“I guess now Dick Cheney knows what it feels like when someone you thought was a friend shoots you in the face.” –Jon Stewart after Megyn Kelly grilled Dick Cheney on Fox about being wrong on Iraq.
“I guess now Dick Cheney knows what it feels like when someone you thought was a friend shoots you in the face.” –Jon Stewart after Megyn Kelly grilled Dick Cheney on Fox about being wrong on Iraq.
Five health care policy items today:
Goldman issued a report on how availability of health insurance allows people the option of retiring early (or as Republicans would put it, become takers) as opposed to waiting until they qualify for Medicare. The found that “the annual probability of retirement–i.e., what share of workers of a given age will retire within the next year–is on average between 2% and 8% higher when retiree health insurance is available.” Early retirement is seen more between the ages of 60 to 64, than in those who are age 55-59.
With Republicans blocking Medicaid expansion in twenty-four states, The Commonwealth Club looked at the healthcare differences in the two Americas:
The Commonwealth Fund’s recently released Scorecard on State Health System Performance, 2014, finds big differences between states on measures of health care access, quality, costs, and outcomes. What’s more, its authors warn that these differences could very well widen in the future. Many of the lowest-performing states are choosing not to expand their Medicaid programs under the Affordable Care Act (ACA). Some also are discouraging eligible uninsured citizens from purchasing subsidized coverage through new ACA marketplaces, though some uninsured are signing up nonetheless.
The fact that so many low-performing states are spurning the ACA’s benefits, while high-performing states are rushing to embrace them, raises profound questions for the future of our country. What would it mean if different parts of the United States find themselves on radically different health care trajectories, with some enjoying progressively better health and health care and others falling further and further behind? In other words, what would it mean if the two health care Americas grow further and further apart over time?
This is unexplored territory for health care researchers and policymakers, but we know enough to point to some possibilities.
To begin with, we know that when people have health coverage they live longer, healthier lives. Widening gaps in rates of insurance coverage between low- and high-performing states will almost certainly lead to growing differences in life expectancy and health status. This is worrisome and regrettable, but probably only part of the story.
An equally important—but much less explored—question is whether differing health care trajectories also will lead to differing economic and social trajectories. All else equal (of course, it never precisely is), will regions with poorer health care and health status suffer economically and socially as well? Will they have less productive workforces, less productive economies, and, as result, lower quality of life overall? Will they become less attractive places to live, work, and do business?
Several lines of evidence suggest that diverging regional health care systems could lead to diverging general welfare. First, untreated physical and mental health problems increase workers’ time off from work, reduce performance while at work, and lower rates of employment. In the early 20th century, infections such as yellow fever, malaria, and hookworm greatly hindered the economy of the American South. In his memoir, Jimmy Carter recalls that, while growing up in rural Georgia, “almost everyone was afflicted from time to time with hookworm,” a parasite that causes anemia, malaise, and fatigue. Eventually, public health measures and improved living conditions brought this and other health problems under control, contributing to a burst of economic growth.
A century later, chronic illness is the equivalent of the infectious illness that once disproportionately taxed the economy of the American South. In the United States, annual productivity losses from diabetes and depression alone exceed $100 billion nationally. And we know this burden can be lightened through good primary and preventive care that will be less available in regions with large uninsured populations.
Second, health insurance boosts economies by protecting people against catastrophic out-of-pocket health care expenses. These costs can lead to bankruptcy, which raises the cost of borrowing for the rest of society as lenders take into account the risk that they will not be repaid. Those avoiding bankruptcy often incur substantial medical debt, with far-reaching consequences. A 2012 Commonwealth Fund survey found that 61 percent of uninsured adults ages 19 to 64 reported problems paying their medical bills or said they were paying off medical debt over time. Among these individuals, more than half said they received a lower credit rating as a result of unpaid medical bills, 43 percent used all of their savings to pay their bills, and 29 percent delayed education or career plans. The 2006 Massachusetts health reform, which has led to nearly universal health coverage, has also led to fewer personal bankruptcies and bills past due and improved credit scores, particularly for those with limited access to credit before the reform…
The report continued to discuss further differences resulting from differing access to health insurance.
Besides blocking Medicaid expansion, conservatives are reducing the number of insured with misinformation campaigns and campaigns to outright dissuade people from obtaining coverage in the exchanges. This has led many uninsured people to fail to obtain coverage through the exchanges to based upon misconceptions spread by conservatives, such as that the cost would be much higher than it actually is. Jonathan Cohn wrote:
About half of the people who McKinsey surveyed did not end up buying insurance—either because they shopped and found nothing they liked, or because they didn’t shop at all. When asked to explain these decisions, the majority of these people said they thought coverage would cost too much. But two-thirds of these people said they didn’t know they could get financial assistance. In other words, they assumed they would have to pay the sticker price for coverage, even though federal tax credits would have lowered the price by hundreds or thousands of dollars a year.
With a little education and outreach, many of these people will discover that insurance costs less than they thought. When next year’s open enrollment period begins, they are more likely to get coverage. But the idea was to help more of those people this year. And if the administration deserves some blame for this shortfall, its adversaries deserve more. Republicans and their allies did their best to taint the law—and, where possible, to undermine efforts to promote it. Without such obstruction, even more uninsured people would probably be getting coverage right now. As Sprung quipped in his post, “Those who deliberately spread disinformation about the ACA and actively encouraged the uninsured to remain in that blessed state of freedom can be really proud of themselves.”
Or as I put it in a recent post: Fox Lied, People Die.
The National Bureau of Economic Research looked at the effects of legalization of medical marijuana on drug use:
21 states and the District of Columbia currently have laws that permit marijuana use for medical purposes, often termed medical marijuana laws (MMLs). We tested the effects of MMLs adopted in seven states between 2004 and 2011 on adolescent and adult marijuana, alcohol, and hard drug use. We employed a restricted-access version of the National Survey on Drug Use and Health (NSDUH) micro-level data with geographic identifiers. For those 21 and older, we found that MMLs led to a relative increase in the probability of marijuana use of 16 percent, an increase in marijuana use frequency of 12-17 percent, and an increase in the probability of marijuana abuse/dependence of 15-27 percent. For those 12-20 years old, we found a relative increase in marijuana use initiation of 5-6 percent. Among those aged 21 or above, MMLs increased the frequency of binge drinking by 6-9 percent, but MMLs did not affect drinking behavior among those 12-20 years old. MMLs had no discernible impact on hard drug use in either age group. Taken together, MML implementation increases marijuana use mainly among those over 21, where there is also a spillover effect of increased binge drinking, but there is no evidence of spillovers to other substance use.
If marijuana turns out not to be a gateway drug, this would be another reason to reevaluate current marijuana laws. Further discussion at Vox.
The Pentagon has contingency plans for any emergency, including the Zombie Apocalypse. It isn’t as ridiculous as it sounds as it is actually a model plan using a fictional situation, as reported by Foreign Policy:
“This plan fulfills fictional contingency planning guidance tasking for U.S. Strategic Command to develop a comprehensive [plan] to undertake military operations to preserve ‘non-zombie’ humans from the threats posed by a zombie horde,” CONOP 8888’s plan summary reads. “Because zombies pose a threat to all non-zombie human life, [Strategic Command] will be prepared to preserve the sanctity of human life and conduct operations in support of any human population — including traditional adversaries.”
CONOP 8888, otherwise known as “Counter-Zombie Dominance” and dated April 30, 2011, is no laughing matter, and yet of course it is. As its authors note in the document’s “disclaimer section,” “this plan was not actually designed as a joke.”
Military planners assigned to the U.S. Strategic Command in Omaha, Nebraska during 2009 and 2010 looked for a creative way to devise a planning document to protect citizens in the event of an attack of any kind. The officers used zombies as their muse. “Planners … realized that training examples for plans must accommodate the political fallout that occurs if the general public mistakenly believes that a fictional training scenario is actually a real plan,” the authors wrote, adding: “Rather than risk such an outcome by teaching our augmentees using the fictional ‘Tunisia’ or ‘Nigeria’ scenarios used at [Joint Combined Warfighting School], we elected to use a completely-impossible scenario that could never be mistaken for a real plan.”
But do they have plans in case of a Dalek invasion?
There is some amazing tunnel vision from James Oliphant in an article on the progressive blogosphere. An article on the subject, or even how it often helps Obama, might make sense. This does not make sense once you get to the second paragraph quoted below:
It’s been a familiar pattern since President Obama took office in 2009: When critics attack, the White House can count on a posse of progressive writers to ride to its rescue. Pick an issue, from the Affordable Care Act to Ukraine to the economy to controversies involving the Internal Revenue Service and Benghazi, and you’ll find the same voices again and again, on the Web and on Twitter, giving the president cover while savaging the opposition. And typically doing it with sharper tongues and tighter arguments than the White House itself.
While the bond between presidential administrations and friendly opinion-shapers goes back as far as the nation itself, no White House has ever enjoyed the luxury that this one has, in which its arguments and talking points can be advanced on a day-by-day, minute-by-minute basis. No longer must it await the evening news or the morning op-ed page to witness the fruits of its messaging efforts.
At least he recognized that sometimes Obama receives criticism from the left further in the column, even if the article does downplay how often this happens. Still, in general, I’ll accept that quite often “the White House can count on a posse of progressive writers to ride to its rescue.” What is wrong is the claim that no White House has ever enjoyed such a luxury.
There are plenty of conservative bloggers to counter liberal bloggers–both having defended Bush when he is in office and in intensifying the attacks on Obama. Obama might have more defenders thanks to the blogosphere, but he also has far more people attacking him, quite often with totally manufactured attacks.
Maybe the conservative blogosphere isn’t as potent a force as the progressive blogosphere. It doesn’t matter. Bush had Fox , which is essentially the unofficial propaganda arm of the Republican Party, actively defending and often lying for him. Bush had the right wing noise machine defending him to a far greater effect than blogs are capable of defending Obama.
When there is not a Republican in the White House, Fox does a 180 degree switch in outlook, having been the biggest attacker of both Clinton and Obama. Fortunately Clinton had his own people to defend him as the liberal blogsophere was not yet a meaningful force back then. Fox provides far more assistance for the right than MSNBC is capable of doing for the left, and there is barely an equivalent to right wing talk radio on the left. On the other hand Obama does have Jon Stewart’s fake news show defending him from the attacks coming from the fake news shows on Fox, when Stewart is not criticizing him from the left.
These days both Democratic and Republican presidents are going to have far more defenders and attackers than was the case in the past, with the progressive blogosphere defending Obama (when not criticizing him from the left) not being anything unique to Obama.
When promoting health care reform there was an implicit assumption that having health care insurance is beneficial. While few rational people would deny this, we now have more data to back up this assumption. The Annals of Internal Medicine published a study comparing counties in Massachusetts to comparable counties in other states to show a reduced mortality among those who received health care coverage. They estimated that giving 830 adults insurance coverage would prevent one death per year.
In this case, supporting health care reform is definitely the pro-life position.
There are a number of variables affecting a reduction in mortality so I would be cautious about extrapolating this number exactly to other areas. The New York Times estimates that the three percent drop in mortality seen would lead to a reduction in 17,000 deaths per year nationally. Harold Pollack extrapolated the reduction of 830 deaths per year to the entire uninsured population, providing an estimate that extending health care to all could lead to a reduction in 24,000 deaths per year. To put this in perspective, “That’s almost the number of Americans who die in auto crashes. It’s more than the number who die of AIDS or the number who are murdered every year.”
Some conservatives have questioned the value of this by arguing that there could be less costly ways to save the same number of lives. This misses the point that there are multiple other benefits of having insurance beyond the reduction in mortality. Providing health care coverage could lead to a reduction in the number of diabetic patients who go blind or lose limbs. Insurance coverage for people with hypertension could reduce the number who have to live with the effects of a stroke. Health care reform also spares people from going bankrupt to pay medical bills.
Some conservatives have also twisted the results of a previous study on those who received Medicaid coverage in Oregon to claim that receiving the coverage is not of benefit. The study actually did show benefits, but was not conducted for a long enough period to show significant differences in those with chronic medical problems. The Massachusetts study published this week helps to clarify this issue. Of course if conservatives want to argue that providing Medicaid is not of value, I would be very happy to see a system in which instead of receiving Medicaid the poor are provided the public option initially proposed, or even regular insurance through the exchange, in place of Medicaid. (Due to their lower incomes, it would also be necessary to provide coverage for the co-pays and deductibles, comparable to how Medicaid covers these costs for those duel eligible for Medicare and Medicaid.)
If providing access to health care saves lives, the converse would also be true. Denying people access to health care coverage would lead to more deaths. The Health Affairs Blog looked at the consequences of denying expanded Medicaid coverage in many of the Republican controlled states:
We estimate the number of deaths attributable to the lack of Medicaid expansion in opt-out states at between 7,115 and 17,104. Medicaid expansion in opt-out states would have resulted in 712,037 fewer persons screening positive for depression and 240,700 fewer individuals suffering catastrophic medical expenditures. Medicaid expansion in these states would have resulted in 422,553 more diabetics receiving medication for their illness, 195,492 more mammograms among women age 50-64 years and 443,677 more pap smears among women age 21-64. Expansion would have resulted in an additional 658,888 women in need of mammograms gaining insurance, as well as 3.1 million women who should receive regular pap smears.
Those denied access to the expanded Medicaid program is probably the largest group who could be covered under the Affordable Care Act as originally passed but are not able to receive coverage. Considering the amount of misinformation being spread by the right wing, and outright campaigns to encourage people not to enroll, there are undoubtedly some people who are not obtaining coverage due to falling for right wing propaganda. The old cry during the Bush years and Iraq war was that “Bush Lied, People Died.” Down the road the sad truth about conservative misinformation on health care might be “Fox Lied, People Died.”
I admit it — last year was rough. Sheesh. At one point things got so bad, the 47 percent called Mitt Romney to apologize.
Of course, we rolled out healthcare.gov. That could have gone better. In 2008 my slogan was, “Yes We Can.” In 2013 my slogan was, “Control-Alt-Delete.” On the plus side, they did turn the launch of healthcare.gov into one of the year’s biggest movies. (Slide of “Frozen”)
But rather than dwell on the past, I would like to pivot to this dinner. Let’s welcome our headliner this evening, Joel McHale. On “Community,” Joel plays a preening, self-obsessed narcissist. So this dinner must be a real change of pace for you.
I want to thank the White House Correspondents Association for hosting us here tonight. I am happy to be here, even though I am a little jet-lagged from my trip to Malaysia. The lengths we have to go to get CNN coverage these days. I think they’re still searching for their table.
MSNBC is here. They’re a little overwhelmed. They’ve never seen an audience this big before.
Just last month, a wonderful story — an American won the Boston Marathon for first time in 30 years. Which was inspiring and only fair, since a Kenyan has been president for the last six.
We have some other athletes here tonight, including Olympic snowboarding gold medalist Jamie Anderson is here. We’re proud of her. Incredibly talented young lady. Michelle and I watched the Olympics — we cannot believe what these folks do — death-defying feats — haven’t seen somebody pull a “180” that fast since Rand Paul disinvited that Nevada rancher from this dinner. As a general rule, things don’t like end well if the sentence starts, “Let me tell you something I know about the negro.” You don’t really need to hear the rest of it. Just a tip for you — don’t start your sentence that way.
And speaking of conservative heroes, the Koch brothers bought a table here tonight. But as usual, they used a shadowy right-wing organization as a front. Hello, Fox News.
Let’s face it, Fox, you’ll miss me when I’m gone. It will be harder to convince the American people that Hillary was born in Kenya.
Of course, now that it’s 2014, Washington is obsessed on the midterms. Folks are saying that with my sagging poll numbers, my fellow Democrats don’t really want me campaigning with them. And I don’t think that’s true — although I did notice the other day that Sasha needed a speaker at career day, and she invited Bill Clinton.a, Bill Clinton, Bill O’Reilly, Captain America, Chris Christie, Community, Donald Trump, Facebook, Fox, George Bush, Health Care Reform, Hillary Clinton, House of Cards, Jeb Bush,
And I’m feeling sorry — believe it or not — for the Speaker of the House, as well. These days, the House Republicans actually give John Boehner a harder time than they give me, which means orange really is the new black.
Look, I know, Washington seems more dysfunctional than ever. Gridlock has gotten so bad in this town you have to wonder: What did we do to piss off Chris Christie so bad?
One issue, for example, we haven’t been able to agree on is unemployment insurance. Republicans continue to refuse to extend it. And you know what, I am beginning to think they’ve got a point. If you want to get paid while not working, you should have to run for Congress just like everybody else.
Of course, there is one thing that keeps Republicans busy. They have tried more than 50 times to repeal Obamacare. Despite that, 8 million people signed up for health care in the first open enrollment. Which does lead one to ask, how well does Obamacare have to work before you don’t want to repeal it? What if everybody’s cholesterol drops to 120? What if your yearly checkup came with tickets to a Clippers game? Not the old, Donald Sterling Clippers — the new Oprah Clippers. Would that be good enough? What if they gave Mitch McConnell a pulse? What is it going to take?
Joel McHale, star of Community and The Soup, did an excellent job. #sixtimesashostandamovie. He has followed a long line of top comedians who have roasted politicians and the media and previous events. The all time best speakers was Stephen Colbert who roasted George Bush in 2006. The full transcript of his speech can be found here.
Following are some of Joel McHale’s best jokes, with video above and full transcript here.
Good evening, Mr. President — or as Paul Ryan refers to you, yet another inner-city minority relying on the federal government to feed and house your family.
I’m a big fan of President Obama. I think he’s one of the all- time great presidents — definitely in the top 50. Please explain that to Jessica Simpson. You’re right. That was low.
All right, how about the president’s performance tonight, everyone? It is — it’s amazing that you can still bring it with fresh, hilarious material. And my favorite bit of yours was when you said you’d close the detention facility at Guantanamo Bay. That was a classic. That was hilarious, hilarious. Still going.
All right, look, I know it’s been a long night, but I promise that tonight will be both amusing and over quickly, just like Chris Christie’s presidential bid.
It’s a genuine thrill to be here in Washington, D.C., the city that started the whole crack-smoking-mayor craze.
The vice president isn’t here tonight, not for security reasons. He just thought this event was being held at the Dulles Airport Applebee’s. Yes, right now Joe is elbow-deep in jalapeno poppers and talking to a construction cone he thinks is John Boehner. Also true.
Hillary Clinton has a lot going for her as a candidate. She has experience. She’s a natural leader. And, as our first female president, we could pay her 30 percent less. That’s the savings this country could use.
Hillary’s daughter Chelsea is pregnant, which means in nine months we will officially have a sequel to “Bad Grandpa.” It also raises the question, when the baby is born, do you give Bill Clinton a cigar?
Jeb Bush says he’s thinking about running. Wow, another Bush might be in the White House. Is it already time for our every-10- years surprise party for Iraq? Yes.
As it stands right now, the Republican presidential nominee will either be Jeb Bush, Rand Paul, or a bag of flour with Ronald Reagan’s face drawn on it. A bag of flour. All right.
People are asking, will Donald Trump run again? And the answer is, does that thing on his head crap in the woods? I actually don’t know. I don’t know.I don’t know if that thing on his head has a digestive system.
Governor, do you want bridge jokes or size jokes? Because I’ve got a bunch of both. I could go half and half. I know you like a combo platter. Now, I get that. I’m sorry for that joke, Governor Christie. I didn’t know I was going to tell it, but I take full responsibility for it. Whoever wrote it will be fired. But the buck stops here. So I will be a man and own up to it, just as soon as I get to the bottom of how it happened, because I was unaware it happened until just now.
I’m appointing a blue-ribbon commission of me to investigate the joke I just told. And if I find any wrongdoing on my part, I assure you I will be dealt with. I just looked into it. It turns out I’m not responsible for it. Justice has been served. He’s going to kill me.
Mr. President, you’re no stranger to criticism. Ted Nugent called you a subhuman mongrel. And it’s comments like that which really make me question whether we can take the guy who wrote “Wang Dang Sweet Poontang” seriously anymore.
Your approval rating has slipped. And even worse, you only got two stars on Yelp.
Mitch McConnell said his number one priority was to get the president out of office. So, Mitch, congrats on being just two years away from realizing your goal. You did it — kind of.
But thanks to “Obamacare,” or, as the president refers to it, “Mecare,” millions of newly insured young Americans can visit a doctor’s office and see what a print magazine actually looks like. That’s awesome.
Now over 8 million people have signed up for “Obamacare,” which sounds impressive until you realize Ashley Tisdale has 12 million Twitter followers. So that’s pretty good.
Sir, I do think you’re making a big mistake with Putin. You have to show a guy like that that you’re just as crazy as he is. He invades Crimea. You invade Cancun. Russia takes back the Ukraine. America takes back Texas. Something to think about.
The director of national intelligence, James Clapper, is here. Finally I can put a face to the mysterious voice clearing its throat on the other end of the phone. It was weird.
And CNN is desperately searching for something they’ve been missing for months — their dignity. Totally. That was just that table. At this point, CNN is like the Radio Shack in a sad strip mall. You don’t know how it’s stayed in business this long. You don’t know anyone that shops there. And they just fired Piers Morgan.
Fox News is the highest-rated network in cable news. Yeah. I can’t believe your table — that far. And it’s all thanks to their key demographic, the corpses of old people who tuned in to Fox News and haven’t yet been discovered.
Former “Inside Edition” host Bill O’Reilly is not here. He did host that. Bill’s got another book coming out soon, so he’s making his ghost writers work around the clock. Bill O’Reilly, Megyn Kelly and Sean Hannity are the Mount Rushmore of keeping old people angry.
This event brings together both Washington and Hollywood. The relationship between Washington and Hollywood has been a long and fruitful one. You give us tax credits for film and television production, and in return, we bring much-needed jobs to hard-working American cities like Vancouver, Toronto, and Vancouver again.
Hollywood helps America by projecting a heroic image to the rest of the world. We just released another movie about Captain America, or, as he’s known in China, Captain Who Owes Us $1.1 Trillion.
There’s a lot of celebrities here tonight. They’re the ones that don’t look like ghouls. Look around. The cast of “Veep” is here. That’s a series about what would happen if a Seinfeld star actually landed on another good show. I like “The New Adventures of Old Christine,” I swear.
I’m not going to spoil the shocking twist on “House of Cards,” but just know that it was so surprising that Nancy Pelosi’s face almost changed expression. Did you like that one, Nancy? I can’t tell.
Biz Stone, the founder of Twitter, is here. So if any of you congressmen want to cut out the middleman, just show him your penis. Not now! Are you nuts?
And here’s why America is the best country in the world. A guy like me can stand before the president, the press and Patrick Duffy — and tell jokes without severe repercussions. And instead of being shipped off to a gulag, I’m going to the Vanity Fair after-party. That’s right. This is America, where everyone can be a Pussy Riot.
Yesterday the Republicans on the House Energy and Commerce Committee released a bogus report which claimed that only 67 percent of those who purchased health care insurance under the Affordable Care Act have paid their first month’s premium. This is despite numerous reports from insurance companies showing that over 90 percent have paid, providing a good example of how Republican misinformation gets spread.
Several sources have already debunked the Republican misinformation, such as here, here ,and here. The Republicans appear to have come up with their falsely low number by taking the number of people who paid their premiums before the premiums were due for those who signed up in March and April. At most the reports shows that people are unlikely to pay their health insurance premiums before they are billed for them.
Needless to say, serial liars such as Rush Limbaugh and many conservative blogs have simply repeated this false information. Limbaugh even claimed that “the premiums were to have been paid by January 1st, which was the beginning of the coverage year.” This is true of policies purchased early enough in December to take effect in January, not policies purchased later in the open enrollment period. This is a perfect example of how Limbaugh and other conservative talking heads twists the facts to make their points.
Others conservative blogs such as Hot Air have questioned the misinformation spread by the House Republicans. The mainstream media has actually done worse than portions of the conservative blogosphere, repeating their usual practice of showing a false objectivity by quoting what each side says, as if the truth is always somewhere in the middle. Even The New York Times helped promote this Republican talking point in the manner in which they reported the story. Of course, unlike Fox and much of the conservative media in which the news reports echo the editorial bias, the supposedly liberal media more typically presents objective news reporting separate from the views of the editorial pages. Unfortunately in a case such as this, using false measures of objectivity in quoting both sides gives undeserved attention to totally bogus numbers presented by Republicans.
More reliable sources than House Republicans expect that over 90 percent will wind up paying their premiums, with the Obama administration wisely being conservative with predictions until the data is actually in, citing numbers between 80 and 90 percent. This will most likely allow them to ultimately show that, as in other areas where we have data, the Affordable Care Act is surpassing expectations. It is also notable that many of those who have not paid their premium have not paid because they wound up qualifying for other coverage and not needing coverage through the exchanges.
Reading liberal versus conservative columnists give entirely different views of the Affordable Care Act. Liberals have been writing about its success while conservatives continue to spread misinformation. Here’s a few examples of liberal views on the topic (which are the fact-based articles):
Tim Dickenson of Rolling Stone (source for the above graphic) writes that Obamacare is working. Instead of the fake conservative horror stories, he linked to stories which show how the Affordable Care Act is helping people. He described the successes, and pointed out that “Republican Party sabotage has also impeded enrollment.” Rather than back away from calling a lie a lie as many journalists will, Dickenson directly addressed Republican lies as lies as he debunked them:
GOP LIE No. 1: THE NUMBERS DON’T MEAN ANYTHING
Over the course of the open-enrollment period, Republicans labored to argue that Obamacare did far less good than advertised because an estimated 4.7 million Americans received letters in the fall warning that their current policies could not be renewed, as they failed to comply with new coverage requirements. They point to these “cancellations” to argue that few of the folks being counted as ACA enrollees previously lacked insurance.
There are three glaring flaws to this argument. First: Many if not most of those whose plans were canceled were automatically transferred into similar policies that complied with the new law. One of the nation’s largest for-profit insurers told House investigators that it had issued fewer than 2,000 outright cancellations.
Second: Through executive orders, Obama gave roughly half of those who received a letter – 2.35 million – the chance to stay in their existing coverage. CBO estimates suggest that just 1.5 million actually continued in their grandfathered plans, as many could find cheaper and/or better coverage on a subsidized exchange or qualify for Medicaid. It’s telling that the Michigan leukemia patient featured in Koch-funded ads intended to convey the horror of these cancellations has found a compliant poicy on the exchange that still covers her oncologist and cut her monthly premium in half.
Giving the Republican argument every benefit of the doubt, this would leave a potential pool of about 3 million people who changed, rather than gained, insurance. This leads to the third flaw in the argument: Obamacare sign-ups were always going to include millions of people who already had insurance. In its latest estimate, the CBO showed just two-thirds (4 million of 6 million) of exchange enrollments coming from people who were previously uncovered. And the limited hard data available from the states suggests the CBO is closer to the mark than the GOP: In New York, nearly 60 percent of buyers were previously uninsured. In Kentucky, it’s even higher: 75 percent.
GOP LIE No. 2: THEY HAVEN’T PAID THEIR PREMIUMS YET
GOP critics point out that the administration hasn’t tracked how many enrollees are actually paying their insurance bills. The complaint about transparency is fair, but the concern is misplaced. Figures from state exchanges and insurers themselves show that between 80 and 95 percent of enrollees are paying their bills.
GOP LIE No. 3: OBAMACARE WILL COLLAPSE UNDER ITS OWN WEIGHT
One legitimate concern as Obamacare ramped up was that it could enter a “death spiral.” This would happen if the number of older, sicker people on the exchanges far outnumbered the young and the healthy. Premiums would spike, year over year, with each increase driving more healthy folks out of the pool – making the exchange unsustainable. While reaching 7 million enrollees is a huge win politically, it doesn’t ensure Obamacare’s viability as an insurance program. “I do think there’s too much focus on the overall number,” Karen Ignagni, a top insurance-industry lobbyist, told reporters. What matters far more, she said, is the insurance pools’ “distribution of healthy to unhealthy.”
The administration wanted 18- to 34-year-olds to make up nearly 40 percent of enrollees. By March, however, only 25 percent of the mix was under 35. That sounds dire. Yet even pools with just 25 percent of younger people would not create a tailspin, forcing premiums to rise by just 2.4 percent, according to the Kaiser Family Foundation.
Additionally, the convoluted structure of Obamacare eliminates systemic risk. Even the 27 states that relied entirely on the federal exchange will end up with state-specific insurance pools. What this means is that if a death spiral were to develop in, say, Ohio, that failure would not pull down neighboring states. What’s more, safeguards within the ACA mean states don’t have to get the mix right in Year One. For the first three years, ACA has shock absorbers to prevent premium spikes in states with problematic pools. Over that same period, the penalties for not buying insurance step up – which should drive younger, healthier people into the market, balancing the risk profile. We lack hard data to get a clear picture of all state pools. But private insurers are sending optimistic signals to investors that all is well. Case in point: Insurance giant WellPoint just raised its earnings forecast.
GOP LIE No. 4: “OBAMACARE IS THE NUMBER-ONE JOB KILLER IN AMERICA”
That’s what Texas Sen. Ted Cruz told a Tea Party convention in Dallas last summer. Since then, the GOP has been making two ACA-connected job-loss claims, both demonstrably false. First, they twisted a February CBO report to claim that Obamacare will cause 2.5 million Americans to lose their jobs. What the CBO actually found is that Americans will be able to work a little less thanks to lower health-care costs, voluntarily scaling back work hours between 1.5 and 2 percent through 2024, or the output of 2.5 million full-time workers. The other GOP lie is that Obamacare is causing employers – who will be responsible for insuring employees who work more than 30 hours a week – to either scale back the hours of full-time employees or hire only part-time workers. This, too, is hogwash. While the share of part-time employment remains historically high, it has actually been in decline since 2010, when Obamacare became law.
I have discussed many of the above points, with links to the evidence, in previous posts on health care reform.
I was also happy to see that he concluded with the same opinion I have expressed that Democrats must take the offensive on health care:
House Republicans have learned the hard way that even nibbling around the edges of Obamacare can backfire. In February, the GOP pushed a bill to tweak the mandate that businesses offer health care to all employees working more than 30 hours. Switching to the GOP’s preferred 40-hour standard, it turns out, would add $74 billion to the deficit by 2024 and cause nearly 1 million Americans to lose coverage. That’s the kind of move that would play right into Democratic hands. Says Greenberg, “Democrats do very well when they hit back at Republicans on what people lose.”
Until recently, Greenberg had been advising Democrats to move beyond Obamacare and turn to bread-and-butter issues like jobs and the minimum wage. “The strongest attack on Republicans,” he says, “is that they’re obsessed with Obamacare instead of critical issues like dealing with the economy.” But his new poll has Greenberg rethinking that counsel. “Until now, this is an issue where the intensity has been on the other side,” he says. But defending Obamacare, he adds, has emerged as “a values argument for our base.” Greenberg now believes Democrats “ought to lean much more strongly” to campaign on the virtues of Obamacare as a means of boosting progressive turnout. “Not apologizing for Obamacare and embracing it actually wins the argument nationally,” he says. “And it produces much more engagement of Democratic voters. That’s a critical thing in off-year elections.”
Eugene Robinson also wrote about the success of Obamacare:
A new report by the nonpartisan Congressional Budget Office estimates that, despite all the problems with the HealthCare.gov Web site launch, 12 million people who previously lacked insurance will obtain coverage this year. By 2017, the year Obama leaves office, the CBO predicts that an additional 14 million uninsured will have managed to get coverage .
Why was the Affordable Care Act so desperately needed? Because without it, 54 million Americans would currently have no health insurance. Within three years, according to the CBO, Obamacare will have slashed the problem nearly in half.
We should do better, and perhaps someday we will. Most industrialized countries have some kind of single-payer system offering truly universal coverage. But if you have to work within the framework of the existing U.S. health-care system — which involves private health insurance companies and fee-for-service care — the Affordable Care Act reforms are a tremendous advance.
Many Republican critics of Obamacare know, but refuse to acknowledge, that the reforms are here to stay. Does the GOP propose to let insurance companies deny coverage because of preexisting conditions, as they could before the ACA? Does the party want to reimpose lifetime caps on the amount an insurer will pay? Tell young adults they can no longer be covered under their parents’ policies?
He concluded by also recommending that Democratic candidates take advantage of the success of Obamacare:
To do well in the fall, Democrats have to infuse their most loyal voters with similar enthusiasm. The success of Obamacare will help. Already, polls are showing upticks in support for embattled Democratic incumbent senators in Louisiana, Arkansas and Alaska. Democrats control their own destiny in November: If they can get their voters to the polls, they’ll win.
In the long run, no matter what happens in the election, I’m more convinced than ever that the Affordable Care Act will be seen as landmark legislation. With minimal immediate impact, the ACA does two tremendously important things.
First, it shifts the incentive structure in the health-care industry in ways that promise to hold down rising costs. And second, it establishes the principle that health care should be considered a right, not a privilege.
Of course it’s not perfect. It’s a thing of beauty anyway. We have liftoff. It’s working.
Paul Krugman described Obamacare as the unknown ideal:
The current state of public opinion on health reform is really peculiar. If you’ve been following the issue at all closely, you know that the Affordable Care Act is one of the great comeback stories of public policy: after a terrible start, it has dramatically exceeded expectations. But hardly anyone seems to know that.
He blamed Fox and Rush Limbaugh for all the misinformation they have spread, the Obama administration for doing a “lackluster job so far in getting the word out,” and “a persistent anti-ACA tilt in news coverage.” He pointed out how factual stories on the success of Obamacare are often buried in the back pages of newspapers.
If one followed politics superficially from the mainstream media, they might come to the incorrect view that we have a two party system in which the two parties differ on some issues but are essentially mirror images of each other. Looking more closely, it becomes apparent that instead we have a centrist party which has been struggling to continue our system of self-government and an extreme right wing party which seeks the destroy the vision of America held by our founding fathers. Among those who have bucked the usual media narrative and have reported on this are Thomas Mann and Norman Ornstein. This pair of centrists who have pointed this out in an essay, Let’s just say it: The Republicans are the problem, and in their book It’s Even Worse Than It Looks: How the American Constitutional System Collided With the New Politics of Extremism, which clearly laid out the extremism of the current Republican Party. They have explained that the mainstream media missed the big story of the 2012 campaign–the dishonesty and extremism of the Republican Party.
Republicans benefit by rigging the system in their favor as much as possible. Some of this is built in to the structure of our government, such as giving small Republican states the same number of Senators as larger, Democratic states. Gerrymandering, as well as the tendency of Democrats to concentrate more in urban areas, give Republican an advantage in the House, even in elections such as in 2012 when more people voted for Democratic representatives than Republicans. Republicans take advantage of control over large segments of the mainstream media, including Fox which operates essentially as a house propaganda organ, and then “play the refs” by complaining of fictitious liberal media bias. If this isn’t enough, they try to rig election laws to make it harder for Democrats to vote.
While Republicans use their influence over the mainstream media to promote misinformation to further their cause, Democrats have done a poor job of promoting a message or even of exposing what their opponents are doing. I was therefore happy to see that Barack Obama has spoken out against Republican restriction of voting rights.
“The right to vote is threatened today in a way that it has not been since the Voting Rights Act became law nearly five decades ago,” Mr. Obama said in a hotel ballroom filled with cheering supporters, most of them African-American. “Across the country, Republicans have led efforts to pass laws making it harder, not easier, for people to vote.”
Speaking a day after a conference in Texas commemorating the 50th anniversary of the Civil Rights Act, Mr. Obama linked the issue to the movement that helped pave the way for him to become the nation’s first black president.
“America did not stand up and did not march and did not sacrifice to gain the right to vote for themselves and for others only to see it denied to their kids and their grandchildren,” he said.
Republicans in some swing states have advanced new laws that go beyond the voter identification requirements of recent years. Among other things, state lawmakers are pushing measures to limit the time polls are open and to cut back early voting, particularly weekend balloting that makes it easier for lower-income voters to participate. Other measures would eliminate same-day registration, make it more difficult to cast provisional ballots or curb the mailing of absentee ballots.
Over the last 15 months, at least nine states have enacted voting changes making it harder to cast ballots. A federal judge last month upheld laws in Arizona and Kansas requiring proof of citizenship, like a birth certificate or a passport, leading other states to explore following suit.
I hope we see more of this. Warnings about the Republican threat to freedom and democracy should not be limited to a single date commemorating a past event. This should be an important part of the political debate between the parties every day. Hopefully people will then realize that they should be wary of a political party which finds that its success depends upon keeping people from voting.
Cross posted at The Moderate Voice
“Absolutely nothing new has happened with the missing plane. It is astounding how they continue to report ‘news’ even though they have zero information, although, it never stopped Fox News.” –Bill Maher
“Fox News, they may be a little biased. We had an earthquake here on Monday and they reported that the Earth’s crust was emboldened by Obama’s weakness.” –Bill Maher
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 winners. Politico 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