumor could not be removed because it had grown around essential structures in his brain. Under the care of some of the country’s finest specialists, Mason had frequent scans. There was little we could do between tests but hope for the best. Like other children his age, Mason played basketball, argued with his siblings and avoided cleaning his bedroom. He managed to undergo chemotherapy for eight months without getting too sick. He insisted on finding ways to laugh, saying things like: “I have brain cancer. What’s your problem?” It was an uneasy peace — until the tumor ruptured in December 2010, three years after his initial diagnosis, and Mason suffered a massive cerebral hemorrhage.
Mason spent most of eighth grade in the hospital. In the six months he was hospitalized, he spent 65 days in the pediatric intensive care unit. He underwent four brain surgeries. Halfway through his hospitalization, the Affordable Care Act was passed, alleviating lifetime limits on coverage and saving us from the financial abyss. Mason moved to a rehabilitation hospital where he was retaught the most basic skills — sitting up, eating and standing. We faithfully paid the premiums on the employer-sponsored plan through which our family is covered, along with the rest of our bills, thanking God and whoever else would listen for our good fortune to have coverage.
The biggest fear for families such as mine is that we will lose our health insurance and be rendered uninsurable because one of us has been sick. The Affordable Care Act does away with dreaded clauses barring preexisting conditions. It also enables us to keep Mason on our insurance until he is 26; then, he will be able to purchase his own coverage on an insurance exchange. At least, that was the plan until last Tuesday, when the government was shut down in protest of such excesses.
As far as the brain tumor goes, our family might have drawn the short straw. Maybe our story lacks a certain universal appeal. People might be thinking to themselves, “I’m so sorry that happened to you, but odds are it won’t happen to me.” I hope it doesn’t, really.
But having lived in hospitals with Mason for months, I have seen that bad things — accidents, freak illnesses — happen to smart, cautious and otherwise undeserving people. It’s one thing we all have in common. We are fragile beings. So what is wrong with allowing us to purchase a financial safety net? What’s so un-American about that?
If I could get John Boehner and Ted Cruz on a conference call, I would explain this to them. I would tell them that, while they were busy trying to derail the Affordable Care Act over the past two years, Mason has again learned to walk, talk, eat and shoot a three-point basket.
By: Janine Urbaniak Reid, a writer in the San Francisco Bay Area, is working on a memoir about her son’s diagnosis; October 9, 2013; Published in The Washington Post Opinions Section, December 4, 2013
“Brazen Dishonesty”: California GOP ‘Reaches For The Bottom’
Health care policy can get confusing, even for policy experts who study the details for a living. It’s one of the reasons dishonesty in the political debate surrounding health care is so damaging – even the most well-intentioned people often don’t know how best to separate fact from fiction.
It’s why efforts from political officials – who know better – to deliberately confuse people are so disappointing. Michael Hiltzik reports:
Opponents of the Affordable Care Act never stop producing new tricks to undermine the reform’s effectiveness. But leave it to California Republicans to reach for the bottom. Their goal appears to be to discredit the act by highlighting its costs and penalties rather than its potential benefits.
The device chosen by the Assembly’s GOP caucus is a website at the address coveringcaliforniahealthcareca.com. If that sounds suspiciously like coveredca.com, which is the real website for the California insurance exchange, it may not be a coincidence.
In theory, this is a site created by California Republicans to serve as a “resource” for those looking for additional information. In practice, the site “is worse than useless” – it didn’t direct users to the in-state exchange marketplace, and includes demonstrable falsehoods intended to deceive the public.
Like what? The site includes the ridiculous notion that the Affordable Care Act increases the federal budget deficit, which is the exact opposite of reality. It also claims the IRS will use the law to target conservatives; it says the law will discourage private-sector hiring; and it even hints in the direction of the death-panel smear by raising the specter of “rationing” for the elderly.
All of these claims are wrong. All of them are presented, however, on a website that presents itself as objective and non-partisan.
Stepping back, dishonesty on this scale is certainly brazen, but it raises anew a lingering question: if the Affordable Care Act is so awful, and will be as horrific as critics claim, why do Republicans continue to feel the need to make stuff up? Shouldn’t reality be damaging enough?
By: Steve Benen, the Maddow Blog, December 4, 2013
“When The Worm Turns”: Republican Fallacies On Obamacare, The Greatest Hits
Before the holiday spirit makes Republican-bashing a little unseemly, it’s time to get in a last ornery blast at the party’s Obamacare stance. Republicans have enjoyed themselves immensely during the Affordable Care Act’s bungled rollout, but most of the claims they’re making are preposterous and phony. Since anyone able to take a longer view knows we’ll one day be well past Obamacare’s self-inflicted wounds, I’d like as a public service to catalog the GOP’s shabbiest arguments, so we’ll all have a handy reference once the worm fully turns.
The selective “humanitarian crisis.” Conservatives have warned of the “humanitarian disaster” that will ensue if several million people with cancelled policies are unable to secure new coverage before January 1. But this theoretical woe (which will almost certainly be avoided thanks to Web site fixes and policy extensions) pales next to the much larger humanitarian disaster of America’s nearly 50 million uninsured — a crisis that’s persisted for decades without conservatives caring a whit. I can’t be the only one who finds the right’s sudden concern for a small subset of the uninsured a bit rich.
The bogus oppression of the young and healthy. Another confused conservative trope bemoans the enslavement of younger or healthier Americans, who’ve supposedly been conscripted to subsidize their older, sicker countrymen. “Liberals justify these coercive cross-subsidies as necessary to finance coverage for the uninsured and those with pre-existing conditions,” the Wall Street Journal editorialized last Saturday. “But government usually helps the less fortunate honestly by raising taxes to fund programs.” Actually, the Journal has the American way of health subsidy exactly wrong. Most people aged 19 to 34 who have health coverage get it from their employer. And, as I’ve noted before, at nearly every firm, young people pay the same premiums as employees who are older and get more expensively sick. In other words, Obama’s scheme to rob Peter to fund health care for Paul already exists, at vastly larger scale, in corporate America. And while Obamacare is only hoping to sign up 2 million or so young people, 20 million Americans aged 19 to 34 get their coverage on the job. Where’s the Wall Street Journal’s rant against corporate America’s “coercive cross-subsidies”? And while we’re at it, when will we stop making all those people whose houses don’t burn down subsidize those whose do?
The “men and 55 year old women don’t need maternity care” fallacy. Well, yes, and people whose genes don’t predispose them to cancer (which tests will reveal soon enough) don’t need cancer coverage. As Bob Kocher, a doctor and former senior Obama health care advisor, explained, if one of our goals is to not charge women higher premiums than men, all plans have to cover maternity. Among younger women, moreover, maternity is the biggest driver of costs — so if you allow optional coverage, the plans young people buy would be super-expensive. “For insurance to work, you can’t allow people to opt into benefits like maternity right before they get pregnant,” Kocher adds. “When spread across the population, it’s not expensive.” Sounds like Insurance 101. Which in the social insurance context, conservatives can’t abide.
Insurance “bailout” baloney. Sen. Marco Rubio talks opportunistically (but I repeat myself) of Obama’s pledge to “bail out” health plans if the folks they sign up end up being unduly costly to treat. Once again, conservatives eat their own. Such “risk adjustment” — after-the-fact payments to reflect the actual vs. expected risk experience of health plans — has been a sensible staple of conservative insurance market reforms since George H.W. Bush proposed it in 1992. Little known but true: Before Romneycare begat Obamacare, Bushcare begat Romneycare. Rubio was only 21 then. He must not know. Or care.
The “Obama is taking over one-sixth of the economy” ruse. In the Fox News cocoon, this truth is self-evident. But it makes as much sense as crying that Ben Bernanke is “remaking 6/6ths of the economy” every time the Fed touches interest rates. The fact that health-care spending is 18 percent of GDP doesn’t mean Obama is “remaking” or “taking over” anything. He’s tweaking a dysfunctional corner of the market where 5 percent of us get our health coverage. He’s also testing ideas that health gurus in both parties have long suggested might help reign in future costs.
Worse than these GOP fallacies is the party’s smug sanctimony. It’s as if conservatives have decided to parody the moral preening they loathe in liberals, except that the right is serious. As one pundit lectured, “the administration didn’t care enough to make sure the people of their country were protected. In the middle of a second age of anxiety they decided to make America more anxious.”
Yes, the rollout was botched. But what is this person talking about? Finally assuring that illness in the United States can’t be the cause of financial ruin is the very essence of “protection.” How galling that conservatives can make such hollow charges while putting forward no plan of their own to “protect” anyone from anything!
Or take the pundit who wrote that “extending enrollment periods does nothing but provide Americans more time to contemplate their miserable choices.” Only someone with no empathy — someone who has never tried and failed to get coverage in the individual market — could possibly say such a thing.
I’ve spent a lot of time over the years arguing that we can solve big problems such as providing insurance coverage in ways that honor both liberal and conservative values. It’s entirely doable — John Rawls and Milton Friedman can be reconciled, trust me. Apart from being sound policy, I’ve assumed such approaches would also be necessary, because with power closely divided in the United States, we’d need to strike big cross-party deals to make progress. The breathtaking intellectual and moral dishonesty of those driving the Obamacare debate in the GOP today makes me feel foolish for having tried.
By: Matt Miller, Opinion Writer, The Washington Post, December 4, 2013
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