Tag Archives: regulatory affairs

As 2013 Comes to an End, Obamacare Starting to Look Pretty Healthy

by JaymeCarvosso Posted on December 30, 2013

Mother Jones

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I’ve been away from the news for a few days, so I’m behind on things. How’s Obamacare doing? Is it still a train wreck, an epic blunder, doomed to failure, the worst thing to happen to the American public since Dred Scott? I guess it must be. What can happen in the space of a few days, after all? Oh wait:

What seemed impossible in October suddenly became a lot more plausible in late December. This weekend, new enrollment data showed approximately 2 million Americans signed up for private health insurance plans since the start of open enrollment. Health policy experts now see a space to get to 7 million — although it’s by no means a guarantee.

“October and November were essentially lost months,” says Larry Levitt, senior vice president at the Kaiser Family Foundation. “December is the first month where we’re getting an indication of how things are working. It’s starting to track with what people, particularly the CBO, projected originally.”

“It was a very impressive December,” says Dan Mendelson, president of health research firm Avalere Health. “The fact that they have about 2 million enrolled is not that far off from the original CBO projection of 3.3 million.”

Huh. How about that? Make a few tweaks here and there, get the marketing machine rolling, fix the website, and Obamacare is close to being back on track. It’s never going to be the answer to all our health care woes—or, thanks to the vagaries of politics, even the best we could have done—but it’s going to do a lot of good for a lot of people. Here in the real world, that’s really the best we can hope for from a big new piece of public policy.

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As 2013 Comes to an End, Obamacare Starting to Look Pretty Healthy

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A Conservative Diagnoses the Decay of American Political Institutions

by Lionel4334 Posted on December 11, 2013

Mother Jones

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Via Tyler Cowen, Francis Fukuyama diagnoses three things that are driving the decay and sclerosis of the American political system:

The first is that, relative to other liberal democracies, the judiciary and the legislature (including the roles played by the two major political parties) continue to play outsized roles in American government at the expense of Executive Branch bureaucracies….Over time this has become a very expensive and inefficient way to manage administrative requirements.

The second is that the accretion of interest group and lobbying influences has distorted democratic processes and eroded the ability of the government to operate effectively.

….The third is that under conditions of ideological polarization in a federal governance structure, the American system of checks and balances, originally designed to prevent the emergence of too strong an executive authority, has become a vetocracy….We need stronger mechanisms to force collective decisions but, because of the judicialization of government and the outsized role of interest groups, we are unlikely to acquire such mechanisms short of a systemic crisis. In that sense these three structural characteristics have become intertwined.

I’m not entirely persuaded about Fukuyama’s second point. There’s not much question that lobbying has exploded over the past half century, nor that the rich and powerful have tremendous sway over public policy. But do powerful interest groups really have substantially more influence in the United States than in other countries? Or do they simply wield their power in different ways and through different avenues? I’d guess the latter.

Nonetheless, even if America’s powerful are no more powerful than in any other country, the fact that they wield that power increasingly via Congress and, especially, the judiciary might very well make their influence more baleful. I’m reminded of an argument from labor attorney Thomas Geoghegan along similar lines. Obviously he allocates blame a little differently than Fukuyama does, but he still concludes that the explosive growth in litigation to solve problems has had pernicious consequences. In the case of workplace complaints, for example, quick and simple arbitration has been largely replaced by scorched-earth court proceedings:

It is not so much about conduct as state of mind. The issue is no longer whether the employer fired the plaintiff for “just cause,” whatever that might now mean in a world of “employment at will.” What the plaintiff must do is show that the employer acted to harm him.

….In post-union America, this is the legal system we now have. It forces us to cast legal issues in the most subjectively explosive way, i.e., “racism,” “sexism,” to get around the fact that we no longer can deal objectively with “just cause.” Do I regret I am part of it? Yes. Are my clients often full of hatred? Yes.

In the same way that financialization has a corrosive impact on a country’s economy and its ability to produce useful goods and services, you might call this the judicialization of governance, which erodes our country’s ability to produce useful, broad-based, widely accepted policy. The best evidence of this is also the most obvious: Over the past few decades, we’ve gotten to a point where more hostility and bitterness are expended over the appointment of judges than over virtually any other legislative or executive priority.

As for Fukuyama’s “vetocracy,” that’s a sore point of longstanding, and one that’s become worse and worse over the past decade. Fukuyama puts it this way:

The United States is trapped in a bad equilibrium. Because Americans historically distrust the government, they aren’t typically willing to delegate authority to it. Instead, as we have seen, Congress mandates complex rules that reduce government autonomy and render decisions slow and expensive. The government then performs poorly, which perversely confirms the original distrust of government. Under these circumstances, most Americans are reluctant to pay higher taxes, which they fear the government will simply waste. But while resources are not the only, or even the main, source of government inefficiency, without them the government cannot hope to function properly. Hence distrust of government becomes a self-fulfilling prophecy.

The whole essay is worth a read. And I congratulate Fukuyama for not even pretending to write a final paragraph with potential solutions. Instead, his final line is, “So we have a problem.” Indeed we do.

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A Conservative Diagnoses the Decay of American Political Institutions

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Here’s the Story Behind the Big Wall Street Reform Rule That Was Just Approved

by HoseaHarpur Posted on December 10, 2013

Mother Jones

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On Tuesday, banking regulators finalized one of the most important provisions of the 2010 Dodd-Frank financial reform law. It’s called the Volcker rule, and it’s supposed to prohibit the high-risk trading by commercial banks that helped cause the financial crisis. Here’s what you need to know about it.

What’s the reason for the new rule? In the run-up to the financial crisis, big banks invested in low-quality mortgage-backed securities. When those over-leveraged bets turned sour, the economy collapsed, and the government had to bail out big financial institutions. The Volcker rule ensures that banks don’t engage in what is called proprietary trading—that is, when a firm trades for its own benefit instead of trading on behalf of its customers. In May 2012, JPMorgan Chase lost $2 billion on a bad trade, which led to calls for a strong Volcker rule.

Why is it called the Volcker rule? The rule is named after Paul Volcker, the chairman of the Federal Reserve in the 1980s, and later an adviser to President Barack Obama. He advocated this change in financial regulation and persuaded the president to back the rule in 2010, when the Dodd-Frank bill was passed.

2010? What took so long? One reason it took three years to finish the rule is that after the legislation was passed, the actual regulation had to be crafted jointly by five banking regulators—the Federal Reserve, the Federal Deposit Insurance Corporation (FDIC), the Office of the Comptroller of the Currency (OCC), the Securities and Exchange Commission (SEC), and the Commodity Futures Trading Commission (CFTC). That’s a lot of coordination amongst people with different backgrounds and priorities. And during the 2012 campaign, Mitt Romney vowed to repeal Dodd-Frank. So for several months, wait-and-see regulators slowed down devising the details of the rule.

Wall Street lobbying also played a big part in delaying the unveiling of the final rule. The financial industry pushed like mad to get key loopholes into the regulation. “It’s relentless, nonstop, day and night lobbying,” Dennis Kelleher, the president of the financial reform advocacy group Better Markets, said a year ago. “It is absolute total nuclear war that Wall Street is engaged in here.” One loophole Wall Street tried to get written into the regulation would characterize certain forms of risky trading as hedging against risk. (Yes, you read that correctly.)

So who won? Kelleher says financial reformers won; these loopholes were not included. “Today’s finalization of the Volcker rule ban on proprietary trading is a major defeat for Wall Street and a direct attack on the high-risk ‘quick-buck’ culture of Wall Street,” he said in a statement. Treasury Secretary Jack Lew said the rule would have prevented JPMorgan’s $2 billion trading loss last year. CFTC commissioner Bart Chilton, a fierce Wall Street critic, is happy with the rule. Former Rep. Barney Frank (D-Mass.), one of the authors of the Dodd-Frank law, told Mother Jones today, “I have been confident all along that it would be a tough rule. I’ll make one prediction: all of the cries of doom that you’re going to hear from the financial institutions, three years from now will come to about as much validity as the cries of doom we heard about same-sex marriage.”

Obama noted, “Our financial system will be safer and the American people are more secure because we fought to include this protection in the law….I encourage Congress to give these regulators adequate funding to effectively and efficiently implement the rule, which will help protect hardworking families and business owners from future crisis, and restore everyone’s certainty and confidence in America’s dynamic financial system.”

But the success of the rule depends on how it is implemented. Marcus Stanley, the policy director at Americans for Financial reform, says that he’s “lukewarm” on the rule, mostly because a lot hangs on how it is interpreted by banking regulators who supervise compliance. “Whoever is the primary supervisor has enormous discretion about how this rule will affect trading,” he says, adding that the final Volcker rule does not include transparency provisions that would allow the public to judge whether banks are complying.

So is financial reform all finished now? No. Proprietary trading contributed to the crisis, but it was not the main cause. Regulators still have other Dodd-Frank provisions to finalize. Wall Street watchdogs have to implement plans to wind down failing banks; finish writing rules governing derivatives trading (which was largely unregulated before the financial crisis); and enforce strong requirements regarding the level of reserves banks must maintain.

What’s next? Wall Street is already preparing to fight the Volcker rule in the courts. The regulation could slash the combined annual profits of the eight largest banks by between $2 billion to $10 billion, according to Standard and Poor’s. “Wall Street’s loophole lawyers and other hired guns will… continue to hit at the rule as if it were a piñata,” Kelleher says.

Additional reporting by Patrick Caldwell.

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Here’s the Story Behind the Big Wall Street Reform Rule That Was Just Approved

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Here’s an Interesting Wrinkle in the Rate Shock Debate

by Kailey A. Aitkin Posted on November 16, 2013

Mother Jones

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Here’s an email from a reader in California with an interesting wrinkle on the rate shock debate:

I’m self employed, with individual health insurance coverage, and my family is one of those whose current health insurance policy is being canceled and whose premium will rise once we purchase insurance on the CA exchange. But it’s not as simple as that. We signed up for our current policy in November 2011 (therefore no grandfathering) and the premium was substantially lower than the policy we had prior to that. In hindsight, I’m guessing that the premium for that newly introduced plan was so low because the insurance company knew it would have to be canceled in 2014. So, they weren’t going to incur a lot of losses or have to make provisions for a long claims tail.

The premium for our new insurance, purchased from the exchange, is going to be about what our original (pre-2011) policy premiums would have been now, allowing for the usual annual premium increases. So, yes, we’re having to move from cheaper to more expensive insurance. On the other hand, it’s very likely that the cheaper policy would never have been available in the first place without the ACA’s 2014 deadline for such plans. Of course, the insurance company didn’t clarify back in 2011 that this policy had a limited lifespan and would have to be replaced in 2014 with a new one.

I wonder if this is at all common?

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Here’s an Interesting Wrinkle in the Rate Shock Debate

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Here Are Some of the People Being Helped by Obamacare

by tobedzieto123 Posted on November 5, 2013

Mother Jones

Since I was just griping about the media not spending any time reporting about the people that Obamacare helps, I should offer some props to Abby Goodnough of the New York Times, who headed down to Kentucky to talk to some of the navigators who are responsible for assisting people who want to sign up for Obamacare. Here’s one story:

Samantha Davis, the clinic employee who helped David Elson apply, explained that based on his income of about $22,000 last year, he was not eligible for Medicaid but had qualified for a federal subsidy of $252 a month toward premium costs for a private plan. “It’s a pretty big one,” she said, reassuringly.

Through the exchange, Mr. Elson, 60, who has advanced diabetes and kidney disease, was offered a choice of 24 health plans, with premiums ranging from $92 to $501 a month after the subsidy. But if he felt elation or relief, he was too preoccupied to show it.

Bleeding at the back of his eyes, caused by a complication of diabetes, had blurred his vision. He had run out of insulin the previous week and had not refilled his prescriptions, which cost almost $500 a month, because a recent tax bill had depleted his bank account. He had an appointment with an eye specialist that afternoon, and the possibility of more debt was hanging heavily over him….“I’m hoping once I have insurance that I can sit down and figure out a budget and see if I have to bankrupt,” he said.

Plenty of people are being helped by Obamacare, and that number will grow dramatically as navigators reach more people; the website improves; and people start to make up their minds and sign up for a plan. For some people, it will mean the difference between getting treatment and going without. For others it will mean the difference between solvency and bankruptcy. And for still others it will be the first time they’ve ever had any health coverage at all.

Those are stories worth telling too.

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Here Are Some of the People Being Helped by Obamacare

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“Rate Shock” is a Middle-Class Problem, So It Gets Lots of Attention

by DunlapXE6NqJSf@hotmail.com Posted on November 5, 2013

Mother Jones

The media has entered a feeding frenzy of coverage about people who are facing “rate shock” from Obamacare. It’s a real story, even if a lot of the reporting has been sloppy and credulous, but the level of media attention has nonetheless been pretty stunning. Jon Chait says this is partly because the press has a natural attraction to bad news over good. But that’s not all:

There’s also an economic bias at work. Victims of rate shock are middle-class, and their travails, in general, tend to attract far more lavish coverage than the problems of the poor. (Did you know that on November 1, millions of Americans suffered painful cuts to nutritional assistance? Not a single Sunday-morning talk-show mentioned it.)

Yep. It’s the same reason that air traffic controllers got funded so quickly during the sequester while food aid didn’t. In addition, I can only assume that writing about the people who are benefiting from Obamacare would strike DC reporters as a little too much like shilling for the Obama administration. Can’t have that, can we?

In addition to the obvious agenda-setting power of Fox and Drudge, I suspect there’s also one other factor at work here: a news drought. Just as the debt ceiling crisis helped Obama in early October by sucking up all the media oxygen and taking attention away from the disastrous rollout of the website, Obama has been hurt by a news cycle that’s been unusually slow lately. There’s just not much to talk about aside from Obamacare. I suspect that the White House must be wishing for a huge hurricane or something right about now to provide the cable nets with something else to obsess over.

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“Rate Shock” is a Middle-Class Problem, So It Gets Lots of Attention

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The Lesson of Obamacare: Sabotage Works

by Kennith30E Posted on November 4, 2013

Mother Jones

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Amy Goldstein and Juliet Eilperin have a big piece in the Washington Post today about the disastrous implementation and rollout of Obamacare following the euphoria of its passage in 2010. Goldstein and Eilperin document plenty of bad decisions along the way, and lots of them reflect poorly on Team Obama. Still, I have to say that my big takeaway from the article was the same as Andrew Sprung’s: sabotage works.

The primary example of this comes early in the story, when the team responsible for building the marketplaces—and the website—was moved under the Centers for Medicare and Medicaid Services (CMS). Partly this was for operational reasons, but:

The move had a political rationale, as well. Tucked within a large bureaucracy, some administration officials believed, the new Center for Consumer Information and Insurance Oversight would be better insulated from the efforts of House Republicans, who were looking for ways to undermine the law. But the most basic reason was financial: Although the statute provided plenty of money to help states build their own insurance exchanges, it included no money for the development of a federal exchange — and Republicans would block any funding attempts. According to one former administration official, Sebelius simply could not scrounge together enough money to keep a group of people developing the exchanges working directly under her.

Now, one obvious question is why the law failed to finance the federal exchanges. That was pretty clearly a mistake. Still, under normal circumstances, even an opposition party would end up cutting a deal eventually to shore up the missing funding. Not this time, though. As one White House official told the Post, “You’re basically trying to build a complicated building in a war zone, because the Republicans are lobbing bombs at us.”

There are plenty of other examples of this, and Sprung outlines them in his post today. No federal program that I can remember faced quite the implacable hostility during its implementation that Obamacare has faced. This excuses neither the Obama administration’s poor decisions nor its timidity in the face of Republican attacks, but it certainly puts them in the proper perspective.

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The Lesson of Obamacare: Sabotage Works

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Taking a Second Look at Rate Shock

by Cletus Posted on October 31, 2013

Mother Jones

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Rate shock is the subject of the day, and I have to confess to a growing unease about it. Here’s why. I think a lot of us expected that young people in good health might see higher premiums under Obamacare. This is largely because Obamacare mandates a maximum 3:1 ratio between premiums for the young and premiums for the old. Roughly speaking, this means that insurers are being forced to charge older buyers artificially low prices, and that in turn forces them to charge younger buyers more. Instead of, say, charging $100 and $500, the 3:1 ratio means they have to charge $150 and $450. In essence, the young are subsidizing the old. Add in the fact that Obamacare forces insurers to provide better coverage, and prices are going to go up even more.

But this means that older buyers shouldn’t see all that much rate shock. After all, they’re getting the benefit of that 3:1 ratio. And yet, they are. A couple of days ago I wrote about the case of Deborah Cavallaro, a 60-year-old woman in Los Angeles who had been profiled on the NBC Nightly News. She currently pays $293 for her coverage, but got a letter saying her plan had been canceled and a replacement would cost $478. I wondered whether her insurance company was simply trying to steer her into a high-cost plan, even though they knew she could do better on the exchange.

In a word, no. I headed over to the California exchange, entered the appropriate numbers, and found a bronze plan from Anthem Blue Cross for $479. Her insurance company wasn’t playing any games.

But maybe this new insurance is better than her existing policy? Michael Hiltzik talked to Cavallaro, who told him that her current policy has a deductible of $5,000 a year, an out-of-pocket max of $8,500 a year, and two doctor visits per year with a copay of $40. (She pays full price for subsequent visits.)

And the Obamacare bronze policy? It has a deductible of $5,000 a year, an out-of-pocket max of $6,350 a year, and three doctor visits per year with a copay of $60. (Subsequent visits are full cost until the deductible is met.)

Now, when you dig into the details, this is indeed slightly better coverage. Lifetime caps are no longer allowed, for example. And Anthem probably would have increased the price of Cavallaro’s policy for 2014 even if Obamacare didn’t exist. On the other hand, the new plan might have a more limited choice of doctors than Cavallaro is getting now. This stuff is probably a bit of a wash, which means that, roughly speaking, the bronze policy costs $2,200 more per year in return for an out-of-pocket max that’s $2,200 lower. Any year in which Cavallaro goes over this max, the Obamacare bronze policy will pay off. Any year in which she stays under it, she’s on the losing end of the deal.

So….I’m not sure what to think about this. The lower out-of-pocket max is a good thing, but basically Cavallaro is now paying for it every year instead of only in the years where she goes over $6,350. It’s hard to spin that as a good deal.

Generally speaking, I’m trying to steer a path between denial and panic on this stuff. As Justin Wolfers illustrates on the right, there are still way more winners than losers under Obamacare. Right now, most of what we’re hearing is anecdotal, and we simply don’t know how everything is going to work out in the end or how many people are going to end up with higher rates. In Cavallaro’s case, as in many others, that will depend a lot on the subsidies she gets. But there’s not much question that any year in which her income is high enough to put her over the subsidy cap, she’ll end up paying quite a bit more for coverage that’s only marginally better. It’s no surprise that she’s unhappy about it.

And the fact that this is happening to 60-year-olds, not just 20-somethings, is a bit of a surprise to me. I’m not going to panic over these stories yet, but the more of them I hear, the less that denial seems like a reasonable response either.

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Taking a Second Look at Rate Shock

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Are All Those Insurance Company Cancellation Letters Too Good to Check?

by Lou Bovee Posted on October 29, 2013

Mother Jones

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Paul Waldman recounts yet another story of someone allegedly getting screwed by Obamacare. This time the victim is Deborah Cavallaro, profiled yesterday on the NBC Nightly News:

We learn in this story that her insurer is cancelling her current plan, which costs $293 a month, because it doesn’t comply with the new law. They’ve offered her a new plan at $484 a month. That sounds like it sucks!….But wait. Maybe she’s not a victim after all. How does the $484 plan her current insurer is offering compare to the other ones she could get? Did she or the reporter go to the California exchange and try to figure that out? Apparently, they didn’t. But I did.

It took less than 60 seconds. Let’s assume that Deborah has a high enough income that she isn’t eligible for subsidies. I put in that I was 45 years old and got nine different choices for a Bronze plan, which in all likelihood most closely resembles what Deborah has now. The average monthly cost was $258, or $35 a month less than what Deborah’s paying now for her bare-bones plan….She can get a Silver plan, with more generous coverage, for $316, only $23 more than she’s paying now. Congratulations, Deborah!

In a follow-up post, Waldman makes the right point about this:

I want to talk about the thing that spawns some of these phony Obamacare victim stories: the letters that insurers are sending to people in the individual market….There’s something fishy going on here, not just from the reporters, but from the insurance companies. It’s time somebody did a detailed investigation of these letters to find out just what they’re telling their customers.

….If the woman I discussed from that NBC story is any indication, what the insurance company is offering is something much more expensive, even though they might have something cheaper available. They may be taking the opportunity to try to shunt people into higher-priced plans. It’s as though you get a letter from your car dealer saying, “That 2010 Toyota Corolla you’re leasing has been recalled. We can supply you with a Toyota Avalon for twice the price.” They’re not telling you that you can also get a 2013 Toyota Corolla for something like what you’re paying now.

I’m not sure that’s what’s happening, and it may be happening only with some insurers but not others. But with hundreds of thousands of these letters going out and frightening people into thinking they have no choice but to sign up for a much more expensive plan, it’s definitely something someone should look into. Like, say, giant news organizations with lots of money and resources.

It’s true that there are some people who are going to end up paying more for coverage under Obamacare than they’re paying now. But Waldman is right: there’s something very fishy about these letters. Over the past three years, insurance companies have swapped their plans around so fast and so often that virtually no one today has a plan more than a couple of years old—something that seems an awful lot like a deliberate effort to evade Obamacare’s original intent that most individual policies would be grandfathered and therefore remain available to existing customers who wanted to keep them.1 Now, having engineered a situation where most current policies aren’t grandfathered, millions of people are getting letters canceling their existing plans and being told that the replacement is far more expensive.

I’m not sure what’s going on here, but there’s at least one lesson in this for the press: never take these letters at face value. If you find someone who’s going to end up paying more thanks to Obamacare, fair enough. Run with the story.2 But first, you’d better perform the due diligence to find out what a comparable plan really costs. That means getting income and coverage details from the subject of your story and then doing a detailed search of the local exchange to find out what’s on offer. We’re not seeing enough of that.

1Plans in existence before March 23, 2010, are grandfathered, which makes them exempt from most of the new requirements of Obamacare. However, if your insurance company switched you into a “better” plan after that date, it’s not grandfathered and can be canceled at any time.

2Of course, it would be nice if you also ran some stories about people who are benefiting from Obamacare, especially since they probably outnumber the other folks by 100:1 or so.

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Are All Those Insurance Company Cancellation Letters Too Good to Check?

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Leaked Documents Reveal the Secret Finances of a Pro-Industry Science Group

by John Grit Posted on October 28, 2013

Mother Jones

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The American Council on Science and Health bills itself as an independent research and advocacy organization devoted to debunking “junk science.” It’s a controversial outfit—a “group of scientists…concerned that many important public policies related to health and the environment did not have a sound scientific basis,” it says—that often does battle with environmentalists and consumer safety advocates, wading into public health debates to defend fracking, to fight New York City’s attempt to ban big sugary sodas, and to dismiss concerns about the potential harms of the chemical bisphenol-A (better known at BPA) and the pesticide atrazine. The group insists that its conclusions are driven purely by science. It acknowledges that it receives some financial support from corporations and industry groups, but ACSH, which reportedly stopped disclosing its corporate donors two decades ago, maintains that these contributions don’t influence its work and agenda.

Yet internal financial documents (read them here) provided to Mother Jones show that ACSH depends heavily on funding from corporations that have a financial stake in the scientific debates it aims to shape. The group also directly solicits donations from these industry sources around specific issues. ACSH’s financial links to corporations involved in hot-button health and safety controversies have been highlighted in the past, but these documents offer a more extensive accounting of ACSH’s reliance on industry money—giving a rare window into the operations of a prominent and frequent defender of industry in the science wars.

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Leaked Documents Reveal the Secret Finances of a Pro-Industry Science Group

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