“Disneyworld has become a popular location for Republican fundraisers. A favorite activity is to ride through It’s a Small World and deport most of the dolls.” –Conan O’Brien
“Disneyworld has become a popular location for Republican fundraisers. A favorite activity is to ride through It’s a Small World and deport most of the dolls.” –Conan O’Brien
Doctor Who first airs at 7:50 London time, so I’m about to make sure Hola unblocker is working fine, and then hooking it up via the HDMI port to my big screen television. For those who are more patient (or won’t be out to dinner as I will be at the time) BBC America is showing it at 8 p.m.
Using Hola to make it appear that my computer is in the U.K. will also come in handy to watch Doctor Who Extra which will be showing on the BBC iPlayer, replacing the old Doctor Who Confidential.
New trailer above, and a scene from today’s episode, Deep Breath, below:
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.
If you want another source besides Nate Silver’s site at FiveThirtyEight for information to make an educated guess about control of the Senate, check out Electoral-vote.com. The page has a map of all the states which links to the latest polls from each state. As an example of how close things are, today’s projection shows the Democrats with 49 seats, the Republicans with 50, and one tied. The Democrats retain control if they can maintain fifty seats due to Vice President Biden casting the deciding vote in a tie.
The tie is in Iowa, which does seem to give the Democrats a fighting chance of winning the 50th seat based upon this projection. FiveThirtyEight gives Democratic candidate Bruce Braley a 55 percent chance of winning that race.
Some of the states are classified as barely leaning towards one party and there is no doubt that some of these (and perhaps other) states will change. For example, Electoral-vote.com has Mary Landrieu barely leading in Louisiana. FiveThirtyEight gives her a 45 percent chance of winning, and predicts that this race will come down to a run-off in December. With control of the Senate very possibly coming down to a single seat, we can easily have a situation where we are waiting until the December run-off, which would then turn into an extremely high profile race.
The Democrats also face a tough challenge in North Carolina despite this state being listed as barely Democratic. FiveThirtyEight sees it as even tighter, giving Kay Hagan a 50 percent chance of winning.
Other races could also provide the Democrats with the 50th seat should the other races go as Electoral-vote.com predicts. They currently have Colorado listed as barely Republican, while FiveThirtyEight gives Mark Udall a 60 percent chance of winning. At this point I would place more credence in a human projection than in Electoral-vote.com’s projections based purely on the polls.
These sites certainly do not provide an answer as to who will win. The next question would be the impact of winning with Ezra Klein joining many other political writers in seeing a Republican controlled Senate as further increasing the chances that the Democratic presidential candidate will win in 2016. Will this keep Hillary Clinton from campaigning for Democrats this fall despite the risk of ill will from some Democrats?
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 warming—like 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 time—from 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…
“Former New York Congressman Anthony Weiner is planning to open a new farm-to-table restaurant in Queens. So, whatever you do, don’t ask to see the special.” –Seth Meyers
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, 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.”
Opponents of Medicaid expansion have often distorted reports of increase Emergency Room use after their expansion of the Medicaid program in Oregon as reason to oppose the program. MACPAC, a nonpartisan federal agency that provides policy and data analysis on Medicaid and CHIP to Congress, has found the problem to not be as serious as suggested as the vast majority of the use of Emergency Rooms is for valid reasons. Fierce Health Finance summarized their findings:
The Medicaid population uses hospital emergency departments (EDs) at a higher rate than patients with other forms of insurance, but for the most part such visits are necessary, according to a new report from the Medicaid and CHIP Payment and Advisory Commission (MACPAC).
The report aims to debunk the notion that Medicaid patients show up at the emergency room (ER) for care because they have been conditioned to do so. “The majority of ED visits by non-elderly Medicaid patients are for urgent symptoms and serious medical problems that require prompt medical attention,” the report said. It noted that Medicaid patients tend to have much higher rates of chronic diseases and debilitating conditions than those in the privately insured population, or even among those who lack health insurance altogether. In many cases, their conditions are so compromised that even their primary care physicians will refer them to the ER.
Moreover, MACPAC also engaged in a systematic review of all the research regarding ED use and the Medicaid population between 1990 and 2010. It concluded that there was no “consistent association” between Medicaid enrollees and unnecessary ER use.
MACPAC also noted that some conditions treated at the ER that are classified as non-urgent are best treated there anyway. “Some problems, such as chest pain in a 50-year old or an infant’s fever and rash, carry high risks for patients and are best evaluated in an ED,” the report said. “This is true even if–after a physician’s evaluation and some rapid testing–the vast majority of cases are resolved.”
Experience from Medicaid expansion in Ohio also showed that better management of the Medicaid patients can lead to better control of chronic disease while limiting Emergency Room use.
“Hillary Clinton has been calling President Obama’s foreign policy a failure. She either wants to be a president or a Fox News anchor. We’re not sure.” –Conan O’Brien