Tag Archives: obamacare

Medicaid Expansion Is a Stealth Success, and That’s Just Fine

by PhoenixBrook3 Posted on January 6, 2014

Mother Jones

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Obamacare ended the year with about 2 million people who signed up through the insurance marketplaces and maybe three times that many who signed up for Medicaid. That makes the Medicaid expansion a big success, but neither party really wants to admit it:

To Drew Altman, president of the Kaiser Family Foundation, this exposes a core reality of U.S. health-care politics. “Republicans don’t like entitlement programs, and Democrats want to portray the ACA as mostly a marketplace solution based on private insurance and not another expansion of a government program,” he said, “so neither side wants to emphasize the ACA’s success enrolling people in Medicaid even though it may be the law’s biggest achievement so far in terms of expanding coverage.”

This has left both the Obama administration and Republicans in a tight spot. The White House can’t really tout the Medicaid expansion because it’ll revive fears on the right that Obamacare is really a stealthy effort to create a single-payer health-care system, and it’ll arouse criticism on the left that the administration should have expanded Medicaid to all.

As for Republicans, they can’t admit the Medicaid expansion is going well because doing so is dangerously close to advocating a single-payer health-care system. The exchanges, marred by their troubled introduction, are also a problem as they are a Republican idea, enshrined in Rep. Paul Ryan’s health-care bill.

I think I’d analyze this a bit differently. I don’t really have a sense that much of anyone associates Medicaid expansion with a push for single-payer. Rather, Democrats don’t want to talk about it because Medicaid is a program for the poor, and they don’t want middle-class voters thinking that Obamacare is just another way to funnel their tax dollars into welfare programs for other people. Likewise, Republicans oppose Medicaid expansion simply because they don’t like entitlement programs; they don’t like higher taxes; and they’ve always wanted to block-grant Medicaid and starve it to death. I don’t think it’s really any more complicated than that.

In any case, I’m fine with this. I think Medicaid expansion is great, but unlike a lot of lefties, I also think it’s a dead end. It’s not going to lead to single-payer, and it’s never going to be a template for future health care reforms. The marketplaces, despite all their problems, have far more potential to eventually lead to health care coverage for all. I think they also have more potential to produce delivery reforms down the road and to rein in cost growth. For that reason, I’m OK with the Medicaid expansion staying under the radar. That’s a fine place for it.

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Medicaid Expansion Is a Stealth Success, and That’s Just Fine

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Even Doctors Believe in Obamacare’s Death Panels

by JackJanesgql Posted on December 19, 2013

Mother Jones

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I learned something new this morning. Two things, actually. First, Sarah Kliff points us to a recent study telling us that even a lot of doctors believe that Obamacare institutionalizes death panels:

This is just a survey of head and neck doctors, so maybe they’re just especially ignorant among the MD set. But probably not.

So what else did I learn? Well, Obamacare has never had death panels in the sense of the question above, but it does reimburse physicians for having end-of-life conversations with their patients. You know, so they can decide about things like DNR notices, how much extraordinary care they want, living wills, and so forth. All perfectly sensible, except that it’s what prompted the death panel nonsense in the first place.

And it’s gone. I didn’t know that. Apparently, after the New York Times put it on the front page in 2011, this provision was eliminated. So the yahoos won another victory, and it didn’t stop the death panel talk anyway. Hooray.

UPDATE: Thanks to a tweet from Austin Frakt, I did a little more digging and it turns out that a weakened version of end-of-life counseling remained in the bill and was implemented by a new regulation adopted in 2010:

The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover “voluntary advance care planning,” to discuss end-of-life treatment, as part of the annual visit.

Under the rule, doctors can provide information to patients on how to prepare an “advance directive,” stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves.

So if a patient asks about end-of-life treatment, doctors are allowed to talk about it and bill the time as an office visit. Death panels!

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Even Doctors Believe in Obamacare’s Death Panels

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Soon, Obamacare Will Get the Blame For Your Kid’s Acne

by jjhhhjz Posted on December 15, 2013

Mother Jones

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From the Associated Press:

Americans who already have health insurance are blaming President Barack Obama’s health care overhaul for their rising premiums….In the survey, nearly half of those with job-based or other private coverage say their policies will be changing next year — mostly for the worse. Nearly 4 in 5 (77 percent) blame the changes on the Affordable Care Act, even though the trend toward leaner coverage predates the law’s passage.

….Employers trying to control their health insurance bills have been shifting costs to workers for years, but now those changes are blamed increasingly on “Obamacare” instead of the economy or insurance companies.

Obamacare has been a boon for employers and insurers who want to cut back their health benefits but don’t want to take the blame for it. They just blame Obamacare instead. This will only work for a year or two, but for now it’s a godsend. Better to have your employees pissed off at the guy in the White House than pissed off at the guy in the corner office.

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Soon, Obamacare Will Get the Blame For Your Kid’s Acne

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Support for a $10 Minimum Wage Is Surprisingly High

by Elva Diller Posted on December 11, 2013

Mother Jones

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I’m not super interested in the latest poll results about whether Obama’s approval is up or down a point or two, or whether Obamacare is up or down a point or two. It’ll all shake out soon enough. But the Wall Street Journal’s latest poll asked about raising the minimum wage, and the results were pretty interesting:

So 63 percent were in favor of raising the minimum wage to $10.10. That’s surprisingly high. Hell, 43 percent even favor raising it to $12.50. I don’t imagine that this support is especially deep or passionate, but it’s still pretty high. As Damon Silvers of the AFL-CIO says, “If I was a House Republican, I’d be concerned about opposing anything that polled at 63%.”

Of course, gun registration polls at better than 63 percent, and so do higher taxes on the rich, just to name a couple of examples. That doesn’t seem to have caused very many Republicans to start quaking in their boots. Still, it’s encouraging news.

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Support for a $10 Minimum Wage Is Surprisingly High

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How Vulnerable Is a Congressman Without Health Insurance?

by FSZLazarots Posted on December 10, 2013

Mother Jones

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Members of Congress have spent the past few weeks grousing about their attempts to enroll in new health insurance plans they forced on themselves when they passed the Affordable Care Act. The law requires members of Congress to get their insurance, and employer subsidy, through the DC health exchange rather than through the Federal Employee Health Benefits Network, where they’d been getting it for decades—at a good price.

Not every member is signing up for the exchange. Some, like Sen. Ted Cruz (R-Texas), have cushy coverage through a spouse’s employer. Others are eligible for Medicare, the government’s plan for the elderly. And then there’s Rep. Louie Gohmert, a Texas tea party luminary and an outspoken opponent of the ACA. Rather than participate, Gohmert says he intends to pay a fine the law imposes and remain uninsured when the ACA’s individual mandate kicks in early next year. “I’ve pledged that I’m not taking the subsidy,” he told Politico. “Too many people in my district have lost their insurance because of Obamacare…and because of Obamacare, the remaining insurance is just too expensive. So I’m not going to have insurance, it looks like.”

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How Vulnerable Is a Congressman Without Health Insurance?

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Republicans Nearing a Dead End on Obamacare

by MaurineLarose Posted on December 3, 2013

Mother Jones

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Greg Sargent says that although the Obamacare website debacle scared some Democrats, in the end virtually none of them meaningfully abandoned the law:

It’s clear they believe the worst is now over and it is safe to return to the message they always expected to adopt.

I know I’m a broken record here, but folks are overlooking the possibility that no matter how unpopular the law, the Republican stance on health care may prove a liability, too. The basic Dem gamble is that disapproval of Obamacare does not automatically translate into zero sum political gains for Republicans, and that voters will grasp that one side is trying to solve our health care problems, while the other is trying to sabotage all solutions while advancing no constructive answers of their own. Polling shows disapproval of the law does not translate into majority support for GOP attempts to repeal or sabotage it, and Dems think this will only harden as more people enjoy the law’s benefits.

It’s funny that Republicans don’t believe their own propaganda. For years, they’ve been hellbent on repealing Obamacare because they knew that once it was fully implemented in 2014, it would have millions of beneficiaries who would fight to keep it. Once the benefits of a new program start flowing, it’s very, very hard to turn them off.

They were always right about that. By the middle of 2014, Obamacare is going to have a huge client base; it will be working pretty well; and it will be increasingly obvious that the disaster scenarios have been overblown. People with employer health care will still have it and very few will notice even a minor change in their normal routine.

Given all this, it’s hard to see Obamacare being a huge campaign winner. For that, you need people with grievances, and the GOP is unlikely to find them in large enough numbers. The currently covered will stay covered. Doctors and hospitals will be treating more patients. Obamacare’s taxes don’t touch anyone with an income less than $200,000. Aside from the tea partiers who object on the usual abstract grounds that Obamacare is a liberty-crushing Stalinesque takeover of the medical industry, it’s going to be hard to gin up a huge amount of opposition. And that’s doubly true since, as Sargent says, the Republican Party will have no credible alternative for a benefit that lots of people will already be getting.

Maybe I’m missing something. But either Republicans are seriously miscalculating, or else they’re simply betting the farm on the hope that Obamacare will be an epic disaster. Maybe it’s a bit of both. Either way, I think they’re fooling themselves pretty badly.

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Republicans Nearing a Dead End on Obamacare

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The Latest Legal Attack Against Obamacare

by julyye56 Posted on December 3, 2013

Mother Jones

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Today, the US District Court for the District of Columbia* will hear arguments in one of the last lingering legal challenges to the Affordable Care Act. The suit, Halbig v. Sebelius, argues that a single phrase in the law creates a loophole big enough to drive a truck through and nullify the whole thing.

The argument goes something like this: When Congress wrote the ACA, it said that premium subsidies would be available for certain qualifying citizens who were “enrolled through an Exchange established by the State.” (Emphasis added.) The law doesn’t say that those subsidies are available to people in the 34 states that declined to set up exchanges, where residents must utilize the now-infamously buggy Healthcare.gov, the federal exchange.

That’s where Obamacare opponents see a fatal flaw in the law. The plaintiffs in Halbig claim that they won’t be eligible for tax credits because their states didn’t start an exchange, so they won’t be able to afford insurance. As a result, they argue that they’ll be subject to the fine for not buying insurance, or to avoid the fine, they’ll have to pay a lot for insurance they don’t want. They want the court to block the IRS from implementing the law.

The complaint is pretty convoluted, and it’s clearly a political attack. Indeed, one of the plaintiffs was also a plaintiff in the lawsuit filed by the National Federation of Independent Businesses challenging the legality of the individual mandate, an argument rejected by the Supreme Court. The other plaintiffs are also conservative operatives, including the lead plaintiff, Jacqueline Halbig, who was a senior policy adviser to the Department of Health and Human Services under George W. Bush. (She’s also been the source of a host of conservative rhetoric about “baby death panels” in the ACA.) The lawyer spearheading the suit, Michael Cannon, is a health care expert at the libertarian Cato Institute who has spent the last few years urging states to refuse to set up insurance exchanges as a means to sabotage Obamacare.

The Obama administration argues that the language Cannon’s case is premised is merely a drafting error common in legislation and routinely reconciled after passage. (Indeed, if Congress were functioning normally, such copy mistake would have been corrected by now, but given the level of polarization in that body, it’s been impossible to make such fixes that were once routine.) An amicus brief in the case filed by Families USA, a nonprofit health care advocacy group helping the administration combat some of the bad PR surrounding Obamacare, argues that the plaintiffs are disregarding the vast body of evidence showing that Congress intended for all low-income Americans to be eligible for tax subsidies, regardless of which exchange they used to purchase insurance.

Timothy Jost, a law professor at Washington and Lee University, has said that Congress essentially fixed the drafting error in another piece of legislation requiring the federal exchange to report information to the IRS and to promulgate regulations around Obamacare. The Congressional Budget Office has also treated the law as if the subsidies are available on the federal exchange.

So far, though, the lawsuit has survived. US District Court Judge Paul Friedman, a Clinton appointee, declined to dismiss the suit, though he did refuse the plaintiffs’ request for an emergency injunction to prevent the IRS from implementing the law. Friedman will hear summary judgment arguments in the case this afternoon.*

The case seems destined for the Supreme Court, where a conservative majority is already hostile to Obamacare. The Roberts court has also shown little interest in considering congressional intent when interpreting the law. (See its history on the Voting Rights Act.) John Roberts has proven to be something of a literalist when it serves his interests. That record alone ought to give the administration and health care reformers pause. If Halbig et al. prevail in the case, Mother Jones‘ Kevin Drum has suggested that premium subsidies could end up available only to people in the 16 mostly blue states that have chosen to run their own exchanges, while the rest of the country (all the red parts) would keep paying taxes to underwrite those subsidies. But Halbig and her backers are clearly hoping that a decision in their favor will kill Obamacare completely.

Correction: An earlier version of this article erroneously stated that an appeal of a trial court decision in the case is being heard in the DC Circuit Court of Appeals on Tuesday. The story has since been fixed.

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The Latest Legal Attack Against Obamacare

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Americans Are Surprisingly Clear-Eyed About American Health Care

by 41laowo Posted on November 25, 2013

Mother Jones

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Austin Frakt draws my attention to a new Gallup poll with this tweet: “Consistent with my hypothesis that people think their care is good/efficient, others is bad/wasteful.” Here’s the poll:

I’d draw a different conclusion. For starters, keep in mind that public sentiment on this question hasn’t changed much over the past decade. There are some ups and downs in recent years about the quality of national health care coverage, possibly based on the ups and downs of Obamacare, but it mostly looks like noise to me.

More importantly, though, I don’t interpret this as a belief that coverage for other people is either bad or wasteful. I interpret it as a surprisingly accurate assessment of U.S. health care. About two-thirds of Americans have either Medicare or company-provided health care (or something similar), and they correctly tell Gallup that their own personal coverage is pretty good. And it is! At the same time, most people also think that overall health care coverage in America is pretty mediocre, and that’s true too. How can you call national coverage good or excellent when 50 million people are uninsured and have crappy access to medical care?

If Gallup had called me, this is precisely the response I would have given them. My own personal coverage is quite good. Thanks, MoJo! However, I’d also say that overall coverage in the U.S. is terrible. Obamacare will, perhaps, upgrade that to merely unsatisfactory, but that’s about it.

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Americans Are Surprisingly Clear-Eyed About American Health Care

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Obamacare Has a Friend in the Health Care Industry

by s4o840t Posted on November 22, 2013

Mother Jones

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In the LA Times today, Noam Levey writes that Obamacare has an ace in the hole: the insurance industry. Sure, they have their gripes:

But since 2010, they have invested billions of dollars to overhaul their businesses, design new insurance plans and physician practices and develop better ways to monitor quality and control costs.

Few industry leaders want to go back to a system that most had concluded was failing, as costs skyrocketed and the ranks of the uninsured swelled. Nor do they see much that is promising from the law’s Republican critics. The GOP has focused on repealing Obamacare, but has devoted less energy to developing a replacement.

…. For many of these organizations, the prospect of new customers and a more rational system outweighs their sometimes intense irritation with the Obama administration. Insurance executives, in particular, have gnashed their teeth at the president’s attacks on their industry….Despite the frustrations, most insurers remain committed to moving to a new market that would achieve the central promise of the Affordable Care Act: that all consumers can buy health plans even if they have preexisting medical conditions.

This is really a crucial point. Like it or not, the entire health care industry has spent the past three years gearing up for the rollout of Obamacare. At this point, they’re committed—and doubly so since the Republican Party very clearly has no real alternative for them. This means that all the doom-mongering on Fox News is basically just chum for the rubes: Obamacare isn’t going anywhere, and everyone knows it. The health care industry will do everything it can to make it work, and one way or another, it’s going to work. Even the Medicaid expansion is almost certain to be taken up eventually by nearly every state as passions cool down a bit and hospitals start complaining about the lost income.

The tea party may not quite know yet that it’s lost the war, and Republican politicians have every reason to egg them on in this delusion, but the war is well and truly lost. It’s all mopping up now.

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Obamacare Has a Friend in the Health Care Industry

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So Far, Obamacare Has Taken Only a Modest Hit in Polls

by Dorcas8538 Posted on November 20, 2013

Mother Jones

Yesterday I misread a poll question about Obamacare, initially thinking it was about whether people wanted to make changes to the law. Today, though, CBS has a poll question that really does ask this. Here it is:

This isn’t very different from Kaiser tracking polls in the past. In the most recent one, among people who expressed an opinion, 56 percent wanted the law kept as is or enhanced, while 44 percent wanted it repealed.

So far, Obamacare hasn’t really taken that big a hit in public opinion, and as the website problems continue to get fixed I expect that public opinion will improve. It’s still early days.

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So Far, Obamacare Has Taken Only a Modest Hit in Polls

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