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

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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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Republicans Had To Hide Support For Fix To Affordable Care Act To Limit Attacks From The Right

The “doc fix”  has become a strange legislative tradition as Congress regularly votes to stop the automatic  cuts in physician payment called for under the flawed Sustainable Growth Rate formula. As I discussed in March, this time there were a couple of new twists which were known, but in addition it turns out that another item hidden in the bill reveals a lot about the Republican Party.

First I’ll recap what we had already known. The “doc fix” proposed to block the cuts which would have taken effect in April was for one year and included multiple other measures, including a delay in implementing change to ICD-10 diagnosis codes until at least October 2015. Physician groups actually opposed this bill because a permanent fix was also under consideration and it was feared that passing yet another temporary fix would lead to abandonment of the permanent fix (which does now appear dead).

The “doc fix” regularly passes with bipartisan support because Congress is not going to risk the backlash which would be created if many Medicare patients could no longer find physicians willing to accept them. This time the House passed the “doc fix” on a voice vote, which allows individual members to avoid being held accountable for the vote.

Over the weekend we learned why House Republicans wanted to pass this on a voice vote. Another item in the bill made some changes in the Affordable Care Act which was desired by small business and which Democrats were willing to make:

At the prodding of business organizations, House Republicans quietly secured a recent change in President Barack Obama’s health law to expand coverage choices, a striking, one-of-a-kind departure from dozens of high-decibel attempts to repeal or dismember it.

Democrats describe the change involving small-business coverage options as a straightforward improvement of the type they are eager to make, and Obama signed it into law. Republicans are loath to agree, given the strong sentiment among the rank and file that the only fix the law deserves is a burial.

“Maybe you say it helps (Obamacare), but it really helps the small businessman,” said Rep. Phil Roe, R-Tenn., one of several physician-lawmakers among Republicans and an advocate of repeal.

No member of the House GOP leadership has publicly hailed the fix, which was tucked, at Republicans’ request, into legislation preventing a cut in payments to doctors who treat Medicare patients.

It is unclear how many members of the House rank and file knew of it because the legislation was passed by a highly unusual voice vote without debate.

This shows how dysfunctional Congress has become. Normally both parties would see it as a victory for the system that they passed a measure to make requested changes in the Affordable Care Act. However, Republicans felt compelled to hide this vote because it contradicts their public policy of only supporting repeal (having voted for repeal over fifty times). Since this became public, the Republicans have faced criticism from the right, probably making it even harder for them to vote on improvements in the Affordable Care Act in the future.

The fix which passed allows small businesses to offer policies with higher deductibles. This allows for lower premiums, and the higher deductibles are often handled separately with Medical Savings Accounts. There are also added protections in new insurance policies under the Affordable Care Act such as annual limits on out of pocket expenses and the elimination of annual and lifetime caps on coverage which help offset the problems created by higher deductibles.

If Republicans should attack the Affordable Care Act based upon including high deductible plans, keep in mind that this is exactly the type of plan which Republicans frequently advocate, and that the Republicans voted to increase the allowable deductible levels in response to requests from small business.  Democrats had no objection to the change as the limit on deductions was originally placed in the bill because it was supported by Republican Senator Olympia Snowe. In response to this addition, Snowe voted for the Affordable Care Act when in the Senate Finance Committee but ultimately voted against the bill on the Senate floor, along with every other Republican Senator.

Cross posted at The Moderate Voice

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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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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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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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Republican Candidate And Pro-Republican Ad Both Making False Claims About Obamacare

Brian Buetler points out that the conservative claims of people not signing up for coverage under the Affordable Care Act are falling apart as we reach the end of the open enrollment period:

Charles Gaba — an ACA supporter and data Hoover — has been documenting the March surge, state by state on his Twitter account and his site, ACAsignups.net. Gaba has the best numbers out there, and has been accurately forecasting official enrollment statistics for weeks. He currently projects total exchange enrollment will hit 6.2 million by the end of the month, not counting enrollment in off-exchange plans, and puts the grand beneficiary total (including Medicaid beneficiaries and “young invincibles” on their parents’ plans) at 11.9-15.6 million as of Saturday. Conservatives are thus, to no one’s surprise, furiously attempting to “un-skew” his figures.

And, as Vanderbilt health policy and med school professor John Graves notes in Health Affairs, turnover is a major hallmark of the insurance market. People who lose or change jobs, and thus become temporarily uninsured, will be eligible for ACA enrollment, even after March 31. Medicaid, isn’t bound by open enrollment. As such, enrollment numbers will continue to grow throughout the election season. Exchange beneficiaries might even reach the elusive 7 million total this year, a few months late, but before the midterms.

He also noted a “glaring error” regarding the Affordable Care Act in a conference call for Michigan Republican Senate candidate Terri Lynn Land. Such errors are quite common whenever Republicans talk about health care. He pointed out that Land’s proposal (an idea commonly promoted by Republicans) could lead to anyone whose coverage lapses being permanently denied insurance coverage.

Just as incorrect and claims about Obamacare are common from Land and other Republican candidates, Glenn Kessler points out that the latest ad from the Koch financed Americans For Prosperity is making more misleading claims:

“Millions of people have lost their health insurance”

We’ve repeatedly written about this claim, most recently when House Speaker John A. Boehner (R-Ohio) incorrectly claimed that so many people have lost insurance that there’s even been “a net loss” of people with insurance. Actually, there has been an increase in the number of people with insurance, though not as much as the Obama administration had hoped.

The Associated Press estimated that nearly 5 million Americans had their insurance canceled, but a large percentage of the people whose old plans were canceled were automatically moved to new plans offered by the same insurance companies. These people may not be happy with their new coverage, but they got a plan without going through HealthCare.gov. Precise figures are not available, as the insurance market is private and fragmented, but insurance company officials say a majority of people could move to new plans they were offered.

The White House last year ordered an administrative fix that, depending on the actions of individual states, allowed as many as 2.3 million people with “canceled plans” to simply stay on their old plans for at least another year. (In early March, the White House extended that deadline to 2016.) The administration in December also announced a new catastrophic exemption to fill any remaining gaps in coverage — estimated to affect as many as 500,000 people.

In other words, only in a narrow sense have “millions” lost their health insurance.

“Millions of people can’t see their own doctors”

This sweeping statement could just as well describe the world before implementation of the Affordable Care Act. Most Americans get their insurance through their employers, and those plans could be changed at any time. Moreover, when people change jobs, they often also change health plans, which could also force changes in doctors. Of course, most plans do not prevent you from seeing a doctor who is not in a network; instead, your co-pays would be higher.

AFP in the past has run ads that feature people upset at losing their doctors, but this line is misleading because it presumes that everything was perfect before the Affordable Care Act became law.

“Millions are paying more and getting less”

This is another sweeping statement, and the most misleading. (Advocates could argue back that “millions more are paying less and getting more.”)

In terms of premiums, there is a fierce dispute now among policy experts about the impact of the law on the cost of health care. When we previously looked at this issue, after President Obama claimed that the law “has helped the cost of health care grow at its slowest rate in 50 years,” we settled on a “verdict pending.” It’s still difficult to compare premiums from before the law with premiums after the law — or to determine how much the law has to do with health-care costs today.

One big reason why it is difficult to compare premiums, before and after, is because the law mandates a comprehensive package of benefits — benefits that many plans in the individual market previously lacked. That increase in insurance coverage, according to a Congressional Budget Office study in 2009, was expected to boost the premiums of nongroup plans by about 30 percent, but the impact would be negligible for large group plans, which already provided many of those benefits.

But, wait, there’s more: Other factors were expected to reduce premiums in the individual market, so the total difference (before subsidies) was an increase of 10 to 13 percent per person. For people receiving subsidies, the cost of premiums in the individual market would actually decline nearly 60 percent, CBO calculated.

In other words, the insurance premiums may be slightly higher for some — or significantly lower for many — but the plans are also more robust.

So how does AFP justify that people are getting “less”? Levi Russell said the ad is referring to narrower health-care networks. He pointed The Fact Checker to an article in The Wall Street Journal on a McKinsey & Co. report that found that the percentage of plans with “ultranarrow” or “narrow” hospital networks had increased — though that also meant lower premium costs. In fact, many people apparently would happily pay less to get less.

“McKinsey found that nearly two-thirds of about 150,000 consumers surveyed since 2011 said they were willing to trade provider choice to lower their premium costs,” the article said.

Insurance companies have also been going to more restricted panels of physicians for several years, and this likely would have increased with or without the Affordable Care Act. The Affordable Care Act also increases the chances people can keep their own doctor as consumers will have more choices in health care plans, giving them greater opportunity to sign up for a plan which their doctor is in.

Update: Lack Of Information And Misinformation Suppressing Enrollment In Insurance Plans

Cross posted at The Moderate Voice

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Don’t Panic Because Nate Silver Predicts Republicans Will Take Senate

I was traveling yesterday and when I finally got on line saw a lot of panic over Nate Silver predicting that the Republicans were favored to take control of the Senate. I don’t find this terribly significant.

We already knew that there was a real possibility that the Republicans could take control of the Senate and Silver’s prediction does not provide any new information. Silver making the prediction does not mean it is any more likely to occur than it was last week. He was way off in predicting a 61 percent chance the Republicans would take control of the Senate in 2012. I hope he is wrong again.

As I noted recently, Nate Silver’s predictions in the 2012 presidential election were similar to those from other sources (ignoring the Republicans who made predictions contrary to polling results). His predictions for the Senate in 2012 were also comparable to predictions being made by others at that point. His prediction for the Senate in 2014 is comparable to predictions already made by others.

There is real reason to fear that the Republicans will take control of the Senate is year, but the news of Nate Silver predicting this does not alter what we knew before he made this prediction and does not mean that it is any more likely to occur.

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Three Types Of Obamacare Winners You Might Not Have Thought Of

Despite all the fake horror stories being spread by conservatives, the vast majority of people in this country are benefiting significantly under the Affordable Care Act. Some benefit due to being able to obtain health insurance when they were not able to in the past due to pre-existing medical conditions and/or cost. Many also benefit due to receiving heath care coverage which cannot be cancelled, cannot have rates increased due to medical problems, and which do not have limitations in coverage which previous polices had. There are three winners which you might not have thought of before–Medicare patients with terminal illnesses, people who bought insurance without subsidies but still came out ahead, and Republicans who benefit from Obamacare.

In contrast to false claims of Medicare cuts, the Affordable Care Act increases benefits for Medicare beneficiaries such as phasing out the donut hole on prescription drugs and covering preventative services which were not previously covered. There are a number of additional aspects of the Affordable Care Act which have not received much attention. One is a demonstration project to consider allowing Hospice patients to receive both curative and palliative care.

Hospice offers extremely valuable services for dying patients, but currently Medicare does not cover Hospice services if a patient continues to receive treatments aimed at attempting cure of a disease. Quite often I have had patients who are terminally ill who could benefit from Hospice services to increase comfort but do not qualify because they want to continue medical treatment. Under this demonstration project, patients will have the option, for example, to both receive chemotherapy and to receive Hospice services aimed at enabling them to die more comfortably if the treatment is not a success.

This is just one of many areas where the Affordable Care Act provides more choice than patients had previously, and I hope that Medicare does make this change for all Medicare patients.

Andrew Sprung discussed another group of winners who are “satisfied unsubsidized.” We have surpassed five million people receiving insurance on the exchanges and it now appears likely that the number will surpass six million due to the surge in people signing up this month. An estimated six million additional are signing up directly through insurance companies, which can be done if not applying for subsidies. Sprung began:

About half of the 12 million Americans buying health insurance on the individual market are subsidy-ineligible, according to the Urban Institute. Are they all fuming and lining up to appear in anti-Obamacare commercials?

Chances are not. As veterans of the individual market, many are accustomed to its shocks and uncertainties. About a quarter of them received cancellation notices last fall, and others face substantial premium hikes. Some will be forced to pay more than in the past, in some cases in part because they are covered for services they don’t want, like childbirth or mental healthcare. But many are finding their options much better and their status less precarious than in the pre-ACA market.

I spoke recently to several people whose family income disqualifies them for subsidies and who bought insurance on the individual market for 2014. All had family members with preexisting conditions, which means they benefited from the ACA’s prohibition on basing price or eligibility on medical history. All had been paying above-market rates or faced limited choices because of a family member’s medical history…

This special category is huge, though. The percentage of Americans with preexisting conditions is anywhere from 19 to 50 percent, according to an HHS report overviewing various studies. And that’s just individuals—in households with more than one person, the chances that someone will have a medical condition that jacked up the price of insurance in the pre-ACA world multiplies.

Sprung gave some specific examples who are far more representative of the changes under the Affordable Care Act than those shown on television by conservative groups with fake horror stories. The satisfied unsubsidized also includes an additional group, people such as myself who did not have to pay higher rates in the past due to medical problems and are paying more now, but still benefit because of now having a policy which cannot be cancelled due to changes in medical condition. Sprung acknowledged us in concluding:

It’s worth keeping in mind, though, that those untroubled by preexisting conditions or by the need to find insurance in the individual market can lose those advantages at any moment—as well as their financial status. Uncertainty is the universal preexisting condition—and thanks to the ACA, such changes should no longer threaten financial ruin or lack of access to medical care.

When listening to the fake horror stories being spread by Republicans, keep in mind that before the Affordable Care Act medical expenses were a major cause of bankruptcies in this country, and three fourths who declared bankruptcy did have medical coverage at the time they became sick or injured.

Last month I looked at Republicans who have benefited from Obamacare and learned to love it. Scott Brown learned about this last Saturday:

Brown found that out on Saturday, when he stopped by the home of Herb Richardson, a Republican state representative. Sitting in Richardson’s home, Brown called Obamacare a “monstrosity” that members of Congress didn’t even bother to read before they passed. At that point, according to the Coos County Democrat, Richardson chimed in to explain that the law had been a “financial lifesaver” for him and his wife. From the the piece (page 14):

Richardson was injured on the job and was forced to live on his workers’ comp payments for an extended period of time, which ultimately cost the couple their house on Williams Street. The couple had to pay $1,100 a month if they wanted to maintain their health insurance coverage under the federal COBRA law.

Richardson said he only received some $2,000 a month in workers’ comp. payments, however, leaving little for them to live on.

“Thank God for Obamacare!” his wife exclaimed.

Now, thanks to the subsidy for which they qualify, the Richardsons only pay $136 a month for health insurance that covers them both.

With so many people benefiting from Obamacare, many Democrats are making a huge mistake by failing to run for reelection based upon this. As I wrote earlier in the week, Democrats need to go on the offensive on health care reform. Explaining these benefits is the only way to counter negative ads and negative polling results based upon misinformation.

Cross posted at The Moderate Voice

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