Gallup Finds Number Of Uninsured Continues To Fall

Percent Uninsured

New figures from Gallup show a further decrease in the number saying they are uninsured. The number of uninsured decreased to 15.6 percent in the first quarter of this year, a 1.5 percent decrease from the fourth quarter of 2013. This is the lowest recorded level since late 2008 and suggests that the Affordable Care Act is successful in providing insurance to the previously uninsured. This also shows a further decrease from a similar survey conducted last month.

The uninsured rate has been falling since the fourth quarter of 2013, after hitting an all-time high of 18.0% in the third quarter — a sign that the Affordable Care Act, commonly referred to as “Obamacare,” appears to be accomplishing its goal of increasing the percentage of Americans with health insurance coverage. Even within this year’s first quarter, the uninsured rate fell consistently, from 16.2% in January to 15.6% in February to 15.0% in March. And within March, the rate dropped more than a point, from 15.8% in the first half of the month to 14.7% in the second half — indicating that enrollment through the healthcare exchanges increased as the March 31 deadline approached.

This report is consistent with The Urban Institute’s Health Reform Monitoring Survey (HRMS) which estimated that the number of uninsured adults had fallen by 5. 4 million before the surge in enrollment in March . Another study performed prior to the late March surge in enrollment showed that at least 9.5 million new people received insurance.

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Paul Ryan Admits Consequences Of Replacing Obamacare With Republican Alternative

Republicans who have been attacking the Affordable Care Act have been unable to provide a specific alternative to replace it with. One problem they face is that, while polls show large numbers of people say they oppose Obamacare, a majority also supports many of the individual components of the law. Paul Ryan admitted what repeal of Obamacare and replacing it with a Republican alternative would mean:

House Budget Committee Chairman Paul Ryan (R-Wis.) says in a new interview that it would be too costly for Republicans to reinstate some of the more popular provisions of Obamacare if and when the law is repealed, but that Republicans should look for alternatives.

The former GOP vice presidential nominee was asked on Bloomberg’s “Political Capital with Al Hunt” about whether Republicans would keep provisions like requiring coverage for pre-existing conditions, keeping kids on their parents’ insurance until they are 26 years old and barring insurance companies from having different rates for those whose jobs include physical labor.

The first two provisions are among the most popular parts of Obamacare, which as a whole is not popular. But Ryan says such provisions would also drive up the cost of insurance too much.

“If you look at these kinds of reforms, where they’ve been tried before — say the state of Kentucky, for example — you basically make it impossible to underwrite insurance,” Ryan said, according to an advance transcript. “You dramatically crank up the cost. And you make it hard for people to get affordable health care.”

Returning to underwriting insurance would mean that insurance companies could once again issue policies based upon who they find the most profitable to cover, denying coverage to those with pre-existing medical conditions and based upon age.

It is less expensive for health insurance companies to sell insurance only to young, healthy people and to revoke coverage when people get sick. However this is not what we need from health insurance, which to be meaningful must be available to everyone and cover people when they become sick. As I’ve pointed out many times in the past, most people going into bankruptcy from medical expenses were insured at the time they first got sick or injured.

Cross posted at The Moderate Voice

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Study Shows Number of Newly Insured Increased By 5.4 Million As Of Early March

Despite favorable numbers on Obamacare enrollment, many Republicans continue to try to deny the positive results. Two common questions brought up are the number paying their premiums and the number of newly insured. Yesterday I pointed out that those claiming that as many as twenty percent are not receiving coverage due to not paying their premiums are incorrect because often the estimates are made prior to premiums actually being billed or due and as many of the people who drop insurance obtained through the exchanges wind up receiving other coverage. In addition to previous estimates, The Urban Institute’s Health Reform Monitoring Survey (HRMS) estimates that the number of uninsured adults had fallen by 5. 4 million before the surge in enrollment in March . Their survey was concluded on March 6. NBC News reports:

More than 5 million Americans who didn’t have health insurance before have been able to get coverage since September, according to a new report released Thursday.

The report seeks to answer one of the big questions surrounding the government statistics surrounding the law known as Obamacare — how many people have gained health insurance under the new rules? Early statistics had suggested that many of the people who rushed to buy the plans available on the new health insurance exchanges were just swapping out of other coverage.

But the new report suggests the law is having its intended effect of getting people covered who weren’t before.

“This represents a major step forward for 5.4 million previously uninsured people who now have health coverage,” said Dr. Risa Lavizzo-Mourey, president and chief executive officer of the Robert Wood Johnson Foundation, which issued the report along with the Urban Institute.

The report shows that 15.2 percent of Americans were without health insurance as of the first week in March, a drop of 2.7 percentage points since September 2013.

The Obama administration says at least 7.1 million people signed up for private health insurance on the online, health insurance exchanges that opened up in October. Close to three million signed up in March alone, the last month for open enrollment, which is now closed.

Separately, the Obama administration says anyone who started to sign up and wasn’t able to finish by the March 31 deadline has until April 15 to finish.

The exchanges are the centerpiece of the 2010 Affordable Care Act, which seeks in part to get coverage to the 47 million Americans who lacked it as of 2013. The Congressional Budget Office projects that 26 million people will buy health insurance on the exchanges by 2022 and that 12 million people will become newly eligible for Medicaid in the states that choose to expand their offerings by 2022.

So far 26 states, plus the District of Columbia, have decided to offer Medicaid to more people as requested under the law. The report issued Thursday doesn’t include any separate estimates of how many people this might be, and also doesn’t include young adults added because of a provision allowing people to stay on their parents’ health insurance up to age 26.

“The survey does not capture the enrollment surge that occurred at the end of the open enrollment period,” the report adds — that would be the 3 million or more people who signed up in March.

This shows that the number of uninsured has already been falling before the March surge, when Republican critics of the ACA were claiming that most of those signing up for coverage were people who had previously been dropped from their health care plans. The percentage of uninsured will drop further as those enrolling in March and April are included, along with those obtaining expanded Medicaid coverage throughout the year.

Cross posted at The Moderate Voice

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Many Of Those Not Paying Obamacare Premiums Obtain Alternate Health Care Coverage And Remain Insured

Now that we have data on the number of people who have signed up through the exchanges there remains a question as to how many will actually pay their premiums and obtain coverage. It is not possible to have an exact number on this as coverage for those who signed up in the late April surge doesn’t start until May 1 and the premiums aren’t due until mid April

National Journal repeats estimates which have been floating around that 15 to 20 percent have not paid premiums. Other estimates have placed this at 10 to 15 percent. The report does make a major error in making assumptions about how many are actually covered based upon these numbers: “If the nationwide payment rate, across all carriers, remains at 80 to 85 percent, the 7.1 million sign-ups Obama announced Tuesday would translate into somewhere between 5.7 and 6 million people who are actually covered.”

This conclusion is erroneous as it suggests that those who do not pay their premiums remain uninsured. Kaiser Health News has found that a large number of those not paying their premiums are not paying because of receiving alternate insurance coverage, not because of remaining uninsured:

Why Some Don’t Pay Their Obamacare Premium: It’s Not What You Think

A new analysis finds that many people who signed up for a Covered California health insurance exchange plan are likely to drop the coverage for a good reason: They found insurance elsewhere.

Researchers at the U.C. Berkeley Labor Center released estimates Wednesday showing that about 20 percent of Covered California enrollees are expected to leave the program because they found a job that offers health insurance. Another 20 percent will see their incomes fall and become eligible for Medi-Cal, the state’s insurance program for people who are low income.

In addition to the 40 percent of enrollees who move to Medi-Cal or job-based insurance, between 2 and 8 percent of those who sign up for Covered California are estimated to become uninsured, the analysis noted.

This process — “churn” to those who study health insurance — is well-known in the Medi-Cal and individual insurance market.

According to the report between 53 and 58 percent of Covered California enrollees are expected to stay in a Covered California plan for 12 months. This analysis is consistent with a Kaiser Family Foundation study published earlier this year. It found that of people who enrolled in an individual insurance plan in 2010, years before the health law fully kicked in, only about 48 percent were still in the individual market two years later. (Kaiser Health News is an editorially independent program of the foundation.)

The question of how many people have paid their premium has become a political issue, with questions being raised about the true enrollment in an ACA plan. But Ken Jacobs, chair of the Labor Center and an author of the new study, said that even 15 percent non-payment of premiums “was not a surprising number.”

He said that according to the analysis, in any 3-month period, an estimated 10 percent of enrollees could be expected to leave Covered California, although he says that indeed some may leave the exchange “because the cost was too high.”

On Monday, Peter Lee, executive director of Covered California said 87 percent of enrollees had paid their premium.

Besides disproving the assumption that not paying premiums indicates that people remain uninsured, it is also notable that thirteen percent have not paid their premium, a lower number than reported by National Journal. The number may decrease further as those who enrolled in late April pay their premiums when due.

Update: ACASignups.net notes additional errors in the numbers given in the article from National Journal and estimates that those actually paying their premiums might be as high as 95%. Lower numbers estimated by others are due to numbers from dates before the premiums are actually billed or due.

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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Another Study Showing No Medical Benefits From Prayer

Periodically there have been reports in which someone actually bothered to compare medical outcomes with and without prayer. As expected, no benefit was found from situations in which someone was praying for someone else without their knowledge (to remove any psychological benefits). Irregular Times has reported on another study:

Does prayer really work wonders? Not according to epidemiologst Maria Inês da Rosa.

Da Rosa and her research team published results of a double-blind randomized trial in the Brazilian Journal of Science and Public Health last year. Half of the more than five hundred pregnant women in the trial had their health prayed for from a distance by a prayer team. The other half received no such prayers. When Da Rosa’s team measured the apgar scores, type of delivery and birth weight of the two groups, there was no difference in pregnancy outcomes.

A few years ago, intercessory prayer researchers were promising a golden age in which they would supposedly prove the effectiveness of their religion. That’s not happening. Careful science is establishing the opposite.

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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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Obamacare Delay Similar To Previous Medicare Delay Under George Bush

Republicans are obsessed with Obamacare delays. Some of the delays have been helpful to allow for orderly transition to the new rules. The latest, allowing people to complete the process if they started an application for insurance before the deadline, seems like common sense and basic fairness (which might be why Republicans have such a problem with it). NBC News pointed out that George  W. Bush also had a similar delay with the Medicare D program:

As Republicans complain about the Obama administration’s latest deadline extension for Americans to purchase health insurance, Democrats are countering with this reminder: The Bush administration did something similar in 2006.

Back then, as it was implementing the Medicare prescription-drug benefit Bush had signed into law, the GOP presidential administration announced it was waiving penalties for low-income seniors and those with disabilities who signed up late.

As one Knight Ridder report put it at the time:

The move follows a recent administration decision to allow the same impoverished beneficiaries to sign up for Medicare drug coverage until Dec. 31.

“In other words, you can apply after May 15th without penalty. And that’s important for low-income seniors to understand,” President Bush told a group of older Americans in Sun City Center, Fla., on Tuesday.

There’s one key difference between Bush’s Medicare prescription-drug benefit and Obama’s health-care law: Democrats didn’t try to scuttle the Medicare law’s implementation (especially since some of them had voted for it), while the same isn’t exactly true of GOP actions regarding the health-care law.

But the 2006 story is a reminder that when it comes to the implementation of complex new laws, both Democratic and Republican administration have changed the rules to encourage enrollment.

Republicans who complain about delays in the Affordable Care Act under Obama had no problem with a comparable delay under George Bush, showing once again that their positions are motivated by opposition to Obama and not any higher principles.

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Bill Calls For Adding ICD-10 Delay To Latest “Doc Fix”

I recently pointed out that the Republicans killed a recent attempt to repeal the Sustainable Growth Rate formula by attaching a measure to end the individual mandate in the Affordable Care Act. With failing to repeal the Sustainable Growth Rate it becomes necessary for Congress to pass yet another temporary “doc fix” to prevent Medicare reimbursement from automatically falling so low that doctors will not be able to afford to see Medicare patients.

Medical Economics reports that a proposal to delay the transition from ICD-9 to ICD-10 diagnoses codes from October 2013 to October 2014. The transition was originally passed under the Bush administration, so ignore the Republican claims which are out there which blame Obamacare for the change. While there are benefits to the newer system which is used by the rest of the world, the change would be very expensive for medical practices. Changes such as this also take up a lot of physician time, reducing the number of patients which can be seen each day.

Such decreases in productivity would come at a poor time in 2013 when millions of new people will receive health insurance due to the Affordable Care Act and will need to find physicians who are accepting new patients. In addition, the second phase of requirements for electronic medical records (EMR’s) also kicks in for many physicians this October and having two sets of major changes will further reduce physician productivity, making it more difficult to accept new patients. Personally I had to greatly restrict accepting new patients for several months after the first phase of requirements went into effect, and anticipate again having to limit accepting new patients this fall if both the new EMR requirements and change to ICD-10 take effect simultaneously.

The AMA and many other physician groups have been lobbying for a further delay in ICD-10 implementation, which has already been delayed in the past. Medical Economics reports:

The ICD-10 transition has been a major point of concern for physicians due to its scope and cost to implement. In recent months the American Medical Association (AMA) ramped up opposition to the ICD-10 transition, and petitioned CMS for a delay to the implementation of ICD-10.

According to the AMA, small practices can expect staggering costs ranging from $56,639 to $226,105 to implement the new code set. According to a February survey by the Medical Management Group Association, 79% of physicians report that they haven’t begun ICD-10 implementation, or were only “somewhat ready.”

Molly Cooke, MD, FACP, president of the American College of Physicians, said the college favors the delay. “The college has expressed concern at every opportunity about the implementation of ICD-10. I’m not sure the healthcare system loses a lot if we delay implementation for another year, and it certainly would give our members a bit of a breather.”Earlier this month, the Republican-led House passed a bill to repeal SGR and replace it with a formula that would calculate payments based on quality metrics. But the bill received widespread opposition from Democrats because it was paid for by a five-year delay in the individual mandate in the Affordable Care Act (ACA).

Cross posted at The Moderate Voice

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