Harold Pollack: Reports of ACA demise: greatly exaggerated: "For this edition...
...I Skyped with Dr. Jonathan Gruber, who is the Ford Professor of Economics at the Massachusetts Institute of Technology and director of the health care program at the National Bureau of Economic Research. He is also the most famous health economist in the United States. He has won numerous awards, and written countless papers and academic articles. He has even written a graphic novel about health reform.
Joshua Holland: Obamacare Is Widening The Gap Between “Red” And “Blue” America: "When the Supreme Court ruled that states could decline Obamacare’s Medicaid expansion without facing a penalty...
...the justices set in motion a process that’s now pushing our two countries even further apart as about half of the states passed on the opportunity to insure their poorer residents.... Obamacare appears to have extended insurance coverage to about ten million people who didn’t have it before.... The rate of uninsured is now almost 50 percent higher in states that refused the Affordable Care Act’s (ACA) Medicaid expansion (18.1 percent) than in those that embraced the policy (12.4 percent)....
It is unclear whether Paul Ryan understands what he is doing or not. But if he does, he is laying it all out there--that the Republican health-care endgame is as follows:
If you are already sick, have the wrong genetic markers, or are poor, the plan is for you to beg at your church for money to pay your health care bills.
Health insurance is to be reserved only for those from the middle class who lack adverse genetic markers and who have no preexisting conditions.
Why? Because freedom!
I swing back and forth between thinking that Paul Ryan understands, thinking that he does not understand, and thinking that he just isn't thinking about it but, instead, simply taking whatever step looks most solid without raising his eyes... READ MOAR
...When they took my insurance card, they asked "Is this marketplace or employer insurance?" I answered that it was from my employer. The receptionist said, "Great. We don't take Obamacare." I had a perplexed look on my face, I guess, because she said, "The marketplace has so many kinks that we're just not participating." Is there any reason that this isn't totally kooky? I mean, why should the doctor's office have any idea if an individual plan was purchased on the marketplace, or if the individual just went to Blue Cross Blue Shield directly? Are they saying "no individual policies at all"? Sure enough, there was a sign hanging in the office, which I'll put below the jump. I assume this is just civilian Republican asshattery...
but referenced throughout–which makes the joke yet richer and more multi-layered by the book’s dense 349 page end. It goes like this: There are two people who actually understand the American health system, and both Victor Fuchs and Alain Enthoven are 90 and 83 years of age, respectively. I don’t care if Zeke Emanuel wrote the joke himself because what he did write is the book that should make all of us a little less fearful…. READ MOAR
At least three ex-Governors have assured me over the past three weeks that all or nearly all states will find some way to do Medicaid expansion before the 2016 presidential election--that current governors, even in the reddest of red states, are now more scared of their doctors and their hospital administrators than they are of the Tea Party. And they are beginning to fear that the Keynesians are right and that a failure to expand Medicaid could throw their states back into recession--for state governors and legislators do believe that their state prosperity depends on workers doing things that create exports and thus dollars flowing into the state, and in the flow-of-funds Medicaid expansion is an "export".
Ed Kilgore: Greasing the Skids for Medicaid Expansion: "Arkansas’ expand-but-privatize approach (which recently survived a near-death experience in the Arkansas legislature, at least for the next year),
and Iowa’s expand-with-“personal-responsibility” approach (allowing more copays and deductibles, and more coercive “healthy choice” programs, than are allowed in traditional Medicaid).... Utah is on the brink of cutting a deal.... Progressives could look at such developments as paving the way for more Republican-governed states to expand Medicaid, which is a good thing, or as concessions that threaten the safety-net features (and “single payer” structure) of Medicaid, which is a bad thing....
But I tell you what: if, God forbid, I were a Republican governor, I’d come up with a package of every conservative pet rock reform I could think of that was applicable for Medicaid, put it into a waiver package, and tell my conservative friends that I was going to try to get Barack Obama to pay for turning Medicaid inside out. However it turned out, I’d be a political winner with the Right.
But Kilgore is wrong: it won't be a political winner on the right--no matter how many bells and whistles are added to the waiver application. The deal-breaker for the right is cooperation--or apparent cooperation--in any way with President Obama...
Ann Marie Marciarille: Missouri State of Mind: Who is Wasting What?: "A purchasing alliance among hospitals interested in quality improvement is reported  to have developed a 'waste index' for participating facilities,
designed to give them information to eliminate waste while maintaining a high level of care. Articles that sound a little like press releases do not usually get that much of my attention, but I read on because the lead example of savings from the application of the “waste index” nearly took my breath away.
in so many respects, as... Sebelius v. Hobby Lobby Stores, Inc. and Conestoga Wood Specialties Corp. v. Sebelius.... Lower court opinions... as well as a majority of the more than eighty briefs filed in the Supreme Court, have been devoted to a question... whether corporations... can exercise religion in a way protected by the Religious Freedom Restoration Act... that is, at best, a distraction.... Those opinions and briefs also repeatedly mischaracterize the relevant statute and regulations... failed to critically examine the facts.... And, contrary to what the plaintiffs and many lower courts have argued, it is untrue that the government’s compelling interests are undermined by an alleged vast network of exemptions that will leave “millions” of women unprotected....
Ezekiel Emanuel is Vice Provost for Global Initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. A breast oncologist with a doctorate in political philosophy, he served for many years as chair of the Department of Bioethics at The Clinical Center of the National Institutes of Health. From 2009 to 2011, he helped to craft the Affordable Care Act (ACA) as a special advisor for health policy to the director of the White House Office of Management and Budget. While serving in that role, Emanuel was the target of one of the most unfounded political attacks I have witnessed in health policy.
If you could only read one book about the American health system and ACA’s valuable (albeit imperfect) contribution to improving that system, his new book Reinventing American Health Care: How the Affordable Care Act will Improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System might be the best one.
Noam Levey: In northern Maine, collaboration brings better health - latimes.com: "Many of the nation's healthiest communities are wealthy and have large numbers of college-educated residents.
But northern Maine is among a handful of telling exceptions, making it an important guidepost as the country searches for ways to improve health.... The region now is among America's poorest.... Yet northern Maine ranks high on national measures of health.... Residents of the region receive recommended screenings and medical care more often than other Americans. They suffer fewer complications in nursing homes and are less frequently prescribed risky medications. And they are nearly half as likely to die from preventable diseases as residents of other low-income areas.... Maine's success owes much to the type of care that Patterson typifies — intensely personal, data-driven and highly coordinated. The approach grew out of a decades-long effort by local leaders that many experts consider a model for how to improve community health.
And based on a report in the Washington Post, it will look a lot like their old health care proposals—the ones that would have done very little to improve access, reduce financial distress, and contain health care spending. But this new plan would be different in one key respect. Implementing this sort of Republican plan now would probably mean taking away coverage from quite a lot of people who just got it. That’s a pretty big deal.... The interesting question is how Republicans intend to present this plan.... If Republicans intend to repeal the Affordable Care Act and replace it with the framework that Costa's story describes—or even something with a bit more money behind it—a lot of those people are going to lose... insurance altogether. Until this year, taking away Obamacare meant taking away a hypothetical benefit. Now that benefit is real.... But really, the policy details are sort of irrelevant here. Notwithstanding the efforts of a few dedicated intellectuals and a tiny cadre of federal lawmakers, the vast majority of Republican officials have zero interest in health care reforms that significantly increase access to care. The new House Republican plan was supposed to show otherwise. If they actually manage to produce something—this isn’t the first time they’ve promised a proposal wasn’t imminent—and if it looks like the media reports suggest, the plan will merely confirm everybody’s suspicions: Significantly increasing access to health care just isn’t a priority for today’s Republican Party.
Ed Kilgore: The Central Flaw in Hobby Lobby’s Suit: "To hear many conservatives and even some liberals, the suit brought by the for-profit company Hobby Lobby seeking relief from the contraception coverage mandate of the Affordable Care Act represents a last line of defense by religious believers (of a certain type, to be sure) against the aggressive secularist agenda of the Obama administration.
Buying into that idea has always required some mental gymnastics. The coverage mandate does not require that employers supply employees with contraceptives. It simply requires that if they provide health insurance it must include coverage for certain preventive procedures, devices and medications, including contraceptives. The employee chooses whether or not to avail herself of this coverage, and no reasonable person would hold the employer morally responsible for that choice, any more than if the employee used her wages to purchase the very same contraceptives, which—lest we forget—are not only legal but are constitutionally protected as legal.
Friday, March 14, 2014
4:00 - 5:30 PM
UC Berkeley Labor Center
2521 Channing Way #5555
Berkeley, CA 94720
- Lisa Aliferis - KQED, State of Health blog
- Larry Jacobs - University of Minnesota, Political Science and Public Policy
- Anthony Wright - Health Access California
- Ken Jacobs - UC Berkeley Labor Center
- Margaret Weir - UC Berkeley, Sociology and Political Science
- Charlie Eaton - UC Berkeley, Sociology
Guest Blogger Associate Professor Ann Marie Marciarille: Teeth-Whitening at the Supreme Court: "Well, that is how the Wall Street Journal described the March 3, 2014 grant of certiorari in North Carolina Board of Dental Examiners vs. Federal Trade Commission, anyway.
And it is a case about teeth-whitening services in North Carolina, in particular, but it is also a case about whether the North Carolina Board of Dental Examiners violated federal antitrust law by banning non-dentists from offering teeth-whitening services in the state.
It is a matter insufficiently appreciated that there are very few high-wire acts without a safety net:
Mistermix: WhatsApp Moocher: "One of the founders of WhatsApp, the messaging app just purchased by Facebook for $19 billion, is a Ukranian immigrant who grew up in a family that needed food stamps after they first arrived in the US.
Because of that history, the founders signed the deal with Facebook at the Mountain View Social Services office, where his family would go for assistance. I just wanted to mention that to remind the McArdles of the world that not all American success stories involve feats of Galtian superheroics–some of the Howard Roarks of the world must eat actual food in order to survive.
Last night pieces by the thoughtful and knowledgeable Uwe Reinhardt, the smart and hard-working Marty Lederman, and that brilliant man of unsound methods Richard Epstein collided on my computer screen, and then held an all-night insomniac hoedown.
This is the result:
Jon Perr: Georgia Republicans are Killing Hospitals--and People: "By now, millions of Americans--most of them in red states-- are growing familiar with the 'coverage gap'.
Thanks to their rejection of the Affordable Care Act's expansion of Medicaid in states they control, GOP leaders are leaving at least five million people in an insurance "dead zone," earning too much to qualify for Medicaid but too little to obtain federal subsidies to purchase coverage... with as many as 17,000 people forecast to needlessly die each year for lack of health insurance. But GOP obstruction won't just kill people in places like Texas, Mississippi and many more. As the case of Georgia shows--where over 600,000 residents will fall into the coverage gap and as many as 1,175 will die this year--Republican policy is killing hospitals, too.... A fourth rural hospital in Georgia is shutting its doors due to a lack of patients who can pay for their medical expenses:
Instead of addressing a subtle and complicated issue with (at least!) two sides, the law’s critics keep turning it into a single-sided moral diatribe about the work ethic and the supposed damage Obamacare is doing to it. A perfect illustration is a recent New York Times Economix column by Casey Mulligan.... The genesis of Mulligan’s article is the surprisingly famous appendix to that CBO report—the part where the agency predicts that the Affordable Care Act will be associated with a reduction in the workforce of the U.S... voluntary job leaving by those who have been “locked” into their jobs by fear of losing health insurance... those who are deterred from working by higher marginal tax rates....
Washington Center for Equitable Growth: Afternoon Must-Read: CBO: Frequently Asked Questions About CBO’s Estimates of the Labor Market Effects of the Affordable Care Act:
Q: Will 2.5 Million People Lose Their Jobs in 2024 Because of the ACA?
We would not describe our estimates in that way. We wrote in the report: “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, almost entirely because workers will choose to supply less labor.”…
Because the longer-term reduction in work is expected to come almost entirely from a decline in the amount of labor that workers choose to supply in response to the changes in their incentives, we do not think it is accurate to say that the reduction stems from people “losing” their jobs.
Chris Cilizza is one of the best reporters the Washington Post has now that the Wonkblog crew is heading off to Vox Media. Chris Cilizza also sees nothing odd or ironic in writing:
Chris Cilizza: Why the CBO report is (still) bad news for Democrats: My job is to assess not the rightness of each argument, but to deal in the real world of campaign politics in which perception often (if not always) trumps reality…
Note the assumptions here:
And at this point, all you can do is quote extensively from Plato’s Republic, the passage on the Allegory of the Cave, and urge Jeff Bezos to immediately change the culture of the Washington Post completely so that it can at least try to step up its game...
So I was reading:
Jagadeesh Gokhale, Ph.D., and Angela C. Erickson: The Effect of Federal Health Care ‘Reform’ on Kansas General Fund Medicaid Expenditures
and I ran across this graph:
and the paper's accompanying conclusion:
By 2023, 21 percent of the Kansas population is projected to be on Medicaid under the PPACA—up from 13 percent currently. Kansas Medicaid expenditures are projected to grow by an additional $4.7 billion (29 percent) beyond the increase projected without PPACA.... With ongoing court and congressional challenges, the final chapter of the PPACA law and state Medicaid spending has yet to be written. However, since a federal court judgment has declared PPACA unconstitutional, Kansas lawmakers should vigorously oppose the implementation of PPACA’s health exchanges and other administrative and operational infrastructure...
And then there is, by Gokhale alone, a 2013 update on the Cato Institute's website:
and the paper's updated conclusion:
Kansas’ lawmakers face a crucial decision about whether to expand Medicaid according to the dictates of the ACA. That decision would expand the program and possibly improve health outcomes for low income households. However, that benefit must be weighted against the lost opportunities to spend on other budget programs that are also valuable.... The incremental 10-year cost to the Kansas general fund from expanding Medicaid of $625 million would arise “at the margin”.... It may be better to spend the $625 million on other Kansas budget items...
But there is one number that I cannot find on either graph or in either version of the policy brief:
That $8 billion is the amount of federal dollars the U.S. government will commit to match 100% of extra costs for the first three years and 90% for the next seven if Kansas expands the Medicaid program as ObamaCare envisions. And that is money that will not flow to Kansas if Medicaid is not expanded by Kansas.
The argument that Kansas has better things to spend its $625 million on over the next decade than on expanding Medicaid rings a little hollow when you reflect that cutting $625 million over the next decade from ACA-projected levels reduces what Kansas can buy by not $625 million but rather $8.625 billion. Kansas would have to get 14 times as much state welfare out of a dollar spent elsewhere than out of a dollar spent on its Medicaid program for that argument to apply.
But, I suppose the honchos of the Cato Institute and of the Kansas Policy Institute think, if you don't mention and certainly don't stress the $8 billion number, maybe Kansas's Republican state legislators won't understand what they are doing in rejecting Medicaid expansion.
Here's the context of all mentions of this $8 billion over the next decade--all mentions of the word "match" in the 2013 version of the policy brief:
That's it. No $8 billion number anywhere I can find.
I could go on. I could point out that Gokhale's claims that sustaining the high match rate that produces the $8 billion number is "infeasible" are grossly overstated--and that we will see whether they are true or not in two years, when we will see whether Gokhale's claim that the "100 percent match rates specified for the first three years of the ACA's implementation" are "simply not feasible". That applies to his (12), (10), (7), (6), (3), (2), and (1). I could point out that his claim that federal Medicaid spending would not boost the Kansas economy rests on a bizarre and empty assertion that in the health care sector and the health care sector alone supply curves do not slope upward. That applies to his (11), (10), and (4). I could point out that his claim that federal lawmakers recognize that "such generous matching of new state Medicaid spending on account of Medicaid expansion is, in reality, infeasible" is simply a lie--a misrepresentation of the meaning of proposals and counterproposals in failed 2011 Supercommittee negotiations. That takes care of his (12), (10), and (6).
Now the federal government does have the power to break its deals with states: no congress can fully bind any future congress. But only in Cato Institute-land does the fact that circumstances may change and the optimal level of Medicaid funding for a state may fall in the future carry the implication that the optimal level of state Medicaid funding for a state is low now.
But the thing that strikes me the most is how anxious both Cato and the KPI appear to be to direct attention away from the numbers: that by failing to commit $625 million, Kansas is losing $8.625 billion.
It's as if they fear that their verbal case would simply dry up and blow away if they were to even whisper the terms of the deal being offered...
David Lieb: Ex-Missouri GOP Senator Kit Bond Now Lobbying For Medicaid Expansion: "As a Republican senator, Kit Bond voted against... [Obamacare.] Now... Bond is pushing Republican legislators in his home state of Missouri to embrace a key provision of the law by expanding Medicaid eligibility.
Bond said Friday that... "I'm getting involved in Medicaid reform now because if our State sits on the sidelines, I'm concerned hospitals in rural and inner city Missouri won't survive."... The Missouri Chamber of Commerce and Industry declined to say how much it is paying Bond's consulting firm.... Bond already has met with Republican legislative leaders and Democratic Gov. Jay Nixon about the potential to expand Medicaid eligibility. "He understands the issues very well, and we're trying to capitalize on his stature, his relationships that he has and his reputation as a one of the best statesmen that this state will ever have," Mehan said.
Lindsay Beyerstein: The latest work-around for abortion docs: "For 32 years, Dr. Lester Minto performed abortions at Reproductive Services of Harlingen, a modest, one-story building in Harlingen, Texas right next door to the regional branch of the state Department of Health.
Ever since October 31, however, he has been barred from performing abortions. Minto lacks local hospital admitting privileges, which Texas’s new abortion law—H.B. 2—requires all abortion providers to have.... The Rio Grande Valley... with 1.3 million inhabitants... is without an abortion provider. Women in the Valley must now make a 300-mile round trip to Corpus Christi or a 500-mile round trip to San Antonio for a clinic abortion....
Tara Cup-Ressler: Judge Permanently Strikes Down Oklahoma's Age Restrictions On Plan B:
On Thursday night, an Oklahoma district court judge permanently struck down a state law that prevented some teenagers from buying Plan B over the counter.... Gov. Mary Fallin (R) approved the measure last year, just a month before the Obama administration approved over-the-counter Plan B for girls of all ages.... [But] lawmakers aren’t allowed to address multiple unrelated issues in a single piece of legislation, and the emergency contraception restriction was tacked onto a law about health insurance regulations.... Despite the fact that Plan B hit pharmacy shelves over the summer, some women are still struggling to access it, thanks to ongoing confusion about the federal and state regulations regarding emergency contraception. And Oklahoma isn’t the only state to attempt to impose state-level restrictions on the morning after pill. Conservatives have been laying the groundwork to push for more state laws to undermine over-the-counter Plan B access, and this type of legislation was recently introduced in Mississippi.
I really do not understand the calculus here: (1) You don't want your teenage daughter to show up pregnant. (2) You don't want your teenage daughter to be sexually active. The first is--presumably--worse than the second. The links between access to contraception and sexual activity are not that strong.
So what is the upside? It really seems to me to be that abortions are better than teenagers planning how to avoid pregnancy...
Fifty years from now which will play worse in historical memory: the conservative southern Democrats' massive resistance to try to civil rights in the 1950s and the 1960s or the conservative Republicans' massive resistance to their poorer fellow-citizens getting health insurance in the 2010s?
I cannot tell. I do, however, think that history will judge the second as stupider: practically everyone has somebody uninsured or at risk of rapidly becoming uninsured in their extended family, and throwing federal Medicaid and exchange subsidy dollars down the toilet does run a measurable risk--10%? 20%? 50%?--of send the red state economies as a group back into recession over the next two years.
But things aren't all going their way. Sy Mukherjee reports:
We're now at the point in "Obama's Katrina" when the number of uninsured people in West Virginia has been reduced by a third.— LOLGOP (@LOLGOP) January 21, 2014
Are you a doctor? A specialist, perhaps? A surgeon? If you are, there's a seminar for you, taking place on January 31st in Kentucky. The American Association of Physicians and Surgeons is sponsoring a seminar in how you and your colleagues can 'Keep Obamacare out of your office'....
You can learn all about how the AAPS is fighting to stop maintenance requirements on specialty certifications, delivered by none other than Andrew Schlafly. The DC Update will be delivered by Charlie Sauer, a self-proclaimed economist and former staffer for Jeb Bush and Chuck Grassley... Tea Party challenger in KY-3, Dr. Michael MacFarlane, and Dr. Alieta Eck from NJ-12. More conference highlights will be delivered by Ayn Rand acolytes Josh Umbehr, MD, who runs Atlas MD Family Practice, and Mark Schiller, MD, who runs the Mind Therapy Clinic in the San Francisco area...
John E.: A View of Obamacare:
Way back in the '80´s, during a downturn in the Oil Patch, a Wall Street Journal reporter visited several highly-skilled Texans who suddenly found themselves without work. One, after describing the hardships of raising a family without income, confessed to finally having to accept unemployment insurance. Whereupon he burst into tears, protesting that he was no socialist, and, in so many words, vowing to make the liberals who had so humiliated him with such an indignity, pay, once he was on his feet again, and able to defend himself. That was what made me finally realize some of what we're up against.
As I continue to try to figure out where the extraordinary animus against ObamaCare comes from not at the level of office-holder posturing but at the level of real ideology, last night pieces by the thoughtful and knowledgeable Uwe Reinhardt, the smart and hard-working Marty Lederman, and that brilliant man of unsound methods Richard Epstein collided on my computer screen, and then held an all-night insomniac hoedown.
This is the result: Washington Center for Equitable Growth | ObamaCare as Dire Infringement of Individual Liberty and in a “Death Spiral”, and LADYPARTS: (Trying to Be) the Honest Broker for the Week of January 19, 2014
Tue Dec 31, 2013 at 13:04:37 PM CST, via Twitter, from Governor Jay Nixon (D):
Tomorrow, billions of dollars will begin to flow to states to improve & reform health care, but Missouri won't be one of them. #momedicaid 12:50 PM - 31 Dec 13
Wait until Missourians realize they're paying for those other states to do so.
Last night pieces by the thoughtful and knowledgeable Uwe Reinhardt, the smart and hard-working Marty Lederman, and that brilliant man of unsound methods Richard Epstein collided on my computer screen, and then held an all-night insomniac hoedown.
This is the result:
Outsourced to: Doktor Zoom: Genius Missouri Bill Will Kill Obamacare By Putting Insurance Companies Out Of Business: "OK, so shutting down the government didn’t work, and the House repealing it umpty-eleven times didn’t work, and the website does work, but maybe it’s not too late for states to save their citizens from the horror of having health insurance. They could maybe try the genius plan introduced in the Missouri Senate by state Sen. John Lamping:
The bill would suspend insurance companies’ state licenses if they accepted subsidies offered by the federal government to help pay health insurance premiums for low- and middle-income Missourians....
Lamping figures that the subsidies are illegal and will totally be declared unconstitutional.... So if you preemptively act as if they are illegal, and punish insurance companies that accept them, somehow that will make the employer mandate go away, hooray!
I very much hope that this was just a one-year blip--that the 2013 numbers will look much more like the 2011 ones...
The suicide rate in Kansas rose by a staggering 30 percent between 2011 and 2012... many believe that a combination of cuts to mental health funding and the socioeconomic stresses brought on by the global recession are to blame.... A recent, first-of-its-kind study measuring the impact of the recession on global mental health found that suicide rates increased significantly in countries whose unemployment rates also rose... a 37 percent higher unemployment rate was linked to a 3.3 percent increase in men’s global suicide rate. In America, the recession exacerbated a suicide rate that had already been rising for over a decade. Unfortunately, that trend corresponded with massive cuts to mental health care funding as cash-strapped states tried to balance their budgets.... Another round of cuts imposed by sequestration has forced the federal government to pull back funding for substance abuse and mental health programs. That hits local communities hard — for instance, one community health center in Kansas lost over half of its funding thanks to a combination of state budget cuts and sequestration. “Treatment dollars have gone down and more and more people are coming to us, a growing number without any other payment for services,” said Marilyn Cook, executive director of the Sedwick County community health center, in an interview with the Wichita Eagle. “[W]ithout adequate funding, it’s difficult for us to get to everybody who needs care and help.”
Yet another target population that could really benefit from ObamaCare. And yet another population whose political masters are doing everything they can to keep people from having access to it...
As best as I can figure out, states that go all-in in their opposition to ObamaCare will lose 3% of their state-level GDP relative to baseline from Medicaid dollars not spent and exchange subsidies not claimed in the short run, and 6% in the long run as those who make the things medical professionals buy move to where the money is...
*Prairie Weather: * Republican efforts to destroy Obamacare may come back haunt them:
I'm beginning to wonder whether the future health of American politics may turn out to owe something to Obamacare. Texas is a ridiculously red state... that has been churning out an embarrassing group of knuckledraggers who find their way to... Congress.... The effort to destroy Obamacare is as alive in Texas these days as in Washington.... Rick Perry's idea of reggle-atin' includes making the navigators pay a hefty fee for their role assisting in the implementation of the Affordable Care Act... "40 hours of training... liability insurance... fees for fingerprints, tests and classes".... To become a navigator in Texas, you'll need to ante up $800.
Josh Marshall: Something to Behold: "It's become something of a cliche: disabled, aged or relatively impoverished whites who literally could not survive without federal government assistance in many case nonetheless raging against Washington, 'hand outs' and government dependency.
It's there with a vengeance in this article in National Journal by Beth Reinhard on GOP plans to double down on race-based class warfare as the ticket to success in the 2014 elections. Kudos to Mark Karlin of Buzzflash for bringing the piece to my attention and specifically the passage I'm about to quote in full. Meet Terry Rupe ...
"I don't have any use for the federal government," Rupe said, even though his household's $13,000 yearly income comes exclusively from Washington. "It's a bunch of liars, crooks, and thieves, and they've never done anything for me. I'm not ungrateful, but I don't have much faith in this health care law. Do I think it's going to work? No. Do I think it's going to bankrupt the country? Yes."
Brian Francisco: Getting an earful on Obamacare:
A health insurance consultant said his own insurance premiums are climbing because of the Patient Protection and Affordable Care Act. But a meat market owner said the health care law will cut his insurance rates by more than half. Rep. Marlin Stutzman, R-3rd, had asked for input on the Affordable Care Act during an open house Monday at his office in the E. Ross Adair Federal Building, and he got it. Nearly 20 people showed up to speak individually with him, and most wanted to talk about the law that is requiring most Americans to obtain medical coverage from private insurers.
The experiences and opinions of Matt Hatfield, the insurance consultant and seller, and Lee Albright, owner of the south-side meat market carrying his last name, were drastically different. Hatfield, a past president of the Northeast Indiana Association of Health Underwriters, told Stutzman his insurance premiums are increasing 50 percent and his medical provider network is shrinking because of changes in his policy prompted by President Barack Obama’s signature legislation. He predicted even greater sticker shock for insurance consumers starting next summer, when policies come up for renewal. “The sooner people get the bad news, especially in an election year, the better” for voters to express their displeasure in the 2014 congressional elections, Hatfield said. “I think Priority One is getting the current (law) tossed out,” he said. “But you also have to come back with, what are you proposing?”
Stutzman replied: “What are you replacing it with? That’s what everybody is asking right now.”
Albright doesn’t want the Affordable Care Act repealed, which Stutzman and the Republican-controlled House have voted to do numerous times. Albright told his congressman that his monthly payment for family health coverage will drop from $3,800 to $1,700 by enrolling in a plan offered through the much-maligned law. Albright said most of his dozen employees also are enrolling in Affordable Care Act plans and will have coverage for the first time. “If the Republican Party thinks they’re going to kill Obamacare, you guys need to realize that those nine people that I add on, are they going to vote Republican ever again if you take their health care from them?”
Stutzman responded: “No, probably not.”...
James Hamilton, of Spencerville... had earlier said to Stutzman, “I’m really disappointed that the Republicans haven’t come forward with an alternative plan,” adding that he would “like to see something that is very different” from the Affordable Care Act.
Stutzman replied: “There’s several Republican plans that are competing with each other right now just internally. After the first of the year, we are going to try to sort through that.”
My healthcare saga began in 2002.... No longer did I have a group plan selected by an employer. I had to shop for my own coverage. At first it was easy.... But each year the dreaded renewal letter arrived, and the premiums increased by leaps and bounds.... But the big shock was yet to come... renewal letter... $756 instead of $463--a staggering 63% increase.... I applied for a very-high-deductible plan that would keep my monthly payment in the $400 range. Given that I was still insured, the insurance folks got a copy of the blood test, which they proceeded to search line by line.... Out of two pages of data, there was a single thyroid reading was outside of “normal” range (side note: there’s nothing wrong with my thyroid; it was simply their excuse to make me pay that outrageous premium). They’d found their so-called preexisting condition, and denied me access to the new plan with the lower premium. With the help of my doctor, who wrote a letter on my behalf, I appealed.... "It wasn’t a government bureaucrat that came between me and my doctor; it was an insurance-company bureaucrat...."
Surely one element of Obama(snarl)care that's really upsetting Republicans is what health insurance could do to Mitch McConnell's political health. The problem for the minority leader is that "on the campaign trail, Senate Minority Leader Mitch McConnell was still blasting the new health-care law as unsalvageable," according to the Washington Post:
Obamacare is doing very well in McConnell's home state of Kentucky. The Post has been following Courtney Lively, one of the officials signing up new applicants.
Truly, truly, truly, I have a very hard time hanging out in the middle of the country without starting to weep uncontrollably...
Greg Sargent: Obamacare class warfare in Kentucky:
Republicans are rolling out an attack on Obamacare that sounds a lot like the Romney 2012 “free stuff” argument... to characterize beneficiaries... particularly... Medicaid expansion as “shiftless freeloaders” enjoying “free health care,” all ”on the backs of hardworking Americans.”...
The handling of Obamacare by McConnell’s Dem opponent, Alison Lundergan Grimes, is worth considering in this context. It reflects the fact that red state Dems are approaching the health law in a more nuanced way than conventional wisdom suggests. Grimes is criticizing parts of the law, and is not embracing it--far from it. But she isn’t running from its general goals, either. Something more subtle is going on.... Here are a couple recent Grimes statements about Obamacare....
Instead of finger-pointing, instead of blaming, instead of attacking the presidential branch, let’s actually — or the executive branch — let’s actually attack the problem that exists here in the commonwealth and find a way for 640,000 [to get health insurance...]
There are 640,000 Kentuckians who previously did not have access to insurance... we don’t need to throw the baby out with the bathwater.
The 640,000 Grimes refers to are the total number of Kentucky residents who are eligible for the Medicaid expansion or are uninsured and must buy insurance, many of them eligible for subsidies.... The class warfare attacks on Obamacare will continue... stoking class warfare and resentment are central to other attacks on the law, too.... Here’s what I expect to see. Grimes will avoid talking about Obamacare where possible, and instead will focus on the minimum wage, pocketbook issues affecting women (equal pay), and McConnell’s decades in Washington. Where necessary, she will call for “fixes” to Obamacare problems....
Kentucky may prove to be an interesting testing ground for a Democratic balancing act... enrollment has been a success, and many beneficiaries are poor and rural.... Dem governor Steve Beshear is one of the most aggressive advocates for the law.... You can see the potential for a more direct argument later about the consequences of repeal. Thus far, nearly 72,000 Kentuckians have enrolled, over 56,000 through the Medicaid expansion, and tens of thousands are eligible for subsidies. Over the months you can picture enrollment piling up to a critical mass that would make it easier for Grimes to argue that repeal would kick all of these people off of insurance, and harder for McConnell to stick to his “free stuff” frame.
Behind the wave of "our red-state governors and legislatures are grinding the faces of our working poor in the dirt and bankrupting them by depriving them of their Medicaid" stories we are currently watching being written will be a wave of "our hospitals are falling apart and our doctors are falling behind blue-state ones because of our red-state governors and legislatures."
We will see whether that coming wave of stories will have any more effect than this one:
And we have yet another article wondering why Prime Minister Obama didn’t just eliminate the American health insurance industry.... The answer, of course, is that Obama didn’t take single payer “off the table.” It was never on the table. The idea that there were 60--hell, that there were 30--votes for single payer in the Senate is sheer fantasy. Diaz-Alvarez doesn’t even try to explain how “a president willing to nationalize health care” could have actually gotten the relevant legislation enacted. (Again, given that the answers tend to be self-refuting things like “threaten to primary legislators who aren’t running for anything” or “offer to campaign for candidates in states where you’re enormously unpopular” this is probably for the best.) Rather, this is a teleological argument. Single payer is more efficient, therefore policy outcomes should naturally gravitate in that direction and if they don’t the only explanation must be that the president--the sole meaningful inhabitant of the American political universe--must be obstructing it.
I’ve already said enough about this line of argument, but wow....
As a corrective, I strongly recommend Alex Pareene’s piece on Elizabeth Warren. The White House isn’t where transformations begin; it’s where if they’re successful, they end.
Outsourced to Ezra Klein: The GOP says Obamacare will cancel 80-100 million insurance plans. Nope:
I appeared on NBC's "Meet the Press".... Before I came on, Mike Rogers, a Republican congressman from Michigan, delivered his take. Obamacare's effects turned out to be more dire than I'd ever imagined.
The next go-round on the business side is 80 to 100 million people will get cancellation notices.... Eighty million people are going to get pink slips. Their own estimate. Eighty million.
That's more cancellation notices than the estimates I've seen by a factor of at least 10. I asked Rogers's press secretary where the number came from. Turns out it's not exactly the administration's own estimates. It's a Daily Caller interview with Christopher Conover.... According to Conover, Rogers, if anything, understated his case... "at least" 129 million people will lose their coverage by the end of 2014....
What Conover's talking about here isn't cancellation notices or pink slips... [but] any change to a plan at all.... This isn't how most people define losing their plan. I have family members whose insurance expanded to cover their adult children. They didn't call me complaining that they lost their plan. They called me ecstatic that their plan had improved.... What Rogers said on "Meet the Press" is... flatly untrue. It's simply not the case that 80 to 100 million people are going to get cancellation notices over the next year.
As for Conover's definition of losing your health insurance, it's telling that so many of the people losing their health insurance don't think they've lost their health insurance. Many of them think their health insurance has improved! And small changes to benefits and premiums are common in employer-provided health-care plans...
William Kristol: Defeating President Clinton's Health Care Proposal
Project for a Republican Future
December 2, 1993
MEMORANDUM TO: REPUBLICAN LEADERS
FROM: WILLIAM KRISTOL
SUBJECT: Defeating President Clinton's Health Care Proposal:
What follows is the first in what will be a series of political strategy memos prepared by The Project for the Republican Future. The topic of this memo is President Clinton's health care reform proposal, the single most ambitious item on the Administration's domestic policy agenda.
These four pages are an attempt to describe a common political strategy for Republicans in response to the Clinton health care plan. By examining the president's own strategy and tactics, this memo suggests how Republicans might reframe the current health care debate, offer a serious alternative, and, in the process, defeat the president's plan outright.
I do keep hearing that the Republican governors of America loathe Chief Justice John Roberts more than anybody else alive. He forced on them a dilemma: either alienate their bases by appearing to enthusiastically endorse implementing ObamaCare via the Medicaid expansion, or alienate their medical-care sectors by refusing to implement the Medicaid expansion and thus leaving a huge number of federal dollars on the sidewalk. They would much rather have not had that choice--have been required by law to implement the Medicaid expansion on pain of losing all Medicaid funds, and so been able to get the money while all the while whining about the infringement of their dignity...
Nevertheless, I would have expected a calculation of the financial fundamentals and simple human charity to have induced more to accept Medicaid expansion by now than in fact have...
Timothy Egan: The South’s New Lost Cause:
What is distressingly similar today is how the South [and the Prairie!] is once again committed to taking a backward path. By refusing to expand health care for the working poor through Medicaid, which is paid for by the federal government under Obamacare, most of the old Confederacy is committed to keeping millions of its own fellow citizens in poverty and poor health. They are dooming themselves, further, as the Left-Behind States. And they are doing it out of spite. Elsewhere, the expansion of Medicaid, the health care program for the poor, has been one of the few success stories of Obamacare. It may be too complicated for the one-dimensional Beltway press. Either that, or it doesn’t fit the narrative of failure.
Aside from the bartender who recorded the notorious “47 percent” video, Jonathan Gruber may have become Mitt Romney’s least favorite person during the 2012 campaign. Gruber damned the former governor of the Bay State with praise that certainly did little to shore up his standing in the Republican base: “He is in many ways the intellectual father of national health reform.”... Recently, Gruber spoke with National Memo executive editor Jason Sattler....
Jason Sattler: You’re estimating that a few million of the insured are in that so-called “losers” category. And you’ve recently described these people as winning the “genetic lottery” — suggesting they’ve been underpaying in the past?
Jonathan Gruber: So basically there’s two different issues. One of them is, what does it mean to be a “loser?”… How many people are being asked to find more generous plans than before? That’s probably about six million people.... The other issue is, how many people going to end up paying more than they did before? That’s probably about four million people.... The point is that a lot of people who are healthier have benefited from existing discrimination in the market....
Sattler: Is the refusal of 25 states to expand Medicaid distorting the market?
Gruber: I think in those states, by my own estimates, it’s going to raise premiums by about 15 percent in the exchange because sicker people will be in the exchange. I think it’s really disgusting that these states aren’t providing their poorest residents free insurance [financed] by the federal government. It’s pretty amazing that they can get away with that.
Sattler: What do you think about the right-wing argument that having no insurance at all is better than Medicaid?
Gruber: It’s just incorrect. There’s no credible evidence to support that....
Sattler: What would success for this law look like?
Gruber: We’re looking for several million people to sign up by March 31. And we’re looking for a reasonable mix of not just sick people, but also healthy people joining too...
Sattler: What did the proportions look like in Massachusetts during the first year?
Gruber: The New England Journal of Medicine study [that] I was part of found that the healthiest people tended to wait until the very end. There was a huge spike among the healthy right near the end of the enrollment period...
Josh Barro: Here's The Real Government Takeover Of Health Car:
For the last few weeks, Republicans have been full of schadenfreude over President Obama's broken "If you like your plan, you can keep it" promise. Now, this issue is about to blow up in Republicans' faces. Sen. Mary Landrieu (D-La.)... has introduced a bill to address the president's broken promise... [by] obligat[ing] insurers to continue offering all the plans they offer today unless they entirely exit the health insurance business in a state. What will Republicans do with this proposal? Do they really want a federal law that says health insurers can't enter or exit specific lines of business?
The way that ObamaCare was supposed to work, as more people became beneficiaries of expanded Medicaid, the current money flows that pay for safety-net hospitals to treat the uninsured would go away--for Medicaid would now be paying. Thus when John Roberts rewrote the Affordable Care Act from the bench to give states the option not just to accept or reject Medicaid as a whole, but to (a) accept Medicaid, (b) reject Medicaid, or (c) simply keep "Old Medicaid", he should also have rewritten the parts of the law that phased-out the payments to safety-net hospitals, shouldn't he? Me? I think a judge who is too lazy to familiarize himself with the case he is deciding and the likely consequences of his actions should resign. What do you think?
Sabrina Tavernise: Cuts in Hospital Subsidies Threaten Safety-Net Care:
The uninsured pour into Memorial Health hospital here: the waitress with cancer in her voice box who for two years assumed she just had a sore throat. The unemployed diabetic with a wound stretching the length of her shin. The construction worker who could no longer breathe on his own after weeks of untreated asthma attacks and had to be put on a respirator.... Many of these patients were expected to gain health coverage... through a major expansion of Medicaid.... But after the Supreme Court in 2012 gave states the right to opt out, Georgia... Republican-led, refused to broaden the program. Now... a government subsidy, little known outside health policy circles but critical to the [safety-net care] hospitals’ survival, is being sharply reduced under the new health law..."
It is indeed amazing. If the federal government wanted to spend $30 billion/year in red states for any other purpose (save registering eligible voters) the Republican governors and the legislatures of those states would be straining every nerve to get their share and more than their share.
But it it is to provide health insurance to poor people? To let the doctors and hospitals stop the game of three-card-monte by which they cross-subsidize to gain the resources to (inadequately) treat the uninsured?
Nope. No way.
Let me turn the microphone over to Dylan Scott of TalKing Points Memo:
The 5 Million People The GOP Cut Out Of Obamacare: The Medicaid expansion field is tentatively set for 2014, and the nation is split down the middle: 25 states (plus D.C.) are expanding, and 25 states are not, according to the Kaiser Family Foundation.