Tag Archives: obamacare

Obama Should Have Personally Announced the Latest Obamacare Deadline Extension

by JosephineCandel Posted on March 27, 2014

Mother Jones

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Chris Hayes used his program tonight to highlight a deadline extension for a health care program—one that happened back in 2006. Here’s how Knight Ridder reported it at the time:

With pressure mounting to extend next Monday’s enrollment deadline for the Medicare prescription-drug benefit, the Bush administration took another small step in that direction Tuesday, waiving penalty fees for very low-income seniors and people with disabilities who sign up late….The move follows a recent administration decision to allow the same impoverished beneficiaries to sign up for Medicare drug coverage until Dec. 31.

“In other words, you can apply after May 15th without penalty. And that’s important for low-income seniors to understand,” President Bush told a group of older Americans in Sun City Center, Fla., on Tuesday.

This is mostly being used to show Republican hypocrisy. They’re all yelling and screaming about President Obama’s “lawlessness” in extending the deadline for Obamacare signups, but none of them uttered a peep of protest when President Bush did the same thing. What a bunch of partisan hacks.

And fair enough. But I have a different lesson to take from this: You’ll notice that Bush treated his extension like something worth taking credit for. He personally announced it. In a speech. That showed up on television. And people heard about it because the press pays more attention to things when the president says them.

Obama’s deadline extension, by contrast, was passively conveyed to the media via anonymous “administration officials.” Granted, Obama is in Europe at the moment, and maybe he’ll say something personally when he gets back. But even if he does, it’ll be old news by then and nobody will bother with it.

That’s a missed opportunity. And it’s especially unfortunate given today’s news that 61 percent of the currently uninsured are unaware of the March 31 deadline. It sure seems like the deadline extension would have been a handy excuse to put the president in front of the cameras to tell everyone that they had only a few days left to start the signup process.

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Obama Should Have Personally Announced the Latest Obamacare Deadline Extension

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Narrow Networks Are Going to Bite a Lot of Obamacare Customers

by JulianneR05 Posted on March 26, 2014

Mother Jones

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A few days ago, reader JF sent me an email about a problem he’s had with his new Obamacare policy:

I’m a single dad living in LA. I have been underemployed/unemployed for the past few years, and until January had been paying through the nose for an individual policy for myself and my son. I am very familiar with the ins and outs of health insurance and I’m used to checking with every provider beforehand to quantify out of pocket costs. It was a godsend to have affordable insurance as of January. I qualified for a heavily subsidized Silver plan. I want the ACA to work, and to work well.

It didn’t for me. Here’s what happened. The first time I sought care under my new policy it was in January for a standard annual checkup. I’m a healthy guy so for me it’s a few questions from the doctor and then they draw blood. My ACA plan allowed me to get this care with a co-pay of $3.

Then I got the bill from the blood lab for $800. The doctor sent it to a lab outside the ACA network. Yeah, I know, I could have double checked with the doc to make sure the blood was sent to an in-network lab (I had already checked once). Bottom line is that a CBC blood test is going to cost me EIGHT MONTHS worth of my subsidized insurance premiums.

Here’s the bad story on the horizon: Imagine what’s going to happen when millions of newly insured people, not savvy about how to police health care costs, start to get bills that far exceed what CoveredCA or healthcare.gov promised them? “My Obamacare policy cost me $800 for a blood test” is the next headline. It’s in line with the horror stories from Steven Brill last year.

I think progressives need to start talking about this because it should be addressed by our side, not just to avoid mid-term election embarrassment, but because poor folks can be harmed by it. Hand waving this away as “we got poor people insurance, our job is done” is a mistake.

How common are experiences like this? Common enough that a recent Commonwealth Fund report explicitly addresses this precise problem. Andrew Sprung saw the report, and it triggered his memory about a similar problem he had a few years ago when he checked himself into an ER with chest pains:

The ER team decided to keep me overnight and informed me that I would be checking out against advice if I left early. By the time I’d had two EKGs it was clear nothing was wrong with my heart, but I subjected myself to a CT-scan with stress test, an ultrasound, and a $20k tab of which we paid nothing except maybe a $100 deductible (and which the self-insured hospital network essentially paid itself, I suppose).

So I was weak and foolish — with one exception. At the beginning, I had to sign a release agreeing to pay for any out-of-network care I received in-hospital. The attending doctor was at hand at the time. I asked him if he was in-network. He said he didn’t know. I said, how can you not know? He said his office dealt with “hundreds” of insurance plans. He offered to check. I said please do. He came back a few minutes later and said he had confirmed that he accepted the insurance plan provided to employees of the hospital he was standing in.

So there are several lessons here. First, narrow networks aren’t unique to Obamacare. They’ve been a growing problem with private insurance plans for years (see chart on right). Second, it gets worse with Obamacare in some states because of the narrow networks supported by nearly all ACA insurers. JF confirmed to me that he had a Blue Shield plan, but that’s not the whole story. “The blood lab in question is in network for Blue Shield, but not for Blue Shield CoveredCA plans, as per everyone I’ve spoken to about it.”

Third, it’s really hard to be alert enough all the time to avoid this. You have to remember to ask every time. You have to ask every doctor, and you have to ask for every lab test. And most doctors don’t know, and don’t really want to be bothered finding out. So you have to be very, very persistent.

And most of us aren’t very, very persistent. Especially if, say, we’re in an ER worried that chest pains might be an indication of an oncoming heart attack.

How big a deal is this? I don’t have any way of knowing. But JF is certainly right that it’s the kind of thing that can give Obamacare a bad name if it happens often enough. Unfortunately, there’s no plausible legislative tweak to address this, since Republicans are implacably opposed to improving Obamacare in any way, shape, or form. At best, there might be a way to partially address it with HHS regulations.

In any case, buyer beware. If you have any kind of health coverage at all, this is probably something to keep in mind. If you have an Obamacare policy, especially in a narrow-network state like California, it’s something to keep doubly in mind.

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Narrow Networks Are Going to Bite a Lot of Obamacare Customers

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Opposition to Obamacare Remains Under 40 Percent, the Same as Always

by LesterCook Posted on March 11, 2014

Mother Jones

Greg Sargent points us to the latest CNN poll on Obamacare today, one of the few polls that accurately judges public attitudes on the subject. Instead of just asking whether people support or oppose the law, CNN asks if their opposition is because the law is too liberal or not liberal enough. The latter aren’t tea partiers who hate Obamacare, they’re lefties and Democrats who mostly support the concept of Obamacare but want it to go further. Counting them as opponents of Obamacare has always been seriously misleading.

I went ahead and charted CNN’s poll results over time, and they’ve been remarkably stable. Ever since the law passed, about 40 percent of the country has opposed it, while more than 50 percent have either supported it or said they want it to go even further. This goes a long way toward explaining the supposedly mysterious result that lots of people oppose Obamacare but few want to repeal it. The truth is that actual opposition has always been a minority view. Polls routinely show that only about 40 percent of Americans want to repeal Obamacare, and there’s nothing mysterious about that once you understand that this is also the level of actual opposition to the law.

Sargent has more here, including some interesting internals and crosstabs.

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Opposition to Obamacare Remains Under 40 Percent, the Same as Always

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The Latest Obamacare Extension Won’t Have Much of an Impact

by yiszkj53 Posted on March 6, 2014

Mother Jones

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Adrianna McIntyre agrees that the optics and legality of allowing consumers to extend old health care policies is dodgy. However, she also thinks that its practical impact is pretty slight:

Senior officials reported that some 1.5 million people might be eligible for the latest administrative tweak to the Affordable Care Act, an extension of the “like it/keep it” fix that would permit individuals to maintain plans that don’t meet new coverage requirements through October 2017. The move has already been roundly criticized, but I’m inclined to believe the substantive policy impact will be small.

The thing about the individual market is that it’s volatile. The Kaiser Family Foundation found that about a third of those enrolled in nongroup plans exit within six months. Fewer than half remain after two years. This coverage is transitory for many, a bridge between employer-sponsored plans or other forms of insurance. Since the “fix” only applies to people maintaining these plans, the population eligible for the extension will dwindle over time.

There’s a fear that individuals who cling to old, less generous plans are healthier than those who already jumped to the exchanges. That might be true, but it also probably doesn’t matter much. CBO estimates that the exchange population will swell to 22 million by 2016 as people become more aware of coverage options and the penalty becomes more severe. The specter of adverse selection fades pretty fast when you set 1.5 million—a number that will erode over the life of the administrative fix—in that context.

Actually, according to research published in Health Affairs, only 17 percent of those with individual coverage keep it for more than 24 months. In other words, by the end of 2015, the number of people affected by this extension will be down to about 250,000 at most. That’s not enough to affect the overall operation of Obamacare very much, and it’s also a small enough number that pushback will be pretty slight by the time those remaining few folks are forced to switch to different plans. This is obviously what makes it politically attractive to the Obama administration.

Bottom line: it’s legally a little dodgy but practically of little consequence. Probably not something to get too worked up about.

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The Latest Obamacare Extension Won’t Have Much of an Impact

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Watch: Patrick Stewart Satirizes Fake Obamacare Horror Stories With Stephen Colbert

by Tamera4915 Posted on March 4, 2014

Mother Jones

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English actor Patrick Stewart appeared on The Colbert Report Monday to lampoon the ongoing series of fake Obamacare horror stories. Stewart plays “actual Louisiana resident” Chuck Duprey, an “average American Joe” and “supposed non-actor.” When howling about his health insurance woes, he says that his problems are “ALL BECAUSE OF THE AFFORDABLE CARE…line?”

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(The Colbert segment ends with “Chuck” dying while shouting, “repeal…and…replace!”)

On Monday night, Stewart tweeted this pic:

Stewart went on The Daily Show last year to talk about his famous lobster costume and how Sen. Rand Paul (R-Ky.) and Toronto Mayor Rob Ford are basically comedians with “bad script writers.” Stewart has also worked with the Ring the Bell campaign (a movement that calls on men and boys to help end violence against women), and stars in several Amnesty International videos on violence against women, including this one in which he discusses growing up in a violent household:

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Watch: Patrick Stewart Satirizes Fake Obamacare Horror Stories With Stephen Colbert

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Obamacare Signups From the Uninsured Appear to Be Surging

by GonzaloQuiros Posted on February 19, 2014

Mother Jones

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Out of all the Obamacare signups to date, how many are from people who were previously uninsured? Extrapolating from signups in New York, Charles Gaba provides the following estimates:

October, November, December — perhaps 50% of 2.15 million = 1.075 million previously uninsured
January — perhaps 75% of 1.15 million = 863,000 previously uninsured
February — probably 90% out of, say, 700,000 = 630,000 previously uninsured
March — probably at least 95% out of (unknown number, depends on strength of the expected “March surge”…assume 1.0 – 1.5 million?) = perhaps 0.9 – 1.4 million previously uninsured

Unsurprisingly, people who were already insured dominated the early signups. Since the beginning of 2013, however, it’s mostly been people who are getting insurance for the first time. If Gaba is right, by March we’ll have about 4 million workers who are newly insured via private plans, plus several more millions who have newly qualified for Medicaid. It’s a start.

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Obamacare Signups From the Uninsured Appear to Be Surging

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Here’s How Democrats and Republicans Could End Up Agreeing on a Compromise Replacement for Obamacare

by JosefinaDenby Posted on February 10, 2014

Mother Jones

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Now that the Coburn-Burr-Hatch health care proposal is on the table, it’s safe to say that the GOP has finally started inching away from its obsession with repealing Obamacare and leaving only a smoking husk in its place. Even if CBH goes nowhere, it’s a sign that at least some Republicans are starting to grapple with the reality that their only option now is to offer up an alternative that’s based on reforming Obamacare, not killing it outright.

So what options are realistically on the table? Andrew Sprung talked with a couple of moderate liberals and one moderate conservative to see how much common ground there might be around a proposal that uses Obamacare as a base but makes substantial changes to it. Here is Yevgeniy Feyman of the Manhattan Institute, our designated conservative:

Feyman enthusiastically embraces CBH as a vehicle for more thoroughgoing reform. Paradoxically, he sees the possibilities for conservative redesign widening, not because supporters of the ACA have been weakened, but because the Tea Party has. The CBH rollout signals that some Republicans at least are ready to deal.

“We’ve seen the hardliners lose a good deal of influence since the shutdown,” Feyman said. “If they don’t gain more seats and influence, I imagine that a bill like this could pass.” Feyman is most excited by the prospect of maintaining subsidies for private insurance but ending the state exchanges’ monopoly of subsidized plans….”In the employer market,” Feyman said, “exchanges are doing a great job directing employees into best locations for care,” providing cost and quality information and incentives to chose the cheapest and best. He would like to see states encourage private exchanges in the individual market, and innovate in other ways, such as providing services that help consumers track their spending or set up HSAs.

The whole piece is longish, but worth a read if you want to dive into the details of possible Obamacare compromises. In my mind, the big question that underlies this is: Why should Democrats even think about making a deal? After all, Obamacare is safe at least through 2016, and almost certainly longer. Even in the unlikely event of a Republican sweep in 2016, they’d still have to deal with two things: Democratic filibusters in the Senate and enormous institutional resistance to changing a program that’s been in place for years. Nobody in the health care industry is going to support big changes after spending half a decade massively modifying their businesses to comply with Obamacare.

The answer, probably, is twofold. First, a compromise would represent a peace of sorts and would truly solidify Obamacare’s survival. Second, Democrats might get some things they want. Donald Taylor, for example, wants to see Obamacare and Medicaid expansion accepted in the South:

For Taylor, a lifelong southerner, the imperative to expand health insurance access in the South is personal….“If I were to argue for negotiation from a pro-ACA perspective,” Taylor said, “I’d be most worried about the uneven rollout, with the South left out. I’d look to come up with some way to make the South willing to expand insurance coverage.”

….”Medicaid expansion is not that consequential in California or Massachusetts where eligibility was already extensive pre-ACA, but in North Carolina, you could cover a half million people in a year, and that’s a huge change. You can leverage $4.1 billion in federal money in 2016 alone. It’s painful to watch that deal go begging.”

I’m not especially optimistic about any of this happening anytime soon. Or even anytime not so soon. On the Republican side there’s just too much tea party energy dedicated to the idea that any compromise is a sellout, and on the Democratic side it’s hard to imagine a compromise deal that would provide enough benefits to make up for Republican demands. But it’s not completely out of the question. If you read Sprung’s piece you’ll know enough to make up your own mind.

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Here’s How Democrats and Republicans Could End Up Agreeing on a Compromise Replacement for Obamacare

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Let’s Get Our Obamacare Story Straight, Folks

by KaseyF15hapa Posted on February 5, 2014

Mother Jones

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Having just berated the nation’s news media for credulously reporting that Obamacare would result in the “loss” of 2 million jobs, I want to push back a bit in the other direction too. Here is Paul Krugman explaining that Obamacare doesn’t destroy jobs, but it does give people more freedom to work fewer hours without fear of losing access to the health care system:

The basic point here is that we started with a system in which incentives were already strongly distorted by the deductibility of employer-paid health insurance premiums. This was a significant benefit, but one in general available only to full-time workers….What we had here was [] a system in which subsidies were available only if you worked more than a certain amount, surely leading some people to work more than they would have wanted to otherwise.

And that’s not a hypothetical — I know a fair number of people in just that situation. I also know some people in “job lock” — feeling trapped in their current job because they aren’t sure they could get implicitly subsidized health insurance if they moved.

Plenty of other liberals have made similar points, and there’s no question that there’s a kernel of truth to it. Someone who’s 62 might retire early because they know they can buy health insurance while they wait for Medicare to kick in. A young worker who wants to start up her own company might be more likely to do it knowing that she can still get coverage for a pre-existing condition. People who lose their jobs might hold out longer for good replacements if they know they can continue to get affordable health coverage while they look.

But the CBO report was pretty clear that this is not really the main channel by which Obamacare reduces employment. It mostly reduces total hours of employment among the poor, which is why it estimates that employment will go down 2 percent but total compensation will only go down 1 percent. And the channel for this reduction is straightforward: workers lose Obamacare subsidies as their incomes go up, which makes it less attractive to work more hours. For instance, if you go from 135 percent of the poverty line to 140 percent of the poverty line—something that could happen by the addition of a mere two or three hours of work a week—you might lose access to Medicaid.

More generally, the problem is that Obamacare subsidies decline smoothly as your income goes up. Here’s an example. If you and your partner earn $10 per hour and your family income is $30,000, you’ll pay about $1,250 out of pocket for health insurance. Subsidies cover the rest. But if you work an extra six hours a week and increase your income to $33,000, your premium cost goes up to about $1,600. That’s not a huge difference, but it means that effectively you’re only making $8.80 for each of those extra hours you work. At the margins, there will always be a few people who decide that’s not worth it, and will decide to keep their old hours. That’s especially true since their family now has health coverage and doesn’t have to worry quite so much about catastrophic expenses.

You can decide for yourself whether this is good or bad. In any case, it’s not something unique to Obamacare. It’s a feature of every means-tested welfare program ever. And it’s the main reason that employment will decline. Not because of early retirees or folks who are now free to tell their bosses to take this job and shove it. It’s mainly because it will cause a certain number of poor people to decide that working extra hours doesn’t pay enough to be worth it.

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Let’s Get Our Obamacare Story Straight, Folks

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Here’s Why the CBO Thinks Obamacare Will Reduce Employment Among the Poor

by ClaireWCAgu Posted on February 4, 2014

Mother Jones

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The Congressional Budget Office has updated its estimate of the effect of Obamacare on employment:

CBO estimates that the ACA will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024….Because the largest declines in labor supply will probably occur among lower-wage workers….CBO estimates that the ACA will cause a reduction of roughly 1 percent in aggregate labor compensation over the 2017–2024 period, compared with what it would have been otherwise.

Why will Obamacare reduce employment? Because it’s a job killer? Because employers will push lots of workers into part-time positions? Because its taxes on the well-off will crater the economy?

No. Those effects are tiny at best. It’s much simpler than that. Obamacare will reduce employment primarily because it’s a means-tested welfare program, and means-tested programs always reduce employment among the poor:

Subsidies that help lower-income people purchase an expensive product like health insurance must be relatively large to encourage a significant proportion of eligible people to enroll.

….For some people, the availability of exchange subsidies under the ACA will reduce incentives to work both through a substitution effect and through an income effect. The former arises because subsidies decline with rising income (and increase as income falls), thus making work less attractive. As a result, some people will choose not to work or will work less—thus substituting other activities for work. The income effect arises because subsidies increase available resources—similar to giving people greater income—thereby allowing some people to maintain the same standard of living while working less. The magnitude of the incentive to reduce labor supply thus depends on the size of the subsidies and the rate at which they are phased out.

If, for example, earning $100 in additional income means a $25 reduction in Obamacare subsidies, you’re only getting $75 for your extra work. At the margins, some people will decide that’s not worth it, so they’ll forego working extra hours. That’s the substitution effect. In addition, low-income workers covered by Obamacare will have lower medical bills. This makes them less desperate for additional money, and might also cause them to forego working extra hours. That’s the income effect.

This is not something specific to Obamacare. It’s a shortcoming in all means-tested welfare programs. It’s basically Welfare 101, and in over half a century, no one has really figured out how to get around it. It’s something you just have to accept if you support safety net programs for the poor.

It’s worth noting, however, that health care is an exception to this rule. It doesn’t have to be means tested. If we simply had a rational national health care system, available to everyone regardless of income, then none of this would be an issue. There might still be a small income effect, but it would probably be barely noticeable. Since everyone would be fully covered no matter what, there would no high effective marginal tax rate on the poor and no reason not to work more hours. Someday we’ll get there.

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Here’s Why the CBO Thinks Obamacare Will Reduce Employment Among the Poor

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Note to GOP: Don’t Reveal Your Fiendish Plan to Destroy Obamacare Until the Last Reel

by muistenam Posted on January 22, 2014

Mother Jones

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One of the reasons that insurers aren’t too worried about the low signup rate for Obamacare is that it’s early days. They figure things will work out eventually, and in the meantime they’re protected from serious losses during the first three years by a provision of the bill called “risk corridors.” The details aren’t too important here. In a nutshell, if it turns out that an insurer has seriously miscalculated the cost of its coverage on the exchanges—perhaps because too few people have signed up—the federal government will reimburse them for part of their losses.

This is all very wonky stuff designed to smooth the transition to Obamacare. You’re only reading about it now because a little while back some bright spark decided that if you called this an “Obamacare bailout” it might turn into a big campaign issue. Maybe Republicans could even get it repealed, which in turn would make life so hard for insurers that they’d drop out of Obamacare entirely! Bwa-ha-ha!

But their plan isn’t going anywhere, and Dave Weigel thinks it’s partly because conservatives have acted too much like a stock villain from a James Bond movie:

I mention Bond villainy for a reason. What’s the mistake that Goldfinger and Blofeld and 006 et al constantly make? They explain the plot while there’s still time for 007 to stop it. Conservative groups from FreedomWorks to Heritage Action have rallied behind Rubio’s bill and a companion House bill, and obviously the hope is that a “no bailout” bill would gather momentum in the Senate and make life difficult for red state Democrats. But Congress just passed an omnibus funding bill that takes care of things for the rest of the year. A good chance to pressure the Senate on Obamacare — slotting the “no bailout” language in the House bill — has been lost. Even a scheme backed by Krauthammer, Ponnuru, and Cannon, all well-respected on the right, failed to gain traction in a Congress that’s been chastened by the shutdown, and is more fearful of causing a crisis to gut Obamacare.

Neither Democrats nor the insurance industry were ever going to be fooled by any of this, but by making it clear that the real goal of repealing risk corridors is to cripple Obamacare completely, proponents lost even the slim chance they had to get a hearing from the press and from independents. They might take another crack at making this a big issue when the debt ceiling comes up, but it probably won’t get them anywhere. Their tea party allies will be thrilled, but everyone else will see it as yet another in a long, tired string of contrived outrages designed to kill Obamacare. Time to move on, folks.

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Note to GOP: Don’t Reveal Your Fiendish Plan to Destroy Obamacare Until the Last Reel

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