Response To Republican Support For Making Birth Control Pills Available Over The Counter

While Republicans have generally been trying to restrict access to contraception, recently some Republicans have been promoting making oral contraceptives available over the counter without prescription. Many people quickly saw through this. It gives the Republicans a way to claim they are removing a barrier to receiving contraception and avoid situations like the Lobby Hobby case. It also does something else–make contraception less accessible for many women. While the Affordable Car Act requires that contraception be covered without out-of-pocket expense to the woman, many insurance plans do not cover over the counter medications. This is also an incomplete response to the issue as there are many other types of birth control, including forms which many Republicans are attempting to restrict.

The Guttmacher Institute issues a statement regarding this topic (via Talking Points Memo):

Birth Control Pills Should Be Available Over the Counter, But That’s No Substitute for Contraceptive Coverage

September 11, 2014

By Adam Sonfield and Sneha Barot, Guttmacher Institute

In recent weeks, some opponents of the Affordable Care Act’s (ACA) contraceptive coverage guarantee have promoted the idea that oral contraceptive pills should be available to adult women without a prescription. Sens. Kelly Ayotte (R-NH) and Mitch McConnell (R-KY), for example, recently introduced the so-called Preserving Religious Freedom and a Woman’s Access to Contraception Act, a bill that would urge the Food and Drug Administration (FDA) to study whether to make contraceptives over the counter (OTC)—though for adults only.

Making birth control pills available over the counter, if done right, would meaningfully improve access for some groups of women. However, such a change is no substitute for public and private insurance coverage of contraceptives—let alone justification for rolling back coverage of all contraceptive methods and related services for the millions of women who currently have it.

The Policy Behind Over-The Counter Contraception
Making birth control pills available OTC has merit, and the Guttmacher Institute is part of a coalition that has been working toward this goal for years. Leading medical groups have also endorsed such a move, including the American Medical Association and the American Congress of Obstetricians and Gynecologists. By removing the need to obtain a prescription, OTC status would eliminate this potential barrier to contraceptive use and thereby increase access.

This is especially true for uninsured women and those who don’t have time for a doctor’s visit or otherwise can’t readily reach a health care provider. However, if the goal is to truly expand access to contraceptive care—and not just provide cover for undercutting insurance coverage for contraceptives—the case to move birth control pills to OTC status should proceed alongside several other important policies and goals:

Protect contraceptive coverage and full method choice: The ACA requires most private health plans to cover the full range of women’s contraceptive methods and services, without out-of-pocket costs for the patient. This policy eliminates cost as a barrier to women’s ability to choose the method that is best for them at any given point in their lives, an approach that has been proven to make a substantial difference in facilitating access to and use of contraceptive services.

Contrary to what some policymakers and commenters have claimed, giving the pill OTC status would not be an effective substitute for the ACA policy. First, it would do nothing to help women access any contraceptive method other than the pill. This matters, since most women use four or more different contraceptive methods over their lifetime to meet their changing needs. If only the pill were available OTC and contraceptives were no longer covered by insurance, women would face significant new barriers in choosing the method that best suited their needs. Cost is a particularly steep barrier for highly effective methods like the IUD or implant that not only have high upfront expenses, but also require a trained provider for insertion and therefore are not candidates for OTC status.

Even for the pill itself, there is no convincing evidence to suggest that moving it to OTC status would substantially lower out-of-pocket costs to patients, let alone come close to the $0 out-of-pocket cost guaranteed under the ACA policy. Rather, making the pill available OTC, if done at the expense of insurance coverage, would replace one barrier (ease of access) with another (cost). Likewise, greater reliance on Health Savings Accounts or Flexible Spending Accounts, as some opponents of insurance coverage have proposed, would also merely replace full insurance coverage with patient out-of-pocket costs—leaving most privately insured women, particularly low-income women, worse off. Uninsured women on average pay $370 for a full year’s supply of the pill, the equivalent of 51 hours of work at the federal minimum wage of $7.25.

Millions of women already benefit from the ACA’s contraceptive coverage guarantee and these hard-won gains must be protected. Rather than substituting for contraceptive coverage of all methods and related services, OTC status for birth control pills should complement and enhance such coverage.

Strengthen coverage for over-the-counter methods: While the ACA’s preventive care provision specifically requires private health plans to cover certain products with over-the-counter status (including the emergency contraceptive Plan B, folic acid, aspirin to prevent heart disease and tobacco use cessation products), a prescription is needed for these items to be covered—essentially negating the benefits of OTC status. This prescription requirement should be eliminated for any current and future over-the counter contraceptives. Coverage of over-the-counter products without a prescription is already the norm in some state Medicaid programs and in the U.S. military’s Tricare insurance program. Further, ensuring full coverage for over-the-counter contraceptives would prevent “free-riding” by insurance companies that benefit from not having to cover pregnancies that were averted through patient out-of-pocket expenditures.

Ensure equal access for young women: Adolescents and young women, who face greater risk of unintended pregnancy and more barriers to accessing contraception than older women, have among the most to gain from a switch to OTC status. However, recent calls to give birth control pills OTC status as a substitute for contraceptive coverage have specifically excluded minors. That would require women 17 and younger to obtain a prescription, without providing any medical evidence to justify such restrictions. This approach would be harmful to adolescent women and would be counterproductive to helping them avoid unplanned pregnancies and the negative health, social and economic consequences that often follow.

In addition, excluding minors would likely not result in a true over-the-counter status, but instead could put contraceptive pills behind the counter, much as happened when the emergency contraceptive Plan B was first approved for OTC sales. To comply with an age restriction, stores would have to require proof of age via a valid picture ID from any woman who looks young enough to potentially be barred from purchasing birth control pills without a prescription. This would be an added hurdle for millions of women, and it ignores the reality that many young women do not have government-issued forms of photo ID.

Keep politics out of FDA decision making: To switch any drug to OTC status, the typical process involves the drug’s manufacturer submitting an application to the Food and Drug Administration (FDA), which—based on several criteria, including the safety and efficacy profile of the medication—decides whether to grant the request. The evidence is quite strong that providing birth control pills OTC would be safe and effective, including for minors. The FDA process should be driven by the evidence and free from political interference by the administration, Congress and others.

It is troubling but not at all surprising that Senator Ayotte and others who purport to be interested in contraceptive access would preempt the FDA with unfounded calls to bar minors from benefiting from any future OTC status for birth control pills. This echoes the longtime political and legal wrangling over minors’ access to OTC emergency contraceptive pills, despite clear evidence that minors could safely use these products without a prescription.

It is also noteworthy that there are dozens of brands and formulations of birth control pills, most of which would likely have to undergo the lengthy and expensive FDA process to gain OTC status separately. Because formulations of the pill are not medically interchangeable, with some women tolerating specific pills better than others, making one or several versions of the birth control pill available OTC would not benefit all current pill users.

Not A One-Size-Fits-All Policy Solution
Just as birth control methods are not “one size fits all” at any point in a woman’s life, let alone for all of her reproductive years, neither is there a one-size-fits-all policy solution to enhance access to the full range of methods, information and services for women of all ages and income levels, regardless of where they obtain their care. A wide range of approaches is necessary to meaningfully respond to women’s family planning needs in a comprehensive way.

One such approach includes making birth control pills available over-the-counter, if done so without additional costs or barriers to women. Doing so can complement and enhance current efforts to help more women become effective contraceptive users, including the ACA’s significant gains for comprehensive private and public insurance coverage for contraceptive counseling, services and supplies.

If anything, contraceptive coverage should be broadened to cover more women and strengthened to eliminate the prescription requirement for OTC methods that are covered. Other urgent priorities include expanded access to Medicaid, public support for safety-net family planning centers and the Title X national family planning program, comprehensive sex education and the development of new contraceptive technologies.

Truly increasing access to contraceptive care requires a multifaceted approach to meet the needs of all women throughout their reproductive lives. Political talking points will not do it.

This article was originally published on Health Affairs Blog at this link.

Click here for a recent statement from the American Congress of Obstetricians and Gynecologists (ACOG) supporting over-the-counter access to birth control pills as part of a broader dialogue about improving women’s health care as opposed to a political tool.

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Big Hype For Apple Today

applewatch-32-580-100

There was certainly a lot of ridiculous hype today. Apple had their big announcement that their phone and watch can now do what Android devices could do for months, if not years, as long as you don’t want the freedom to configure things the way you want them to work, as opposed to how Apple thinks your devices should work. They were even doing their own live tweeting of the event, showing what control freaks they are.

There might have been a time when Apple was on the leading edge. Now they are just charging more for old tech which has an Apple logo on it. The Apple watch will start at $349–well more than the cost of my Sony Smartwatch II, even with the more expensive metal wrist band. The only real surprise was that the watch will be called the Apple Watch and not iWatch.

When I first responded to the event on Facebook and Twitter as the news came in, I did get a comment questioning the value of a smartwatch. I’ve been using a smartwatch for over two years and do find it to be of value, but I suspect that the majority of people do have little real need for one.

For me, the smartwatch essentially replaces my beeper. I receive many messages a day on my phone, including Facebook notifications, personal text messages, news bulletins, along with messages from the hospital or answering service which previously went over a pager. I need to both make sure I don’t miss any important messages, and know when an incoming message is important enough to respond to immediately versus letting it sit on the phone.

The smartwatch allows me to very quickly see whether an incoming message is urgent, and is far more discreet to check than pulling out a phone every time it vibrates. In some situations this is especially important, such as in a dark movie theater where it would be awkward to turn on the phone every time a message comes in. It also comes in handy if at the pool. I can put my phone safely in a nearby bag, and pick up messages on my waterproof smartwatch. In the event anyone does see me checking messages, people tend to think it is cool to see a message come in over a watch due to the novelty factor, while it often looks tacky to look at a phone when with other people.

Under some situations I just want to use the watch to monitor for important messages. At other times I can read more. This includes text messages, email, RSS feeds, and any notifications which a smartphone app can make.

Plus my smartwatch has an advantage which the Apple Watch does not–it is connected by blue tooth to an Android phone.

Of course there are many other things it can do. Some try to respond to tweets on their smart watch, but personally I think that if you are actually following an ongoing discussion, and especially if you want to type responses, at that point it makes more sense to just use your watch. (I also prefer to use a blue tooth keyboard if doing very much typing). Fitness apps are popular on Android smartwatches and I’m sure that many will use them on the Apple Watch. Some use their watch for fitness apps which track their foot steps every day but I found a limitation to this. I sometimes take the phone out of my pocket to charge during the day, preventing a complete count. While my LG G3 will generally last all day, I hear bigger fears that the iPhones will not do so, and changing the battery during the day is not an option as on many Android phones.

While certainly not essential, my smartwatch will also tell me the weather and remotely control my phone. I haven’t yet used the apps to remotely see the view screen of the camera or take pictures, but I can see situations where this might come in handy. I do use it to remotely control music sent from my phone to a blue tooth speaker. I have impressed friends over for football games when, after a score, I tap my watch and a speaker across the room starts playing Hail to the Victors. Sadly, for the first time since 1984, there was no opportunity to do this last Saturday.

Update: Reading more about the Apple Phone, it does look like some of the fitness/health capabilities are beyond what is currently available for Android. Of course, by the time the Apple Watch makes it to market, there are likely to be even more advanced Android apps. Plus, trusting your private health information with Apple sounds as sensible as sharing your nude selfies with them. Just ask Jennifer Lawrence.

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Another Survey Shows Decrease In Obamacare Insurance Premiums For 2015

There is yet more good news on the Affordable Care Act. Rather than the “death spiral” which so many Republicans warned about, yet another study shows an average decline in health insurance premiums next year:

An early look at the cost of health insurance in 16 major cities finds that average premiums for the benchmark silver plan – the one upon which federal financial help under the Affordable Care Act to consumers is based – will decrease slightly in 2015.  The new study from the Kaiser Family Foundation analyzes premiums in the largest cities in 15 states and the District of Columbia where information from rate filings is available.

Premiums for the second-lowest cost silver plan for individuals will fall by an average of 0.8 percent from current levels in these cities when open enrollment begins on Nov. 15, according to the study. The analysis finds that the premium for the second-lowest-cost silver plan is decreasing in 7 of the 16 areas studied – but also that changes in average premiums will vary considerably across areas. They range from a decline of 15.6 percent in Denver, Colorado (to $211 per month), to an increase of 8.7 percent in Nashville, Tennessee (to $205 per month). In both cases premiums are for a 40-year-old nonsmoker, before taking into account any tax credit.  It is important to note that rate changes may be different in different rating areas in these states.

This is certainly a huge improvement over the double digit increases we typically had on insurance purchased on the individual market. Plus the new plans, as opposed to many previous plans sold, provide real, comprehensive coverage. Unlike any previous plans, they are available to anyone regardless of pre-existing conditions, and cannot be cancelled due to changes in health.

Incidentally, yesterday I also received details on the insurance I purchase to cover my employees which is being improved to become fully compliant with the requirements of the Affordable Care Act. It will cost me an additional $15 a month per employee. Of course for some reason I occasionally receive claims from Republican business owners that they are going to be forced out of business due to the higher cost of health insurance. I suspect that many American Republicans, due to their lack of understanding of how the economy works, and tenuous relationship with reality, are the worst businessmen on earth.

There is one caution in the news about a decrease in the premiums for the benchmark plans. These are used to determine government subsidies. The lower premiums mean that the government will have to pay less on subsidies than planned. However if people receiving subsidies fail to shop around, they are at risk of receiving lower subsidies than this year if they do not have a policy which matches the lower premiums.

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Hundreds of Thousands More People To Obtain Health Care Coverage Under Obamacare With Pennsylvania Joining Expanded Medicaid Program

Pennsylvania has become the 27th state, and 9th with a Republican governor, to accept the expanded Medicaid program. This significantly increases the number of people to receive health care coverage under the Affordable Care Act starting with about 300,000 and increasing to over a half million over the next two years. Some Republican governors are vulnerable for failing to join the program, especially considering that the federal government will pay 100% of the expense for expanding health care coverage through 2016, and afterwards it will gradually fall to 90 percent. Corbett is in danger of losing his reelection bid in Pennsylvania but it does not appear that his late adoption of the program will be enough to save him.

Currently three additional states, Indiana, Missouri, and Utah, are considering expansion and twenty states are not  considering Medicaid expansion at this time.

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Study Shows Reduction In Opioid Overdoses By 25% In States Which Have Legalized Medical Marijuana

A major problem with narcotic pain medications is the risk of overdose. This problem has led to the DEA announcing last week that hydrocodone combination pain medications such as Norco and Vicodin are being reclassified as Schedule II narcotics, with additional restrictions being placed upon prescribing them. Any measures to help control chronic pain while reducing the incidence of overdose would certainly be welcome. The August 25, 2014 issue of JAMA Internal Medicine presents a study of states which have legalized medical marijuana, showing a reduction in opioid overdoses by almost 25 percent:

Three states (California, Oregon, and Washington) had medical cannabis laws effective prior to 1999. Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted medical cannabis laws between 1999 and 2010. States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate (95% CI, −37.5% to −9.5%; P = .003) compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time…

The study did not indicate the cause of this association. It is speculated that some people with chronic pain might use less opioid when medical marijuana is available. More study is needed to confirm this, but considering the problems faced with opioid overdoses, marijuana should be considered as an alternative. At very least, when considering any potential adverse consequences to legalization of medical marijuana, it must be kept in mind that the currently used medications for chronic pain do have a serious potential for adverse effects themselves.

Marijuana is now classified as a Schedule I drug which prevents prescribing it. (In states where medical marijuana is legal, the change in the law protects those using it from prosecution but marijuana still cannot be prescribed). Many have already questioned the classification of marijuana as a Schedule I drug as it appears to show less risk of problems from overdose compared to current Schedule II and Schedule III drugs. This study suggests that marijuana might also help protect against some of the adverse effects of narcotics.

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Patrick Stewart Shows How To Handle The Ice Bucket Challenge

Yesterday I posted the videos of Matt Smith and Benedict Cumberbatch in the Ice Bucket Challenge. Here’s one for Star Trek fans in which Patrick Stewart shows the right way to do this.

My wife and I had sort of the same idea yesterday. We both mixed up a couple of glasses of gin and tonic and sent in a contribution.

Contributions to the ALS Association can be sent through their web site.

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SciFi Weekend: Doctor Who; Matt Smith and Benedict Cumberbatch Take Ice Bucket Challenge; Gotham; True Blood; Minority Report; Dating Naked; Richard Attenborough

Doctor Who Deep Breath

We now have a new regeneration of the Doctor, a redecorated TARDIS, and a new title sequence on Doctor Who. Unfortunately the plot of Deep Breath was not very good. There was the return of the droids from The Girl in the Fireplace. Unlike the challenge of not blinking in Blink and other stories with the Weeping Angels, the challenge in this episode was seeing how long you could hold your breath. There was plenty of humor between the confusion of the Doctor post-regeneration, along with cultural misunderstandings and the usual Strax humor. In addition, Moffat’s inner teenager came out wigh having a dinosaur and multiple allusions to Clara either removing her clothes or having sex. The Doctor did do some flirting, but only with the female dinosaur and not Clara, plus there was a human/lizard lesbian kiss. There was even the reported cameo by Matt Smith, telephoning Clara from his past.

While this episode was far from one of the better post-regeneration episodes, the episode did leave me confident that Peter Capaldi will make an excellent 0ld school style Doctor, and of course Jenna Coleman remains an excellent companion, even if there is no flirting or actual removal of her clothing. There are some vague clues of things to come. While we know that the reason the Doctor has seen his face before is because Peter Capaldi has appeared on Doctor Who in other roles, it appears that the reason for the same face will be given an explanation within the story in future episodes. The end of this episode left open the possibility that this could be the start of a new arc, with Missy apparently having had key roles in the past, such as giving Clara the Doctor’s phone number in The Bells of St. John. Capaldi presented what could also be a theme for the season: “I’m the Doctor, I’ve lived for over 2,000 years, and not all of them were good; I’ve made many mistakes, and it’s about time I did something about that.”

Next week: Daleks.

There is a rumor that Jenna Coleman will be leaving Doctor Who in the Christmas episode. Peter Capaldi denies this.

There are alternative versions of Doctor Who. For example, check out the above video celebrating fifty years of American  Doctor Who. IO9 looked at a porn parody of Doctor Who which can be viewed at Woodrocket.com.

Matt Smith has taken the Ice Bucket Challenge to raise money for research on ALS (amyotrophic lateral sclerosis). Benedict Cumberbatch of Sherlock went even further, including getting naked in the shower for a repeat exposure. Contributions to the ALS Association can be sent through their web site.

Last week I noted that the pilot for A to Z is available on line. A sit-com pilot with an even stronger genre connection was released this week–Selfie staring Karen Gillan.

A four-part You Tube series with background on Gotham has been released. The first part is above.

True Blood finally reaches the true end tonight. Does anyone even care anymore whether Bill really goes through with true death or if the show end with true love? At least there were some humorous moments in the final few episodes, such as Ginger finally getting to have sex with Eric. The scene is discussed more here.

My theory as to how the series ends is that Sookie will decide to become a vampire to convince Bill that the two of them can spend eternity happily ever after. Bill refuses to turn her into a vampire so she goes to Eric. By the time Sookie gets out of the ground she finds that Bill has already died from Hepatitis V. Meanwhile Pam, thinking Eric turned Sookie into a vampire for herself, kills Sookie. Jessica (Deborah Ann Woll) then leaves the show for a role on Daredevil. We will find out later tonight if my prediction comes through.

Steven Spielberg is developing a television series based upon the movie Minority Report.

Dating Naked

The big law suit this week stemming from television is Jessie Nizewitz suing Viacom for $10 million because not everything was obscured in the airing of Dating Naked. This led to many web sites (including here) posting the uncensored picture. I do not think a model should film a television show entirely naked if she has any qualms about pictures of her crotch getting out. Plus I would bet that far more people have now seen her nude pictures following the publicity from this law suit.

Richard Attenborough has died at age 90.

Lord Attenborough was one of Britain’s leading actors, before becoming a highly successful director.

In a career that spanned six decades, he appeared in films including Brighton Rock, World War Two prisoner of war thriller The Great Escape and later in dinosaur blockbuster Jurassic Park.

As a director he was perhaps best known for Gandhi, which won him two Oscars.

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Democrat Running Ad On Benefits Of Affordable Care Act

It is good to see that some Democrats are now campaigning on the benefits of the Affordable Care Act, such as in the above ad being broadcast by Mark Pryor. He is yet another Democrat in a close Senate rate in addition to those I mentioned yesterday. Time described the ad:

In the personal new ad, Pryor’s father, David, a former senator himself, talks about his son’s battle with sarcoma, a rare form of cancer, in 1996. “When Mark was diagnosed with cancer, we thought we might lose him,” David Pryor says in a voiceover. “But you know what? Mark’s insurance company didn’t want to pay for the treatment that ultimately saved his life.”

By opening up about the struggle for his own life, Pryor aims to connect with his constituents. “No one should be fighting an insurance company when you’re fighting for your life,” he says in the ad. “That’s why I helped pass a law that prevents insurance companies from canceling your policy if you’re sick or deny coverage from preexisting conditions.”

Pryor’s ad does at least three things right. First, he hones in on the most popular aspect of the Affordable Care Act: coverage for those with preexisting conditions, which has support across the aisle. “We all agree that nobody should be denied coverage due to a pre-existing condition,” David Ray, a Cotton campaign spokesman, told TIME in an emailed statement.

Second, Pryor’s ad doesn’t use the term “Obamacare,” the Affordable Care Act’s nickname first coined by its critics. A Kaiser Health Tracking poll released August 1 found that a little over half of the public—53%—have an unfavorable view of Obamacare. But when referred to by a different name, the law’s negative ratings can decrease, polls show. One Kentucky poll in May found that while 57% of registered voters disliked “Obamacare,” only 22 percent had unfavorable views of Kynect, the state exchange created as a result of the Affordable Care Act’s passage in 2010.

Democrats cannot hide from Obamacare but they can take advantage of the many aspects of it which people support. Most voters want insurance which cannot stop paying benefits when they get sick, and are happy about receiving better insurance at a lower price through the exchanges. Democrats need to learn to place the Republicans on the defensive for the negative changes which would come about from their policy of repealing Obamacare.

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Tea Party Has Republicans Afraid To Discuss Scientific Consensus On Climate Change

ocean temperature increase

Republicans must say idiotic things to get elected, often denying science, but that does not mean that all elected Republicans are idiots. Bloomberg has discussed the scientific consensus on climate change with many Republicans. While well ninety-seven percent of climate scientists agree on how human action has caused global warming, rank and file Republican remains in denial, often seeing this as stemming from a left wing conspiracy. Republicans must play to this attitude even if they know better:

In stark contrast to their party’s public stance on Capitol Hill, many Republicans privately acknowledge the scientific consensus that human activity is at least partially responsible for climate change and recognize the need to address the problem…

In Bloomberg BNA interviews with several dozen former senior congressional aides, nongovernmental organizations, lobbyists and others conducted over a period of several months, the sources cited fears of attracting an electoral primary challenger as one of the main reasons many Republicans choose not to speak out.

Most say the reluctance to publicly support efforts to address climate change has grown discernibly since the 2010 congressional elections, when Tea Party-backed candidates helped the Republican Party win control of the House, in part by targeting vulnerable Democrats for their support of legislation establishing a national emissions cap-and-trade system…

While environmental groups continue to search for Republican candidates to back, Goldston said the Tea Party movement has swept many more deniers of climate change into Congress than ever before, and it has pushed Republicans away from basic environmental principles. He disagreed with others who said many Republicans privately acknowledge the risks of climate change, even if they don’t say so publicly.

“It’s very comforting for people to think that these people are pretending,” Goldston said. “It’s not true. The problem would be in many ways easier to solve if it was true.”

Chris Miller, who served as a senior energy policy adviser to Senate Majority Leader Harry Reid (D-Nev.), agreed with Goldston’s assessment that the Tea Party has made it “impossible” for Republicans to speak on the issue.

“I have had no or very few private and honest interactions with Republicans on the topic,” Miller told Bloomberg BNA. “They’re all too scared of speaking the truth.”

It is ironic that Republicans are now afraid to express support for cap and trade considering that this was largely a Republican idea in the past, similar how Republicans now oppose aspects of the Affordable Care Act which were initially advocated by Republicans such as the individual mandate and selling insurance through exchanges.

In order to oppose the scientific consensus on climate change, conservatives frequently spread false claims and distort statements from scientists. For example, Rebecca Leber recently described how conservatives misquoted climate scientists to promote their claims that global warming is on hiatus:

Norman Loeb, an atmospheric scientist with NASA, gave a crash course in climate change science for the public at Virginia Air and Space Center on Tuesday. He talked about all the evidence that the planet is warminglike the fact that temperatures right now are the hottest they’ve been since record-keeping began in 1850. He also noted that the rise in surface temperatures has slowed considerably since 2000. This doesn’t contradict the theory of global warming, he explained. Land temperature regularly varies, and much of the warming in the last decade is happening unseen in the ocean.

The same day, the frequently conservative-leaning Washington Times ran a short story on the talk. It said that a prominent NASA scientist had admitted global warming is on “hiatus.” As the writer explained, “The nation’s space agency [has] noticed an inconvenient cooling on the planet lately.”

It was pretty much the opposite of what Loeb was trying to say. But it’s not an isolated incident. Conservatives love to cite the relative stability of global surface temperatures for the last 15 years as proof that climate change is a hoax. And they frequently twist the words of scientists to do it. I read or hear versions of this argument all the timefrom outlets like Forbes, National Review, and Fox News. Sometimes the conservatives even talk about “global cooling,” joking that maybe we should be more worried about that, instead. This sort of commentary probably helps explain why still find that just 67 percent of Americans accept that humans cause climate change, even though there is nearly unanimous scientific consensus.

Needless to say, the conservatives have it all wrong. And the science really isn’t that hard to understand…

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Biggest Lies About Obamacare Debunked Once Again

Michael Tomasky described how, despite all the predictions and lies from opponents, the Affordable Care Act is working and the dire predictions are all failing to come true. He suggested why all the predictions of doom have failed to come true:

…maybe it’s not just dumb luck that the law seems to be working, especially in the states that took the Medicaid money and set up well-run exchanges. Maybe it’s working because bureaucrats (!) anticipated all the potential problems and planned for them in the writing of the law. Nancy-Ann DeParle, one of the administration’s chief architects of Obamacare, put it this way: “When President Obama took office, there were 42 million uninsured Americans, premiums that were unaffordable for families and businesses, a delivery system with the wrong incentives, and unsustainable cost growth. The Affordable Care Act was the product of nearly two decades of bipartisan analysis and discussions among health policy experts and economists to address these problems, and most–indeed, virtually all–of the policies in the law had widespread agreement from these experts.” In other words, writing this law wasn’t guesswork.

He then listed what he considered to be the five biggest lies about Obamacare and why they are not true:

1. Healthy People Won’t Sign Up

Or call this “Death Spiral Part I.” The idea here, spread lustily by many conservatives since 2010 but especially during last fall’s disastrous roll out, was that healthy people simply wouldn’t buy insurance. Senator Orrin Hatch said last November that “at this pace, the Obama administration will never be able to meet their enrollment goals.” Speaker John Boehner at the time groused that “the idea that the federal government should come in and create a one size fits all for the entire country never was going to work.”

Their hope was that only really sick people would sign up, which would lead rates to spike—the much-feared death spiral (more on that later). But lo and behold it turned out that millions of healthy people did want health insurance. As noted above, the precise numbers are hard to come by. But Gallup’s estimate is that the country has roughly 10 million newly insured citizens under Obamacare. And insurance companies report that around 80 to 85 percent of them are paying their premiums (this was another canard spread on the right, that people would sign up but never pay).

In sum, the law’s advocates were right, and its critics wrong, that health insurance was something normal Americans did in fact want. “There never was any realistic prospect of a death spiral,” says Jon Gruber of MIT, one of the country’s top health-care economists.

2. You Won’t Be Able to Choose/Keep Your Doctor/Plan

It’s true that this happened in a limited number of cases—maybe six or seven million people who bought policies on the individual market got cancellation letters from insurers telling them that their plans didn’t meet the minimum requirements under the new law, as NBC News explosively reported last fall.

It harmed the administration’s credibility, and rightly so. But it didn’t represent much of a change from the past — the “churn-rate” in the individual market has always been high. More importantly, no one seems to have followed up with this population to try to figure out what percentage did, in fact, lose coverage and/or have to pay considerably more for a new plan, so we don’t actually know how many of those six or seven million walked away satisfied or dissatisfied.

But more broadly, in a country where some 260 million people have health insurance, no one has adduced any proof that the ACA has resulted in anything remotely like the cataclysm opponents predicted. In fact, last fall, Factcheck.org rated such claims as outright falsehoods. And Gruber noted to me that if some people are “losing” their doctors, it’s often by their own choice, because now that they have so many different coverage options, many are choosing less expensive or so-called “limited network” plans. “No one is making people buy these plans,” Gruber says. “They’re cheaper alternatives. This is capitalism at its finest. For the right to criticize that is just ludicrous.”

3. Obamacare Will Explode the Federal Deficit

You heard this one a jillion times back when the law was being debated. Still today, Republicans and conservatives are deft at cherry-picking numbers out of official reports that can convey the misleading impression that fiscal watchdogs think the law will be a disaster.

The truth is that the Congressional Budget Office said in 2010 and reaffirmed this summer that the Affordable Care Act’s budget impact would be positive. The 2010 estimate was that the ACA would cut deficits by $124 billion over its first decade. And in June, CBO head Douglas Elmendorf reported that his experts “have no reason to think that their initial assessment that the ACA would reduce budget deficits was incorrect.”

Now, he throws in a number of caveats, as any bureaucrat should, having to do with the fact that many provisions of the act will kick in later. But Elmendorf sees no hard evidence to suggest that initial estimates were wrong. In fact, says Paul Van de Water of the Center on Budget and Policy Priorities, “The CBO has estimated that the law will especially reduce the deficit in its second decade, and there’s every reason to believe that those estimates are on course.”

4. Okay, Then, It Will Bust States’ Budgets

Texas’ Rick Perry, Florida’s Rick Scott, and numerous other Republican governors have said that Obamacare will bust their budgets. They’re basing that on the fact that the federal government will pay 100 percent of the costs of Medicaid expansion through 2016, but a little less than that thereafter (although never less than 90 percent). So states are going to have to start shelling out (that is, states that take the money in the first place, which Texas and Florida did not).

That’s true as far as it goes. But here’s the part Perry and Scott leave out. All states have, of course, an existing relationship with the Medicaid program in which states pay for some portion of the program’s implementation. And a number of studies estimate that in that pool of funds, states will save significant amounts of money that will offset most of the new expenses incurred under Obamacare. For example, Massachusetts found that after implementation of Romneycare, its costs for “uncompensated care”—charity work, basically—decreased considerably. And one study released in June found that uncompensated care costs are already dropping dramatically under the ACA—but only in the states that have taken the Medicaid money.

Thus, Perry, Scott, et alia are perhaps agents of a self-fulfilling prophecy: Yes, the ACA might bust the budgets of their states—the states trying to kill off Obamacare. But in the states trying to make it work, the budgetary impact, say most nonpartisan experts, will be a little bit negative, but pretty small.

5. Premium Rates Will Shoot Through the Roof

This is the big enchilada, and the culmination of the alleged death spiral. The charge here is that the lack of healthy enrollees will force insurers to jack rates up to the heavens, because they’ll have all these sick and dying people on their hands. Premium hikes for this year were all over the map, because they were based on guesswork by the insurance companies about who was enrolled. But now, the companies have hard data. So just watch, critics say, as the rates go boom.

To be sure, you can go to your Google machine and enter “insurance premium increases 2015” and find a lot of scary headlines from earlier this year. But you can ignore them all, because no one really knows yet.

Here’s how it works. By roughly this past Memorial Day, insurance companies submitted their 2015 rate requests to the states. These could range from tiny to huge—but they’re just requests. State insurance commissioners are now reviewing the requests. Final, approved rates will be made public in November (before November 15, when Obamacare’s second enrollment period begins). By the way, the ACA, for the first time ever, rationalized this “rate season,” so that everything happens in almost every state at the same time and in more or less the same way. Before, there was no national logic to the process at all.

Again, to echo back to what DeParle said: The people writing the law knew all this was coming, and understood very well that rate shock would be a risk. As a result there are numerous provisions in the law designed to guard against it. The most notable one carries an obvious name: “rate review.” Under rate review, any request for an increase of 10 percent or more has to be approved by a board, to which the insurer has to offer copious documentation proving that such a hike is necessary. Prior to the ACA, there was no such review.

Before we go any further, let’s step back. What’s a typical, pre-ACA rate increase? Good question. In 2008 it was 9.9 percent; 2009, 10.8 percent; 2010, 11.7 percent. Within those broad averages, numbers were all over the map: In 2010, rates went up in Kentucky by just 5.5 percent, but in Nebraska by 21.8 percent.

The numbers released in November will similarly be all over the map. There are just too many variables to say otherwise—how much competition there is among insurers in any given state (in general, it’s increased); what the risk pool looks like in a state (how old, how sick); and other factors. So undoubtedly, there will be some isolated hair-raising increases.

We don’t know, but we do have some early indications and studies, and they are pretty hopeful. The Health Research Institute at PricewaterhouseCoopers looked at rate requests from insurers that have been filed across 29 states and the District of Columbia and found that the average increase is 8.2 percent, which is impressively low and definitely not “sticker shock.” And remember, these are mostly just requests (in Rhode Island and Oregon, the rates are final), which aggressive state insurance commissioners might seek to make still lower.  “So far, the filings suggest modest increases for 2015, well below the double digit hikes many feared,” says Ceci Connolly, the managing director of the institute.

All the above is about the individual market—people buying insurance on their own, either through state exchanges or the federal marketplace. For a host of reasons, that’s the best barometer by which to measure the law’s success. But there are other markets, too, notably the small-business market, where employers with fewer than 50 employees buy for their workers. There has been some grumbling among conservatives that this “small-group” market will take an especially hard hit, but that seems not to be the case either.

Again, there will be great variance in the small-group market, according to Jon Kingsdale, of the Wakely Consulting Group in Boston. He says the biggest impact will be that, because of some technical changes made by the law, employers with older employees and larger families will likely see rates increase, while employers with younger workers and smaller families may see rates decrease.  But overall, says Kingsdale, “I do not believe there will be a significant jump in rate in the small-group market, because the underlying body of people being insured is not so different from the prior year.”

One last point on rates: This is another area where Republican saboteurs of the law can, if they choose to, make it not work. That is, Republican state insurance commissioners can approve big premium hikes just to make the law look bad. Says Sally McCarty, the former Indiana state insurance commissioner, now at the Georgetown Center on Health Insurance Reforms: “States that are in earnest about implementing the law will likely see lower increases, and states not so concerned about seeing the law succeed will see higher increases.”

 

 

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