“Lower Premiums Is A Big Effing Deal”: The House GOP’s Futile Poorly Timed Efforts To Gut Obamacare
Guess whose heath care premiums are poised to drop considerably?
House Speaker John Boehner’s (R-Ohio) timing could be better. Hoping to capitalize on the bad press surrounding delay in the implementation of the Affordable Care Act’s employer mandate provision (even though the move was substantively meaningless), House Republicans are set to move on their latest idea: a vote on delaying the individual mandate, too.
Politically, the move arguably makes some sense. Even though Republicans came up with the idea of the individual mandate, they’ve since turned it into one of the least popular provisions in “Obamacare.” By singling it out for a delay, GOP lawmakers bring attention to a controversial health care policy and put Democrats on the spot for defending it. Their bill won’t become law, of course — Republicans love symbolic, post-policy governing — but they might get a few attack ads out of this.
But substantively, there’s a problem. In fact, there’s more than one.
First, by going after the individual mandate, House Republicans are taking a bold stand in support of leaving 13.7 million Americans without any health care coverage at all.
Second, GOP lawmakers are also simultaneously (and admittedly) positioning themselves in support of a policy that leads to higher premiums and gaps for Americans with pre-existing conditions.
And third, Republican lawmakers are, for purely political reasons, obsessed with gutting federal health care law at the same time as new-but-inconvenient evidence emerges that the law is working extremely well.
Individuals buying health insurance on their own will see their premiums tumble next year in New York State as changes under the federal health care law take effect, state officials are to announce on Wednesday.
State insurance regulators say they have approved rates for 2014 that are at least 50 percent lower on average than those currently available in New York. Beginning in October, individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly. With federal subsidies, the cost will be even lower.
Supporters of the new health care law, the Affordable Care Act, credited the drop in rates to the online purchasing exchanges the law created, which they say are spurring competition among insurers that are anticipating an influx of new customers. The law requires that an exchange be started in every state.
If elected officials’ principal goal is to pursue policies that benefit the public, launching a crusade to sabotage the Affordable Care Act really doesn’t make any sense.
Skeptics have noted this morning that New York’s insurance market is uniquely messy, so the results aren’t representative of the impact we’ll see elsewhere. Perhaps. But Matt Yglesias argues persuasively that it’s “a big deal anyway.”
The first reason is that New York is a really big state. Its almost 20 million residents account for over 6 percent of the American population.[…]
But this is also important because there’s a lesson here. At various points, the Affordable Care Act’s critics in Congress have suggested that they might be interested in keeping the popular-sounding aspects of Obamacare — the community rating, the guaranteed issue — but just scrap all that unfortunate mandate talk and tax increases. The New York experience shows why that won’t work. That lesser plan is essentially what New York did some years back, and the consequences were enormous premium hikes as the state’s market was rocked by adverse selection. Affordable Care Act implementation, by adding the nasty elements back in, is fixing a huge problem that other states don’t suffer from but that would exist everywhere if Congress took the approach of just doing the easy parts.
In light of this, House Republicans are eager — desperate, even — to boast about their efforts to gut the law, no matter what it does to the uninsured and people with pre-existing conditions, and even though it does more of what we already know doesn’t work.
Before we move on, let’s also not forget that this isn’t limited to the Empire State. In California, exchanges are taking shape and premiums will be even lower than expected; insurers in Oregon are also lowering premiums; and health care expenditures overall are slowing, just as Obamacare was designed to accomplish.
Congressional Republicans and a few too many pundits want you to believe the implementation of the Affordable Care Act is a disaster. It’s not. They want you to believe gutting the law would make things better. It won’t.
By: Steve Benen, The Maddow Blog, July 17, 2013
“Obamacare Is For Republicans, Too”: If GOP Governors Think Stonewalling Health Exchanges Hurts Only Democrats, They’re Wrong
Three months from now, Americans will get their first look at whether Obamacare works. The answer will depend a lot on Republican governors and legislatures — and they should want the law’s exchanges to be successful as much as the president does.
The new state insurance exchanges are supposed to start selling health coverage Oct. 1. The idea behind these marketplaces is that allowing apple-to-apple comparisons between health plans will foster competition and lower prices. Most Republican governors and legislatures, however, have resisted running their own exchanges; 19 states have refused to play any role whatsoever.
Continued resistance could hamper an already fraught process. In a report this week, the U.S. Government Accountability Office warned that the federal government is behind schedule in building exchanges in states that have refused to do so. This makes it even more crucial that all states pitch in to help.
Why should Republican opponents of the exchanges change tack now? First, there are the crass politics: Many residents who stand to benefit are their constituents. Federal exchange subsidies are available for people earning between 138 percent and 400 percent of the poverty level, or $32,500 to $94,200 for a family of four. According to 2012 exit polls, 42 percent of people with family incomes between $30,000 and $50,000 voted for Mitt Romney; for those earning between $50,000 and $100,000, the share was 52 percent. If Republican governors think stonewalling exchanges hurts only Democrats, they’re wrong.
Then there are the economic reasons: States with weak exchanges could become less attractive to businesses. John Hickenlooper, the Democratic governor of Colorado, said this week that his state supports its insurance exchange in part to help small businesses, which want healthy and productive workers.
Finally, and most compellingly, there is the human reason – – rather, 25 million human reasons. Well-run exchanges will make getting health insurance easier and more affordable. Even philosophical opponents of the Patient Protection and Affordable Care Act must concede this practical point. Obamacare also happens to be the law of the land.
Some Republican governors have already accepted a role in their exchanges. Iowa and Michigan are partnering with the federal government, while Idaho, Nevada and New Mexico agreed to build their own. It’s too late for other states to follow those courses, but there are still meaningful steps they could take.
One thing they can do is smooth the path for “navigators” – – people or organizations that will help others shop for insurance on the exchanges. Florida requires navigators to register with the state, and Pennsylvania is considering a similar move. This should be fine as long as registration is quick and straightforward.
States should also build solid lines of communication between the exchanges and state-run programs, especially Medicaid. Exchanges can use the information that states keep about people’s income and insurance status to determine whether they’re eligible for subsidies. Easy access to Medicaid databases will mean fewer errors and faster service for people in both programs.
State insurance regulators, who have the authority to approve insurance plans sold on federally run exchanges, can do their part by monitoring the participating insurance plans aggressively enough to keep rates down.
Perhaps the single biggest thing Republican officials could do is simply be ready and willing to address the inevitable hiccups. If states look for ways to stall progress, they’ll find them. Conversely, if governors who oppose the law nonetheless direct their officials to cooperate, the exchanges are more likely to survive those hiccups.
Governors could set a positive tone by reminding their residents that the exchanges are coming. Instead of saying the exchanges “are not going to work,” as Texas Governor Rick Perry did in December, they should encourage their constituents to see whether they’re eligible for subsidies. It doesn’t need to cost the states anything.
By: The Editors, Bloomberg, June 20, 2013
“No Shedding Crocodile Tears Here”: Obamacare Critics Should Stop Using Young Men To Fuel Their Arguments
In January, one of Obamacare’s most controversial provisions will come into effect:
Every person in America will be required to either have health insurance or pay a penalty.
Overall, the effect will likely be a net positive: Because of subsidies, the cost of insurance will be kept down for many households, and in many states, a Medicaid expansion will help even more families pay for their health care. But while the outlook is great for millions of workers, things are going to be tougher for at least one group: healthy, financially secure men in their twenties.
So, guess which group Obamacare critics have focused on when they attack the effects of the program? I’ll give you three guesses, but you’ll probably only need one.
On Wednesday, New York magazine’s Jonathan Chait pointed out the surprising trend, noting that critics of the Affordable Care Act have almost universally cited the group in their attacks. Likening the move to an old-time patent medicine show (“You, sir – the healthy 25-year-old in front who has never been hospitalized or needed medication in his life! Step right up!”), he suggested that the attacks on Obamacare are, to put it mildly, skewed.
On the surface, targeting the law’s impact on healthy 25-year-old men seems like a masterstroke. After all, it’s hard to argue for the fairness of a system that charges healthy young people to pay for the health care needs of sickly older ones. The trouble is, today’s healthy 25-year-old male could easily become tomorrow’s hit-and-run victim, desperately in need of long-term medical care. And, barring that, today’s healthy 20-something will, with any luck, become a less-healthy 50-something, in need of an affordable method to cover his medications and regular doctor’s visits.
(Or, as happened to me when I was an uninsured man in my mid-20s, today’s healthy young 25-year-old could be tomorrow’s guy paying out-of-pocket for wisdom teeth extraction.)
Obamacare has numerous provisions that will extend coverage and make health insurance cheaper. Among other things, it will help cover the Medicare Part D coverage gap, will end exclusions for pre-existing conditions, and will require health care plans to cover preventative care.
For tens of millions of people, these provisions, and others, will translate into lower medical costs, a previously unimaginable access to health care, and a generally improved quality of life. Given the huge potential benefits, maybe it’s time for Obamacare’s critics to stop shedding crocodile tears for the relatively small portion of the populace that is going to have to take one for the team — and, in the process, get insurance that may well make them safer and healthier.
By: Bruce Watson, Business Insider, Originally Published in DailyFinance, June 10, 2013
“A Matter Of Life And Death”: Leave It To Scott Walker To Turn Medicaid Expansion Into Medicaid Contraction
Several red states are turning down Medicaid expansion — only Scott Walker (R-WI) is actually using Obamacare as an excuse to cut Medicaid.
Wisconsin’s Badgercare health care plan is one of the best in the country. Families qualify for comprehensive coverage if they earn up to 185 percent of the federal poverty level.
So when the Affordable Care Act offered all 50 states a chance to expand their Medicaid programs to cover all the working poor who earn too much for Medicaid but make up to 133 percent of the poverty level, what did Governor Scott Walker decide to do?
He put forward a plan to drastically cut Badgercare.
If Walker gets his way, his state’s plan will only cover residents who earn 100 percent of the poverty level or below – $11,490 a year for a single adult.
Tens of thousands of Wisconsites will be forced from completely subsidized health care to the federal insurance exchanges, where they can purchase private plans with a subsidy. To do this, Walker has to give up federal funding that would cover 84,7000 residents, which would lead to a $119 million cut to his state budget.
“But a detailed analysis of the plan by the Legislative Fiscal Bureau finds that many of the people now receiving state Medicaid coverage would likely not buy the more costly insurance through the federal program,” The Milwaukee Journal Sentinel reports.
“As a general rule, they’re going to be really strapped to do it,” Jon Peacock, research director of the Wisconsin Council on Children and Families, told the Journal Sentinel. “They won’t scrape together the money unless they really need it.”
The Bureau estimates that 7 percent will not buy the coverage. Peacock thinks that’s overly optimistic.
A new UW Madison study shows that Badgercare – which was expanded in 2009 — reduces hospitalization and improves management of chronic disease.
Even Senate Majority Leader Scott Fitzgerald (R-Juneau) admits that Walker’s plan could send thousands to emergency rooms for care, driving up the cost of care for all residents. The legislature is considering additional payments to hospitals to make up for the costs of the uninsured.
Medicaid expansion is a great deal for the states. The federal government will fund 100 percent of the initial expense; that decreases to 90 percent over the next decade.
Rand Corporation just released a study that underlines the cruelty of rejecting expansion. “States rejecting the expansion will spend much more, get much, much less, and leave millions of their residents uninsured. That’s a lot of self-inflicted pain to make a political point,” according to The Washington Post‘s Ezra Klein and Evan Soltas.
“This is not a small issue,” writes The Guardian‘s Michael Cohen. “In fact, it is a matter of life and death.”
Cohen points to a New England Journal of Medicine study that shows increased access to Medicaid results in fewer deaths. A recent study in Oregon found that Medicaid eliminated economic hardships brought on by health problems and dramatically improved mental health.
What Walker is doing is even worse than his more than two dozen Republican colleagues who are rejecting expansion. He’s taking health care away from the working poor, knowing that doing so will cost his state money, well-being and even lives.
By: Jason Sattler, The National Memo, June 4, 2013
“Affordable And Accessable”: The Shocking Truth About Obamacare’s Rate Shock
Imagine you went to Best Buy and found a great deal on a plasma television set. I want to be clear here: You didn’t find a great television set. This television set is actually a bit crummy. The picture is fuzzy. Consumer Reports says it breaks down a lot and it’s expensive to fix. But it’s really cheap. The price tag reads $109.
When you take it to the counter, the saleswoman tells you that the set will actually cost you $199. And count yourself lucky, she confides in a conspiratorial whisper. There are customers whom Best Buy won’t sell it to at any price. You ask her which customers those are. The ones who need the TV most, she replies.
So here’s the question: Does that television really cost $109?
Best Buy, of course, would never do this to you. If they say you can buy a television set for $109, you can buy it for $109. Plus, they’re handsome, and their customer service is great, and I hope they advertise in The Washington Post forevermore, amen.
But this is actually how the individual health-insurance market works. And understanding why is crucial to understanding a lot of what you’re going to read about health reform in the next year.
Last week, California released early information on the rates insurers intend to charge on the new insurance marketplaces — known as “exchanges” — that the state is setting up under Obamacare. They were far lower than anyone expected. Where analysts had anticipated average premiums of $400 to $500, insurers were actually charging $200 to $300. “This is a home run for consumers in every region of California,” crowed Peter Lee, director of the state’s exchanges.
The Affordable Care Act’s critics saw it differently. Avik Roy, a conservative health writer at Forbes, said Lee was being “misleading” and that “Obamacare, in fact, will increase individual-market premiums in California by as much as 146 percent.” Obamacare, he said, would trigger “rate shock,” the jolt people feel when they see higher rates. That doesn’t sound like a home run at all.
Who’s right? In typical columnist fashion, I’m not going to tell you just yet. But stick with me, and you’ll be able to parse the next year of confused and confusing Obamacare arguments with ease.
Here’s the first thing to know: We’re talking about a small fraction of the American health-care system. This isn’t about people on Medicare or Medicaid or employer-based insurance. It’s about people joining Obamacare’s insurance exchanges. That’s people who buy insurance on their own now, as well as some of the uninsured. In 2014, 7 million people, or 2.5 percent of the population, is expected to buy insurance through the exchanges. By 2023, that will rise to 24 million people, or 8 percent.
So we’re talking about a small portion of the market. Worse, we’re talking about that small portion of the market all wrong.
Roy got his 146 percent by heading to eHealthInsurance.com, running a search for insurance plans in California and comparing the cost of the cheapest plans to the cost of the plans being offered in the exchanges. That’s not just comparing apples to oranges. It’s comparing apples to oranges that the fruit guy may not even let you buy.
I ran the same search Roy did. I looked for insurance in Irvine, Calif. — my home town. The average monthly premiums of the five cheapest plans is $114. So I took the middle plan, HealthNet’s IFP PPO Value 4500. It’s got a $4,500 deductible, a $2,500 deductible for brand-name medications, huge co-pays and a little “bestseller” icon next to it. And it’s only $109 a month — if they’ll sell it to you for that price.
That’s the catch, and it’s a big one. Click to buy the plan and eventually you’ll have to answer pages and pages of questions about your health history. Ever had cancer? How about an ulcer? How about a headache? Do you feel sad when it rains? When it doesn’t rain? Is there a history of cardiovascular disease in your family? Have you ever known anyone who had the flu? The actual cost of the plan will depend on how you answer those questions.
According to HealthCare.gov, 14 percent of people who try to buy that plan are turned away outright. Another 12 percent are told they’ll have to pay more than $109. So a quarter of the people who try to buy this insurance product for $109 a month are told they can’t. Those are the people who need insurance most — they are sick, or were sick, or are likely to get sick. So, again, is $109 really the price of this plan?
Comparing the pre-underwriting price of this plan to those in Obamacare’s exchanges is ridiculous. The plans in Obamacare’s exchanges have to include those people. They can’t turn anyone away or jack up rates because of a history of arthritis or heart disease.
They also have to offer insurance that meets a certain minimum standard. Under Obamacare, for instance, the out-of-pocket limit for someone making 100 to 200 percent of the poverty line is $1,983. Under the Value 4500, you could spend up to $9,500 before the out-of-pocket limit kicked in. Obamacare also has subsidies for people making up to four times the poverty line. The poor pay next to nothing. The rich pay full freight.
“We as a society have never really said here’s what reasonable insurance is,” says Larry Levitt of the Kaiser Family Foundation. “It’s just been anything goes. For the first time they’re setting a minimum about what reasonable insurance should be.” They’re also setting a minimum about who should be able to get it, and at what cost. Now it really will work like Best Buy, where the price on the tag is the price everyone actually pays.
Some people will find the new rules make insurance more expensive. That’s in part because their health insurance was made cheap by turning away sick people. The new rules also won’t allow for as much discrimination based on age or gender. The flip side of that, of course, is that many will suddenly find their health insurance is much cheaper, or they will find that, for the first time, they’re not turned away when they try to buy health insurance.
That’s why the law is expected to insure almost 25 million people in the first decade: It makes health insurance affordable and accessible to millions who couldn’t get it before. To judge it from a baseline that leaves them out — a baseline that asks only what the wealthy and healthy will pay and ignores the benefits to the poor, the sick, the old, and women — well, that is a bit shocking.
By: Ezra Klein, Wonkblog, The Washington Post, June 1, 2013
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