Tag Archives: insurance

Insurance experts rank climate change as top risk for 2019

by yqgroberto Posted on May 3, 2019

It’s no secret that climate change comes at a cost — so much so that even the insurance industry has flagged it as a priority. According to a new industry survey, actuaries (the people who calculate insurance risks and premiums based on available data) ranked climate change as the top risk for 2019, beating out concerns over cyber damages, financial instability, and terrorism.

When actuaries correctly measure and manage climate risks, they can help nudge societies away from poor planning — such as overbuilding in high-risk coastal flood zones — and towards better choices — like building more resilient infrastructure designed to withstand anticipated sea level rise.

“The survey shows actuaries are engaged and tackling this risk frontier,” Steve Kolk, actuary and climate data scientist, told Grist. “It thrills me to see actuaries join the effort and help us all build a sustainable planet more quickly.”

The survey, published by the Joint Risk Management Section and two other organizations that represent professional actuaries, found that out of 267 actuaries surveyed, 22 percent identified climate change as their top emerging risk. It was also the top-ranked choice for combination risk and tied with cyber/interconnectedness of infrastructure for top current risk. It’s a dramatic shift from previous years, when climate change lagged well behind other dangers to people and property. In last year’s survey, only 7 percent of respondents rated climate change as the top emerging risk.

The survey results align with several current and future projections of climate change’s impact on the global economy. According to one estimate, natural disasters caused about $340 billion in damage across the world in 2017, with insurers paying out a record $138 billion. The insurance industry plays a huge role in the U.S. economy at $5 trillion (Insurance spending in 2017 made up about 11 percent of America’s GDP). Climate change can make a sizable dent on economic growth by disrupting supply chains and demand for products, and creating harsh working conditions, among other issues.

“Actuaries, on the whole, are recognizing not only the magnitude of rising climate-related risks but, more importantly, that they can play a positive role in helping society actively manage those risks,” said Robert Erhardt, associate professor of statistics at Wake Forest University.

While the report could signal a potential change in risk awareness, it may also have come down to timing: The Intergovernmental Panel on Climate Change report was released in October 2018, a few weeks before the survey.

“The effects of climate change became a common front-page story in the past year — and risk managers are taking notice,” Max Rudolph, a fellow with the Society of Actuaries who prepared the report, told E&E News.

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Insurance experts rank climate change as top risk for 2019

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Your future home could be in a flood zone — and no one’s required to tell you

by JonasLchfpiinrcl Posted on September 20, 2018

Olga McKissic lives in an airy, white-brick home with a pillared porch, the kind where you might sit and watch fireflies late in the night. The only issue is that every few years, the rising waters from a nearby river pour into her Kentucky home, ascending the porch like an uninvited guest. Her home flooded in 1997, 2006, 2013, and 2015.

“That property that we purchased back in 1986, that we thought was such a wonderful, tranquil, lovely place — it’s a nightmare to live here with the thought that it is going to flood again,” says McKissic in a video produced by the Natural Resources Defense Council. She explains that the first time it flooded, she replaced the carpet with tiles. When the water tore up the tiles, she installed linoleum. And when the linoleum failed to survive the next flood, she settled for just painting the concrete.

McKissic is just one of 30,000 homeowners or renters in the United States who live on a severe repetitive loss property, by National Flood Insurance Program standards. In North Carolina, where flooding from Hurricane Florence continues to threaten homes and lives, there are 1,132 such properties. From 1978 to 2018, the National Flood Insurance Program shelled out over $1.2 billion to North Carolina alone to repair and rebuild properties damaged by flooding, which often need to be rebuilt all over again after the next flood.  

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So why do homeowners all over the country invest in flood-prone property in the first place? One issue is that they don’t have enough information to know better. Due to an insubstantial patchwork of flood risk disclosure laws, “many Americans who are about to make one of the biggest financial investments of their lives have zero knowledge of whether a house has flooded and is likely to flood again,” according to research published last month in a joint project between the NRDC and the Sabin Center for Climate Law.

In 21 states, there are no statutory or regulatory requirements for a seller to disclose a property’s flood risks or past flood damages to a potential buyer, according to the research. The other 29 states have varying degrees of disclosure requirements. Kentucky and North Carolina, for instance, have some requirements, but not enough to protect many homeowners. (View an interactive map of your state’s laws here.)

“What Hurricane Florence and other major flooding events have really illustrated over the past few years is that the nation’s flood risk is getting worse,” explains Joel Scata, a climate and water attorney at the NRDC. “That really sets potential home buyers to be in a bad situation where they are buying property where they are not fully informed of the risk.”

The Carolinas’ vague, insubstantial disclosure laws likely helped contribute to the situation they now find themselves in: While millions of homes at risk of flooding, only 335,000 have flood insurance.

“Both North Carolina and South Carolina’s disclosure requirements were rated inadequate in our assessment,” explains Dena Adler, a researcher for the flood risk disclosure project and fellow at the Sabin Center for Climate Law. The research found that there are no requirements in North Carolina for home sellers to disclose previous flood damage to structures on the property or any requirement to carry flood insurance for the property.

In North Carolina, the Real Estate Commission must disclose that a property is located within a federally designated flood zone, which is based on hundred-year floodplains. That’s the land predicted to flood during a 100-year storm — one so severe it has a 1 percent chance of occurring during any given year. But storms have been getting stronger lately. In the last two years, North Carolina has seen two 1,000-year flood events: Hurricane Matthew and now, Hurricane Florence.

For more accurate flood risk maps, FEMA needs to take climate change into account. “Climate change is a loaded dice, because it makes the risk different,” Scata says. “By not looking at the future effects of climate change on flooding, like sea-level rise and bigger rain events contributing to bigger floodplains, you’re not getting the full picture.”

Scata and the NRDC recommend that states participating in the National Flood Insurance Program should explicitly disclose flood risks. Additionally, FEMA should provide homeowners a “right to know” about their property’s past history and create a public, open-data system to share information related to flood damage.

If better laws were in place, they could help mitigate what has become an unsustainable cycle: real estate developers buying up coastal properties, selling them to unknowing buyers, and then forcing them into a cycle of flooding and buyout.

Another solution is a significantly improved and expanded voluntary property buyout program, where FEMA provides funding for the local government to purchase the flood-prone property and convert it to open space. Currently, the National Flood Insurance Program focuses most of its funding on rebuilding homes, many of which are destined to flood again, and there is only a limited pool of money for property buyouts. As a 2017 report from NRDC puts it: “For every $100 FEMA has spent to rebuild properties through the NFIP, a paltry $1.72 has been spent to help move people to higher ground.”

Oh, and one more thing: The future of flood risk is closely related to what we do about climate change. As Scata explains, “Our future greenhouse gas and carbon emissions will dictate the various levels of sea-level rise. So if it’s going to be business as usual, it’s going to be a lot higher risk than if we take action.”

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Your future home could be in a flood zone — and no one’s required to tell you

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The cost of flood insurance is a price worth paying

by CedricPettiford Posted on August 5, 2018

This story was originally published by CityLab and is reproduced here as part of the Climate Desk collaboration.

Almost 75 percent of declared disasters in the United States are flood-related, and flood risk continues to rise due to development in floodplains and a changing climate. The beleaguered National Flood Insurance Program (NFIP), which was due to expire on July 31 but just got a four-month extension from Congress, can help lessen some of that risk and serve as a lifeline for survivors.

However, in reauthorizing the program, Congress did not fix its many problems. The need to make the NFIP more effective is urgent. And as America’s flood risk grows, we will be even more reliant on it.

The NFIP was created 50 years ago after losses mounted from disasters such as 1965’s Hurricane Betsy. In creating the program, Congress recognized three things: first, that the federal government would have to provide flood insurance because private insurers would not. Private insurers had, by and large, refused to cover floods since the Great Mississippi Flood of 1927, the most destructive river flood in U.S. history to that point. Insurers must weigh the level of risk to individual properties, how much payouts will cost and how profitable policies are, and homeowners’ willingness to pay premiums — all of which are problematic for assessing flood risk.

Second, Congress knew that national flood risk was too high. The government had been working to address this through the Flood Control Act of 1938 and other laws. But by 1968, these policies had been relatively unsuccessful at lowering the risk; flood insurance was seen as a different strategy. Third, and finally, Congress realized that homeowners needed financial assistance to recover from floods.

In its first four decades, the program was generally solvent — that is, revenue from premiums was approximately equal to payouts. Between 1968 and 2005, when the program did incur debt, FEMA, which oversees the NFIP, borrowed money from the U.S. Treasury and quickly repaid it.

Then, in 2005, Hurricane Katrina and the resulting levee failure instigated an outpouring of anger and frustration with the NFIP. Katrina’s impacts were more severe than anything the United States had experienced since the program began. Post-Katrina, FEMA borrowed $18 billion from the Treasury without a repayment plan, instead of adding it to the supplemental appropriations passed by Congress. The agency borrowed billions more after Hurricane Sandy, and the debt eventually rose to $24.6 billion.

This debt has become the pressure point for the NFIP, with critics citing it as evidence of the program’s failure. But when we consider why the program was created, the debt shows just how vital the NFIP is. Private insurers could not provide affordable flood insurance to the people who needed it, but through subsidies, the federal government — and by extension, the American taxpayer — could. So complaints about insolvency seem misplaced, given that the program’s debt is an obvious outcome of its design.

Financial solvency is of clear interest to taxpayers and politicians. But it’s worth considering the other problems, besides the scarcity of private insurance, that Congress hoped to address by creating the NFIP: flood mitigation and recovery.

A key objective of emergency management is to prevent or limit risk from disasters. Homeowners tend not to voluntarily implement such measures, but the designers of the NFIP thought the program could be used to incentivize safer building and better land-use practices. To this end, the NFIP was intended to work in tandem with the community rating system (CRS), which scores communities for undertaking flood mitigation (by, for example, building levees or changing land-use policies) and offers commensurate reductions in premiums.

There is evidence that the NFIP has succeeded in improving mitigation. Even so, it could do more. The program could be reformed so that more communities are incentivized to join and participate fully in CRS, and it could refuse to cover repetitive-loss properties, or require that they be rebuilt to higher standards.

Repetitive-loss properties are a real problem: Less than 1 percent of homes insured under the program have been responsible for nearly 10 percent of paid claims. Allowing homes to be rebuilt or repaired multiple times without requiring sufficient modifications to prevent future damage is not an efficient use of taxpayer money, and this loophole needs to be closed.

The NFIP was designed to provide insurance to people who could not afford to pay its actuarial price. Critics claim that simply by offering affordable flood premiums, it incentivizes development in hazardous areas. In fact, researchers have found that other factors, such as the high desirability of beachfront property, road and bridge access, and the availability of public services, are equal if not bigger contributors to the increase of development in high-risk areas.

To the extent that the NFIP does help encourage such development, of course, it must be reformed to prevent that. For example, former FEMA Administrator Craig Fugate argued that future development in 100-year floodplains should be ineligible for NFIP coverage.

The NFIP was also designed as a resource for American homeowners during recovery from floods. Disaster survivors often describe recovery as “the second disaster,” a long, expensive process of cobbling together aid from savings accounts, second jobs, loans, friends, family, nonprofits, and the government.

Homeowners with flood insurance can receive substantially more money than those who are helped through FEMA’s individual-assistance program. The maximum NFIP payout is $350,000, whereas the largest possible individual-assistance payment is about $34,000. After Sandy, the average payout from FEMA’s individual-assistance program was only $8,000, compared with over $66,000 from the NFIP. Nevertheless, some survivors have struggled to access the NFIP funds they needed or were entitled to. An investigation following Sandy found evidence of poor management by both FEMA and the private insurance companies tasked with NFIP’s administration.

The extremely small number of people who carry policies also inhibits the program’s assistance in recovery. Currently, only about 5 million American households (or about 4 percent) hold flood-insurance policies, even though about 10 percent of households are located in the 100- or 500-year floodplain and face substantial risk. And the real number is likely higher, given the inaccuracy of flood maps.

These, too, are fixable problems. To improve NFIP’s effectiveness in recovery, FEMA must strengthen its oversight. The agency must provide clarity to policyholders about payout requirements and increase the number of people who buy flood insurance by updating flood maps and extending the requirement to purchase a policy to homeowners at lower risk of flooding.

Congress has, on numerous occasions, attempted to reform the NFIP so that it would avoid future debt. These efforts have consistently failed, because the financial burden they place on homeowners is so large and so politically unpalatable. As a result, the program has been caught in a cycle of short-term reauthorizations, with debt from Katrina and Sandy keeping it on the proverbial chopping block.

As attempts at reform have demonstrated, big, expensive changes to the program will be unpopular. Still, the NFIP has the potential to create safer communities and help people recover faster and more smoothly. Another way of looking at it: The federal government spent more than $100 billion on the response to and recovery from Katrina, and over $48 billion for Sandy. The NFIP’s debt of $24.6 billion is just what’s left of those bills.

That the NFIP costs American taxpayers money is the result of policy choices made over decades. We decided we weren’t going to pay up-front to avoid climate change, and we decided to build along the coasts and in floodplains. The debt the NFIP has incurred is expensive, and it will continue to grow. But it is only a small fraction of the interest on the loan that we’ve taken out on our future.

The debt also tends to overshadow the real good that the program does for Americans. Nearly 1.8 million losses have been paid out since the program’s inception. Without it, where would these survivors be in their recovery process?

Although the country has been debating whether and how to limit long-term climate change, we have done relatively little to protect ourselves from its consequences that are already here, including more flooding. The NFIP can help us manage the effects of climate change. But for it to be successful, we have to make it more effective and just — which means accepting its financial cost.

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The cost of flood insurance is a price worth paying

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Trump Wants to Let Your Boss Take Away Your Birth Control

by CesarColmenero Posted on May 31, 2017

Mother Jones

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The Trump administration is considering a broad exemption to Obamacare’s mandate on contraceptive coverage, according to a leaked draft of the proposed rule published by Vox on Wednesday.

Since 2011, the Obamacare provision has required that most employers provide insurance that covers birth control, without any cost to the patient. The rule has been the target of a number of lawsuits by religious employers who felt that the requirement violated their religious beliefs. Showing sensitivity to such concerns, in 2014 the Supreme Court ruled in Burwell v. Hobby Lobby that some religious employers could opt out of the coverage. But the court required them to file paperwork indicating their objection, in turn triggering separate contraceptive coverage for employees provided directly by the insurance company. That ruling, though, didn’t settle the issue for religious groups. In a follow-up 2016 Supreme Court case, Zubik v. Burwell, a number of religious organizations said that even this accommodation required them to violate their beliefs, as the paperwork made them complicit in providing birth control coverage. The Supreme Court sent the case down to the lower courts, where it has still not been resolved.

Now, the Trump administration seems ready to extend the birth control exemption beyond just religious employers. According to the leaked draft, dated May 23, the new rule would allow virtually any organization to opt out of the mandate if they feel contraception coverage violates “their religious beliefs and moral convictions.”

“This rule would mean women across the country could be denied insurance coverage for birth control on a whim from their employer or university,” said Dana Singiser, vice president for public policy and government relations of Planned Parenthood Federation of America, in a statement. “It would expand the Supreme Court’s Hobby Lobby ruling to allow any employer—including huge, publicly traded companies—to deny birth control coverage to their employees. Think about it: Under this rule, bosses will be able to impose their personal beliefs on their female employees’ private medical decisions.”

What’s more, this draft doesn’t require employers opting out of the mandate to notify the government they are doing so; they’re only required to notify employees of a change in their insurance plans. Insurance companies could also themselves refuse to cover contraception if it violates their religious or moral beliefs.

This appears to provide an even broader exemption than what team Trump has previously signaled it would enact. Throughout the campaign, Trump assured religious leaders their organizations would not have to comply with the contraception mandate: “I will make absolutely certain religious orders like the Little Sisters of the Poor are not bullied by the federal government because of their religious beliefs,” he wrote in a letter to Catholic leaders last year, referring to the order of nuns that were party to the Zubik Supreme Court case. And on May 4, Trump, flanked by the Little Sisters of the Poor, signed an executive order about religious liberty, which encourages several agencies to address religious employers’ objections to Obamacare’s preventive care requirements, including contraception.

It is unclear what changes may have been made to this draft since May 23, but what is clear is that the rule is in an advanced stage of the process; the Office of Management and Budget announced that it is currently reviewing it, the penultimate step before the rule is enacted via posting in the Federal Register.

You can read the full draft, obtained by Vox, below:

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Preventive Services Final Rule (PDF)

Preventive Services Final Rule (Text)

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Trump Wants to Let Your Boss Take Away Your Birth Control

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Trump Is Playing Chicken With Millions of Health Plans. The Result Might Be a Government Shutdown.

by RoyceSteinmetz Posted on April 18, 2017

Mother Jones

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Members of Congress are home in their districts until next week, but when they come back to town they’ll be facing an imminent government shutdown—unless they manage to pass last-minute legislation to keep federal programs funded. A shutdown now appears a little more likely thanks to some gamesmanship from President Donald Trump over Obamacare that prompted Democrats to issue threats of their own last week.

The showdown involves an Obamacare program know as “cost sharing reduction,” which requires insurance companies to offer discounted copayments and deductibles to low-income people who buy health plans on the individual market. In return, the federal government makes payments to compensate insurers for this expense. Last week, Trump threatened to stop making these payments to insurers—a move that could lead to massive price spikes for millions of people and cause insurers to flee from the individual marketplaces.

By issuing the threat, Trump was attempting to scare Democrats into agreeing to repeal Obamacare. “Obamacare is dead next month if it doesn’t get that money,” Trump told the Wall Street Journal. “I haven’t made my viewpoint clear yet. I don’t want people to get hurt…What I think should happen and will happen is the Democrats will start calling me and negotiating.”

But Trump’s gambit may have backfired. Democratic leaders are now saying they might not vote to keep the government funded next week unless that funding bill includes a provision appropriating money specifically for the cost sharing reductions. “We will not negotiate with hostage takers,” Sen. Ron Wyden (D-Ore.) warned last week.

Democrats may actually have a surprisingly strong negotiating position. Despite controlling both chambers of Congress, the GOP needs their help to keep the government open. Republicans will need support from at least eight Democratic senators in order to avoid a filibuster. And given House Republicans’ penchant for defying party leadership, Speaker of the House Paul Ryan (R-Wisc.) might also need some Democratic votes to overcome conservative objections to the funding bill.

When it comes to the controversies surrounding Obamacare, the cost sharing reduction payments have received relatively little attention. But they are an essential component of how the law makes insurance affordable for lower-income families. For anyone who makes less than 250 percent of the federal poverty line ($30,150 for an individual, $61,500 for a family of four), the government pays insurance companies to lower out-of-pocket costs.

About 58 percent of people who purchase insurance through Obamacare’s marketplaces qualify for the reduced copays and deductibles, totaling more than 7 million people. For consumers, the savings can be substantial. The Kaiser Family Foundation found that for people below 150 percent of the poverty line, average deductibles dropped from $3,609 to $255 thanks to the program. It all adds up to $7 billion in federal spending for 2017, and it’s projected to rise to $10 billion next year and $11 billion in 2019.

The current debate revolves around a quirk in the way the law was written. The Affordable Care Act requires the government to reimburse insurance companies, but lawmakers apparently failed to include a provision to explicitly “appropriate” money for these payments. (It’s not enough for Congress to authorize a program; under the Constitution, Congress must also appropriate funds for a program before the government can spend money on it.) The Obama administration started to dole out the funds anyway, citing a different appropriation authority, but House Republicans objected and sued. A federal judge sided with Republicans last year, though that decision was stayed pending appeal. (The details are too convoluted to explain in full here, but Vox has a great description.)

After Trump won the presidency, House Republicans asked the courts to hold off on the case, since they’re hoping they can end the program by repealing Obamacare. Now, the Trump administration has until May 22 to let the court know if it still plans to appeal the ruling. If Trump chooses, the administration could unilaterally drop the case and let stand the lower court decision barring the payments.

But while the administration can choose to stop making the payments to insurance companies, insurers would still be required to offer discounted policies. On that point, the law is explicit: Insurance companies must reduce out-of-pocket costs for low-income consumers. In other words, they would still have to offer cheaper copays and deductibles—just without the government assistance they were promised.

An analysis by the Kaiser Family Foundation found that, in order to offset those lost funds, insurers would have to increase premiums by 19 percent on average. That increase would not be evenly distributed across the country, though. The rate increase would likely be far less drastic in states that expanded Medicaid under Obamacare, since Medicaid provides government-sponsored insurance to low-income people who would otherwise use the individual marketplaces. North Dakota would see the smallest premium spike if the payments to insurers stopped—a 10-percent increase. By contrast, insurance premiums would rise 27 percent in Mississippi and 25 percent in Florida and Alabama.

It isn’t just Democratic politicians who are crying foul over Trump’s threats. The health care industry industry last week implored Trump to maintain funding for the subsidies. In a letter to the president—signed by the American Medical Association, America’s Health Insurance Plans, BlueCross BlueShield, and the US Chamber of Commerce—industry groups warned that unless Trump makes clear that he’s going to continue the payments, insurers will flee the markets in 2018, and premiums for the remaining options will skyrocket.

“The most critical action to help stabilize the individual market for 2017 and 2018,” the letter says, “is to remove uncertainty about continued funding for cost sharing reductions.”

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Trump Is Playing Chicken With Millions of Health Plans. The Result Might Be a Government Shutdown.

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On Health Care, Republicans Are Caught Between a Rock and a Hard Place

by DessieCowen315 Posted on March 7, 2017

Mother Jones

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The New York Times reports that the Koch brothers are about to unleash the hounds. They. Have. Had. Enough:

Saying their patience is at an end, conservative activist groups backed by the billionaire Koch brothers and other powerful interests on the right are mobilizing to pressure Republicans to fulfill their promise to swiftly repeal the Affordable Care Act.

….The sudden caution of the Republican Party leadership, as it grapples with the enormously complicated challenge of replacing the Affordable Care Act, has baffled conservatives who have been fighting the health law for years. In the House, Republicans have voted dozens of times to dismantle the law, and it has been a primary issue in congressional races since 2010. Repealing the law, many conservative lawmakers believe, is the one clear mandate they have from voters.

….The repeal effort by the conservative groups is intended to sway members of Congress who may be hesitating because of public pressure back home. That pressure, conservatives said, is no reason to renege.

Talk about clueless. Sure, constituent pressure is having an effect, but it’s nowhere near the biggest issue here. The biggest issue is that after voting to dismantle Obamacare dozens of times when they knew it was just a symbolic protest vote, Republicans suddenly have to think about what will happen if they dismantle it in real life. Answer: they now have to admit that they can’t dismantle the whole thing. They never fessed up to that before, so it’s no wonder the base is confused, but the House and Senate leadership have always known it. They can only dismantle the parts related to the budget because Democrats can filibuster the rest. And if Republicans dismantle only half the law, it will probably destroy the individual insurance market.

Oops. That would be bad, even by Republican standards. Plus there’s the fact that millions of people would lose coverage, which is bad by centrist voter standards, even if Republicans don’t really care about it. In other words, the GOP leadership is finally having to face up to the fact that repealing and replacing Obamacare is a tough nut to crack. Centrists will abandon them if they cause chaos, but hardliners will abandon them if they spend too much money. That’s why they’ve agreed to modify their current plan to exclude subsidies for the well-off:

The concession on tax credits is a middle ground between what conservatives were demanding and what leadership wanted. Freedom Caucus Chairman Mark Meadows (R-N.C.) and RSC Chairman Mark Walker (R-N.C.) in recent weeks came out against the GOP plan to replace Obamacare tax subsides with advanceable health care tax credits.

They preferred a tax deduction that would not allow those who don’t pay taxes to receive a check in the mail, calling such “advanceable” credits a “new entitlement.” At the crux of their concerns is the price tag, which they worry would increase the deficit.

A tax deduction, of course, would be useless to the poor and working poor, the very people who need help the most. But the Freedom Caucus doesn’t care about that. Luckily for them, their leadership understands just what a political disaster that would be.

In any case, the Freedom Caucus is right about one thing: advanceable tax credits are a new entitlement. Or, more accurately, a continuation of an old entitlement. There’s really not much difference between Obamacare’s subsidies, which are paid directly to insurance companies, and Ryancare’s tax credits, which are paid to the taxpayer, who then pays the insurance company.

As for the deficit, well, Ryan’s plan will only increase the deficit if Republicans also repeal all of Obamacare’s taxes and then decline to pass any new ones. Which they will. So that’s a legitimate complaint too.

As usual, it all comes down to money. That’s really the only thing that matters.

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On Health Care, Republicans Are Caught Between a Rock and a Hard Place

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Insurers Have Remained Mysteriously Quiet About Obamacare Repeal

by ShawnaKinsela Posted on March 3, 2017

Mother Jones

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A reader emails with a question:

The repeal-Obamacare mania has been on for years, but I have NEVER read anything about what the insurance industry is thinking or doing about it.

Neither have I! And it’s damn mysterious. Obviously the insurance industry was heavily involved in lobbying for Obamacare back in 2009, and just as obviously there are parts of Obamacare they don’t like. The patient pools have turned out to be sicker than they projected and insurance companies have struggled to make money on Obamacare policies. This year, however, they’re finally there—or close to it. The market has shaken out, premiums have risen to CBO-projected levels, and Obamacare is probably a break-even or better prospect for the insurers who have gutted through the first three years.

What’s more, like it or not, they’ve spent years adapting the way they do business. Everything from computer systems to physician compensation now follows Obamacare’s rules. This has cost tens of millions of dollars, but now it’s done. The last thing they need is to rip it all out and start from scratch.

And yet insurance companies have been surprisingly silent about the Republican plan to kill Obamacare. Do they prefer getting rid of it even if there’s an upfront cost? Have they given up, and assume that repeal is a foregone conclusion that’s not worth fighting? Is all their lobbying behind the scenes? It’s not clear. Insurers are pretty unanimous about wanting some certainty in the rules, but aside from that, this eight-week-old story from the New York Times still describes things pretty well:

Far from reflecting the magnitude of the moment, the most prominent message from lobbyists that lawmakers saw in their first week back at work was a narrowly focused advertisement from the U.S. Chamber of Commerce….Health care professionals are not totally silent, but industries that were integral to the creation of the Affordable Care Act in 2010 are keeping their voices down as Republicans rush to dismantle it.

….Some lobbyists have tacitly accepted the likelihood that major provisions of the health law will be repealed, setting their sights instead on shaping its replacement. They fear that if they come out strongly in opposition to repealing the law, they will lose their seats at the table as congressional Republicans and the Trump administration negotiate a replacement.

Insurers spent $150 million lobbying in support of Obamacare in 2009. So far they’ve spent virtually nothing in 2017. I continue to be mystified by this.

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Insurers Have Remained Mysteriously Quiet About Obamacare Repeal

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8 People Who Owe Their Lives to Obamacare

by KristyA6116555 Posted on February 27, 2017

Mother Jones

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President Donald Trump has vowed to dismantle the Affordable Care Act (ACA)â&#128;&#138;—â&#128;&#138;a move that could leave some 30 million Americans without health insurance. ACA literally sustains millions of livesâ&#128;&#138;. Without the health insurance it provides, many people wouldn’t have access to medicine and procedures that they need to survive. When we asked people on Twitter and through healthcare advocacy organizations to share their stories of how ACA keeps them alive, we were overwhelmed with responses. We heard from people waiting for organ transplants, from cancer survivors, from people with debilitating mental illness, and more. They told us about the toll that disease has taken on their lives: Before the ACA, some were forced to skip treatments because of the price; others couldn’t get insurance at all because they were already sick. Here are a few of their stories.

Claudette Williams

Claudette Williams, 58, Orlando, Florida: I lost my job in 2005. After that I decided to purchase a policy. I found them online. They had a gentleman come to my house, and we talked about my blood pressure medications. The insurance was almost twice what they had quoted me because of the medication, and also because of my condition. I eventually couldn’t afford it any more. I was uninsured, except for one year when I qualified for Medicaid. I ended up in the emergency room on a few occasions for heart trouble. I also developed diabetes. I couldn’t afford to have regular mammograms. In 2014 I signed up for Obamacare. I was diagnosed with breast cancer in September of last year. The lumpectomy alone was billed at $40,000. I have four more chemo sessions to go, and after that, I have to do radiation. Luckily my cancer is only a stage one, so my prognosis is pretty good. But it is really scary thinking about my insurance being taken away. This is a fight for my life.

Charis Hill

Charis Hill, 30, California: When I was 25, in 2012, I had a series of unexplained and undiagnosable respiratory challenges that felt like the flu or bronchitis or pneumonia. Doctors just couldn’t figure out what was wrong with me. My condition got worse and worse. I visited urgent care a few times. I thought I was having a heart attack once. They tried to blame it on anxiety.

Eventually reached out to my dad, who was estranged from me. I knew that he had a severe health condition. The first words out of his mouth were, it sounds like you have what I have, which is ankylosing spondylitis (AS). I knew that I would need health insurance to be treated. But if I were to get a diagnosis before getting health insurance, I would have the preexisting condition working against me. So I got the cheapest plan that existed. I wasn’t getting all the tests done or getting all the treatments. Then, ten months later, the ACA was implemented, and because of my income, I was eligible for a subsidy to purchase health insurance on the exchange in California. I got a better plan for less than I was paying before, which meant that I could access more treatment and not skip medication.

I have infusions of a drug every eight weeks. I have to go to an infusion center for 2.5 hours. There’s no generic. There’s no way to get those treatments unless I have insurance. They slow down the progression of my disease. I also take anti-inflammatory medications orally. AS is a severe inflammatory condition. It primarily affects the spine. It causes a lot of pain and fatigue from the body trying to fight that inflammation. I’m permanently disabled. I was a college athlete, and now I’m not even able to run. I use a wheelchair sometimes. As hard as I fight to be healthy, I’m never going to be healthy, and I’m always going to have to rely on the medical system to keep me alive.

John Weiler, 27, Oakland, California: I got HIV when I was 19. When I was in college, I was on my parents health insurance, so when I started meds when I was 21, I took it for granted that I was going to have insurance that would cover it, because it was so easy. When I went to grad school, I naively accepted a position without asking any questions about how the insurance was structured. When you do a science PhD, it’s typical for the school to pay your tuition, pay your health insurance premium, and give you a stipend. In my program, the stipend is about $30,000 a year. So when I enrolled and started to look at my insurance situation, I realized the policy offered to students provided up to $10,000 worth of prescription coverage per academic year, and that was it. But in 2013, the student government got together and petitioned the university to change across the UC system. The students basically said, ‘We don’t care if our insurance premiums are higher, we don’t want these things that the ACA offers to not be part of the insurance plan for the school.’

I was on a med cocktail called Complera, and that one was $22,000 a year. HIV meds are super expensive. I switched to a different medication since then, called Stribild, and I don’t know exactly what it is this year, but if I remember correctly, that one was closer to $27,000 a year.

I’m about to graduate and find a job, and, let’s say worst case scenario, first Congressional session they manage to totally gut the ACA and revert to how things were before. If that were to happen and I were to get a job, it would be totally legal for an employer to be like, ‘Hey, yeah, we’re not covering this.’ I’d be looking at close to $35,000 a year in medical expenses just for maintenance, let alone if I got sick.

Ruth Linehan

Ruth Linehan, 26, Portland, Oregon: I graduated college in May 2012. I was 22. About a month later, I started an internship as a software developer at a Portland startup. Thanks to ACA I was on my parents’ insurance. After four months I was offered a full time job, but the insurance didn’t start until 6 weeks after my first day as an employee. On my first day I was diagnosed with Burkitt’s Lymphoma. I looked like I was 7 months pregnant. I started chemo the day after I was hospitalized. This is an incredibly fast-growing cancer. I was in the hospital for seven weeks. I received about four rounds of chemo. After four months I was declared in remission. I continue to be in remission. The hospital bills were about half a million dollars. I only had to pay about $10,000 because I was on my parents’ insurance.

If I lose my job and the cancer comes back, what am I going to do? I worry about illness down the road. I’ve had cancer at a very young age and a lot of very harsh chemo. I worry that I won’t be able to get affordable insurance, or get insurance at all.

Larry Sterlingshires, 35, Tennessee: I have a condition called hidradenitis surruptiva—look it up, do not look at pictures, because it’s not a good time—it’s a chronic skin condition that’s ultimately debilitating. As it progresses, it causes tissue degradation on the skin layer that doesn’t heal, like normal wounds do. Sometimes it creates lesions that don’t heal for a year and half. It’s debilitating because it’s painful—the tissue underneath is exposed without that protective layer, so it bleeds regularly. You have to keep everything patched and bandaged, and it easily gets infected. But because of the ACA, I can have medication that can’t completely undo the symptoms, but it seems to have halted its progression, and even promoted some healing. Complications related to the tissue damage and infections can be fatal.

The medications I’m on right now, in addition to just my normal medications for diabetes and hypertension, will help me survive longer. This lets me afford something called Claravis, and another medication called Humira. Humira runs approximately $7300 a month, and the Claravis is about $4000 a month. Those basically keep me functional without being completely disabled. That’s no exaggeration. If you check the disability schedule, it’s so painful and considered debilitating enough that you can qualify for full disability with it. The Affordable Care Act covers all of that medication in full. I come from poverty, I’m just now getting used to having insurance for the first time in my adult life, and now that seems like it might evaporate.

Debbie Lynn Smith, 59, Las Vegas, Nevada: I was a TV writer and producer. In 2000 I was diagnosed with bronchiolitis obliterans. It’s also called popcorn lung. I got it from buttered popcorn. When you work in TV, you work 15 hour days. They provide snacks and things. Microwave popcorn is one of the things they give you. I ate a lot of it. It just so happened that I was susceptible to this disease.

I was in remission for 16 years, but I was living with 50 percent of my lung capacity. I couldn’t do TV anymore, couldn’t put in those long hours. I really had a hard time working and being reliable because I would get sick. So I couldn’t get insurance through work. I had insurance through the high-risk California program and I was paying $2,000 a month for that. My husband was on it, too, he had prostate cancer. We moved to Nevada. When the ACA came around we were ecstatic. We were both out of work at the time, so we went on ACA.

This year, in April, my disease came out of remission. I am now down to 30 percent of my lung capacity and waiting for a lung transplant. So you can imagine the fear I have—being so close to getting a transplant—that they might repeal the ACA right away, and I will no longer have access to insurance, and I won’t be able to get my transplant. I am extremely stressed. I was so stressed before the election that I could not take anything else. I was working for Hillary and I ended up in the hospital.

Michele Munro

Michele Munro, 64, Southern California: I was first diagnosed with breast cancer in 1997. I was 44. I was a single mom with two boys. I had Kaiser insurance. It wasn’t a bad cancer, and we caught it early. Then seven years later I was diagnosed with a different type of breast cancer. That was 2004. I also had a hip replacement. The Kaiser premium doubled, so I went without insurance for the first time in years. I was working as a freelancer, and insurers told me I was uninsurable. In 2011, ACA started to kick in. It was not allowing insurance companies to consider preexisting conditions. I applied and was accepted into Aetna. The first thing I did was go for a mammogram, and, sure enough, I had a triple–negative tumor. Very aggressive. It was small and early, so we caught it just in time. I had a double mastectomy and chemotherapy and breast reconstruction, all covered through ACA. I went into the hospital seven times total for infections. The billing was $900,000. Aetna settled and paid out $180,000.

I’m feeling really good right now because December was the fifth anniversary of being cancer-free. I exercise a lot. I’m doing everything I can on my end. But there is only so much you can do. I’m scared for myself, and also for my children. My parents had to claim bankruptcy for health insurance reasons. They were not covered for a medical emergency.

Suzanna Moore, 29, Fairfield, Iowa: When I was a baby, I had a stroke. I recovered well, but I would always have issues afterward. Throughout my childhood, it always a concern if I would have proper health care. I grew up in a pretty poor family in New England. With Obamacare, I went to an orthopedist for the first time in forever and got a prescription for orthotics to alleviate chronic pain in my knees and ankles on one side, because my right side was affected more from the stroke than my left side. The pain built up for a while, but basically throughout my twenties, I was never able to get it addressed, because I was living on my own in Tennessee and was unable to focus any money toward my personal health care.

I also had a meniscus tear during that time. Had I had surgery on that on my own, it would have been like $15,000 or more. With Obamacare, we still had to prioritize, but we didn’t go in debt over it.

My husband has a rare condition called achalasia, which means the muscles in his throat stopped working the way they were supposed to, so he had trouble swallowing and eating. He had to force food down his esophagus with air and water. After a while, it got so painful that he was eating less and he was losing weight rapidly. It was hindering his quality of life, and, left untreated, it could contribute to throat cancer. So he had to have surgery about eight months after I had my knee surgery. We were able to afford all of it. We wouldn’t have been able to do that without Obamacare.

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8 People Who Owe Their Lives to Obamacare

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S&P Says Obamacare Isn’t Failing

by TeriHLMGdow Posted on December 27, 2016

Mother Jones

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S&P says that Obamacare isn’t failing at all:

With better data supported by actual individual market experience, most insurers put in for increased premium pricing for 2016. Also, several insurers introduced narrower network products to control medical costs. Regulatory changes such as tightening the SEP rules also helped this year-over-year improvement. We expect the full-year 2016 underwriting losses to be lower than in 2015 and 2014.

….Insurers have put in meaningful premium rate increases for 2017…but we view 2017 as a one-time pricing correction….For 2017, we believe the continued pricing correction and network design changes, along with regulatory fine-tuning of ACA rules, will result in closer to break-even results, in aggregate, for the individual market, and more insurers reporting profits in this segment.

Hey, how about that! Now that insurers are pricing their coverage about where the CBO expected it to be, they’re starting to move toward profitability. Who could have guessed that?

This reminds me of something. A lot of lefties were unhappy with Obamacare because, in the end, it didn’t include a public option. Thanks, Joe Lieberman! But the truth is that although a public option would have been nice, it’s not really what Obamacare needed. What Obamacare needed was two things:

About twice as much funding.
A higher tax penalty for not buying insurance.

That’s it. But Democrats were fixated on Obamacare costing under $1 trillion (over ten years), and that prevented them from creating a program that people truly would have loved. If, instead, they had supported funding of, say, $2 trillion, generous subsidies would have continued into the working and middle classes; maximum deductibles could have been set much lower; and more insurers would have entered each local market. Combine that with stiffer penalties to back up the individual mandate and a lot more young people would have joined the insurance pools—and would have done so without resentment since the cost would truly be affordable. All of this together would have made Obamacare far more popular with the public and much easier to manage for insurers.

But where would that extra trillion dollars have come from? This is where the hack gap comes into play once again. If this were a Republican plan, and it were something they really wanted, they wouldn’t have bothered with funding. They would have just made up a story about medical inflation coming down (which it is) and broader health coverage leading to improved economic growth blah blah blah. Democrats weren’t willing to do that. Alternatively, they could have just funded a $2 trillion program. That would have meant even higher taxes on the rich and maybe some higher taxes all the way down into the upper middle class. Or maybe a small increase in the payroll tax. Who knows? There are plenty of possibilities.

But Democrats weren’t willing to be hacks and they weren’t willing to raise taxes more than they did. This is despite the fact that the public plainly doesn’t care much about deficits no matter how much they may say so, and the public is positively delighted with higher taxes on the rich. Multiple polls repeatedly show this by a wide margin.

This would have solved virtually every problem Obamacare has had. Higher taxes on the rich would have been a populist winner. Higher funding would have made the program genuinely affordable and far more popular. And the increase in both funding and the mandate penalty would have made the eventual insurance pool closer to what insurers expected, which would have kept them nearer to profitability and truly duking it out to gain market share against their competitors. It was a missed opportunity.

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S&P Says Obamacare Isn’t Failing

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Note From a Conservative: Republicans Can’t Repeal Obamacare on Their Own

by BlondellWisdom Posted on December 16, 2016

Mother Jones

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Conservative Ramesh Ponnuru considers what would happen if Republicans “repealed” Obamacare but left in place the preexisting conditions ban:

This course could cause the insurance exchanges, already in trouble, to collapse entirely. That’s because the Republican bill would scrap the individual mandate while keeping Obamacare’s requirement that insurers treat sick and healthy people alike.

….The Republicans to whom Philip Klein talked are blasé about this possibility. If millions of people lose their coverage, these Republicans plan to say that the exchanges were already collapsing before they touched the law. It seems unlikely that the press will go along with this narrative, in part because many health-care experts, liberal and conservative, will tell reporters that it’s false.

What Republicans have not faced is that they don’t have the votes to repeal Obamacare. Calling a bill that doesn’t repeal Obamacare’s central provisions “repeal” is no escape from that dilemma.

It’s a sign of the times that Ponnuru has to warn Republicans that the press won’t go along with their preferred narrative because it’s a lie. It’s also a bit starry-eyed, unfortunately. The fact that it’s a lie certainly wouldn’t stop the right-wing press; wouldn’t stop Trump; and would quite likely affect the rest of the press at least to the extent of calling it “controversial” and declining to take sides.

That said, Ponnuru is right. If you repeal some of Obamacare but leave the rest in place, it would cause the entire program to collapse. It might even go further, and cause the entire individual insurance market to collapse. Republicans better think hard about whether they want to be on the business end of something like that happening.

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Note From a Conservative: Republicans Can’t Repeal Obamacare on Their Own

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