Tag Archives: medicare

Medicaid Is the Most Widely Used Benefit Program in Existence

by AlyciaLinder Posted on June 3, 2017

Mother Jones

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Aaron Carroll points me to this surprising result from a new Kaiser survey:

Is it really true that 71 percent of Republicans think it’s important to keep ACA’s Medicaid expansion? Yes it is, though with less intensity than Democrats and Independents. Is it because they’re confused and think this is about Medicare? Nope. The question explicitly starts out, “Now thinking specifically about Medicaid, the program for certain low-income adults and children…”

The answer probably lies here:

Even among Republicans, nearly half say Medicaid is personally important to their family. If that’s the case, it’s not really surprising that 71 percent support Medicaid expansion. That includes all the Republicans who think it’s personally important plus another sizeable chunk who have one or more friends who depend on it. (Plus, presumably, some who are unaffected by Medicaid but support it out of ordinary human decency anyway.)

These numbers may seem surprisingly high, but they’re really not. In the Kaiser poll, among all party IDs, 58 percent say that Medicaid is personally important to them and their families. In the US there are, roughly speaking:

68 million Medicaid enrollees
85 million families

If, say, there are 35 million families with one Medicaid enrollee; 10 million with two; and 4 million with three or more; that’s a total of 68 million Medicaid enrollees spread out among 49 million families. And that’s 58 percent of all families.

It’s a big number because Medicaid is the most widely used major benefit program in existence.1 Most people don’t know this.

1I think. It’s more widely used than Social Security (61 million), Medicare (55 million), food stamps (44 million), unemployment insurance (6 million at the height of the recession), the home mortgage deduction (about 60 million), 401(k) plans (about 52 million), IRAs (about 60 million), EITC (26 million), and TANF (about 4 million). Am I missing any major programs?

There is one fly in this ointment: employer health insurance. About 155 million people receive medical coverage through their employers, and they all benefit from the tax advantages of employer health plans. If you count this, then Medicaid is only the second most widely-used benefit program.

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Medicaid Is the Most Widely Used Benefit Program in Existence

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American Health Care Is Expensive. It Will Take Years to Change That.

by LavonRoyston Posted on May 26, 2017

Mother Jones

A couple of days ago I tossed off a late-night post pointing out that health care is expensive, so it’s hardly surprising that estimates of California’s proposed single-payer plan have clocked in at a net additional cost of around $200 billion. That was pretty much my only point, but this post caused quite a…stir…on Twitter from the usual suspects, who were outraged that I hadn’t assumed single-payer would radically slash medical costs. Today, Jon Walker provides a more measured version of the argument:

It is critical to address this weird claim from Drum because the idea that single-payer would cut health care costs isn’t some optimistic liberal talking point. It is a near universal assumption and the main reason achieving single-payer has politically been so difficult. It is the heart of the whole debate.

Again, this is not a liberal idea. The Lewin Group, a health care consulting firm owned by UnitedHealth Group, has repeatedly concluded that single-payer would cut health care costs. For example, they analyzed a single-player plan for Minnesota and concluded, “that the single-payer plan would achieve universal coverage while reducing total health spending for Minnesota by about $4.1 billion, or 8.8 percent.” It reached the same basic conclusion looking at a national single-payer plan in years past.

As it happens, I’ve found Lewin Group estimates in the past to be a little optimistic, but set that aside. I put the ballpark additional cost of national single-payer health care at $1.5 trillion, but if someone wants to assume it would be $1.36 trillion instead, that’s fine. That’s still in the ballpark. More important, though, is this chart, which accompanies that Lewin report on Minnesota:

This is basically right. As I mentioned in the original post, “If we’re lucky, a good single-payer system would slow the growth of health care costs over the long term, but it’s vanishingly unlikely to actually cut current costs.” And that’s pretty much what Lewin shows. The initial cost saving is small, but the cost containment measures inherent in a government-funded plan push the cost curve down over time. Their estimate is that within a decade Minnesota’s proposed plan would have been a third less expensive than business-as-usual. This is roughly what I’d expect for a national single-payer plan too.

Is it technically possible to cut initial spending more? Sure. We could nationalize the whole medical industry, cut nurse and doctor pay by a third across the board, and create a mandatory formulary for drugs at a tenth of the price we currently pay. When the revolution comes, maybe that will happen—and doctors and pharma executives will be grateful we didn’t just take them out and shoot them. In the meantime, I’m more interested in real-world movements toward single payer. Obamacare was a good start. Adding a public option would be another step. Medicare for all might be next. And something better than Medicare would be the final step. That will be hard enough even if we don’t make mortal enemies out of every single player in the health care market.

Roughly speaking, if we adopted national single-payer health care today it would cost us an additional $1.5 trillion in taxes. That’s reality, and as a good social democrat I’m fine with that. In theory, after all, my taxes might go up 30 percent, but Mother Jones will also increase my salary 30 percent because they no longer have to provide me with health insurance. Roughly speaking, this would be a good deal for half the country, which pays very little in income taxes; a wash for another third; and a loss for the top 10 percent, whose taxes would go up more than the cost of the health insurance they currently receive. If we decide to tax corporations instead of individuals, the incidence of the tax would pass through to individuals in a pretty similar way.

So that’s that. I don’t believe in Santa Claus, and I don’t believe that we can pass a bill that slashes health care costs to European levels. They’ve had decades of cost containment that got them to where they are. We, unfortunately, haven’t, so we have to start with our current cost structure. One way or another, that’s what we have to deal with.

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American Health Care Is Expensive. It Will Take Years to Change That.

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Slavitt: Obamacare Should Be Profitable This Year if Republicans Don’t Blow It Up

by TyreeP48paejrf Posted on February 10, 2017

Mother Jones

Andy Slavitt ran the Centers for Medicare and Medicaid Services under President Obama, which included responsibility for Obamacare. Here’s a tweetstorm he posted today:

I talked today/last night to 5 health plan CEOs. Won’t use names but: 1 Blues, 1 integrated w hospital, 2 non-profit, 1 VC backed. All 5 health plan CEOs believe they priced 2017 #ACA business & should at least breakeven. Several of the plans beat their ACA membership projections.

Of the 5 plans, w/ current uncertainty none can yet commit 2 participate in 2018. All seemed aware that new #ACA stability reg is coming. One plan said with all the work to be profitable in the #ACA (they hadn’t been), ironic to question participation now.

….They didn’t say, but I will: if there is ambiguity, they will raise prices if they participate. One CEO who has an actuarial background said he would be at single digit rate increases but for all the uncertainty. It sounds like the plans will submit #ACA rates for 2018 high to hold place in line. Big increases all from repeal & mandate uncertainty.

It is a shame. Not sure if representative, but single digit if we would wipe uncertainty off table. Still can. But needs to be fast….I think people are so weary of the unpredictability of politics. It zaps energy from their real jobs.

We don’t yet have final enrollment figures for 2017, but it appears that even with double-digit rate increases, uncertainty over Republican repeal plans, and deliberate sabotage from the new Trump administration, signups will be only 2-3 percent lower than last year. That’s a pretty stable market, and probably a profitable—or at least breakeven—one. Fairly modest changes could fix a lot of Obamacare’s existing problems, and higher funding could fix the rest of them.

Instead, we have massive uncertainty in an industry that felt like things had finally settled down after years of work. Slavitt is right: it’s a shame. We can only hope that Republicans will wake up and decide that repairing Obamacare and then taking credit for its success is a better path than blowing up the entire individual health insurance market.

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Slavitt: Obamacare Should Be Profitable This Year if Republicans Don’t Blow It Up

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We Are Seeing a Return of the Mayberry Machiavellis

by whitfieldElder Posted on February 8, 2017

Mother Jones

Consider the following three things that have happened in the past month:

After years of promising to repeal Obamacare, Republicans finally have the power to do it. But they’ve suddenly discovered that it’s going to be a lot harder than they thought.
President Trump kept his campaign promise to institute “extreme vetting” of refugees and visitors to the US, but the rollout was bungled so horribly that he’s losing support for it even among Republicans.
Last week Trump approved his first military operation. It was a disaster. The evidence here is a bit murky, but it suggests that the raid was vetted less stringently than usual because of Trump’s desire to cut through red tape and give the military more freedom to fight terrorism.

These are examples of what Barack Obama was talking about when he told Trump that “reality has a way of asserting itself.” More generally, it’s the result of a Republican Party that has been averse to policy for a very long time. They have principles and beliefs, but they don’t spend much time thinking hard about how to implement those principles in the most efficient possible way.

They believe that Obamacare is a failure. They believe that immigration should be shut down. They believe the military should be unleashed. But these are just bumper stickers. They haven’t spent much time developing serious policy responses on these topics because (a) that would give Democrats something concrete to attack, (b) their base likes bumper stickers, and (c) policy analysis has a habit of highlighting problems with ideological purity and pushing solutions toward the center.1

George W. Bush had the same problem with policy. Remember what John Dilulio said in his famous “Mayberry Machiavellis” letter to Ron Suskind?

In eight months, I heard many, many staff discussions, but not three meaningful, substantive policy discussions. There were no actual policy white papers on domestic issues. There were, truth be told, only a couple of people in the West Wing who worried at all about policy substance and analysis, and they were even more overworked than the stereotypical, nonstop, 20-hour-a-day White House staff. Every modern presidency moves on the fly, but, on social policy and related issues, the lack of even basic policy knowledge, and the only casual interest in knowing more, was somewhat breathtaking — discussions by fairly senior people who meant Medicaid but were talking Medicare; near-instant shifts from discussing any actual policy pros and cons to discussing political communications, media strategy, et cetera. Even quite junior staff would sometimes hear quite senior staff pooh-pooh any need to dig deeper for pertinent information on a given issue.

This problem is now a couple of decades old and shows no signs of abating. Quite the opposite: Donald Trump makes Bush look like an analytical genius. But even on their own terms, conservative rule is going to end disastrously if both Trump and congressional Republicans don’t spend a little more time on policy analysis and implementation issues. There are only so many disasters that even their own base will put up with.

1Democrats, arguably, have the opposite problem—too much regard for policy analysis—which is why lefties are often so contemptuous of them.

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We Are Seeing a Return of the Mayberry Machiavellis

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Why Do Republicans Hate Obamacare?

by evelyne6707 Posted on January 16, 2017

Mother Jones

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Why are Republicans so hellbent on repealing Obamacare? This came up on Twitter the other day, and at first it sounds like a silly question. They’ve been opposed to Obamacare from the start, and they’ve been vocal about what they don’t like.

But it’s a more interesting question than it seems. After all, we no longer have to guess about its effects. We know. So let’s take a look.

The Good. Obamacare has provided more than 20 million people—most of them low-income or working class—with health coverage. It has done this with no negative effects on either Medicare or the employer health insurance market. It didn’t raise taxes more than a few pennies on anyone making less than six figures. It’s had no effect on the willingness of companies to hire full-time workers. Health care costs under Obamacare have continued to grow at very modest rates. And it’s accomplished all this under its original budget.

The Bad. Obamacare unquestionably has some problems. About 20 percent of its customers choose Bronze plans with very high deductibles. Some of the least expensive plans have narrow networks that restrict your choice of doctor. Some insurers have left the exchanges because they were losing money. And premium increases have been volatile as insurers have learned the market. But every one of these things is a result of Obamacare’s reliance on private markets, something that Republicans support. Insurers are competing. They’re offering plans with different features at different price points. Some of them are successful and some aren’t. That’s how markets work. It’s messy, but eventually things settle down and provide the best set of services at the best possible price.

The Popular. Obamacare is popular unless you call it “Obamacare.” If you call it Kynect, its negatives drop. If you call it the Affordable Care Act, its negatives drop. If you ask about the actual things it does, virtually every provision is popular among Democrats and Republicans alike. Even Obamacare’s taxes on the rich, which are fairly modest, are popular. Aside from the individual mandate, the only truly unpopular part of Obamacare is the name “Obamacare.” (And even that’s only unpopular among Republicans.)

So why the continued rabid opposition to Obamacare? It’s not because the government has taken over the health care market. On the contrary, Obamacare affects only a tiny part of the health insurance market and mostly relies on taking advantage of existing market forces. It’s not because the benefits are too stingy. That’s because Democrats kept funding at modest levels, something Republicans approve of. It’s not because premiums are out of control. Republicans know perfectly well that premiums have simply caught up to CBO projections this year—and federal subsidies protect most people from increases anyway. It’s not because everyone hates what Obamacare does. Even Republicans mostly like it. The GOP leadership in Congress could pass a virtually identical bill under a different name and it would be wildly popular.

In the end, somehow, this really seems to be the answer:

Republicans hate the idea that we’re spending money on the working class and the poor. They hate the idea that Barack Obama is responsible for a pretty successful program. They hate the idea that taxes on the wealthy went up a bit. They hate the idea that a social welfare program can do a lot of good for a lot of people at a fairly modest price.

What kind of person hates all these things?

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Why Do Republicans Hate Obamacare?

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Here’s How Obama Is Trump-Proofing His Legacy

by ShannonZaleski Posted on December 29, 2016

Mother Jones

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So what has President Obama done over the past month to get a few last-minute liberal priorities in place before Donald Trump takes over? Obama has moved forward on eight substantial executive actions so far:

Enacted a permanent ban on offshore oil and gas drilling in areas of the Arctic and the Atlantic Seaboard.
Refused to veto a UN resolution condemning Israel’s settlements in the West Bank.
Designated two new national monuments totalling more than 1.6 million acres: Bears Ears Buttes in southeastern Utah and Gold Butte in Nevada.
Instructed the Department of Homeland Security to formally end the long-disused NSEERs database, which Trump could have revived as the backbone of a new Muslim registry.
Instructed the Army Corps of Engineers to deny final permits for the Dakota Access Pipeline where it crosses the Missouri River near the Standing Rock Sioux reservation.
Issued a final rule that bans the practice among some red states of withholding federal family-planning funds from Planned Parenthood and other health clinics that provide abortions.
Finalized rules to determine whether schools were succeeding or failing under the Every Student Succeeds Act.
Began an investigation into charges of Russian hacking during the presidential campaign.

This last-minute flurry of activity is actually fairly normal, but Trump is annoyed anyway, saying he’s doing his best to “disregard the many inflammatory President O statements and roadblocks.” Too bad, Donald: there’s more to come. According to Politico, “As many as 98 final regulations under review at the White House as of Nov. 15 could be implemented before Trump takes office. Seventeen regulations awaiting final approval are considered “economically significant,” with an estimated economic impact of at least $100 million a year.” Here are fifteen of the most important ones:

A new policy making it easier to hire and retain highly skilled immigrants.
A new rule forcing state regulators to tighten oversight of for-profit colleges that operate online courses in their state.
New energy efficiency standards.
Regulations designed to discourage speculation on commodities trading.
A new rule that would regulate air pollution from the oil industry.
A change in the way Medicare drug payments are administered.
Reform of Medicare payments to doctors, moving toward a system that better evaluates the quality of care they provide.
Finishing up an investment treaty with China (though it would require Senate approval in 2017).
Speeding through a backlog of debt relief claims from students at ITT Tech and Corinthian Colleges, two for-profit colleges that went out of business under pressure from the Obama administration.
A ban on cellphone calls on commercial flights.
A rule requiring that most freight trains have at least two crew members on duty.
Rules for the 2018 version of the Obamacare state insurance marketplaces.
Regulation of methane releases from oil and natural gas wells.
A major rule on leases for wind and solar projects on federal land.
A rule that aims to ensure poor and minority students get their fair share of state and local education funding.

Some of these actions could be overturned either by Trump or by Congress, but not all of them. Congress is restrained by the fact that it has limited floor time to review new rules. Trump is restrained because agency rules go through a lengthy rulemaking process before they’re finalized, and he would have to start up this entire process all over again to repeal them.

Of course, all of these actions are also susceptible to court fights, just as they always are. There’s no telling how that might turn out.

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Here’s How Obama Is Trump-Proofing His Legacy

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How Trump’s Deportation Plans Could Damage Our Economy

by Leatha5457 Posted on December 18, 2016

Mother Jones

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In 2012, President Barack Obama issued an executive order establishing Deferred Action for Childhood Arrivals (DACA), which allows undocumented immigrants who were brought to the United States as children to apply for two-year work permits and exemptions from deportation. They initially were able to renew their DACA status for a second two-year period, which was later expanded to three years. The immigration plan that President-elect Donald Trump issued during his campaign for presidency calls for ending DACA, describing it as “illegal executive amnesty.” Now, a new report by the Immigrant Legal Resource Center outlines the possible economic effects that could occur if the Trump administration follows through on its proposed elimination of DACA.

As of June 2016, DACA has granted thousands of undocumented immigrants who came to the United States as children the ability to get jobs legally, according to the Immigrant Legal Resource Center. Of the 741,546 people in the program, 87 percent are currently employed. A June 2015 survey of the economic and educational effects of DACA by a political scientist from the University of California-San Diego and the National Immigration Law Center showed that DACA both improved the lives of recipients and was good for the US economy. The higher wages that DACA recipients earn have translated into increased tax revenue and economic growth for the United States. According to a September 2016 study by the Center for American Progress, ending DACA would mean a $433 billion reduction of the nation’s GDP over a decade.

This week, the Immigrant Legal Resource Center, a national nonprofit resource center that provides legal trainings and other resources for immigrant rights, has published a report using data on the program until June, 2016 that outlines the possible economic effects on Social Security and Medicare, and the costs to employers, if DACA is completely abolished.

The total contributions to Social Security and Medicare would be reduced by a little more than $24 billion over a decade—$19.9 billion would be lost to Social Security and there would be a $4.6 billion drop to the overall contributions to the Federal Insurance Contributions Act. (FICA requires contributions from both employees and employers for Social Security and Medicare, so the reduction of a significant number of employees overall would also mean a drastic drop in contributions.) Also, employers could potentially suffer. About 645,145 DACA recipients would lose their employment authorization, and those layoffs would cost employers at least $3.4 billion in recruitment and training costs for replacing those employees.

Trump has not backed off the idea of ending DACA. But he told Time that he would have a plan for undocumented immigrants “that’s going to make people happy and proud.”

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How Trump’s Deportation Plans Could Damage Our Economy

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Now Even Conservatives Are Calling Them "Tax Cuts For the Rich"

by SteffenWheen Posted on December 17, 2016

Mother Jones

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National Review editor Rich Lowry thinks that although Donald Trump’s fans love his populist blather, they might start to lose patience with some of the big programs that Congress tries to pass. For example:

Obamacare “repeal” without a replacement, a deficit-increasing traditional Republican “tax cut for the rich,” and even — although this is much less likely — Medicare reform. Trump may find his political capital depleting rapidly in the cause of passing conventional Republican legislation that isn’t as important to him as his populist calling cards.

I don’t want to make too much of this, but when was the last time you heard a conservative, let alone the editor of NR, refer to tax reform as a “traditional Republican” “tax cut for the rich”? That’s the way liberals jeer at supply-side voodoo. Conservatives insist that tax cuts like Trump’s (or Paul Ryan’s) are “broad based,” “capital deepening,” and “job creating.” They are most definitely not “tax cuts for the rich.”

But now they are. What does this mean?

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Now Even Conservatives Are Calling Them "Tax Cuts For the Rich"

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The House GOP Just Revealed Its Plan To Cut Social Security

by KelleeKarr3 Posted on December 9, 2016

Mother Jones

Late Thursday, Congressman Sam Johnson (R-TX), the Chairman of the House Social Security subcommittee, introduced a bill to “reform” (i.e. cut) Social Security.

Josh Marshall warns, “Republicans apparently aren’t going to be satisfied with phasing out Medicare. They’re going to try to pass huge cuts to Social Security this year too. Not Bush-style partial phaseout but just big, big cuts. And you’re out of luck even if you’re a current beneficiary. “

The Washington Examiner describes it thusly:

The bill…would reduce costs by changing the benefits formula to reduce payments progressively for high earners. It would also gradually raise the full retirement age from 67 to 69 for people who are today 49 or younger. Lastly, it would change the inflation metric used to calculate benefits to one that shows lower inflation, essentially slowing the growth in benefits, and eliminate cost of living adjustments for high earners.

You can read the full bill below. Democrats are not pleased.

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The House GOP Just Revealed Its Plan To Cut Social Security

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This Is the Only Recent Time Jeff Sessions Voted to Expand Health Care Coverage

by HoracioLee Posted on November 18, 2016

Mother Jones

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President-elect Donald Trump’s pick to be attorney general, Sen. Jeff Sessions (R-Ala.), has voted numerous times against expanded access to health care. He has cast just one vote in recent years to expand health care access. The group he believed deserved better access to coverage? Fetuses.

In 2008, Sessions voted yes on an amendment to remove pregnant women from the State Children’s Health Insurance Program (SCHIP) and instead give coverage to the fetus. At the time of the vote, Sen. Dianne Feinstein (D-Calif.) described the amendment as follows: “It takes it away from the woman and gives it to the fetus. Now, if the woman is pregnant in an accident, loses the child, she does not get coverage, the child gets coverage.” The amendment failed, with 46 senators voting for it and 52 against it.

It’s the only time in recent years that Sessions has voted in favor of expanding health care coverage—if you can call it that. He voted against expanding access to care for low-income people under Medicare and Medicaid in 2008, against expanding SCHIP to four million children in 2009, and against the Affordable Care Act in 2010. The clear difference, of course, is that Sessions’ vote for fetuses wasn’t really a health care vote; it was an anti-abortion vote.

If confirmed as attorney general, Sessions would have a huge say on the issues of abortion and women’s reproductive health care. Sessions could choose to investigate Planned Parenthood, for example, and defend state and federal policies that make it harder for women to access an abortion or reproductive care.

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This Is the Only Recent Time Jeff Sessions Voted to Expand Health Care Coverage

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