“This Is Why We Need Obamacare”: Life And Death Is When You Need Care And Can’t Afford To Get It
The biggest health care crisis in America right now is not the inexcusably messy rollout of Obamacare.
No, far more serious is the kind of catastrophe facing people like Richard Streeter, 47, a truck driver and recreational vehicle repairman in Eugene, Ore. His problem isn’t Obamacare, but a tumor in his colon that may kill him because Obamacare didn’t come quite soon enough.
Streeter had health insurance for decades, but beginning in 2008 his employer no longer offered it as an option. He says he tried to buy individual health insurance but, as a lifelong smoker in his late 40s, couldn’t find anything affordable — so he took a terrible chance and did without.
At the beginning of this year, Streeter began to notice blood in his bowel movements and discomfort in his rectum. Because he didn’t have health insurance, he put off going to the doctor and reassured himself it was just irritation from sitting too many hours.
“I thought it was driving a truck and being on your keister all day,” he told me. Finally, the pain became excruciating, and he went to a cut-rate clinic where a doctor, without examining him, suggested it might be hemorrhoids.
By September, Streeter couldn’t stand the pain any longer. He went to another doctor, who suggested a colonoscopy. The cheapest provider he could find was Dr. J. Scott Gibson, a softhearted gastroenterologist who told him that if he didn’t have insurance he would do it for $300 down and $300 more whenever he had the money.
Streeter made the 100-mile drive to Dr. Gibson’s office in McMinnville, Ore. — and received devastating news. Dr. Gibson had found advanced colon cancer.
“It was heartbreaking to see the pain on his face,” Dr. Gibson told me. “It got me very angry with people who insist that Obamacare is a train wreck, when the real train wreck is what people are experiencing every day because they can’t afford care.”
Dr. Gibson says that Streeter is the second patient he has had this year who put off getting medical attention because of lack of health insurance and now has advanced colon cancer.
So, to those Republicans protesting Obamacare: You’re right that there are appalling problems with the website, but they will be fixed. Likewise, you’re right that President Obama misled voters when he said that everyone could keep their insurance plan because that’s now manifestly not true (although they will be able to get new and better plans, sometimes for less money).
But how about showing empathy also for a far larger and more desperate group: The nearly 50 million Americans without insurance who play health care Russian roulette as a result. FamiliesUSA, a health care advocacy group that supports Obamacare, estimated last year that an American dies every 20 minutes for lack of insurance.
It has been a year since my college roommate, Scott Androes, died of prostate cancer, in part because he didn’t have insurance and thus didn’t see a doctor promptly. Scott fully acknowledged that he had made a terrible mistake in economizing on insurance, but, in a civilized country, is this a mistake that people should die from?
“Website problems are a nuisance,” Dr. Gibson said. “Life and death is when you need care and can’t afford to get it.”
The Institute of Medicine and the National Research Council this year ranked the United States health care system last or near last in several categories among 17 countries studied. The Commonwealth Fund put the United States dead last of seven industrialized countries in health care performance. And Bloomberg journalists ranked the United States health care system No. 46 in efficiency worldwide, behind Romania and Iran.
The reason is simple: While some Americans get superb care, tens of millions without insurance get marginal care. That’s one reason life expectancy is relatively low in America, and child mortality is twice as high as in some European countries. Now that’s a scandal.
Yet about half the states are refusing to expand Medicaid to cover more uninsured people — because they don’t trust Obamacare and want it to fail. The result will be more catastrophes like Streeter’s.
“I am tired of being the messenger of death,” said Dr. Gibson. “Sometimes it’s unavoidable. But when people come in who might have been saved if they could have afforded care early on, then to have to tell them that they have a potentially fatal illness — I’m very tired of that.”
Streeter met with a radiologist on Thursday and is bracing for an arduous and impoverishing battle with the cancer. There’s just one bright spot: He signed up for health care insurance under Obamacare, to take effect on Jan. 1.
For him, the tragedy isn’t that the Obamacare rollout has been full of glitches, but that it may have come too late to save his life.
By: Nicholas D. Kristof, Op-Ed Contributor, The New York Times, November 2, 2013
“The Obamacare Bait And Switch”: America’s Beloved Health Insurance Industry Demonstrates Why We Needed Reform All Along
So here’s my advice: If you’re somebody who’s smoking hot about the Big Lie of the Affordable Care Act — you know, how President Obama told everybody that if they liked their current health insurance policy they could keep it — do yourself a favor. Avoid the county fair midway.
Because if you go, you’re apt to encounter a quick-handed scoundrel running a shell game, and that boy will take your money. Doubtless Obama should have said almost everybody could keep their current plan, or that 95 percent could, but he apparently found that too, um, subtle for the campaign trail.
So now old Mitt “47-percent” Romney gets to call him a liar.
But while your attention’s fixed on the president’s “mendacity,” and “paternalism,” to quote one characteristically overwrought scribe, America’s beloved health insurance industry is demonstrating exactly why we needed reform all along. Certain companies are taking advantage of the political confusion to sell people in the “individual market” far more expensive plans than they need and blame “Obamacare.”
As usual, the nation’s esteemed political media have gone along for the ride. CBS News, rapidly morphing into Fox News Lite, presented the heartbreaking tale of one Diane Barrette, a 56 year-old Floridian who got a letter from her insurance company cancelling her $54 a month policy and offering a replacement for $591 a month—a lot of money to her.
CBS correspondent Jan Crawford, deemed smart enough to cover the U.S. Supreme Court, took Barrette’s story at face value. The idea that health insurance worth having could be purchased at a monthly cost of less than a steak dinner apparently failed to arouse her reporter’s curiosity.
Poor Barrette choked up telling CBS her story, leading to several appearances on Fox News itself.
Had CBS done elementary due diligence, they’d have learned why Ms. Barrette’s plan was so cheap. Reporters who did learned that among other shortcomings, it didn’t cover hospitalization. In reality, she had no health insurance at all. A serious accident or illness might have bankrupted her—precisely the kind of ripoff the Affordable Care Act makes illegal.
Also, Barrette was taking the insurance company’s word about the cost of a replacement policy. Writing for BillMoyers.com, Joshua Holland ran her numbers through Kaiser Permanente’s subsidy calculator. With assistance from Obamacare, she can have a real policy covering preventive care and hospitalization for an out-of-pocket cost of $97 monthly, or a more generous “Silver” level plan for $209.
Now she calls it “a blessing in disguise.”
In short, CBS News couldn’t have gotten the story more backward had they tried. For its part, NBC News featured Los Angeles real estate agent Deborah Cavallaro, whose similar experience led her to conclude that “there’s nothing affordable about the Affordable Care Act.”
However, LA Times columnist Michael Hiltzik found that Cavallaro had simply failed to consult Covered California, the state’s health plan exchange. When he did so, he quickly found that “better plans than she has now are available for her to purchase today, some of them for less money.”
No doubt some among the three to five percent of Americans whose individual health care policies have been cancelled are experiencing genuine sticker shock. However, nobody should take his insurance company’s word at face value without double-checking—a task admittedly made harder by Healthcare.gov’s website meltdown.
See, when you read a story about a couple like Dean and Mary Lou Griffin of Chadd’s Ford, PA, who told the Associated Press they’d expected to be able to keep the policy they bought three years ago, what reporters aren’t asking is where they’d gotten that idea.
From President Obama? Possibly.
More likely, however, from an insurance broker. See, all providers have known about new coverage standards ever since the Affordable Care Act passed in March 2010. Since then some have clearly been “churning” the market, offering low-risk, healthy customers bargain policies they knew perfectly well would no longer pass muster come January 1, 2014.
So now come the inevitable cancellation letters, and guess what? If they were lucky—and health-wise the Griffins have been fortunate—here comes the bad news. “We’re buying insurance that we will never use and can’t possibly ever benefit from,” Dean Griffin complains. “We’re basically passing on a benefit to other people who are not otherwise able to buy basic insurance.”
Two thoughts: One, don’t get cocky, you never know.
Two, boo-hoo-hoo. You can afford it.
Meanwhile, Dylan Scott at Talking Points Memo has documented companies sending “misleading letters to consumers, trying to lock them into…more expensive health insurance plans rather than let them shop for insurance and tax credits on the Obamacare marketplaces.” Authorities in four states have disciplined Humana affiliates for exactly that.
It’s a classic bait and switch: luring customers with unsustainably low rates, and then blaming the White House for their chicanery.
That’s basically why we needed Obamacare to begin with.
By: Gene Lyons, The National Memo, November 6, 2013
“Once Again, The Pundits Get It Wrong”: The Virginia Election Was A Big Win For Obamacare.
As the Affordable Care Act was about to go fully into effect last month, the New York Times ran a big front-page article highlighting the fact that millions of Americans would go uncovered by the law as a result of the Supreme Court decision making it possible for states to opt out of the expansion of Medicaid. Half of the states have made this choice, creating a confounding scenario in which middle-income people can qualify for subsidies to obtain private coverage but the neediest working poor, who were supposed to be covered by Medicaid, are getting no help at all.
“How can somebody in poverty not be eligible for subsidies?” an unemployed health care worker in Virginia asked through tears. The woman, who identified herself only as Robin L. because she does not want potential employers to know she is down on her luck, thought she had run into a computer problem when she went online Tuesday and learned she would not qualify.
At 55, she has high blood pressure, and she had been waiting for the law to take effect so she could get coverage. Before she lost her job and her house and had to move in with her brother in Virginia, she lived in Maryland, a state that is expanding Medicaid. “Would I go back there?” she asked. “It might involve me living in my car. I don’t know. I might consider it.”
Last night, the prospects for Robin L. and the estimated 400,000 Virginians who would be eligible under a Medicaid expansion brightened considerably. The gubernatorial election was won by Terry McAuliffe, who made the Medicaid expansion such a central part of his campaign that for a time he was even threatening to shut down the state government unless legislators included it in their budget. The expansion, which is now being studied by an ad hoc state panel, still faces big hurdles—the General Assembly remains firmly in Republican control, and the Koch brothers are spending heavily to pressure those Republican state legislators who dare to support the expansion. Still, the odds of the expansion happening are infinitely greater with McAuliffe in the Governor’s Mansion than with the fiercely anti-Obamacare Ken Cuccinelli.
So, the election was a clear win for Obamacare, right? Nope, say the pundits. The fact that Cuccinelli finished closer than recent polling suggested, they say, is a clear sign of strong public opposition to Obamacare, which Cuccinelli made a centerpiece of his campaign in the final days.
From CNN.com:
Virginia was the first swing state to hold an election after the Affordable Care Act website’s troublesome rollout, a controversy that has permeated national news coverage for weeks. Almost 30% of Virginia voters said health care was the most important issue in the race. While Democrat Terry McAuliffe narrowly beat out conservative Republican Attorney General Ken Cuccinelli, analysts credit a GOP focus on Obamacare for boosting Cuccinelli’s vote total. “This is what kept this race close,” CNN’s John King said Wednesday on “New Day.”
And Politico proclaimed: “Obamacare almost killed McAuliffe”:
Exit polls show a majority of voters—53 percent—opposed the law. Among them, 81 percent voted for Cuccinelli and 8 percent voted for Libertarian candidate Robert Sarvis. McAuliffe won overwhelmingly among the 46 percent who support the health care overhaul.
Cuccinelli actually won independents by 9 percentage points, 47 percent to 38 percent, according to exit polls conducted for a group of media organizations. They made up about one-third of the electorate. “Obamacare helped close the gap,” said Richmond-based strategist Chris Jankowski, the president of the Republican State Leadership Committee.
I’m not sure when I last saw such a stark example of election spin and punditry floating away from the substantive reality of governing and its impact on actual people. There is no mention in these accounts of the greatly enhanced prospects for the Medicaid expansion in Virginia as a result of McAuliffe’s win. No, it’s all about the exit polls and what it might mean for Obama and the Democrats. But Obama’s not on the ballot again, ever, and the Democrats aren’t on it again for another year. Who knows what voters will think of Obamacare then—the troubles with the rollout will either have resolved by then or they will not have. All we know right now is that after a very rough patch for the law, the guy who ran strongly in support of it beat a guy who was strongly opposed to it, in the most purple state in the country. And as a result, hundreds of thousands of working poor may get health insurance coverage. How removed from the reality of these people’s lives does one have to be to chalk up such a result as a loss for Obamacare?
By: Alec MacGillis, The New Republic, November 6, 2013
“Sanctifying Defenders Of The Status Quo”: The GOP’s Obsession With Rate Shock Victims
Last week, the Obamacare war room detected a twist in the national narrative that concerned them. The media’s obsessive focus on the failed website launch was beginning to give way to stories about individuals who found higher-than-expected prices on the exchanges. A memo instructed participants to prepare for such “media inquiries”: “The media attention will follow individuals to plan selection and their ultimate choices; and, in some cases, there will be fewer options than would be desired to promote consumer choice and an ideal shopping experience,” warned the memo. “Additionally, in some cases there will be relatively high-cost plans.”
CNN’s Jake Tapper obtained the memo. Here is how he described it: “Officials expressed concern that the next shoe to drop in the evolving story about the Affordable Care Act would be disappointment from consumers once they are able to get on the troubled Healthcare.gov website — disappointment because of sticker shock and limited choice.” Notice the crucial difference in framing. The memo simply acknowledged that in some cases — a caveat that appeared twice — consumers would have fewer options and higher prices than the administration would like. In CNN’s characterization, the caveat disappears altogether. Tapper portrays the problem as “disappointment from consumers,” writ large. The minority facing sticker shock has become a stand-in for the entire public.
This turns out to be a synecdoche for the entire Obamacare narrative now. The world of the Republican Party’s fever dreams has sprung to life in the mainstream media, where the Affordable Care Act now exists primarily as a series of cruel, oppressive acts of theft against innocent Americans. Here are CBS News, The Wall Street Journal, and the Washington Post chronicling the parade of horribles.
The stories often turn out to be either more complicated than initially depicted, or wildly overblown. But it is surely true that some people will find themselves worse off, at least immediately, under the new law. That their fate has blotted out everything else about the law explains why health-care reform is so maddeningly difficult to enact in the first place.
Everybody knows about the two main ways in which the American health-care system is awful: It’s the most expensive in the world, by far, and also the only advanced health-care system that denies basic care to many citizens. There’s also a third awful trait as well: The system is resistant to change. The very insecurity of American health care, the ever-present fear of finding one’s insurance lifeline snapped and plunging into the howling void of the 50 million uninsured, renders those with insurance understandably terrified of change.
The Affordable Care Act worked around the inherent change aversion of the system by leaving the vast majority of it in place. Insuring tens of millions of Americans costs money, and that money has to come from somewhere, but the law’s author’s carefully apportioned the burden in a relatively painless way. Some of the money comes from higher taxes on the rich — a source of anger and resentment on the right, though conservatives have shrewdly recognized that complaining about higher taxes on wealthy investors to pay for covering the uninsured is not a winning message. Some of it comes from reshuffling Medicare spending, so that the government essentially shifts funds from reimbursing hospitals for treating uninsured patients in emergency rooms to basic medical care, a clear positive-sum transfer.
And, yes, some of the cost is borne by the minority of healthy individuals paying higher premiums. (These individuals will, of course, go from Obamacare victims to Obamacare beneficiaries the moment anybody in their household develops a serious medical condition, in the same manner that fire insurance is a bad deal for people whose houses don’t burn.)
Why has their plight attained such singular prominence? Several factors have come together. The news media has a natural attraction to bad news over good. “Millions Set to Gain Low-Cost Insurance” is a less attractive story than “Florida Woman Facing Higher Costs.” Obama overstated the case when he repeatedly assured Americans that nobody would lose their current health-care plan. There’s also an economic bias at work. Victims of rate shock are middle-class, and their travails, in general, tend to attract far more lavish coverage than the problems of the poor. (Did you know that on November 1, millions of Americans suffered painful cuts to nutritional assistance? Not a single Sunday-morning talk-show mentioned it.)
The point here is not that Obamacare represents a perfectly optimal restructuring of the health-care system. Almost nobody would regard it as such. The point is that it represents the least-disruptive, least-painful way to clear the minimal threshold of any humane reform. The preferred alternatives of both right and left would impose an order of magnitude of more dislocation — creating not a few million “victims,” but tens of millions. What’s on display at the moment is a way of looking at the world that sanctifies defenders of the horrendous status quo and places all the burden upon those trying to change it.
By: Jonathan Chait, New York Magazine, November 5, 2013
“Obstructing Obamacare Navigators”: The Republican Suppression Syndrome Continues
On August 15th, Jodi Ray, a project director at Florida Covering Kids and Families, a University of South Florida program that works to get uninsured children access to health care, won a federal grant to hire ninety people as health-care “navigators”: workers who will help applicants apply for insurance through the exchanges set up as part of the Affordable Care Act. In states that declined to set up their own exchanges, like Florida, the Department of Health and Human Services awarded funding worth sixty-seven million dollars for outreach efforts to help the uninsured enroll through the federal marketplace. Nearly four million people in Florida are uninsured—the third highest figure in the country—and Ray had six weeks to recruit staff from community-service groups in sixty-four counties across the state, and guide new hires through twenty hours of online federal training attached to her grant.
“But our navigators don’t only have to comply with federal requirements for the training,” Ray said. “We have state requirements that we have to comply with, too.” Last spring, the Florida legislature, apparently concerned that swindlers would land jobs as health-care experts with access to Social Security numbers and tax information, decided that the navigators should undergo fingerprinting and criminal background checks, and barred them from visiting state-run health clinics. Ray preferred not to comment on what the advocacy group Healthcare For America Now calls “navigator-suppression measures.” She only said, “I’m keeping my head down, the noise out, and focusing on what we are supposed to be doing.”
After the government shutdown ended, attention shifted to the blips and seizures bedevilling the federal marketplace’s Web site, healthcare.gov. Thirty-four states, all but seven of them Republican-controlled, chose not to set up their own exchanges, leaving hundreds of millions of dollars in outreach funding on the table, and forcing their residents onto the federally-operated Web site at the center of the current uproar. Twenty-one of those states are also expected to refuse nearly three hundred billion dollars in federal funding to expand Medicaid coverage over the next decade, which would have extended care to more than six million people; a majority of those excluded will likely be African-Americans and single mothers. To compound the effects of their recalcitrance, conservative governors, state legislators, and members of Congress have also passed navigator-suppression measures in thirteen states—Arkansas, Florida, Georgia, Iowa, Illinois, Indiana, Maine, Missouri, Montana, Ohio, Tennessee, Texas, and Wisconsin—home to seventeen million people without insurance who are eligible for coverage under the A.C.A.
Two weeks after Ray received her grant, she was notified by the House Energy and Commerce Committee that she would have to participate in a phone interview with the committee’s staff in September; she was also asked to give written answers to half a dozen questions from the committee and provide “all documentation and communication related to your Navigator grant.” Similar notifications were sent to navigator offices in eleven of the most underinsured states in which residents will need to use the federal health-care exhange—including Texas, Florida, and Georgia, home to about a quarter of the nation’s uninsured. Representative Henry Waxman, a Democrat from California, protested, in an open letter to the committee’s chairman, Michigan Republican Fred Upton, that the requests appeared “to have been sent solely to divert the resources of small, local community groups, just as they are needed to help with the new health care law.”
On September 18th, Darrell Issa, the Republican chairman of the House Committee on Oversight and Government Reform, released a report that singled out Florida as the site of “numerous reports of scam artists posing as navigators and Assisters to take advantage of people’s confusion about ObamaCare.” On October 2nd, Fox News aired footage of volunteers for Get Covered America, a non-profit advocacy campaign, going door-to-door in a Miami suburb to distribute flyers about the new insurance marketplace—but wrongly identified them as federally-funded navigators, giving the impression that these “navigators” were hawking plans like pushy insurance salesmen. Upton linked to the report on his Web site. Ray, who still spends much of her time getting new navigators licensed while the federal government fixes the Web site’s glitches, was reticent about discussing the maelstrom of controversy. “It’s been busy,” she said.
As these tactics jam up early efforts in many states, they also amplify the contrast with successful rollouts in states that have wholeheartedly embraced the new law, like Colorado, Connecticut, New York, Kentucky, and Washington.
Elisabeth Benjamin, who leads New York’s largest team of navigators at the Community Service Society, spent much her early career improving health-care capacity in developing countries like India, Tunisia, and postwar Iraq—where, she said, people often told her, “I don’t understand why you’re in our country. You have a lot of problems with health care and poor people in your country.” Back home, she started a health-law unit at the Legal Aid Society to assist low-income New Yorkers with unforgiving medical bills. In 2008, she unveiled an insurance ombudsman program at C.S.S. to help people at every income level understand their options for medical coverage. “If you need a loaf of bread, it’s a buck,” she said, explaining health care’s central distinction from other forms of assistance. “If you need a transplant, it’s five hundred thousand dollars.”
Around the same time Benjamin was starting her program, Eliot Spitzer, then the governor of New York, proposed statewide health-care reform similar to the law Massachusetts had passed four years earlier. Vermont’s legislature had expanded coverage, and Arnold Schwarzenegger had made national news by calling for a similar program in California. Benjamin joined an affordable-health-care advocacy campaign, Healthcare for All New York, and testified before the New York State Legislature. “We just assumed there would be a state-by-state movement to extend coverage,” Benjamin said. But two years later, the Obama Administration, with the help of a Democrat-controlled House and Senate, passed the Affordable Care Act. New York’s governor, Andrew Cuomo, along with the state legislature in Albany, accepted the expansion of Medicaid, and the state established its own online exchange. After the Supreme Court upheld the constitutionality of Obamacare, in June, 2012, Cuomo released a statement that said, “We look forward to continuing to work together with the Obama administration to ensure accessible, quality care for all New Yorkers.”
That spirit of coöperation has been integral to New York’s early success. Elisabeth Benjamin, in New York, and Jodi Ray, in Florida, offer exactly the same services to people who were previously unable to obtain medical coverage: they help determine voucher amounts, parse available options, and submit applications online, over the phone, or through the mail. But because New York set up its own exchange, the state received twenty-seven million dollars to fund its navigators, while Florida has just eight million dollars for outreach. Benjamin, who is herself a trained navigator, conceded that there were glitches on New York’s Web site the first week, but said that most of them have been resolved. In the second week, she helped enroll a woman who had worked as a home-health-care aid for twenty years, earning around twenty-four thousand dollars annually. Home health care “has to be the hardest job in America—so physically taxing and emotionally draining,” Benjamin said. “And we don’t give them health coverage. Are you kidding me? They’re part of the health-care system.” Benjamin helped find a plan for the woman that costs seventy-two dollars a month. “I was crying,” Benjamin said. “That’s what it’s all about.”
For the A.C.A. to succeed in its goal of providing coverage for all citizens at an overall reduction in cost, a critical mass of people—old and young, sick and healthy—will need to participate in the insurance exchanges. As of October 23rd, New York had enrolled thirty-seven thousand people, more than twice the goal set by H.H.S. for the entire month of October. Florida won’t know how many people have enrolled until H.H.S. releases its figures sometime in November. The Congressional Budget Office has estimated that a total of seven million people nationwide could enroll in the first year. But Dr. Kavita Patel, a health-care-reform expert at the Brookings Institution, and a former policy advisor in the Obama Administration, told me, “If by the end of 2014 there are three million people enrolled, that would be a success.” The politicians who are currently bemoaning the looming failure of Obamacare might consider doing more to help navigators like Jodi Ray make it work.
By: Rob Fischer, The New Yorker, November 1, 2013
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