Beware Of Those Politicians Who Spread Fear–We Have No Reason To Fear Ebola As Long As We Respond Sensibly

A mood of fear is engulfing the country which might very well affect the midterm elections. Hopefully people will react rationally and reject the Republicans who promote unwarranted fears, play politics, and advocate for counterproductive responses such as travel bans. Unfortunately but this is not the probable response.

As I discussed last week, even citing a report on Fox, we have no need to fear Ebola as long as proper precautions are taken.

There is no need to panic, or initiate measures which would be counterproductive such as a travel ban at this time. There is no meaningful problem with Ebola in this country and the biology of the virus makes it unlikely we will have a problem in the future. The nature of Ebola makes it a serious problem in countries without a Public Health infrastructure, but not in countries like the United States.

To date we have had exactly one patient with Ebola come into the country beyond medical personnel transported back here. Despite some serious mistakes being made, he did not infect a single person in the general population. The spread was limited to two nurses who cared for him at the most infectious stage, but before this stage the viral load is very low and Ebola is not likely to spread. This is also why, despite people who did come into contact with him having traveled, not a single other person has contracted Ebola.

Ebola is a serious problem in countries without sufficient infrastructure to deal with it, and if we are ever to be at serious risk it would be due to more widespread infection outside of the United States first. Our major focus must be on eradicating Ebola in West Africa, and anything which hinders this will make this more difficult and be counterproductive.

We also must closely track those who have been exposed, and a travel ban would also make this far more difficult. One of the major reasons for Ebola spreading in West Africa is an atmosphere which causes people who have been exposed to hide this until they are very sick and courageous. We must avoid an atmosphere such as this in the United States if we are going to prevent spread here.

We see in Nigeria that Ebola can be beaten, with the country now being free of the disease. Among the measures cited for eradicating Ebola are avoiding fear and keeping the borders open:

Nigeria has not closed its borders to travelers from Guinea, Sierra Leone and Liberia, saying the move would be counterproductive. “Closing borders tends to reinforce panic and the notion of helplessness,” Shuaib said. “When you close the legal points of entry, then you potentially drive people to use illegal passages, thus compounding the problem.” Shuaib said that if public health strategies are implemented, outbreaks can be controlled, and that closing borders would only stifle commercial activities in the countries whose economies are already struggling due to Ebola.

Similarly, Republicans are playing on exaggerated fears of terrorism and unfounded claims that the Affordable Care Act will cause increases in premiums when insurance companies are actually reporting plans for lower premium increases than were the norm prior to Obamacare.

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California Study Debunks Claims That Medicaid Expansion Will Increase ER Utilization Long Term And Excessively Increase Costs

Opponents of the Affordable Care Act and Medicaid expansion have often twisted the results of a study in Oregon showing an increase in Emergency Room utilization after their expansion of Medicaid. Subsequent studies have debunked claims that Medicaid patients are abusing Emergency Rooms and studies of the Medicaid expansion in Ohio showed that better management of the Medicaid patients can lead to better control of chronic disease while limiting Emergency Room use. A new analysis from the UCLA Center for Health Policy Research released Wednesday also specifically debunks claims made based upon the Oregon study, showing that the increase in Medicaid utilization is short-lived. From Kaiser Health News:

While the Medicaid expansion may lead to a dramatic rise in emergency room use and hospitalizations for previously uninsured people, that increase is largely temporary and should not lead to a dramatic impact on state budgets, according to an analysis from the UCLA Center for Health Policy Research released Wednesday.

Researchers reviewed two years of claims data from nearly 200,000 Californians, including a group  who had enrolled in public programs well in advance of the expansion of Medi-Cal,the state’s version of Medicaid, in January. These programs were designed to ease the expansion of Medicaid by providing insurance to low-income adults who were not eligible for Medi-Cal at that point but would be when the health law’s expansion went into effect earlier this year. The researchers  divided the group into four categories, based on the researchers’ assessment of each group’s pent-up demand for health care.

In July 2011, after being enrolled in California’s Low Income Health Program, the so-called “bridge to reform,” the group with the highest pent-up demand had a rate of costly emergency room visits triple — or more — that of the other groups. But from 2011 to 2013, that high rate dropped by more than two-thirds and has remained “relatively constant,” according to the analysis.

“We were hoping that this would be the case,” said lead author Jerry Kominski, director of the UCLA Center for Health Policy Research, “because we think that that’s what access to care does for low-income individuals … that there’s an additional increase in demand for services and that that demand, or utilization, drops off pretty rapidly.”

Rates of hospitalization for the “highest pent-up demand” group also started high and dropped by almost 80 percent over the two-year period. Curiously, if ER and hospitalization rates were dropping, it’s reasonable that outpatient visits might rise. But that wasn’t the case; the rate of outpatient visits was largely unchanged during the two-year period.

Kominski said that one of the fears of the Medicaid expansion was the potential high cost of low-income patients. He argued that this analysis should ease those fears: “What our findings say to the country is (that) concerns about Medicaid expansion being financially unsustainable into the future are unfounded.” Under the Affordable Care Act, the federal government provides 100 percent of the cost of the newly eligible under the Medicaid expansion, but in 2017 that contribution will phase down until it reaches 90 percent in 2020.

As was the case in Ohio, a key factor in keeping costs down was better coordination of patient care:

One factor in helping drive down the higher rates of use, Kominski said, is better efforts at coordination for Medi-Cal beneficiaries. For example, virtually all Medi-Cal beneficiaries are now enrolled into a Medi-Cal managed care plan. “To the extent that other states don’t have adequate coordinated care mechanisms in place for their Medicaid populations, then the kinds of drop off that we observed in California may not occur there,” Kominski said.

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Media Lets Republicans Get Away With Absurd Statements On Obamacare & Other Issues

Republicans have been successful at “playing the refs” with false claims of liberal bias, helping them get away with spreading their misinformation. Liberal blogs and magazines, have commented a lot on Mitch McConnell’s absurd statement in support of the popular and successful Kynect exchange site while attacking Obamacare, which makes Kynect possible. Fact checkers have debunked this claim months ago. However the mainstream media is paying little attention to this–considerably less than the far less significant refusal of Alison Lundergan Grimes to say who she voted for.

Brian Buetler thinks that the media is largely giving McConnell a pass on this due to failing to understand this, and not really liking to discuss policy. He explained, as so many have in the past, why McConnell is both wrong and dishonest:

During the debate, McConnell said he’d be “fine” with it if Kentucky decided to hold on to Kynect if and when Republicans repeal Obamacare. The subtext of Holmes’s tweet is that Kynect would simply become a hub for the kinds of plans that existed in Kentucky before Obamacare. After all, it’s true there was an insurance market (a non-group market) before there was Obamacare. It could follow that McConnell’s proposition is perfectly reasonable.

But there were also websites before there was Kynect. One of those websites is a Kynect-like exchange called ehealthinsurance.com. Yet somehow, before Obamacare and Kynect came along, it wasn’t processing half a million Kentuckyians a year. The uninsurance rate in Kentucky was extremely high and showed no signs of falling on its own.

That’s because prior to Obamacare, the non-group market was dysfunctional. It excluded and priced out the sick and poor. It offered decent plans to young people who posed minimal health risks, but also sold junk policies that left people who believed they were doing the responsible thing exposed to medical bankruptcy.

It took Obamacare (and, thus, Kynect) to transform that market into something that proved inviting to half of Kentucky’s uninsured population almost overnight. Take away Obamacare, and Kynect might still exist as a website. But it’d be about as useful to Kentuckians as ehealthinsurance was prior to last year. Not totally useless, perhaps, but dramatically diminished and completely superfluous.

You need to know all this if, as a political reporter, you’re going to dismiss the McConnell camp’s spin and call him out as clearly as you (presumably) called out Grimes. Likewise, when McConnell implies that Kentucky could simply replicate the ACA’s private insurance expansion and its Medicaid expansion, you need to know that Kentucky probably couldn’tand certainly wouldn’tever do it on its own. McConnell is suggesting that Kentuckians replace a valuable, paid-for federal benefit with one that would impose steep new burdens on the people of the state alone, knowing it’ll never happen.

Once you grasp it all, then it becomes obvious why McConnell’s contradiction is theoretically so dangerous. He isn’t just painting a shiny gloss on a controversial position. He’s exploiting the public’s confusion over it, playing voters for fools by peddling absurdities. Something that can come to define a campaign just as easily as Grimes’ political cowardice might ultimately come to define hers.

This isn’t the only dishonest statement to come from Republicans in recent debates. Tom Cotton, Republican Senate candidate in Arkansas, made an absurd claim that people with pre-existing conditions were better off before the Affordable Care Act. I happened to listen to the debate in Virginia on C-Span, hearing Ed Gillespie make multiple false claims, such as repeating the Republican lie that Medicare is being cut to pay for Obamacare.

Part of the problem is that many in the media sees their job as “objectively” reporting what each side says, regardless of whether one side is saying far more absurd things. The conventional wisdom this year is that Republicans are doing better because there have not been statements such as Todd Akin talking about “legitimate rape,” but in reality Republicans continue to say many totally off the wall things which are being ignored by the media. Paul Waldman discussed absurd statements which Republicans are getting away with this election cycle and concluded:

…in the last few years, there’s a baseline of crazy from the right that the press has simply come to expect and accept, so the latest conspiracy theorizing or far-out idea from a candidate no longer strikes them as exceptional. Sure, there are exceptions: For instance, Republicans Sharron Angle and Christine O’Donnell both saw their candidacies derailed by their crazy or outsized statements. But their utterances were truly, deeply bizarre or comical, so they broke through.

But during this cycle, Republican crazy just hasn’t broken through at all. It’s almost as if the national press has just come to accept as normal the degree to which the GOP has moved dramatically to the right. At this point so many prominent Republicans have said insane things that after a while they go by with barely a notice. This is an era when a prominent Republican governor who wants to be president can muse about the possibility that his state might secede from the union, when the most popular radio host in the country suggests that liberals like Barack Obama want Ebola to come to America to punish us for slavery, and when the President of the United States had to show his birth certificate to prove that he isn’t a foreigner.

So ideological extremism and insane conspiracy theories from the right have been normalized. Which means that when another Republican candidate says something deranged, as long as it doesn’t offend a key swing constituency, reporters don’t think it’s disqualifying. And so it isn’t.

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The Highly Successful Presidency Of Barack Obama

Paul Krugman has been defending Barack Obama much more recently, such as in a recent article in Rolling Stone and on ABC’s This Week. Krugman’s views on Obama have evolved over the years. I think that early on he was critical of Obama based upon disagreements on policy matters. Two things have altered how he discusses Obama. First there are all the off the wall attacks on Obama from both the right and many mainstream commentators. Secondly, he is doing a better job of separating differences of opinion with a more centrist president from outright condemnation where he disagrees. This includes both recognition of Obama’s actual accomplishments and realization that wherever he disagrees with Obama, the Republicans would be far, far worse.

In Rolling Stone, Krugman looked at the various types of attacks on Obama:

All Obama-bashing can be divided into three types. One, a constant of his time in office, is the onslaught from the right, which has never stopped portraying him as an Islamic atheist Marxist Kenyan. Nothing has changed on that front, and nothing will.

There’s a different story on the left, where you now find a significant number of critics decrying Obama as, to quote Cornel West, someone who ”posed as a progressive and turned out to be counterfeit.” They’re outraged that Wall Street hasn’t been punished, that income inequality remains so high, that ”neoliberal” economic policies are still in place. All of this seems to rest on the belief that if only Obama had put his eloquence behind a radical economic agenda, he could somehow have gotten that agenda past all the political barriers that have con- strained even his much more modest efforts. It’s hard to take such claims seriously.

Finally, there’s the constant belittling of Obama from mainstream pundits and talking heads. Turn on cable news (although I wouldn’t advise it) and you’ll hear endless talk about a rudderless, stalled administration, maybe even about a failed presidency. Such talk is often buttressed by polls showing that Obama does, indeed, have an approval rating that is very low by historical standards.

But this bashing is misguided even in its own terms – and in any case, it’s focused on the wrong thing.

There’s a different story on the left, where you now find a significant number of critics decrying Obama as, to quote Cornel West, someone who ”posed as a progressive and turned out to be counterfeit.” They’re outraged that Wall Street hasn’t been punished, that income inequality remains so high, that ”neoliberal” economic policies are still in place. All of this seems to rest on the belief that if only Obama had put his eloquence behind a radical economic agenda, he could somehow have gotten that agenda past all the political barriers that have con- strained even his much more modest efforts. It’s hard to take such claims seriously.

Finally, there’s the constant belittling of Obama from mainstream pundits and talking heads. Turn on cable news (although I wouldn’t advise it) and you’ll hear endless talk about a rudderless, stalled administration, maybe even about a failed presidency. Such talk is often buttressed by polls showing that Obama does, indeed, have an approval rating that is very low by historical standards.

But this bashing is misguided even in its own terms – and in any case, it’s focused on the wrong thing.

Yes, Obama has a low approval rating compared with earlier presidents. But there are a number of reasons to believe that presidential approval doesn’t mean the same thing that it used to: There is much more party-sorting (in which Republicans never, ever have a good word for a Democratic president, and vice versa), the public is negative on politicians in general, and so on. Obviously the midterm election hasn’t happened yet, but in a year when Republicans have a huge structural advantage – Democrats are defending a disproportionate number of Senate seats in deep-red states – most analyses suggest that control of the Senate is in doubt, with Democrats doing considerably better than they were supposed to. This isn’t what you’d expect to see if a failing president were dragging his party down.

More important, however, polls – or even elections – are not the measure of a president. High office shouldn’t be about putting points on the electoral scoreboard, it should be about changing the country for the better. Has Obama done that? Do his achievements look likely to endure? The answer to both questions is yes.

From there, Krugman looked at Obama’s achievements on health care, financial reform, the economy, the environment, national security, and social change. As Obama has so many favorable accomplishments, I would suggest seeing the original article rather than trying to list them all here. He then concluded:

Am I damning with faint praise? Not at all. This is what a successful presidency looks like. No president gets to do everything his supporters expected him to. FDR left behind a reformed nation, but one in which the wealthy retained a lot of power and privilege. On the other side, for all his anti-government rhetoric, Reagan left the core institutions of the New Deal and the Great Society in place. I don’t care about the fact that Obama hasn’t lived up to the golden dreams of 2008, and I care even less about his approval rating. I do care that he has, when all is said and done, achieved a lot. That is, as Joe Biden didn’t quite say, a big deal.

Andrew Sullivan cited Krugman’s article and added:

Just a year ago, I had a conversation with a friend as the healthcare website was crashing. All that mattered, we agreed, was if, this time next year, the healthcare reform is working and the economy is doing better. Well, both those things have happened – Obamacare is actually a big success so far; the growth and unemployment rates are the envy of much of the Western world – and yet we are now told that he’s a failure. WTF? The architects of the Iraq War – like, yes, Clinton and McCain – somehow believe they have a better grasp of foreign affairs in the twenty-first century than he does. And the party that bankrupted this country in eight short years now has the gall to ignore the fastest reduction in the deficit ever, and a slow-down in healthcare costs that may well be the most important fiscal achievement of a generation.

Add to this two massive social shifts that Obama has coaxed, helped or gotten out the way: marriage equality and the legalization of cannabis. These are not minor cultural shifts. They are sane reforms, change we can absolutely believe in and have accomplished on his watch. Jihadist terrorism? It has murdered an infinitesimal number of Americans in the past six years, compared with almost any other threat. Yes, Americans are still capable of PTSD-driven panic and hysteria over it, and Obama has failed to counter that more aggressively, but to be where we are in 2014 is something few expected after 9/11.

The idea that he has “lost Iraq” is preposterous. We “lost” Iraq the minute we unseated the Sunnis, disbanded the Baathist army and unleashed the dogs of sectarian warfare.

The only sane response to continuing unrest there is to cut our losses, act as an off-shore balancing power, and protect ourselves. And one reason we have this capability is that Obama managed to pivot nimbly last fall to ensure the destruction of Assad’s WMDs. The Panettas and McCains and usual suspects still seem to believe that it would have been better to have bombed Assad, let him keep his WMDs, and … what exactly? Can you imagine ISIS with its hands on those weapons in a failed state with a deposed leader? Think Libya today with poison gas. Who prevented this? Obama. And he is still pilloried for it.

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Republican Tactics Of Fear And Voter Suppression

Republicans, lacking a real agenda or any solutions to problems, are basing their campaign this year on a combination of fear and voter suppression. They are even trying to politicize Ebola with threats that it will cross our borders (along with people of other colors) and even mutate to become airborne to attack us. (Does their belief that Ebola will change into an airborne infection suggest a new found belief in evolution for some?) First Read writes:

…these advertisements we’re seeing (here, here, and here) go well beyond faith in institutions or government competence. They’re about fear. And frankly, they come when there’s no evidence of ISIS coming across the border and when (remarkably) there’s still been just one confirmed case of Ebola in the United States. Now we understand why Republicans are picking up this theme — they want to nationalize the election, and they have every incentive to. (The more they get voters going into the voting booth upset at Washington, the more likely they are to get Republicans defeating Democratic incumbents in Senate races.) But some of these candidates are walking a fine line; there is a Chicken Little aspect here regarding Ebola and it can border on the irresponsible.

The New York Times reports:

Playing off feelings of anxiety is a powerful strategy for motivating the Republican base. And few issues have proven as potent when linked together as border security and the fear of terrorism. Representative Duncan Hunter, Republican of California, said this week on Fox News that border agents had told him they apprehended 10 Islamic State fighters in Texas. The Department of Homeland Security said his statement was “categorically false.”

Fear has always been a centerpiece of Republican strategy. They scare poorly educated white males into fearing that minorities and women will take their money. They scare Republican voters into believing that Democrats will take away their guns and their bibles. More recently they have been concentrating on fear of Obamacare, even if every single one of their predictions of dire consequences has failed to come about.

Republicans rely upon fear to get their supporters to turn out to vote, and resort to voter suppression to try to keep Democrats from voting. As the GAO reported, Republican-supported voter ID laws aimed at voter suppression result in fewer minorities and young people voting. Fortunately the Supreme Court has thrown out voter ID laws in Wisconsin and Texas, but they have also allowed a law to stand in North Carolina.

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Fox Shocked That Obama Would Point Out Their Misinformation On Affordable Care Act

Obama is pushing back against the misinformation spread by Fox about the Affordable Care Act in a speech at Northwestern:

There’s a reason fewer Republicans are preaching doom on deficits — because the deficits have come down at almost a record pace, and they’re now manageable. There’s a reason fewer Republicans are running against Obamacare – because while good, affordable health care might seem like a fanged threat to the freedom of the American people on Fox News, it’s working pretty well in the real world.

He repeated the criticism of Fox on Twitter:

Fox was stunned, with Gretchen Carlson asking reported Ed Henry, “My question to you, Mr. Henry, is why would he do this?”

Most likely they will continue to report the same misinformation about both the deficit and Obamacare, with their viewers remaining out of touch with reality. While a futile gesture, it is good to see Obama respond to all the misinformation spread by Fox.  Fox is certainly not going to admit that it was George Bush and the Republicans who were to blame for running up the deficit, or how much it has fallen under Obama’s far more conservative spending. Nor are they going to talk about how many more people are now covered under Obamacare, and how all the right wing predictions of doom have failed to come true.

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Another Activist Conservative Judge Attempts To Destroy Obamacare

A federal judge in Oklahoma, appointed by George W. Bush, has repeated the same ridiculous argument given by previous activist conservative judges to attempt to stop Obamacare. The claim is that the Affordable Care Act only provides for subsidies for policies purchased on state-run exchanges and not the federal exchange. This is based upon taking one portion of the law, which is poorly written and might suggest this, while ignoring all the other portions of the law which do not make such limitations on who can qualify to receive subsidies.

Previously the 4th Circuit Court of Appeals in Richmond, Virginia ruled that subsidies should be available for policy holders regardless of whether they were purchased on a state or the federally run exchange.  The D.C. Court of Appeals ruled in the opposite direction, with two Republicans voting that subsidies should be limited to policies purchased on state exchanges and one Democrat backing the Affordable Care Act. Subsequently the court vacated that decision in order to have the full court rule on this.

Think Progress has more on the case, and the arguments against the view which has only been supported by Republican judges.

The partisan divide on this issue raises some concern about how the Supreme Court might rule. I suspect that Chief Justice John Roberts would again break with the other Republicans and oppose such an effort which would destroy Obamacare as he has done in the past. If for no other reason, he might not want his court to go down in history for keeping the United States as the only major industrial nation without anything approaching universal health care based upon such a frivolous argument. However it is not entirely reassuring to have to hope that Roberts will vote in a reasonable manner.

While Republicans in public would probably support destroying Obamacare in this manner, those who are not totally out of touch with reality might actually prefer that this case does not succeed. While they wouldn’t mind seeing their party take credit for destroying Obamacare in general, despite how successful the law has been, would they really want to be responsible for increasing taxes on millions of Americans by taking away their tax subsidies which help pay for health care coverage?

Republican backers in the insurance industry are also likely to want to see this case fail. The worst case scenario for the insurance industry would be if they are required to provide health insurance to everyone who applies without regard to pre-existing conditions but if they don’t see increased business, and expansion of the risk pool, from sales to those receiving subsidies.

 

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Small Business Exchanges Providing Coverage To Small Business At Lower Cost

SHOP Marketplace

With Obamacare having been such a success on the individual market, providing coverage for millions of people, generally at a lower cost than previously, some opponents of health care reform have concentrated on scare stories claiming that the cost of coverage will harm small business. While not many states had the small business exchanges operational in the first year, a study has now shown that the small business exchanges are offering coverage at a lower cost where available:

Health plans available to small businesses on the law’s new health marketplaces are on average about 7 percent cheaper than comparable plans offered elsewhere, according to analysis conducted by a team of researchers at the National Opinion Research Center at the University of Chicago. For middle-tier plans, for instance, the disparity translates into about $220 in annual premium savings for plans purchased on the SHOP exchanges.

“It’s definitely surprising,” said Jon Gabel, a senior fellow at the center, noting that many insurers had expressed disinterest in selling plans on the SHOP exchanges. “So, I expected them to price those plans higher than the plans sold off the SHOP, but it didn’t turn out that way — in fact, just the opposite.”

Gabel’s team conducted the analysis using information pulled from state insurance databases in 26 states, 15 of which built their own exchanges and 11 of which defaulted to the marketplace built and run by the federal government. States not included in the study were ones in which health insurance data wasn’t made available.

So what’s behind the lower rates on the new exchanges? In part, Gabel said, the results can likely be attributed to the one of underlying premises behind the exchanges — that is, to drive up competition among insurance carriers by placing their rates next to one another for shopping comparison. Indeed, health officials have reported cases of insurers revising their rates on the marketplaces after seeing lower prices from their competitors.

However, there are likely some other factors at play, too. In many cases, Gabel said, the plans available on the exchanges may have a more narrow provider network, which would drive down the price but perhaps leaving small employers and their workers with more limited options when they need to visit a physician. In addition, he noted that some of the plans offered in the non-exchange marketplace may offer more non-essential benefits.

Despite the potential trade-offs, offering plans at even slightly lower rates than what’s available in the private market could make all the difference for the SHOP exchanges, most of which have thus far failed to gain any real traction with employers. Another recent study conducted by research center showed that, among small business owners who do not currently offer health coverage, 82 percent said their decision to start providing insurance would depend on prices being lower than they are today.

In addition, 83 percent said that the availability of tax credits would be an important factor and 90 percent say they would want to send only one check per month to cover all their workers’ premiums — both features that available to small businesses only through SHOP marketplaces. More than four in five said being able to compare different plans online would make a difference — an option that will eventually be available nationwide.

Allowing small businesses to obtain less expensive health  care insurance will help them become more competitive in hiring compared to larger businesses, which historically have been able to obtain insurance coverage for their employees at a lower cost.

Of course all the benefits of the Affordable Care Act won’t stop conservatives from continuing to attempt to cripple Obamacare.

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Two Successes For Obamacare In Reducing Health Care Costs

Two stories today show further areas where the Affordable Care Act was successful, with both helping to reduce health care costs. While conservatives claim that Obamacare is a government takeover of health care, it actually expands market choices. In the past it was very common for one insurance company to dominate an area, contributing to high prices. Selling health policies through exchanges, and expanding the market of those having coverage, is leading to more insurance companies which plan to sell insurance. From Kaiser Health News:

The number of health insurance companies offering plans in the marketplaces this fall will increase by 25 percent, giving consumers more choices for coverage, Health and Human Services Secretary Sylvia Burwell announced Tuesday.

When the marketplace enrollment reopens in November, 77 new insurers will be offering coverage in the 44 states for which HHS had data, which includes the 36 states that use the federal marketplace and eight states that run their own, the department reported.

The number of competitors on the marketplaces is considered important because it signifies the vitality of the exchange and can mean increased competition and lower prices for consumers. It also means that insurers see the health law’s online marketplaces or exchanges, as a good business opportunity, senior HHS officials said…

Burwell sought to cast the increase as one of a number of recent announcements suggesting that the 2010 health law has been successful in improving health care options for Americans.  She pointed to figures announced last week that 7.3 million people who signed up for the exchanges and paid their premiums, findings that HHS released Monday that 8 million people enrolled in Medicaid or the Children’s Health Insurance Program since the beginning of open enrollment last year, and a 26 percent reduction of uninsured adults.

“I think we need a bit of a course correction in this country when it comes to how we talk about these issues — and it starts with collectively turning down the volume a bit,” she said. “Surely, we’d all agree that the back-and-forth hasn’t been particularly helpful to anyone — least of all the hardworking families who we all want to help.”

She also said that backers of the law “haven’t done a very good job of explaining why middle-class families who already had insurance are better off.” Families are paying less for coverage, Burwell said, and they benefit from knowing they “no longer have to worry about losing their homes or having their hard-earned savings wiped-out by an accident, or unexpected diagnosis.”

The New York Times showed how Accountable Care Organizations which were organized under the Affordable Care Act can save money:

IT may have been the most influential magazine article of the past decade. In June of 2009, the doctor and writer Atul Gawande published a piece in The New Yorker called “The Cost Conundrum,” which examined why the small border city of McAllen, Tex., was the most expensive place for health care in the United States.

The article became mandatory reading in the White House. President Obama convened an Oval Office meeting to discuss its key finding that the high cost of health care in the country was directly tied to a system that rewarded the overuse of care. The president also brought up the article at a meeting with Democratic senators, emphasizing that McAllen represented the problem that needed to be fixed.

Five years later, the situation has changed. Where McAllen once illustrated the problem of American health care, the city is now showing us how the problem can be solved, largely because of the Affordable Care Act that Mr. Obama signed into law in 2010…

One of its provisions created the Medicare Shared Savings Program, which rewards doctors for keeping their patients healthy. Participation in the program requires primary care doctors to create networks, called accountable care organizations, or A.C.O.s, to better coordinate patient care. These networks are reimbursed for delivering high-quality care below a baseline of historical Medicare costs.

In 2012, doctors in McAllen formed the Rio Grande Valley Accountable Care Organization Health Providers, and signed up for this experiment. The early results are in, and they are stunning: From April 2012 to the end of 2013, the Rio Grande Valley A.C.O. saved more than $20 million from its Medicare baseline.

This is just two more ways in which the real world successes for Obamacare show a totally different picture than the right wing media has been portraying.

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Health Care Advocates File Suit Against California For Lag In Enrollments In Expanded Medicaid Program

By most measures the Affordable Care Act has been a success, increasing the number insured without the problems predicted by Republicans. However not everything has worked out perfectly to date. The biggest problems have been with the expansion of Medicaid. The worst problem has been seen in the Republican controlled states which have blocked Medicaid expansion, but there are also problems in some states which are attempting to participate in the program. Last May, Joe Gandelman reported at The Moderate Voice on a case in which someone he knew who was in need of immediate medical attention had difficulty obtaining coverage. It turned out that the problem was that he qualified for the expanded Medicaid program in California. As he qualified for this, he could not receive subsidies in the exchanges, but he did not receive timely coverage due to a backlog of around 600,000 people who qualified but were not processed for the program.

Since then I have looked at this backlog periodically as data came out and while the number has decreased, hundreds of thousands of people have still not received coverage. A coalition of health care advocates has now filed a suit against the state in response to this backlog. Kaiser Health News reports:

California’s lingering backlog of Medi-Cal applications has left hundreds of thousands of people unable to access the health care they are entitled to receive, according to a lawsuit filed Wednesday by a coalition of health advocates and legal services groups.

The lawsuit, filed in Alameda County Superior Court, says the state is failing to process applications within 45 days as required by law. Some applicants have been waiting to receive their Medi-Cal cards since the end of last year, according to the suit. The applicants include children, pregnant women and adults with life-threatening health conditions, who advocates say are either postponing treatment or paying cash to see doctors.

Medi-Cal is the state’s version of Medicaid, the publicly funded health insurance program for low-income Americans. About 11 million people receive Medi-Cal benefits in California, including 2.2 million who applied since January. Roughly 350,000 applications are still pending.

The lawsuit cites several cases, including that of Tulare County resident Robert Rivera, who applied for Medi-Cal in January but died of a pulmonary embolism while the state was determining if he was eligible for the insurance. Two months after his death, Rivera’s mother received a letter saying that the benefits had been approved.

Los Angeles County resident Mark Mullin submitted an application in February 2014, but wasn’t approved until four months later — after he sought legal help. During the time his application was stuck in the backlog, Mullin had to undergo an emergency appendectomy.

The suit is asking the state to process cases within 45 days and to grant people Medi-Cal benefits while officials verify applicants’ incomes. The coalition is also asking the state to send notices to Medi-Cal applicants who have been waiting for 45 days notifying them of their right to go before an administrative law judge.

The long wait is “unacceptable,” said Katie Murphy, managing attorney at Neighborhood Legal Services of Los Angeles County. Murphy said she is concerned that the problems will get worse as more people apply for Medi-Cal. “If they are not fixed, more people will continue to wait and more will continue to suffer medical emergencies,” she said.

California Department of Health Care Services officials said they have been working closely with the counties and have reduced the backlog by 250,000 since early July. Many of the cases are still pending because of incorrect or incomplete information.

Department spokesman Tony Cava said people who need immediate care can get in-person assistance with their application at a county social services agency. They also can get their medical bills covered for care received while their applications were pending, he said.

The lawsuit was filed by several organizations throughout California, including Neighborhood Legal Services of Los Angeles County, the National Health Law Program and Bay Area Legal Aid.

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