Success Of Obamacare Might Translate Into Political Success

The number of people signing up for private insurance coverage under the Affordable Care Act has now reached eight million. While primarily symbolic, it does represent a victory after initial projections of seven million were reduced to six million due to the problems when the exchanges opened. We know that if they failed to meet these projections, Republicans would be making a big deal of them. In addition, late enrollees included a high percentage of young people.

Good news means more positive head lines, such as National Journal writing that Obamacare is on a Winning Streak. The political climate is changing, with some Democrats now being more willing to run on its success.  I think it is essential that they do this to reduce the risk of the loss of a large number of seats this November. The evidence shows that Obamacare is a success but if Democrats don’t defend it, voters will only hear Republican attacks. Hiding from Obamacare will only make Democrats look weaker, and will not protect them from voters who vote against Democrats based upon Republican misinformation.

Ezra Klein writes that the right suffers from Obamacare Derangement Syndrome, being unable to admit that it is working:

Republicans used to talk about Bush Derangement Syndrome. Washington Post columnist Charles Krauthammer defined it as “the acute onset of paranoia in otherwise normal people in reaction to the policies, the presidency — nay — the very existence of George W. Bush.” Republicans like Krauthammer understood that BDS helped the Bush administration in two ways: it fired up their supporters and it distracted liberals from more modest, but effective, critiques.

Today, the right struggles with Obamacare Derangement Syndrome: the acute inability to see Obamacare as anything but a catastrophic failure that the American people will soon reject. For those suffering from ODS, all bad Obamacare news is good news, and all good Obamacare news is spin. In this world, delays of minor provisions in the law prove that the entire structure is collapsing, while surges of millions of people enrolling in insurance don’t prove anything at all…

But it’s coming at a moment when Obamacare’s successes are getting tougher and tougher to deny. The law signed up more than 7.5 million people in the exchanges, more than 3.5 million people in Medicaid, and it led millions more to get health care through their employers or directly through insurers. Premiums are lower than the Congressional Budget Office predicted when the law passed, and insurers are already thinking about how to compete for applicants in 2015. The White House has a much better story to tell than anyone — including me — thought possible in December.

For Republican pundits it might not matter that Obamacare is a success. Republicans show more intensity in their views, and very little concern for the truth. Campaigning against Obamacare might still motivate Republicans to get out and vote.

Andrew Sullivan might be a bit overly optimistic about the political effects of the success of Obamacare, but I hope he is right:

There’s simply no denying that the law has been rescued by an impressive post-fiasco operation that did to ACA-opponents what the Obama campaign did to the Clintons in 2008 and to Romney in 2012. Obama out-muscled the nay-sayers on the ground. I have a feeling that this has yet to fully sink in with the public, and when it does, the politics of this might change. (Since the law was pummeled at the get-go as something beyond the skills of the federal government to implement, its subsequent successful implementation would seem to me to do a lot to reverse the damage.) There are some signs that this is happening. A new Reuters/Ipsos poll finds the following:

Nearly one-third of respondents in the online survey released on Tuesday said they prefer Democrats’ plan, policy or approach to healthcare, compared to just 18 percent for Republicans. This marks both an uptick in support for Democrats and a slide for Republicans since a similar poll in February.

That’s mainly because of renewed confidence and support from previously demoralized Democrats. But it’s also a reflection, it seems to me, of the political vulnerability of Republicans who have failed to present a viable alternative to the law, and indeed seem set, in the eyes of most voters, merely to repeal ACA provisions that are individually popular. And this bad position is very likely to endure because of the intensity of the loathing for Obama/Obamacare among the Medicare recipients in the GOP base. It seems to me that right now, the GOP cannot offer an alternative that keeps the more popular parts of Obamacare without the air fast leaking out of their mid-term election balloon. And so by the fall, the political dynamics of this may shift some more in Obama’s direction. By 2016, that could be even more dramatic. One party – the GOP – will be offering unnerving change back to the status quo ante, and the other will be proposing incremental reform of the ACA. The only thing more likely to propel Hillary Clinton’s candidacy would be a Republican House and Senate next January.

It’s that long game thing again, isn’t it? Like the civil rights revolution of the Obama years, it seemed a close-to-impossible effort to start with, and then was gradually, skillfully ground out. It also seems true to me that the non-event of the ACA for many, many people will likely undermine some of the hysteria on the right. The ACA-opponents may be in danger of seeming to cry wolf over something that isn’t that big a deal. Yes, they may have premium hikes to tout as evidence of the alleged disaster. And every single piece of bad news on the healthcare front will be attributed to the ACA, fairly or not. But the public will still want to know how premiums can go down without people with pre-existing conditions being kicked out of the system, or without kids being kicked off their parents’ plan, and so on. I think, in other words, that the GOP’s position made a lot of short-term political sense in 2010 and even 2012. But it’s a much tougher sell in 2014, let alone 2016. Once again, they have substituted tactics for strategy. Every time they have done that with Obama, they have failed.

Sullivan described how he has benefited from the Affordable Care Act and concluded, “Yes, I am just one tiny, and rare example. But for me, at least, Obamacare has over-delivered and over-performed. If my experience is replicated more widely, then I suspect the polling and politics will shift yet again.”

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Insurance Companies Plan To Increase Policies Offered On Exchanges Following 2014 Success, And Other Health Care News

The first year of enrollment for insurance under the exchanges is largely for first getting our feet wet, with more people projected to sign up in the future. It certainly exposed problems in the computer system and allowed for them to be fixed (although further testing before October was clearly needed). Insurance companies got to see whether this was a profitable market they would want to enter. In the past one or two insurance companies dominated in most areas on the individual market. One of the benefits of selling coverage through the exchanges was the hope that multiple companies would now begin to offer coverage.

Even conservatives who oppose the Affordable Care Act should agree with the benefits of having more companies offer insurance, including the likelihood of competition leading to lower prices. Actually exchanges, along with mandates, were originally supported by Republicans until they opposed the plan when supported by Barack Obama.

So far we are receiving good news following the initial IT problems. The Affordable Care Act now looks like a good policy which just got off to a rocky start. Enrollment is estimated at 7.5 million, exceeding predictions made even before they were adjusted downward with the early computer problems, with more healthy young people signing up at the last minute. Politico reports that insurance companies are happy with what they are seeing and want to get in:

Health insurers got their first taste of Obamacare this year. And they want seconds.

Insurers saw disaster in the fall when Obamacare’s rollout flopped and HealthCare.gov was a mess. But a strong March enrollment surge, along with indications that younger and healthier people had begun signing up, has changed their attitude. Around the country, insurers are considering expanding their stake in the Obamacare exchanges next year, bringing their business to more states and counties. Some health plans that skipped the new marketplaces altogether this year are ready to dive in next year.

At least two major national insurers intend to expand their offerings, although a handful of big players like Aetna, Humana and Cigna, are keeping their cards close for now. None of the big-name insurers have signaled plans to shrink their presence or bail altogether after the first rocky year. And a slew of smaller health plans are already making moves to join more states or get into the Obamacare business for the first time.

“[W]e see 2014 as just the beginning for exchanges,” said Tyler Mason, a spokesman for UnitedHealth Group, one of the nations’ largest insurers. “As the economics, sustainability and dynamics of exchanges continue to become clearer, we believe exchanges have the potential to be a growth market with much to offer UnitedHealthcare and other insurers and consumers.”

Nurturing this growth and health plan participation will be one of the first tasks of Sylvia Mathews Burwell, assuming she is confirmed to succeed Kathleen Sebelius as secretary of Health and Human Services.

The article reviewed plans by many of the larger insurance companies and also noted that several smaller companies now want to start selling insurance. Being able to offer their plans on the same computer site as the larger companies will allow small companies to compete for sales more easily than in the past, further increasing choice for consumers.

It is not only insurance companies which see the Affordable Care Act as succeeding. The latest Reuters/Ipsos poll shows the number of people who prefer Democrats over Republicans on health care has increased:

Americans increasingly think Democrats have a better plan for healthcare than Republicans, according to a Reuters/Ipsos poll conducted after the White House announced that more people than expected had signed up for the “Obamacare” health plan.

Nearly one-third of respondents in the online survey released on Tuesday said they prefer Democrats’ plan, policy or approach to healthcare, compared to just 18 percent for Republicans. This marks both an uptick in support for Democrats and a slide for Republicans since a similar poll in February.

Not surprisingly, Gallup has found a greater decrease in the uninsured in states which have embraced the Affordable Care Act, such as by setting up their own exchanges and taking advantage of the expanded Medicaid program.

Having Gallup survey the number of uninsured is of value as the Census Bureau is changing how it is surveying the uninsured, with Gallup providing a second set of numbers for comparison. Many Republicans see a conspiracy to make Obamacare look good. Actually this looks like a change to get more accurate results, which might actually show a greater number of uninsured. The changes also started with 2013 so we will still be able to compare the year prior to the exchanges to subsequent years. Sarah Kliff explained further at Vox.

Cross posted at The Moderate Voice

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Coverage Of The Success of Obamacare And Debunking Republican Lies

Obamacare Winning

Reading liberal versus conservative columnists give entirely different views of the Affordable Care Act. Liberals have been writing about its success while conservatives continue to spread misinformation. Here’s a few examples of liberal views on the topic (which are the fact-based articles):

Tim Dickenson of Rolling Stone (source for the above graphic) writes that Obamacare is working. Instead of the fake conservative horror stories, he linked to stories which show how the Affordable Care Act is helping people. He described the successes, and pointed out that “Republican Party sabotage has also impeded enrollment.” Rather than back away  from calling a lie a lie as many journalists will, Dickenson directly addressed Republican lies as lies as he debunked them:

GOP LIE No. 1: THE NUMBERS DON’T MEAN ANYTHING
Over the course of the open-enrollment period, Republicans labored to argue that Obamacare did far less good than advertised because an estimated 4.7 million Americans received letters in the fall warning that their current policies could not be renewed, as they failed to comply with new coverage requirements. They point to these “cancellations” to argue that few of the folks being counted as ACA enrollees previously lacked insurance.

There are three glaring flaws to this argument. First: Many if not most of those whose plans were canceled were automatically transferred into similar policies that complied with the new law. One of the nation’s largest for-profit insurers told House investigators that it had issued fewer than 2,000 outright cancellations.

Second: Through executive orders, Obama gave roughly half of those who received a letter – 2.35 million – the chance to stay in their existing coverage. CBO estimates suggest that just 1.5 million actually continued in their grandfathered plans, as many could find cheaper and/or better coverage on a subsidized exchange or qualify for Medicaid. It’s telling that the Michigan leukemia patient featured in Koch-funded ads intended to convey the horror of these cancellations has found a compliant poicy on the exchange that still covers her oncologist and cut her monthly premium in half.

Giving the Republican argument every benefit of the doubt, this would leave a potential pool of about 3 million people who changed, rather than gained, insurance. This leads to the third flaw in the argument: Obamacare sign-ups were always going to include millions of people who already had insurance. In its latest estimate, the CBO showed just two-thirds (4 million of 6 million) of exchange enrollments coming from people who were previously uncovered. And the limited hard data available from the states suggests the CBO is closer to the mark than the GOP: In New York, nearly 60 percent of buyers were previously uninsured. In Kentucky, it’s even higher: 75 percent.

GOP LIE No. 2: THEY HAVEN’T PAID THEIR PREMIUMS YET
GOP critics point out that the administration hasn’t tracked how many enrollees are actually paying their insurance bills. The complaint about transparency is fair, but the concern is misplaced. Figures from state exchanges and insurers themselves show that between 80 and 95 percent of enrollees are paying their bills.

GOP LIE No. 3: OBAMACARE WILL COLLAPSE UNDER ITS OWN WEIGHT
One legitimate concern as Obamacare ramped up was that it could enter a “death spiral.” This would happen if the number of older, sicker people on the exchanges far outnumbered the young and the healthy. Premiums would spike, year over year, with each increase driving more healthy folks out of the pool – making the exchange unsustainable. While reaching 7 million enrollees is a huge win politically, it doesn’t ensure Obamacare’s viability as an insurance program. “I do think there’s too much focus on the overall number,” Karen Ignagni, a top insurance-industry lobbyist, told reporters. What matters far more, she said, is the insurance pools’ “distribution of healthy to unhealthy.”

The administration wanted 18- to 34-year-olds to make up nearly 40 percent of enrollees. By March, however, only 25 percent of the mix was under 35. That sounds dire. Yet even pools with just 25 percent of younger people would not create a tailspin, forcing premiums to rise by just 2.4 percent, according to the Kaiser Family Foundation.

Additionally, the convoluted structure of Obamacare eliminates systemic risk. Even the 27 states that relied entirely on the federal exchange will end up with state-specific insurance pools. What this means is that if a death spiral were to develop in, say, Ohio, that failure would not pull down neighboring states. What’s more, safeguards within the ACA mean states don’t have to get the mix right in Year One. For the first three years, ACA has shock absorbers to prevent premium spikes in states with problematic pools. Over that same period, the penalties for not buying insurance step up – which should drive younger, healthier people into the market, balancing the risk profile. We lack hard data to get a clear picture of all state pools. But private insurers are sending optimistic signals to investors that all is well. Case in point: Insurance giant WellPoint just raised its earnings forecast.

GOP LIE No. 4: “OBAMACARE IS THE NUMBER-ONE JOB KILLER IN AMERICA”
That’s what Texas Sen. Ted Cruz told a Tea Party convention in Dallas last summer. Since then, the GOP has been making two ACA-connected job-loss claims, both demonstrably false. First, they twisted a February CBO report to claim that Obamacare will cause 2.5 million Americans to lose their jobs. What the CBO actually found is that Americans will be able to work a little less thanks to lower health-care costs, voluntarily scaling back work hours between 1.5 and 2 percent through 2024, or the output of 2.5 million full-time workers. The other GOP lie is that Obamacare is causing employers – who will be responsible for insuring employees who work more than 30 hours a week – to either scale back the hours of full-time employees or hire only part-time workers. This, too, is hogwash. While the share of part-time employment remains historically high, it has actually been in decline since 2010, when Obama­care became law.

I have discussed many of the above points, with links to the evidence, in previous posts on health care reform.

I was also happy to see that he concluded with the same opinion I have expressed that Democrats must take the offensive on health care:

House Republicans have learned the hard way that even nibbling around the edges of Obamacare can backfire. In February, the GOP pushed a bill to tweak the mandate that businesses offer health care to all employees working more than 30 hours. Switching to the GOP’s preferred 40-hour standard, it turns out, would add $74 billion to the deficit by 2024 and cause nearly 1 million Americans to lose coverage. That’s the kind of move that would play right into Democratic hands. Says Greenberg, “Democrats do very well when they hit back at Republicans on what people lose.”

Until recently, Greenberg had been advising Democrats to move beyond Obamacare and turn to bread-and-butter issues like jobs and the minimum wage. “The strongest attack on Republicans,” he says, “is that they’re obsessed with Obamacare instead of critical issues like dealing with the economy.” But his new poll has Greenberg rethinking that counsel. “Until now, this is an issue where the intensity has been on the other side,” he says. But defending Obamacare, he adds, has emerged as “a values argument for our base.” Greenberg now believes Democrats “ought to lean much more strongly” to campaign on the virtues of Obamacare as a means of boosting progressive turnout. “Not apologizing for Obamacare and embracing it actually wins the argument nationally,” he says. “And it produces much more engagement of Democratic voters. That’s a critical thing in off-year elections.”

Eugene Robinson also wrote about the success of Obamacare:

A new report by the nonpartisan Congressional Budget Office estimates that, despite all the problems with the HealthCare.gov Web site launch, 12 million people who previously lacked insurance will obtain coverage this year. By 2017, the year Obama leaves office, the CBO predicts that an additional 14 million uninsured will have managed to get coverage .

Why was the Affordable Care Act so desperately needed? Because without it, 54 million Americans would currently have no health insurance. Within three years, according to the CBO, Obamacare will have slashed the problem nearly in half.

We should do better, and perhaps someday we will. Most industrialized countries have some kind of single-payer system offering truly universal coverage. But if you have to work within the framework of the existing U.S. health-care system — which involves private health insurance companies and fee-for-service care — the Affordable Care Act reforms are a tremendous advance.

Many Republican critics of Obamacare know, but refuse to acknowledge, that the reforms are here to stay. Does the GOP propose to let insurance companies deny coverage because of preexisting conditions, as they could before the ACA? Does the party want to reimpose lifetime caps on the amount an insurer will pay? Tell young adults they can no longer be covered under their parents’ policies?

He concluded by also recommending that Democratic candidates take advantage of the success of Obamacare:

To do well in the fall, Democrats have to infuse their most loyal voters with similar enthusiasm. The success of Obamacare will help. Already, polls are showing upticks in support for embattled Democratic incumbent senators in Louisiana, Arkansas and Alaska. Democrats control their own destiny in November: If they can get their voters to the polls, they’ll win.

In the long run, no matter what happens in the election, I’m more convinced than ever that the Affordable Care Act will be seen as landmark legislation. With minimal immediate impact, the ACA does two tremendously important things.

First, it shifts the incentive structure in the health-care industry in ways that promise to hold down rising costs. And second, it establishes the principle that health care should be considered a right, not a privilege.

Of course it’s not perfect. It’s a thing of beauty anyway. We have liftoff. It’s working.

Paul Krugman described Obamacare as the unknown ideal:

The current state of public opinion on health reform is really peculiar. If you’ve been following the issue at all closely, you know that the Affordable Care Act is one of the great comeback stories of public policy: after a terrible start, it has dramatically exceeded expectations. But hardly anyone seems to know that.

He blamed Fox and Rush Limbaugh for all the misinformation they have spread, the Obama administration for doing a “lackluster job so far in getting the word out,” and “a persistent anti-ACA tilt in news coverage.” He pointed out how factual stories on the success of Obamacare are often buried in the back pages of newspapers.

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Fact Checking Valuable, But Not Always Right

Pinoccio

The Moderate Voice has a post yesterday on the increase in fact-checking in journalism. Fact-checking is preferable to the standard media practice of quoting both sides as if they are equally valid, generally with an implied assumption that the truth is somewhere in the middle. This leads to erroneous reporting when one side is intentionally using misinformation and lying far more than the other. However labeling something fact checking doesn’t necessarily mean it is immune from journalistic problems. Paul Krugman pointed out one problem:

“The people at PolitiFact are terrified of being considered partisan if they acknowledge the clear fact that there’s a lot more lying on one side of the political divide than on the other,” Krugman wrote in 2011.

“So they’ve bent over backwards to appear ‘balanced’ — and in the process made themselves useless and irrelevant.”

As Krugman pointed out, there are fact checkers which label an equal number of statements from Democrats and Republicans as being wrong in order to give the appearance of being impartial. That typically means that outrageous lies from Republicans are called lies but to provide a sense of balance,  statements from Democrats which are generally true but in which there is an exception are also called lies.

The entire idea of calling something true or a lie is often a poor way to handle complex issues which are stated by politicians in brief statements. Sometimes politicians are trying to be truthful, but boiling down a complex issue into a brief statement, or commercial, will result in exceptions where the statement is false. Often it is preferable to look at what is true in what is being said and where it isn’t entirely true and explain the issue rather than just calling it truth or a lie.

While Republicans have been hit far more with big lies on health care, Democrats have been harmed by the problems in how some fact checkers declare something either true or a lie (being a lie if not 100% true in every case). There have been two big examples of this. The first is Democrats saying that the Medicare proposals in the Ryan budget would destroy Medicare. Technically this is untrue as Ryan would replace Medicare with something named Medicare. On the other hand, it is true because the Republican proposals would change Medicare into something fundamentally different with far less protection for seniors. Rather than just calling it a lie, fact checkers would have done more good by explaining why Democrats consider these changes to be destroying Medicare.

The other is the greatly exaggerated “lie of the year” when Obama said people could keep their own doctor under the Affordable Care Act. This was an absurd statement on one level because every year insurance companies and doctors make decisions which can affect this which the government has no  power over. On the other hand, Obama was right in the context where he was speaking, even if worded poorly. Republicans were lying when they claimed that Obamacare would make people join some sort of government run program which would tell them which doctors they can see. The Affordable Care Act actually makes it more likely that people could have insurance which would allow them to keep their doctor than had been the case in the past and does nothing to force people to lose their doctor. People have a better chance of keeping their doctor when protected from losing their insurance. Frequently people are forced to change doctors because of employers changing insurance plans. Employees have a better chance of keeping their own doctor when provided more choice in plans, as under the Affordable Care Act.  Where Obama got it wrong was that the same forces already present which lead to people having to change doctors, while diminished, would still exist. It would be far better to explain this complex issue, where Obama was mostly right, than to just declare it a lie because it is not true one hundred percent of the time.

Cross posted at The Moderate Voice

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Obama Warns Of Threats To Right To Vote

Protect Vote

If one followed politics superficially from the mainstream media, they might come to the incorrect view that we have a two party system in which the two parties differ on some issues but are essentially mirror images of each other. Looking more closely, it becomes apparent that instead we have a centrist party which has been struggling to continue our system of self-government and an extreme right wing party which seeks the destroy the vision of America held by our founding fathers. Among those who have bucked the usual media narrative and have reported on this are Thomas Mann and Norman Ornstein. This pair of centrists who have pointed this out in an essay, Let’s just say it: The Republicans are the problem, and in their book  It’s Even Worse Than It Looks: How the American Constitutional System Collided With the New Politics of Extremism, which clearly laid out the extremism of the current Republican Party. They have explained that the mainstream media missed the big story of the 2012 campaign–the dishonesty and extremism of the Republican Party.

Republicans benefit by rigging the system in their favor as much as possible. Some of this is built in to the structure of our government, such as giving small Republican states the same number of Senators as larger, Democratic states. Gerrymandering, as well as the tendency of Democrats to concentrate more in urban areas, give Republican an advantage in the House, even in elections such as in 2012 when more people voted for Democratic representatives than Republicans. Republicans take advantage of control over large segments of the mainstream media, including Fox which operates essentially as a house propaganda organ, and then “play the refs” by complaining of fictitious liberal media bias. If this isn’t enough, they try to rig election laws to make it harder for Democrats to vote.

While Republicans use their influence over the mainstream media to promote misinformation to further their cause, Democrats have done a poor job of promoting a message or even of exposing what their opponents are doing. I was therefore happy to see that Barack Obama has spoken out against Republican restriction of voting rights.

“The right to vote is threatened today in a way that it has not been since the Voting Rights Act became law nearly five decades ago,” Mr. Obama said in a hotel ballroom filled with cheering supporters, most of them African-American. “Across the country, Republicans have led efforts to pass laws making it harder, not easier, for people to vote.”

Speaking a day after a conference in Texas commemorating the 50th anniversary of the Civil Rights Act, Mr. Obama linked the issue to the movement that helped pave the way for him to become the nation’s first black president.

“America did not stand up and did not march and did not sacrifice to gain the right to vote for themselves and for others only to see it denied to their kids and their grandchildren,” he said.

Republicans in some swing states have advanced new laws that go beyond the voter identification requirements of recent years. Among other things, state lawmakers are pushing measures to limit the time polls are open and to cut back early voting, particularly weekend balloting that makes it easier for lower-income voters to participate. Other measures would eliminate same-day registration, make it more difficult to cast provisional ballots or curb the mailing of absentee ballots.

Over the last 15 months, at least nine states have enacted voting changes making it harder to cast ballots. A federal judge last month upheld laws in Arizona and Kansas requiring proof of citizenship, like a birth certificate or a passport, leading other states to explore following suit.

I hope we see more of this. Warnings about the Republican threat to freedom and democracy should not be limited to a single date commemorating a past event. This should be an important part of the political debate between the parties every day. Hopefully people will then realize that they should be wary of a political party which finds that its success depends upon keeping people from voting.

Cross posted at The Moderate Voice

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Quote of the Day: Bill Maher on The Ryan Budget And Obamacare

“Game of Thrones returns this weekend on HBO. I’m sure you know it as a magical fantasy where you’re never quite sure who’s going to live or die. Or maybe I’m thinking of Paul Ryan’s budget.” –Bill Maher

Bonus Quote:

“Obamacare hit its numbers. Despite all the initial problems, Healthcare.gov surpassed the enrollment goal, over 7 million. Now the Republicans are saying that they’re going to repeal the Internet.” –Bill Maher

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Obama Delivers “The Best Medicine” To Ted Cruz, John Boehner, and Michele Bachmann

CV1_TNY_04_14_14Blitt.indd

Barry Blitt said this about the above cover for The New Yorker: “This whole enterprise was just an elaborate excuse. I enjoyed drawing Ted Cruz, John Boehner, and Michele Bachmann as petulant children—and I especially wanted to draw an open-mouthed Mitch McConnell being spoon-fed his meds.”

Obama is certainly delivering the “medicine” as news comes in showing that enrollment in the Affordable Care Act exceeded projections of seven million, and the number of uninsured is falling to new lows. While good for the United States, this is certainly bitter medicine for Republicans. There is additional bitter medicine for Mitch McConnell as the number signing up in Kentucky exceeded 360,000 with 75 percent previously uninsured.

Cross posted at The Moderate Voice

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Good News On Obamacare Enrollment Leading To More Favorable Coverage

Democrats have suffered damage from the Affordable Care Act far more from negative press than actual negative results. Of course they make the problem far worse by running away as opposed to standing up for the successes of the Affordable Care Act. Two stories last fall did the most harm–the failed roll out and news of people receiving cancellation letters. The computer problems were IT issues which have nothing to do with the benefits of the Affordable Care Act as policy. Now that we have some data on enrollment, we know that the initial IT problems did not decrease enrollment at all from initial projections. We also now know that most of the people who received cancellation letters received alternate coverage, frequently from the same company, with better coverage at a lower price.

Bad news tends to lead to more bad news but good news often leads to more good news, and hopefully the Democrats will show the ability to capitalize on it. Republicans who made claims of Obamacare leading to fewer people having coverage or failing to meet projections look as foolish as the Republicans who ignored the polls and projected a Romney victory in 2012. Instead of negative stories, we are seeing stories such as this from Politico: Obamacare critics: Homina, homina, homina:

Back in the fall, conservatives seized on the flubbed Obamacare rollout as proof that President Barack Obama’s brand of liberalism doesn’t work.

Now, the law’s opponents aren’t about to say that critique was wrong — but they’ve lost the best evidence they had.

On Tuesday, Obamacare sign-ups passed 7 million, six months after the launch of a federal website that could barely sign up anybody. There are still a lot of questions about how solid that figure is, but the idea that the law could even come close to the original goal after such a disastrous start would have been laughable even a few weeks ago.

It was also a wake-up call for Republicans and conservatives, and even the occasional liberal, who pushed the argument that the failed website challenges the idea at the heart of Obama’s agenda — that government can still solve big social problems.

Of course Fox and other right wing outlets are still running negative headlines, but otherwise success is leading to the rest of the media being more positive. While conservatives spread false stories of Obamacare nightmares, there are more stories on those who benefit under the Affordable Care Act. The New York Times has pointed out that many people have purchased insurance directly from insurance companies in addition to the over seven million purchasing through the exchanges:

Millions of newly insured people are hiding in plain sight.

They are the people who have bought new health insurance since the start of this year but have chosen for one reason or another to bypass the state and federal exchanges that opened last year under the Affordable Care Act. While the exact number is unknown, some health care experts estimate that it may be in the millions.

Politicians and policy makers have focused on the number of people who signed up through the exchanges — at nearly seven million and counting a day after the March 31 deadline — but they have largely overlooked the group that did not use the exchanges, even though it could have a major impact on the program’s financial success in the years ahead…

All individual health insurance plans offered after Jan. 1 must adhere to several new requirements, regardless of whether they are bought through the marketplaces. Insurers must offer more comprehensive coverage and charge healthy and sick people the same rates. And they can no longer turn people away if they have existing medical conditions.

It makes little difference to insurers how the new customers arrive at their door: What matters most is that they get there. Insurers must bring in enough new customers, including a significant number of healthy ones, to offset the higher costs of complying with the law.

Aaron Billger, a spokesman for Highmark, an insurer that offers plans in Delaware, Pennsylvania and West Virginia, said about 30 percent of the approximately 133,000 members that Highmark had enrolled as of mid-March had signed up outside the marketplaces. The large insurer WellPoint, which has said it expects to enroll about one million customers nationwide in new plans, has reported that about 20 percent of its sign-ups have occurred off the exchanges.

Some people are saving money by purchasing insurance from co-ops which are being set up in some states thanks to the Affordable Care Act as an alternative to the large insurance companies. It is too soon to tell whether they will really lower costs, but they do sound like a promising alternative:

The names of the big health insurance companies are familiar – Blue Cross, Aetna, United Healthcare. But what about CoOportunity Health, or Health Republic Insurance of New York?  These are among 23 new health insurance companies that started under the Affordable Care Act.  They’re all nonprofit, member-owned cooperatives, and the aim is to create more competition and drive prices down…

“In some states, co-ops are dominating the marketplace, with 80 percent of the enrollees going to the co-op,” he says.

That’s in Maine. Morrison says most co-ops are very happy with their enrollment numbers. Their rates are often the lowest available through an exchange.

“The co-op states have 8.4 percent lower premiums on average than the non-co-op states, across the marketplace,” says Morrison. “So co-ops are creating that competition. They’re keeping rates down in the states they’re operating in.”

The Los Angeles Times told the story of a cancer patient who benefited from Obamacare:

Robertson wrote a passionate account of his cancer and posted it on the White House website to illustrate how important insurance is even for younger people. Noting that he had paid just 1% of the $900,000 cost for five surgeries, radiation and chemo, he wrote, “Without that, I would have bankrupted my family just to stay alive.”

And without Obamacare’s guarantee that he could buy affordable insurance despite his preexisting medical condition, he wrote, “there’s no telling what life would have been like for us moving forward.”

A major benefit of the Affordable Care Act is to enable people to obtain coverage on the individual market who had difficulty obtaining coverage in the past, when most coverage outside of government programs came from large businesses. There have already been stories on some of the winnersPolitico reported on how Obamacare has helped self-employed artists and actors:

Abromaitis is among the hundreds of thousands of artists, musicians, dancers, actors and filmmakers around the country who especially stand to gain under Obamacare, either through the plans and premium subsidies available on its new insurance exchanges or from the plans employers must start offering.Typically a well-educated but lower-earning demographic — whose members are self-employed more often than not — these Americans have frequently struggled to buy insurance on their own. Some were able to afford union plans, but others paid for costly coverage on the individual market or went without it despite the risk.

A survey last year by The Actors Fund found that 43 percent of individuals working in the visual and performing arts lacked coverage, more than double the national uninsured rate. More than a third of those who had coverage said they got it on the individual market, compared with the 6 percent of Americans generally who turn there for health insurance.

Many are now flocking to Obamacare’s federal- and state-run exchanges, hoping for a way to get covered without breaking the bank. They’re finding both good and bad: more affordable plans but sometimes narrow provider networks and high deductibles.

The narrow provider networks and high deductibles did come as a surprise to some but this has actually been a characteristic of insurance sold through the individual market for a long time. When I purchased new coverage (directly from the insurance company, bypassing healthcare.gov), there was a choice of policies with more restrictive networks with a lower premium, along with choices without restrictive networks but with a higher premium. Most people who wind up in plans with the most restrictive network did so out of a choice to save money. The choices I saw were no different from the choices offered prior to the Affordable Care Act. The difference was that the coverage was far more comprehensive, had new limits on out of pocket expenses, and could never be canceled due to medical problems.

There is far  more good news this week on the Affordable Care Act. Hopefully the Democrats will finally stop being scared of negative and false attacks from Republicans and go on the offensive and develop a new message to take political advantage of the law they passed.

Cross posted at The Moderate Voice

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Obamacare Enrollment Surpasses Seven Million

The number of people purchasing insurance under the Affordable Care Act has exceeded seven million. This slightly surpasses initial predictions. This also surpasses the reduced prediction of six million made by the Congressional Budget Office as a result of the initial IT problems, (with more expected to sign up in future years) and shows that conservative opponents of Obamacare were wrong in predicting lower numbers.

Millions more purchased health insurance directly from insurance companies. This also does not include the newly insured due to Medicaid expansion or due to students being able to remain on their parents’ policy until age 26. Even when estimates come in including those covered by Medicaid expansion, the number can continue to grow as there is no deadline for signing up for Medicaid. In Michigan the Medicaid program did not even begin taking enrollments until today. There are also some situations in which people can purchase insurance offered through the exchanges after the deadline, such as in case of loss of job or divorce.

There are not yet accurate numbers nationally regarding the number of people signing up who previously had insurance versus those newly insured.

Conservatives are raising questions regarding how many people have not paid premiums and ultimately will not keep this insurance. Estimates on this are premature as coverage for those signing up in late March does not begin until May and premiums will not even be due until mid April.

These numbers are already out of date in light of the surge of people signing up at the last moment, but The Los Angles Times reported on Monday that Obamacare has led to coverage for at least 9.5 million new people:

• At least 6 million people have signed up for health coverage on the new marketplaces, about one-third of whom were previously uninsured.

• A February survey by consulting firm McKinsey & Co. found 27% of new enrollees were previously uninsured, but newer survey data from the nonprofit Rand Corp. and reports from marketplace officials in several states suggest that share increased in March.

• At least 4.5 million previously uninsured adults have signed up for state Medicaid programs, according to Rand’s unpublished survey data, which were shared with The Times. That tracks with estimates from Avalere Health, a consulting firm that is closely following the law’s implementation.

• An additional 3 million young adults have gained coverage in recent years through a provision of the law that enables dependent children to remain on their parents’ health plans until they turn 26, according to national health insurance surveys from the federal Centers for Disease Control and Prevention.

• About 9 million people have bought health plans directly from insurers, instead of using the marketplaces, Rand found. The vast majority of these people were previously insured.

• Fewer than a million people who had health plans in 2013 are now uninsured because their plans were canceled for not meeting new standards set by the law, the Rand survey indicates.

Conservatives have falsely claimed that due to the cancellations of insurance there is a net decrease in the number insured. Most of those who received cancellation notices have received alternative insurance plans, often from the same insurance company. Those who qualify for subsidies are receiving coverage at a lower rate. Everyone who changed from the old plans to new plans on the individual market benefit from changes such as being safe from losing their insurance if they become ill and their insurance company would prefer to stop covering them to save money. The new policies also have annual limits on out of pocket expenses and do not have lifetime caps on coverage as old plans often did.The above data is consistent with Gallup polling showing a decrease in the number of uninsured:

The decrease parallels a similar drop recorded by Gallup, which found in its national polling that the uninsured rate among adults had declined from 18% in the final quarter of last year to 15.9% through the first two months of 2014. Gallup’s overall uninsured rate is lower than Rand’s because it includes seniors on Medicare.

Gallup Editor in Chief Frank Newport said that March polling, which has not been released yet, indicates the uninsured rate has declined further.

“While it is important to be cautious, the logical conclusion is that the law is having an effect,” he said.

Although estimates vary, about 45 million to 48 million people are believed to have been uninsured before the marketplaces opened last year.

The Courier-Journal estimates that about 75 percent of those signing up through the state-run exchange in Kentucky were previously uninsured.

The goal of the ACA was to help cover 48 million Americans, including 640,000 in Kentucky, who lack health insurance.

Although the state set no official first-year goal, its 360,000-plus sign-ups — 75 percent of whom were previously uninsured — represents a sizable chunk.

Although Obama said that the success of enrollments for the Affordable Care Act means “the debate over repealing this law is over,” Republicans are not likely to stop fighting and spreading misinformation. They know that this will help improve Republican turn out this fall. The Koch-financed Americans for Prosperity has put out additional dishonest ads.

Fox, the propaganda organ for the Republican Party, has generally spread their misinformation, including an attempt to distort interpretation of the number of people signing up. Even Fox has not been entirely consistent in backing the Republicans.  On Monday Jenna Lee asked Senator Lindsey Graham why the Republicans have not offered an alternative to the Affordable Care Act despite repeatedly voting to repeal it.

Cross posted at The Moderate Voice

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Democrats Need A Message

One reason that the Republicans get people to turn out to vote in off year elections, often to vote against their economic self-interest, is that they have a message. The message might be based upon dishonest claims and incorrect views as to how the economy and government work, but it is a message. In contrast, many Democratic voters feel less interested in turning out to vote, especially in off year elections. To some degree the Democrats have difficulty in defining a message as they are a big tent party which wins elections by appealing to a wide variety of voters, ranging from center-right to left wing. Issues which appeal to some Democratic voters might turn off others.

The Washington Post describes how Senate Democrats are struggling to define a message:

Senate Democrats’ latest effort in that regard is a 10-point plan for legislation they intend to bring to the floor over the spring and summer.

The issues are familiar ones for Democrats, and poll well among Americans generally.

Yet they are top priorities to narrower slices of the Democrats’ constituency — particularly those who showed up to vote for President Obama in 2012, but who do not have a history or voting in off-year contests.

The first items up for Senate debate will be increasing the minimum wage, from $7.25 an hour to $10.10 an hour, and a bill to assure paycheck equity between male and female workers.

Democratic pollster Celinda Lake said that those are measures that would have their greatest impact on young people, unmarried women, Latinos and African-Americans — all of whom can be difficult to turn out in years when there is no presidential election.

“This doesn’t replace a broader economic message. In the long run, we have to do that. But in the short run, this is very helpful,” said Lake, who has warned that the Democrats face a large turnout disadvantage in a year when Republican voters appear to be more motivated.

GOP pollster Neil Newhouse said the Senate Democrats’ targeted strategy echoes that of Obama’s 2012 reelection campaign, where he emphasized a number of “niche group” issues such as the Dream Act, mandatory contraception coverage under the Affordable Care Act, student loan expansion and support for same-sex marriage.

Why haven’t Democrats been pushing for legalization of same-sex marriage more strongly in the past? As Michigan and other states saw recent legal victories for marriage equality I thought that, although this is an issue far more associated with Democrats than Republicans, the victories are in the courts and not the result of actions by the Democratic Party.

Perhaps Democratic leaders did not want to be associated with bringing about marriage equality out of a fear of losing socially conservative Democratic voters. Maybe, but I also wonder how many socially liberal people who lean Democratic don’t bother to get out to vote because of not seeing a real commitment from Democratic leaders for liberal causes.

Republicans have learned that people tend to take on the other views of the party they associate with when there is a consistent message. They get social conservatives to back their economic policies by joining these as a common conservative philosophy. If the Democrats were to put out a more consistent message, perhaps those who vote for Democrats for other reasons would also “evolve,” as Barack Obama has, on issues such as same-sex marriage.

Democrats should frame this as a consistent platform of keeping government out of the private lives of individuals, along with support for reproductive rights and ideally an end to marijuana prohibition (or at least a stronger defense of medical marijuana). It is amazing that Democrats have allowed Republicans to take an advantage on issues which should be seen as reasons to vote Democratic, from size of government as it relates to private lives to support for Medicare.

Democrats also think too small on economic matters. Rather than just concentrating on issues such as increasing the minimum wage, Democrats need an economic message showing how Democratic ideas strengthen and grow the economy while Republican economic policies lead to economic stagnation and a concentration of wealth in a small minority. Income inequality is an important issue, but only when placed in an overall economic message of expanding the economy and how extreme income inequality destroys the middle class. An economic message seen as merely dislike for the rich (or the Koch brothers) will never sell.

Of course making a coherent economic message which will not only mobilize their own voters but bring in new voters will take time and cannot be done in only one election year. The Republicans have been working for years at indoctrinating the country in their type of Voodoo Economics. It will also take several years to get out the message on how the economy actually works, but the Democrats might as well start now.

Health care remains one of the strongest reasons to vote for Democrats. Even those who have a negative view of the Affordable Care Act based upon Republican misinformation still prefer to improve it over either repeal or turning to any Republican alternative. As I have written before, Democrats need to go on the offensive on health care reform, not run away from the issue. Joe Conason has the same message again, with numbers now out showing that enrollment through the exchanges has exceeded the projected number of six million:

Success for Obamacare might boost the turnout projections that Republicans have tried so hard to suppress and that Democrats have so far proved unable to resuscitate.

Dominant forces in the Republican Party — including the tea party and its billionaire financiers — have staked everything on the commonplace assumption that Obamacare will drag down Democrats across the country.

Indeed, they make almost no other argument. Bolstering that cynical bet is the Democratic hesitation to mount a powerful counteroffensive on health care, with the impulse to push the minimum wage, unemployment benefits, and other vital issues that still feel safer.

But as Clinton warns, they will find no shelter from this storm. They cannot hide from their own history; and the more they pretend to do so, the more they risk contempt. For decades, Democrats have insisted that all Americans must have health coverage — a momentous and admirable goal advanced by the Affordable Care Act.

With the numbers now on their side, they should lift their heads, raise their voices, and lean into the midterm debate. They have no better choice.

Cross Posted at The Moderate Voice

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