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“The GOP’s Health Crisis”: The Republican Party’s Worst Nightmare Is Coming True

Oh dear. The Republican Party’s worst nightmare is coming true. Obamacare is working.

The news that nearly 1.2 million people signed up last month for insurance through the Affordable Care Act exchanges is highly inconvenient for GOP candidates nationwide. It looks as if the party’s two-word strategy for the fall election — bash Obamacare — will need to be revised.

Wednesday’s status report on the health-insurance reforms was by far the best news for Democrats and the Obama administration since the program’s incompetent launch. January was the first month when new enrollments surpassed expectations, as the balky Web site began functioning more or less as intended.

Cumulatively, 3.3 million people had chosen insurance plans through the state and federal exchanges by the end of January. That is fewer than the administration had originally hoped but well above the predictions of critics who believed — or hoped — that the program would never succeed. The Congressional Budget Office projects that 6 million people will have chosen plans through Obamacare when the initial enrollment period ends March 31, down from a pre-launch estimate of 7 million. Not bad at all.

The numbers are even more encouraging when you look more closely. The proportion of young people — from 18 and 34 — who chose insurance plans through the exchanges increased slightly to 27 percent, compared with an average of 24 percent in previous months. This is important because premiums would have to rise if not enough young, healthy people enrolled.

The administration had hoped the percentage of young enrollees would reach about 40 percent. But the January figure — and the rising trend — should put to rest any notion that the whole program could go down the drain in an actuarial “death spiral.” Administration officials are convinced this won’t happen.

According to the January report, about 80 percent of those signing up for Obamacare are eligible for subsidies to help them pay for insurance. The administration believes, but does not have the data to prove, that most of the new enrollees were previously uninsured.

These figures do not include the additional people who have been determined newly eligible for insurance under the federal-state Medicaid program. Overall, the program appears to be doing exactly what it was designed to do: make health insurance accessible and affordable for those who truly need it.

The Affordable Care Act could be doing even more if Republican governors such as Rick Perry of Texas and Rick Scott of Florida were not doing all they could to sabotage the program. But even in states that refused to set up their own health-insurance exchanges or to expand Medicaid eligibility, growing numbers of the uninsured are obtaining coverage.

Politically, this is terrible news for Republicans who hoped that the botched Web site launch and President Obama’s misleading “you can keep your insurance” pledge would be the gifts that kept on giving.

Bashing Obamacare will always have resonance for the GOP’s conservative base. But if you’re trying to win the votes of independents, it’s more profitable to target a failed program than a successful one.

Critics will doubtless try to blame Obamacare for anything bad that happens to anyone’s health insurance before the November election. But all of this is just noise without the central narrative of a “failed program.”

Attack ads against vulnerable Democratic senators, such as Kay Hagan of North Carolina and Mary Landrieu of Louisiana, are already trying to paint Obamacare as a character defect — the president and his supporters “lied” when they said everyone could keep their insurance. The response from Democrats should be to shift the focus to the actual program and its impact. Imperiled incumbents can point to constituents who are benefiting from the Affordable Care Act in life-changing ways.

If you assume that Affordable Care Act enrollment remains on its current trajectory, the February numbers should look even better. Polls consistently show that even if voters have mixed views about the health-care reforms, most do not want to see them repealed. By the fall, the whole Obamacare-is-a-disaster line of attack could sound stale and irrelevant.

Republicans may even have to take the drastic step of saying what they advocate, rather than harping on what they oppose. Is there a GOP plan to cover those with preexisting conditions? To cover the working poor? Is expanding access to health insurance really such an awful thing?

Sorry, I didn’t catch what you said.


By: Eugene Robinson, Opinion Writer, The Washington Post, February 13, 2014

February 16, 2014 Posted by | Obamacare, Republicans | , , , , , , , | 1 Comment

“Imminent ‘Death Spiral’ Premature, Over-Hyped”: Young People Are Just Procrastinating On ObamaCare

ObamaCare enrollees are, so far, generally older and therefore potentially less healthy than the general public. And on the flip side, only one-fourth of sign-ups are in the crucial 18-35 year-old age bracket, well below the administration’s roughly 40 percent target, according to new enrollment data released Monday.

Given the top-heavy enrollment figures, critics and skeptics are again raising a doomsday scenario in which an elderly pool of enrollees, without adequate subsidization from healthier, younger people, causes premiums to skyrocket so much the entire system crumbles.

“Hello, Death Spiral,” snarks a National Review headline.

Terrifying, right?

However, the administration expected that young people would procrastinate until the last minute, while older and sicker people would be more motivated to get coverage as soon as possible. People have until the end of March to sign up for ObamaCare before the individual mandate’s penalty kicks in, so assuming that works as something of a metaphorical term paper deadline, there could very well be a surge of young people into ObamaCare in the next couple of months.

Massachusetts’ experience implementing Romneycare in 2006 offers some historical precedent. As an analysis by MIT economics professor Jonathan Gruber shows, the percentage of Romneycare sign-ups in the 19-34 year-old bracket hovered in the low 20s for the first few months before gradually rising into the mid-30s range by the end of the year.

ObamaCare, likewise, saw an eight-fold increase in young adults enrolling in December compared to the two months prior, indicating that young people were indeed waiting until the last minute. Hence Aaron Smith, head of the nonprofit Young Invincibles, whose goal is getting uninsured young people enrolled, says the latest numbers show they “are on the right track.”

The White House is also planning to up its outreach to young people, including a National Youth Enrollment Day on February 15. That should help drive up youth enrollment above its current level.

And even if that effort fizzles, it’s still extremely unlikely the death spiral will materialize if the current enrollment demographics remain unchanged. A December report form the nonpartisan Kaiser Family Foundation concluded that “the financial consequences of lower enrollment among young adults are not as great as conventional wisdom might suggest.” Even in a worst-case scenario where young people comprise 25 percent of the overall pool, Kaiser estimated premiums would rise marginally, or “well below the level that would trigger a ‘death spiral.'”

There are two months of open enrollment left, so proclaiming dire predictions is a tad premature at this point. And even if the supposedly deadly enrollment demographics remain unchanged come April, and premiums go up, it almost certainly won’t imperil the law.


By: Jon Terbush, The Week, January 14, 2014

January 15, 2014 Posted by | Affordable Care Act, Obamacare | , , , , , , | Leave a comment

“A Gaping Wound In The Republican Psyche”: Obamacare Is No Longer Doomed, It Will Become A Scandal

Obamacare — actual, real, Obamacare, with doctors and cards and everything — has been operational for nearly a week now. It has been … extremely boring. It does not look like Stalinist collectivization. There aren’t even any beheadings. It looks like regular medical insurance, except several million more people now have it than before.

How conservatives will respond next to this mundane new world has become the subject of combative speculation. Greg Sargent predicts Republicans will soon come to terms with the law and begin negotiating for incremental improvements. On the right, Conn Carroll angrily replies that the law’s demise remains “inevitable” and liberals will turn against the law, citing Michael Moore as a harbinger of pro-single-payer liberals who will help Republicans dismantle Obamacare, somehow.

I predict a slightly different outcome than either. Obamacare will neither collapse, nor will Republicans accept its legitimacy, but the nature of their opposition will instead slowly morph. Gleeful predictions of imminent collapse will give way to bitter recriminations at the nefarious tactics used to make the law work. Obamacare will cease to be the something certain to destroy Obama and become something Obama has gotten away with.

In recent weeks, it has begun to dawn on some conservatives that the actuarial death spiral they confidently predicted for years — in which the young and healthy shun the exchanges, leading to sicker and costlier patients and rising prices, in turn driving out the remaining healthy customers — may not actually transpire. It won’t for several reasons, one of them being a set of protections embedded in the law itself called risk corridors and reinsurance, which compensate insurance companies that wind up with a sicker customer base in the first three years of the law’s operation, thus preventing a death spiral.

Republicans, having just learned of these provisions, demand that they be abolished, to hasten the death spirals. Repentant immigration reformer Marco Rubio is at the forefront with a bill to strike them from the law. Obviously Obama would never sign such a bill, but Charles Krauthammer offers a solution: demand he sign it or else refuse to lift the debt ceiling. The program is “a huge government bailout,” argues Krauthammer. This is true in the sense that any cost overrun by a defense contractor is also a huge government bailout — which is to say, it’s not true.

But it feels true, and that is the important thing. The premise that Republicans will seek to alter Obamacare in conservative-friendly ways assumes that the policy design of health-care law is their primary motivating force. Everything about the history of Republican health-care thought suggests the opposite. Just five years ago, Mitt Romney was running on a platform of taking his Massachusetts plan, with its individual mandate, national, provoking only the mildest grumbling on the right.

Obamacare is a gaping wound in the Republican psyche, representing not only the rise of a majority moocher class but a potential symbol of a successful Obama presidency. Health-care reform, George F. Will has ludicrously if representatively declared, amounts to Obama’s “single” achievement. If it lives, it will vindicate his presidency as a liberal Reagan, rather than the reprise of Jimmy Carter (or George W. Bush) Republicans wish him to be.

If and when the law melds into the national fabric, the proximate Republican response will not be to adapt their policy ideas to it, but to denounce it as a kind of stolen law. You can see this spirit creeping out not only in Rubio’s proposal but elsewhere. Eleven Republican attorneys general have denounced Obama’s various administrative maneuvers to make the law functional as illegal. “It was powerful corporate America, with its influential lobbyists, that got an additional year to meet the insurance mandate — when individuals did not,” complains The Wall Street Journal columnist Kimberly Strassel, “It was the unions that got a reprieve from a health-insurance tax — when individuals and small businesses were left to pick up the tab.” The hapless Obamacare is slowly giving way to the devious Obamacare.

In the very long run, Obamacare may become a thing, like Social Security and Medicare, that Republicans initially predict will destroy the fabric of capitalism but eventually accept and then finally swear up and down they will not harm. In the shorter term, it will remain a bloody shirt. Obamacare will be Benghazi or the IRS scandal writ large.


By: Jonathan Chait, Daily Intelligencier, New York Magazine, January 5, 2014

January 7, 2014 Posted by | Affordable Care Act, Obamacare, Republicans | , , , , , , | Leave a comment

“A Million Here, A Million There”: Millions Of People Have Health Insurance Thanks To Obamacare

The big number in the news this week was 1.1 million – the number of people who signed up for health insurance through Obamacare’s federal insurance marketplace this year. This is an important figure, especially given the fact that it stood at little more than 100,000 at the end of November.

Nevertheless, that 1.1 million figure dramatically understates what the Affordable Care Act has already accomplished. The number we should be talking about is at least 9 million and could be 14 million people who are currently getting coverage under the law.

How many people are currently covered through the law? Start with the 1.1 million who have gotten care through the federal website. If you layer on the number of enrollees who have gotten coverage through state-run exchanges that number tops 2.1 million, Secretary of Health and Human Services Kathleen Sebelius announced Tuesday. Then throw in the 3.9 million people who have gotten health coverage under Obamacare’s Medicaid expansion. Oh and don’t forget about the young adults under 26 who are still covered by their parents’ health insurance plans thanks to the Affordable Care Act. A year-and-a-half ago, the Department of Health and Human Services put the number at 3.1 million but an August study by the Commonwealth Fund, a private foundation that focuses on health policy research, estimated that the figure had reached 7.8 million. Total those numbers and you get a minimum of 9 million Americans covered through Obamacare and a maximum of nearly 14 million.

To borrow Everett Dirksen’s old adage: A million here, a million there, and pretty soon you’re talking about real coverage. This is why Wisconsin Sen. Ron Johnson told the New York Times last week that the Affordable Care Act is “no longer just a piece of paper that you can repeal and it goes away. … We have to deal with the people that are currently covered under Obamacare.”

To be sure there are provisos and qualifications. Obamacare critics will point out that some number of those insured are only replacing coverage they lost thanks to the law disqualifying their plans (of course that will require those same critics to acknowledge that very few of the people losing their health coverage are now bereft); and in the context of 50 million uninsured it’s only a start – but it is a start. And while I’m writing this in the waning hours of 2013, it doesn’t take a great feat of prognostication to know that the first days of 2014 may well bring another round of Obamacare horror stories as people find out that they don’t have coverage they thought they signed up for. The October website disaster’s effects are still being felt – the administration had been aiming for 3.3 million signups by now, for example, so the 2 million figure is well short.

The law’s well-publicized stumbles have certainly taken their toll in polls. Finally clear of its shutdown self-immolation, the GOP seems to be building its 2014 strategy around Obamacare’s flaws. “Ideally, we’d freeze things the way they are in amber until November,” a senior House Republican aide told Time’s Jay Newton-Small last month.

But putting aside for a moment the fact that 11 months is an age and a day in politics, there’s a fundamental flaw in this GOP calculus: Obamacare’s not the cutting issue they seem to think it is. Democratic pollsters Stan Greenberg, James Carville and Erica Seifert surveyed the 86 most competitive House districts and found that the country remains deeply divided on the Affordable Care Act. “Health care is not a wedge issue,” they concluded.

The right’s problem is that it fixates on approval-disapproval numbers without digging into them. So while a CNN/ORC poll conducted in mid-December found that 35 percent favor the law and 62 percent oppose it, only 43 percent oppose the law because it’s too liberal; if you add the 35 percent who favor the law to the 15 percent who dislike it because they wish it did more, the GOP 2014 game plan becomes more puzzling. An early December New York Times/CBS News poll tells the same story: 50 percent oppose the law while only 39 percent approve. But only 42 percent think the law goes too far while a total of 50 percent think it either doesn’t go far enough or is just right.

Those are the figures right now. But in February of last year, the Congressional Budget Office estimated that 7 million people would be covered this year through the exchanges. Is that figure realistic? The Washington Post’s Obamacare guru, Sarah Kliff, reported this week that the health research firm Avalere Health estimated what the pace of enrollments should look like, modeling it off of the 2006 Medicare drug program rollout. Their guess for Obamacare was 2.4 million people by the end of 2013, making the 7 million target plausible.

One factor which will help? The health insurance industry is going all-in on the law. As the Wall Street Journal reported last month, health insurers are fighting for these millions of new customers. The Journal suggested that insurers will spend $500 million on local TV ads in 2014. Here’s my favorite part of the article: “The ad campaigns are a major shift in strategy for health insurers, most of whom have never really had to market directly to consumers aggressively until now.” It’s the free-market flipside of Obama’s infamous promise: If you don’t like your insurer, you don’t have to keep it. A full fight for customers could help the law reach the 7 million mark – bringing the total number of people insured under it to nearly 20 million.

Is the GOP really going to spend the fall campaigning to take health care away from nearly 20 million people?


By: Robert Schlesinger, U. S. News and World Report, January 3, 2014

January 4, 2014 Posted by | Affordable Care Act, Obamacare | , , , , , , , | Leave a comment

“Call It A Comeback”: More Than 9 Million Americans Have Health Insurance Through Obamacare

You don’t get much credit for fixing something that should have worked in the first place, but the Obama administration has avoided a major catastrophe by delivering on its promise to fix for most Americans.

After two months of barely functioning, the federal online health care exchanges delivered, racking up 975,000 enrollments in the month of December. That brings the total number of people who have picked a plan through an exchange since October 1 to about two million. The administration reached about two-thirds of its goal of enrolling 3.3 million by the end of 2013 after being fully operational one-third of the time. And it turns out most of the enrollments came during the one-week extension the White House gave itself after the initial problems with the site became apparent.

Four million people have qualified for Medicaid, according to Another 3.1 million young adults are covered by their parents’ health insurance, thanks to a provision in the Affordable Care Act (ACA).

This means over nine million people have gained coverage through the ACA since it first became law.

That number could easily shrink or grow as insurers report on how many people purchased ACA-compliant policies directly through them. It’s also unclear how many canceled policies were replaced by plans purchased through the exchanges.

Looking at the rate of enrollments for Medicare Part D, president of health research firm Avalere Health Dan Mendelson believes that the administration can hit its goal of seven million enrollments by the close of open enrollment on March 31.

“Where they are, with about two million enrolled, if they continue to enroll at the present rate, and there’s a little acceleration at the end, they could get to seven million,” Mendelson told the Washington Post‘s Sarah Kliff.

However, Republicans are still predicting doom for the president’s signature legislative accomplishment, suggesting that the disastrous rollout of the exchanges is just the beginning of the problems.

“Just about everyone on the right is still living in October, the annus horribilis of Obamacare (yes, I know it was just a month, and I don’t care), and is waiting to move in for the kill after the whole thing collapses,” The New York Times‘ Paul Krugman wrote.

Republicans are assuming that the estimated 3 percent of Americans who will be paying more under the law along with disruptions of relationships with doctors will overwhelm both the news of millions gaining coverage and Republican states denying Medicaid expansion to five million working people.

Predictions of Obamacare’s death made sense when it seemed a very real possibility that could not be fixed.

Now that those predictions have been proven wrong, the law will have a chance to be judged on its merits.


By: Jason Satler, The National Memo, December 30, 2013

December 31, 2013 Posted by | Affordable Care Act, Obamacare | , , , , , , , | 2 Comments

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