Ways In Which Obamacare Saves Consumers Money Which You Might Not Have Been Aware Of

In our highly polarized country there are two general reactions to the Affordable Care Act, repeating the same lies no matter how often debunked and engaging in ridiculous attempts at blocking the law on the right, versus those in the reality-based side of the political spectrum who have been documenting the many benefits of the law. Many of the major benefits, including increasing the number of people insured, making coverage more affordable, reducing health costs,  and eliminating the ability of insurance companies to deny coverage to those who have medical problems, have been widely discussed. There are a few other benefits which many might be less aware of which help reduce costs.

Regulations to reduce medical errors has both saved lives and reduced costs. McClatchy reports:

Improved patient safety and fewer mistakes at U.S. hospitals saved the lives of roughly 50,000 people from 2011 to 2013, the Obama administration reported Tuesday.

Incidents of hospital-induced harm – such as adverse drug events, infections, falls and bedsores – fell by 17 percent, or an estimated 1.3 million episodes, from 2010.

The improvements, driven by a number of public and private initiatives, saved an estimated $12 billion in health care spending, according to a new government report that found dramatic progress in the fight to curb preventable medical injuries at U.S. hospitals.

The law has saved money for consumers both from lower than anticipated premiums as well as other means which are lowering out of pocket costs. In the past many insurance plans would have a maximum coverage limit in order to protect the insurance company rather than the consumer from catastrophic expenses. The Affordable Care Act not only eliminated maximums in coverage but also places new maximums on total out of pocket costs. While people typically compare insurance policies based upon premium first and then maybe the deductible, this is a factor which many ignore. Besides having this benefit, Kaiser Health News  has reported that many plans, including seventy-four percent of silver plans, have even lower out of pocket maximums than is allowed under the law.

Consumers shopping on the health insurance marketplaces will find many plans with out-of-pocket spending limits that are lower than the maximums allowed under the health law, according to an analysis by Avalere Health.

Seventy-four percent of 2015 silver level plans’ out-of-pocket spending caps are below the $6,600 spending limit allowed for individual plans and $13,200 maximum for family plans, according to Avalere, a consulting firm. The average out-of-pocket maximum for 2015 individual silver plans will be $5,853, says Caroline Pearson, a vice president at Avalere. Silver was the most popular plan type this year, selected by about two-thirds of enrollees.

After a policyholder reaches the out-of-pocket spending limit during the year, the insurer pays all the bills, unless, for example, they involve doctors and hospitals not in the health plan’s network.

The vast majority of other plans also feature lower limits on out-of-pocket spending—which includes deductibles, copayments and co-insurance, but not premiums. Seventy-one percent of bronze plan spending limits were below the allowed maximum (with an average spending limit for single coverage of $6,381), as were 94 percent of gold plans (average limit, $4,458) and 98 percent of platinum plans (average limit, $2,145).

In addition, many plans are paying for more coverage than is required before the deductible is met. The Affordable Care Act requires that many preventative services be offered with no copay or deductible. Some plans are now offering benefits such as office calls and prescription drug coverage prior to meeting the deductible. By comparison, when I last shopped around for insurance on the individual market prior to the star of the Affordable Care Act, I could not find any plans being offered which covered either office calls or medications.

Consumers are also benefiting from the new requirements on medical loss ratios which require that eighty percent of premiums collected go to paying out claims. This means that many consumers are receiving partial refunds on their premiums, along with this helping to lower premiums:

A new report from federal health officials, which concludes that health spending had grown at a historically slow rate in 2013, says the so-called MLR provision is helping drive the broader easing of spending growth in the industry.

The medical-loss-ratio requirement mandates that insurance companies spend at least 80 percent of premiums on actual health benefits. It is one of the various provisions intended to help shape the behavior of insurance companies, making the market more efficient and cost-effective for consumers. Administrative costs are kept down, meaning that more of people’s money is going to real care.

“The medical loss ratio requirement and rate review mandated by the ACA put downward pressure on premium growth,” officials from the federal Centers for Medicare and Medicaid Services wrote in their report. Overall private insurance spending, of which premiums are a part, grew at a 2.8-percent rate — the lowest since at least 2007.

As Larry Levitt, vice president at the non-partisan Kaiser Family Foundation, put it to TPM in an email: “That is how it’s intended to work.”

If insurers don’t meet the MLR requirement, then insurers must pay a rebate to their customers. But the intention was that it would drive premiums down, to the level needed to cover actual care. The rebates were just a means of enforcing it, and the companies seem to be responding.

Despite conservative misinformation which dissuades some from purchasing health insurance, Bloomberg News predicts that enrollments in insurance plans through the exchanges will exceed expectations this year. HHS is trying new ways to get out information on purchasing health insurance, including messages on the bottom of 7-Eleven receipts. Increased participation in the health plans will help increase the risk pool and further reduce costs for consumers in the future.

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Americans Generally Satisfied With Healthcare Costs But Those On Medicare Are Happier Than Those With Private Insurance

A Friday afternoon news dump is not always bad news. Gallup released a poll under this headline on Friday: As ACA Takes Effect, Majority OK With Personal Health Costs. Gallup reported, “Nearly six in 10 Americans (57%) say they are satisfied with the total cost they pay for healthcare, on par with other readings over the last five years. So far, there is little indication that the Affordable Care Act (ACA), also known as ‘Obamacare,’ has affected the way Americans view their healthcare costs, either positively or negatively.”

Gallup Insurance Satisfaction

Note that the graph above shows very little change over time, with the current numbers very close to when Obama took office. Satisfaction did increase slightly in 2014, presumably because of more people having coverage thanks to the Affordable Care Act.

Satisfaction increased by age, essentially correlating with reaching age 65 and having Medicare. The assumption that those who are older are more satisfied because they have Medicare is verified when the results are broken down by type of insurance. Satisfaction with costs  is at 74 percent among those with Medicare or Medicaid, compared to 58 percent with those on private insurance. Note that another recent study did show that overall satisfaction was much closer than this poll on satisfaction with costs. Out of pocket payments for those on Medicare are typically significantly lower than those covered by private insurance, except for those with the most generous employer-paid plans.

Gallup Insurance Satisfaction by Age

Other findings were that people were generally satisfied with the quality of health care but less satisfied with healthcare coverage as a whole in the United States compared to other countries. Gallup concluded:

U.S. adults holding health insurance via a private insurance plan are about as likely to rate their coverage positively (77%) as Americans holding either Medicare or Medicaid (75%), suggesting both groups are about equally happy with their plans. But, as noted earlier, Medicare and Medicaid holders are far more satisfied with the cost of their plan.

As Gallup has found in the past, Americans are far less effusive with their praise for healthcare coverage in the U.S. as a whole. This year is not an exception: Fewer than four in 10 Americans now rate healthcare coverage in the U.S. as excellent or good.

Before passing the ACA, the large majority of Americans who had health insurance were broadly satisfied with their medical care and coverage and their healthcare costs. Thus, a major test of the ACA will be whether it succeeds in expanding affordable healthcare to the previously uninsured while doing “no harm” to the large majority of Americans who are already highly satisfied with their healthcare coverage. So far, the verdict is positive. Gallup finds no decrease in insured Americans’ satisfaction with their healthcare services and their costs. At the same time, the uninsured are as negative as ever, but their numbers have dwindled. Gallup’s annual November updates of these trends will monitor whether this positive outcome persists as implementation of the ACA progresses.

Republicans have backed high deductible plans as a way to restrain health care costs for quite a long time. Now that they got what they want with plans sold on the exchanges (like plans previously sold in the individual market) generally having high deductibles, they have been using this as a line to attack Obamacare. If this is the main objection, rather than cowering in the face of attacks on the ACA, Democrats might be better off taking advantage of this as a reason to push for the type of single payer plan that most liberals supported before Obama compromised and promoted what was previously a Republican health care plan.

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Four More Studies On The Benefits Of Obamacare

Over the past year I receive reports from various medical journals and medical practice publications with what feels like a constant flow of studies showing the success of the Affordable Care Act, many of which I have written about in previous posts. Jonathan Chait has an article in New York Magazine on 4 New Studies Show Obamacare Is Working Incredibly Well which gives a representative sample of the studies now being published. While there are more, for the moment I’ll just stick to briefly mentioning the four studies described by Chait, partially in response to Chuck Schumer’s recent comments questioning whether the Democrats should have passed the Affordable Care Act for political reasons .

He started with one of the main goals of the law, expanding the number people who have medical coverage, while also pointing out that the number would be significantly higher if the Supreme Court hadn’t blocked Medicaid expansion:

Every serious method of measuring has shown the law effecting significant reductions in the uninsured rate. The latest, a report by the Urban Institute yesterday, shows that the uninsured rate has fallen nationally by 30 percent…

That rate is 36 percent in states participating in the Medicaid expansion. The states whose Republican governors or legislators have boycotted the expansion have seen their uninsured rates fall by just 24 percent, dragging down the average.

See his full article for more information along with charts demonstrating these benefits.

He next looked at health care costs:

When the law passed, conservatives insisted it would increase rather than decrease health-insurance costs. (Esteemed conservative intellectual Yuval Levin, in 2010, insisted it “completely fails” to reduce overall health-care spending.) Since the law passed, health-care inflation has fallen to historically low levels. Conservatives have repeatedly insisted this was a blip that would soon be reversed, and seized upon any apparent evidence for this case. When health-care spending spiked in the first quarter of 2014, Megan McArdle announced vindication: “After all the speculation that Obamacare might be bending the cost curve, we now know that so far, it isn’t.” (It turned out the first-quarter spike in health-care spending was a preliminary miscount that has since been corrected.)

Also yesterday, the Centers for Medicare and Medicaid reported that health inflation in 2013 not only remained in, it fell to the lowest level since the federal government began keeping track…

His third  study was on medical errors:

Obamacare has a wide variety of reforms designed to bend the cost curve. One of them is a new payment system that encourages hospitals to avoid readmissions. The old Medicare system reimbursed hospitals for every procedure. This meant they had a perverse incentive to do a bad job taking care of their patients — a patient who developed an infection, or needed readmission, would produce a second stream of revenue for the hospital. Obamcare’s payment reforms changed that incentive. A new report finds that hospital-acquired medical conditions has fallen by 17 percent since 2010. (This has not only saved huge amounts of money, it has also saved 50,000 lives.)

He concluded by quoting from a Kaiser Health News analysis  on the benefits of increased competition:

A surge in health insurer competition appears to be helping restrain premium increases in hundreds of counties next year, with prices dropping in many places where newcomers are offering the least expensive plans … In counties that are adding at least one insurer next year, premiums for the least expensive silver plan are rising 1 percent on average. Where the number of insurers is not changing, premiums are growing 7 percent on average.

The downside is that the lower prices require consumers to actively shop on the exchanges. Customers who automatically renew their existing plan without comparison shopping will miss out.

That is an important point at the end. Failing to shop around can lead to paying much higher premiums than is necessary. The Obama administration is considering a plan in which people can choose to be automatically be placed in the least expensive plan available in a tier as opposed to automatically having the current plan renewed. This has the downside (as in recognized in the proposal) that people would then be at greater risk of winding up in a plan which their doctor doesn’t accept. It is far safer to shop around for the best plan on your own, taking into consideration factors such as which doctors are in a plan.

Now, if only more Democrats would talk about the benefits of the plan they passed, as opposed to cowering in terror when attacked by Republicans, the party, and the country, would be far better off.

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Ignore Chuck Schumer–The Democrats Were Right To Pass Obamacare

Charlie Cook is usually an astute political observer but he is making a mistake in paying too much attention to what Chuck Schumer said about Obamacare hurting the Democrats. The argument, which many have brought up, is that the Democrats made a political mistake by concentrating on health care as opposed to the economy. There are many problems with this theory to explain the Democratic loses in 2014.

This premise is incorrect. Obama  did concentrate on the economy first, getting us out of the depression which Bush had us heading into. This included the stimulus, which was successful, and saving the auto industry. In retrospect a larger stimulus package would have done more good, but this was not feasible politically, regardless of whether Obama also worked on health care reform.  Obama can walk and chew gum at the same time. Working on health care reform did not prevent him from working on the economy.

Those who argue that Obama should have put off health care reform for a later date are forgetting that he had a narrow window and that it could not have passed if postponed. While Republicans often claim that Obama had a super-majority in the Senate, along with controlling the House, for his first two years and therefore could have done whatever he wanted, this is not true. Due to vacancies from matters such as the delay in seating Al Franken and Ted Kennedy’s illness and later death, Democrats and independents caucusing with them had sixty votes for only five months. This included Joe Lieberman and Ben Nelson who often did not go along with the rest of the Democrats. It was also these two who blocked the Medicare buy-in and public option, so they are the ones you should be angry with if you are facing higher premiums than you want to pay for insurance under the Affordable Care Act.

The Affordable Care Act, among its other benefits, is also important for its effects on economic recovery. Obamacare helps those in the middle class who had medical expenses they could not afford in the past. In is also beneficial to the economy long term by eliminating the problem of people being forced to work for larger companies to obtain coverage. This allows more people to work for smaller companies, or to start companies of their own to stimulate the economy. In Republican-speak, Obamacare increases the number of job creators.

Those who blame Democratic loses on Obamacare ignore all the other factors involved in 2014, such as Democrats being forced to defend so many seats in red states in the sixth year of a presidency. Even Ronald Reagan could not prevent his party from losing the Senate in his sixth year in office.  Obamacare did not turn out to be the major issue that many had predicted, and even without Obamacare it is likely there would have been an anti-Democratic mood. Larry Sabato pointed out this week that it is actually the norm for a political party to lose Congressional seats when they control the White House.

The Democrats also made serious mistakes which hurt politically. They failed to make the case for the harm done by Republican economic policies, and take credit for their own successes. On Obamacare, the mistake was not passing the law but having Democratic candidates run away from it when they should have been explaining the benefits of the law. Democratic candidates ran away from Obama and his policies, and then were shocked when the Obama voters didn’t turn out to vote for them. Polls show that a majority supports the Democrats on the issues, including the specifics of the Affordable Care Act, but this does not help the Democrats when they run as Republican-lite.

For Schumer to argue that they should not have passed Obamacare because it hurt politically also is another sign of how the Democrats, while far preferable to the Republicans, far too often are afraid to stand for anything. What is the point of winning election if the victories are not used to accomplish something? LBJ was not afraid to pass the civil rights act despite knowing that this would help Republican politicians take the south from the Democrats.

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Hillary Clinton And Some Potential Challengers For The Nomination

With the midterm elections behind us, it finally makes sense to talk more about the 2016 presidential election. NBC News has a recent report claiming that Hillary Clinton will be announcing her candidacy in January, but Politico reports that she still has a paid speech scheduled for February 24, which may or may not give a clue as to her plans:

It isn’t clear that the speech says anything about Clinton’s time frame for declaring a decision about a second White House campaign. Her timetable is a topic of disagreement among her supporters: Some people think she is already being attacked and defined by Republicans and only adds to the perception that she’s being coy the longer she waits. Others say she should stick to her stated time frame of early next year.

Clinton could, of course, cancel the appearance or decline a speaking fee if she announces a campaign before the speech. It’s highly unlikely she would continue to give paid speeches once she’s a candidate, something Republican Rudy Giuliani did in 2007 and took heat for.

But the fact that Clinton is still signing up for speeches also gives weight to what a number of people close to her say: that she hasn’t completely made up her mind about running. The conference is about women in the workforce, an issue Clinton is also focused on at her family’s foundation.

While Clinton leads in the polls, there is less enthusiasm for her candidacy among many on the left. The reluctance to have the Democratic Party led by someone as conservative as Clinton may have been intensified by the midterm election results in which Democratic candidates ran away from Democratic principles, only to see Democratic voters stay home. Polls show considerable support for liberal positions on the issues, but voters are not going to turn out for Democratic candidates if they cower in fear and run as Republican-lite.

There has been no lack of condemnation for Democrats who, among other acts of cowardice ran away from the Affordable Care Act rather than promote how successful it has been. One of the more recent such comments came from Andrew Sullivan:

Yes, there has been a mountain of propaganda against it. But that doesn’t excuse political malpractice in defending it. This is the Democrats’ most significant piece of domestic legislation in decades. And yet they cannot manage to make the case for it. That tells you so much about why that party remains such a shit-show, rescued temporarily by this president, but still wallowing in its own dysfunction, inability to communicate and pusillanimity.

While it seems like a futile effort, the memory of Barack Obama defeating Clinton in 2008 gives hope. While they get little mention in the media, there are other potential candidates. Elizabeth Warren was the one bright spot of the 2014 campaign, showing a real ability to communicate, and she  has toned down her earlier statements that she will not run. It is doubtful she would actually challenge Hillary Clinton, and someone more experienced in government might make a better candidate. Bernie Sanders is toying with the idea of running, but a self-proclaimed Socialist has no chance, and  his primary role would be to force Clinton to discuss liberal positions.

Other more conventional candidates are actually looking into running.  Jim Webb has become the first to announce an exploratory campaign. Martin O’Malley is also making moves towards a possible campaign.

In addition to these names which have been mentioned frequently, Michael Kazin has another suggestion in an article at The New Republic, Sherwood Brown:

At the risk of seeming ridiculous, I think Sherrod Brown should run for president. I know that, barring a debilitating health problem or a horrible scandal, Hillary Clinton is likely to capture the Democratic nomination. I realize too that Brown, the senior senator from Ohio, has never hinted that he may be tempted to challenge her. “I’m really happy where I am,” he told Chris Matthews last winter, when the MSNBC’s paragon of impatience urged him to run.

Yet, for progressive Democrats, Brown would be a nearly perfect nominee. During his two decades in the House and Senate, he has taken strong and articulate stands on every issue which matters to the party’s broad, if currently dispirited, liberal base. When George W. Bush was in office and riding high, Brown opposed both his invasion of Iraq and the Patriot Act. He has long been a staunch supporter of abortion rights and gay marriage, and is married to Connie Schultz, a feminist author who writes a nationally syndicated column.

Brown’s true mission, however, is economic: He wants to boost the well-being of working Americans by any means necessary. Brown has been talking and legislating about how to accomplish it for years before Elizabeth Warren left Harvard for the Capitol. During Obama’s first term, he advocated a larger stimulus package, called for re-enacting the Glass-Steagall Act to rein in big banks, and stumped for comprehensive immigration reform. He champions the rights of unions and the power of the National Labor Relations Board and criticizes unregulated “free trade” for destroying manufacturing jobs at home. He also led the charge among Senate Democrats that pressured Obama to drop his plan to appoint Larry Summers to head the Federal Reserve and appoint Janet Yellen instead.

At the moment pushing Sherrod Brown to challenge Clinton might seem ridiculous, but certainly no more ridiculous than Barack Obama challenging her in 2008.

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Another Unforced Error On Selling Obamacare

The Obama administration has done an excellent job policy-wise with the Affordable Care Act, but politically has made a few major mistakes along the way. The most recent was discovered today when Bloomberg reported that the administration had made mistakes in reporting the number of people who obtained health coverage through the exchanges in its first year. The error came from adding sales of dental plans available under the Affordable Care Act to the total number who actually purchased plans.

HHS Secretary  Secretary Sylvia Burwell responded on Twitter that, “The mistake we made is unacceptable. I will be communicating that clearly throughout the dept.”

From a practical point of view, the mistake does not really change anything. The important factor is the benefits provided, not the number of people who signed up the first year, especially when the number was depressed by a dishonest right wing smear campaign. The actual number still exceeded the predictions of the Congressional Budget Office. Nearly seven million did obtain coverage on the exchanges in the first year, with about seventy percent happy with their coverage–a number comparable to those receiving employer-paid coverage and Medicare.

Unfortunately an error such as this plays into the false right wing narrative that the Obama administration was not transparent in promoting the Affordable Care Act. They ignore the degree to which every aspect was publicly debated for months, and every version of the law was posted on line. Of course many conservatives were probably unaware of the discussion which was occurring as the right wing media was too busy spreading lies than to actually report on what was being openly discussed.

Man on the right are cherry picking and distorting the words of Jonathan Gruber, as I recently discussed here and here. They falsely claim that Gruber was the “architect” of the Affordable Care Act and falsely attribute his views to the Obama administration. Gruber was an outside academic consultant who had worked on Mitt Romney’s health care plan. He was paid to make economic projections based upon this to predict the economic effects of Obamacare. He had no role in the legislative strategy to pass Obamacare, and does not speak for the Obama administration in making statements which Obama disagrees with.

Being an academic outside of Washington, it is very likely that the somewhat convoluted legislative actions used by both parties to achieve the best scores from the Congressional Budget Office might seem to lack transparency. This does not mean that those promoting Obamacare were in any way dishonest. They honestly presented the facts about the law. In contrast, when George Bush pushed through his Medicare drug plan, he not only lied about the cost, but threatened to fire the chief Medicare actuary if he testified before Congress about the true cost.

Gruber’s claims of a lack of transparency would be more meaningful if he actually demonstrated any areas in which the proponents of the ACA were not open about the plans. He spoke about the mandate, but this penalty for not purchasing insurance was widely discussed before passage. He also concentrated on how the ACA is a transfer of wealth, but this was both openly discussed, and a common feature of all insurance. All insurance plans transfer wealth from those who pay premiums and do not wind up needing the coverage to those who receive benefits. While conservatives are quoting Gruber because his statements seem to reinforce their biases, once you look at the details there is no evidence of dishonesty present.

On the other hand. , the real dishonesty came from Republicans who lied about death panels, the number not paying their premiums, the effects of the ACA on jobs and the economy, the cost of coverage, and falsely claiming that Obamacare is a government take over of health care.  Even the corrected numbers show that far more people purchased coverage than many Republicans have claimed. Republican politicians continue to repeat the same lies even when disproven.

Prior Political Errors

Unfortunately the error in reporting the number who purchased coverage is not the first unnecessary error which wound up hurting politically. The most prominent error was in failing to properly test the computer programs behind the exchange before they went live in 2013. The problems were quickly fixed and the exchanges opened successfully this week, but the Obama administration never fully recovered from the poor first impression.

The second error was in over simplifying the issues when making statements that people can keep their own plans and/or their own doctors. Obama was being honest in the context in which he was speaking, but in over simplifying the matter in this way he was incorrect. Obama was responding to far more inaccurate right wing claim that the Affordable Care Act amounts to a government take over of health care. They spread horror stories of people being forced to lose their current health plans (and doctor) and instead being placed on some imaginary government-run Obamacare plan. I had patients call me in horror, asking if they would be lose me as a doctor because of having to change to Obamacare.

Obama was right in answering that people would not be forced into a new government plan and would not arbitrarily be forced to change doctors.

He was incorrect  in how he worded it because other factors were involved. Insurance companies elected to cancel plans, often when they could be grandfathered in. Doctors go in and out of health plans every year, regardless of Obamacare, but Obamacare does not assign people to new doctors. With or without Obamacare, some people would have to change health plans and doctors every year.

Most people had the option to get insurance, from the same company as before if they desired, with better coverage at a lower cost. It is also a bit ambiguous as to what keeping the same plan means considering that in the individual market it has been common for insurance companies to substitute similar but different plans quite frequently. Most people would feel like they had the same plan as it was from the same company with only minor differences (or with better coverage).

When Obama realized his statement was technically wrong, he not only apologized but acted to make it right by making it even easier to grandfather in old plans. Many of the old plans which were discontinued provided extremely limited coverage for the price, and people were better off replacing them with a better plan. I have often seen patients with plans purchased on the individual market in the past who were shocked to find that their plan paid nothing or only a tiny fraction of their bills. The Affordable Care Act guarantees both that health plans will provide reasonable coverage and that nobody can be dropped because of developing health problems, as frequently happened in the past.

By guaranteeing that people cannot be dropped from their health plan, by making insurance more affordable,  and by providing a greater choice of health plans, it is far less likely that people will have to change their health plan or doctor against their will as happened in the past. For the most part, Obama was right, but he worded this in a poor way as there were exceptions. Needless to say, Republicans concentrate on the rare cases where Obama was wrong, even though their health plans would ultimately lead to far more people being unable to keep their insurance or their doctor. By making these political mistakes, the Democrats have made it easier for Republicans to mislead.

Now yet another mistake has been uncovered which means little but which Republicans will be able to use to mislead the public.

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People Not Directly Affected By Obamacare Are Unhappy With It

With the exchanges opening for its second year, Gallup has found that support for the Affordable Care Act remains low at 37 percent. I have to wonder about how those answering are coming to this opinion. After all, there is tremendous evidence as to the success of the Affordable Care Act, and Gallup also found recently that about 70 percent who are actually obtaining coverage through the exchanges are satisfied. This number is comparable with the number who are happy with other forms of coverage such as Medicare and employer-paid health care.

It appears that those who are unhappy with Obamacare aren’t the ones who are most directly affected. Most likely this polling result comes from all the dishonest information being spread by the right wing, with many people who are not directly affected at present expressing dissatisfaction with a law they do not understand.

The Affordable Care Act also receives less support than it might because many of those who stand to benefit in the future don’t realize it. Besides providing affordable coverage for millions who could not obtain coverage in the past, the ACA protects those with coverage from their employer, guaranteeing that they won’t be unable to obtain coverage should they become seriously ill or lose their job. This had been a common cause of bankruptcy in the past, but many people are not going to appreciate this benefit if they are not undergoing such problems.

Another problem for the Affordable Care Act is that it makes it easier for Republicans to blame anything wrong with health care on Obama, even if the Affordable Care Act is not involved. For example, although the ACA provides additional benefits for Medicare beneficiaries, many who receive these benefits do not realize this. On the other hand, they are blaming Obama when their pharmacy plan increases their copays, even though this has nothing to do with Obamacare.

This does not mean that the Affordable Care Act is perfect. It is built on top of a faulty health care system, correcting several of its problems. However the bulk of the old system, with all its problems and inefficiencies, have continued. With Obamacare so unpopular, I am surprised that there is not more effort by supporters of a single payer plan to promote this as the solution to the problems of Obamacare, as opposed to Republican proposals which would resume all the problems we had in the past.

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The Big Losers From Grubergate

Conservatives love to repeat quotes which reinforce their biases, even if the facts don’t really support them. We continue to hear conservative opponents of Obamacare quote Jonathan Gruber and search for even more videos of him saying the same thing. I’ve already pointed out how these quoted mean little here and here, but conservatives never let facts get in their way. The fact that most people who purchased plans through the exchanges are happy with their plans also will not keep opponents from finding irrelevant objections.

We can safely assume that we will continue to hear quotes from Jonathan Gruber. It is doubtful this will affect actual support for the Affordable Care Act. Those who are repeating his quotes are those who were already opposed. There are two actual losers now that his quotes have received such publicity.

The first big loser is Mitt Romney, who appears to be flirting with the idea of running yet again. Romney already had trouble with the fact that he had established his health plan in Massachusetts. Should Romney attempt to run again in the Republican primaries he will face endless clips of Gruber comparing Obamacare and Romneycare and saying “Basically, they’re the same f—ing bill.” Ironically some conservatives who falsely claim that Gruber was the “architect of Obamacare” and all his currently discovered quotes about Obamacare should be taken as gospel, are also twisting the facts to say that Gruber was wrong on this point. Some conservatives will have no problem believing that Gruber was right on things which reinforce their biases but incorrect when he spoke about Romneycare, but others will not fall for such fallacious attempts to make these distinctions.

The other big loser is Jonathan Gruber. Consulting is a great way to make money when you can get it. Gruber made $400,000 for the economic projections he made during the development of the Affordable Care Act. (That is what he worked on–not the legislative strategy to pass the law). It is hard to see Democrats hiring him again, and any others thinking of hiring him will also think twice about what he might say. His name is toxic to Republicans, who will always think of him as someone who passed off lies to sell Obamacare (even if he revealed no actual lies and everything in his quotes was openly discussed during the debate over passage).

This leaves some questions. How long until this is becomes called the Grubergate Scandal?

When does Gruber become a verb? There are actually more than one possible meanings. To Gruber might mean someone with expertise in one area (in this case economics) making bold but incorrect public statements in an area outside of his area of expertise (in this case passing legislation). To Gurber might come mean to betray those who hired you by making incorrect statements, or even to accuse others of being dishonest when you are the one who is saying things which are misleading.

Update: Obama states he did not mislead on health care

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Obamacare A Huge Success Despite Easily Debunked Conservative Claims

The exchanges set up under the Affordable Care Act open tomorrow. While there were initially problems when the exchanges opened last year, these were quickly fixed, allowing millions to obtain health care coverage, including those who previously could not obtain coverage due to preexisting conditions or cost. A Gallup poll found that most people who obtained coverage through the exchanges last year were satisfied:

Over seven in 10 Americans who bought new health insurance policies through the government exchanges earlier this year rate the quality of their healthcare and their healthcare coverage as “excellent” or “good.” These positive evaluations are generally similar to the reviews that all insured Americans give to their health insurance.

These findings are consistent with previous polls showing how people benefited from Obamacare.

Insurance coverage has been made more affordable by the exchanges, with eighty-three percent of enrollees qualifying for subsidies last year. Those who qualified payed an average of $82 per month in premiums. Those obtaining Silver plans paid an average of $69 per month.

Three was some sticker shock on the part of many who did not realize that they qualify for subsidies along with those of us who do not qualify for subsidies. While we pay the full premiums, the coverage is far better than was available on the individual market in the past, including guarantees that we cannot lose our coverage if we get sick and caps on maximum annual out of pocket expenses. Some people, especially those who were not familiar with the individual insurance market were expecting lower premiums. Despite conservative claims that Obamacare is a right wing take over of health care, the insurance is sold through private companies and their rates have always been high, and frequently increased by double digit amounts annually.

Conservatives also complain about the deductibles, especially on the plans with lower premiums. These plans have higher deductibles and a lower premium, with Medical Savings Accounts available to help with these out of pocket expenses. Plans on the individual market have typically had higher deductibles than employer plans. The attacks from conservatives regarding this are also rather hypocritical as conservatives have long been advocating high deductible plans paired with MSA’s as a way to reduce costs. Now that they have what they advocated, they are suddenly complaining. I guess we shouldn’t be surprised as many other components of Obamacare have long been advocated by conservatives, including the individual mandate and selling insurance through exchanges.

While there may be higher deductibles, there are also total caps on out of pocket costs which we did not have before. The Affordable Care Act has eliminated the old maximums on coverage. Republicans never mention this, but these factors could result in lower out of pocket costs for many, along with eliminating the risk of bankruptcy for those with expensive diseases who outspend their coverage. All plans cover preventative services with no deductible. Some plans now being sold will provide some other forms of coverage before the deductible is met, including office calls and prescriptions.

While premiums in 2014 were consistent with previous premiums, instead of seeing double digit increases in 2015 most people are seeing comparable rates due to the increased number of insurance companies offering coverage and the larger risk pool as more people have coverage. Many people will even see lower insurance rates:

In preliminary but encouraging news for consumers and taxpayers, insurance filings show that average premiums will decline slightly next year in 16 major cities for a benchmark Obamacare plan.

Prices for a benchmark “silver” or mid-priced plan sold through the health law’s online marketplaces aren’t all moving in the same direction, however, a report from the Kaiser Family Foundation (KFF) shows. (Kaiser Health News is an editorially independent program of the foundation.) In Nashville, the premium will rise 8.7 percent, the largest increase in the study, while in Denver it will fall 15.6 percent, the largest decrease.

But overall the results, based on available filings, don’t show the double-digit percentage increases that some have anticipated for the second year of marketplace operation. On average, rates will drop 0.8 percent in the areas studied.

Opponents of the Affordable Care Act have spread a wide variety of lies about the plan. Although these lies have repeatedly been debunked, Republicans continue to repeat them.

The latest attack from dishonest opponents of the plan has been to repeat irrelevant quotes from Jonathan Gruber, an economist who worked on Mitt Romney’s plan and also made economic projections on the impact of the Affordable Care Act. He is not a part of the Obama administration, and is not the “architect” of the plan as conservatives claim. Nor did he have a role in the writing or the promotion of the legislation. His comments that the American people were stupid do not reflect the views of anyone other than himself. His claims of a lack of transparency are incorrect, with the law having been written in open hearings and with the various versions having been posted on line.  The two items he brought up, the penalties for not obtaining coverage, and the transfer of wealth from the healthy to the sick, were both openly discussed prior to the passage of the law. Besides, all insurance has always represented a transfer of wealth from those who purchase insurance and do not require the benefits to those who do require insurance benefits. Apparently many conservatives fail to understand how insurance works.

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Why The Republicans Won Despite Being Wrong On The Issues, Revisited

Paul Krugman discussed how the Republicans won in the midterm elections despite being wrong about pretty much everything. Kurt Eichenwald has more in Vanity Fair looking at many of the things conservatives were wrong about over  the past thirty years. Although the list is far from complete, I’d suggest checking out the full article for the specifics. Topics covered include:

  • Tax cuts pay for themselves
  • Deregulating the Thrift Industry Will Save It
  • Iraq I: The Tilt
  • Giving Iranian Moderates Weapons Will Help America
  • Raising Taxes Will Cause a Recession
  • Abolishing Some Bank Regulations Will Help the Economy
  • The U.S.–led Bombing of Yugoslavia Would Be a Disaster
  • Bin Laden Was a Front for Iraq
  • Iraq 2: W.M.D.s and a Short, Inexpensive War
  • Obamacare

Many people have given different ideas regarding the other part of the question as to how the Republicans won. Fivethirtyeight.com looked at one issue  from polling data in Iowa. They found that, “White voters in Iowa without a college degree have shifted away from the Democratic Party.”

Loss of white working class votes has been a problem for Democrats for several election cycles, and was most pronounced in the 2012 elections. It will be interesting to see if there is any reduction in this trend when Barack Obama is no longer on the ticket. This is certainly not exclusively an issue based upon a black president. The Republicans have depended upon the southern strategy since the 1960’s, using this in the south along with provoking racial fears to gain the votes of less educated white voters in the north.

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