Insurance Companies Plan To Increase Policies Offered On Exchanges Following 2014 Success, And Other Health Care News

The first year of enrollment for insurance under the exchanges is largely for first getting our feet wet, with more people projected to sign up in the future. It certainly exposed problems in the computer system and allowed for them to be fixed (although further testing before October was clearly needed). Insurance companies got to see whether this was a profitable market they would want to enter. In the past one or two insurance companies dominated in most areas on the individual market. One of the benefits of selling coverage through the exchanges was the hope that multiple companies would now begin to offer coverage.

Even conservatives who oppose the Affordable Care Act should agree with the benefits of having more companies offer insurance, including the likelihood of competition leading to lower prices. Actually exchanges, along with mandates, were originally supported by Republicans until they opposed the plan when supported by Barack Obama.

So far we are receiving good news following the initial IT problems. The Affordable Care Act now looks like a good policy which just got off to a rocky start. Enrollment is estimated at 7.5 million, exceeding predictions made even before they were adjusted downward with the early computer problems, with more healthy young people signing up at the last minute. Politico reports that insurance companies are happy with what they are seeing and want to get in:

Health insurers got their first taste of Obamacare this year. And they want seconds.

Insurers saw disaster in the fall when Obamacare’s rollout flopped and HealthCare.gov was a mess. But a strong March enrollment surge, along with indications that younger and healthier people had begun signing up, has changed their attitude. Around the country, insurers are considering expanding their stake in the Obamacare exchanges next year, bringing their business to more states and counties. Some health plans that skipped the new marketplaces altogether this year are ready to dive in next year.

At least two major national insurers intend to expand their offerings, although a handful of big players like Aetna, Humana and Cigna, are keeping their cards close for now. None of the big-name insurers have signaled plans to shrink their presence or bail altogether after the first rocky year. And a slew of smaller health plans are already making moves to join more states or get into the Obamacare business for the first time.

“[W]e see 2014 as just the beginning for exchanges,” said Tyler Mason, a spokesman for UnitedHealth Group, one of the nations’ largest insurers. “As the economics, sustainability and dynamics of exchanges continue to become clearer, we believe exchanges have the potential to be a growth market with much to offer UnitedHealthcare and other insurers and consumers.”

Nurturing this growth and health plan participation will be one of the first tasks of Sylvia Mathews Burwell, assuming she is confirmed to succeed Kathleen Sebelius as secretary of Health and Human Services.

The article reviewed plans by many of the larger insurance companies and also noted that several smaller companies now want to start selling insurance. Being able to offer their plans on the same computer site as the larger companies will allow small companies to compete for sales more easily than in the past, further increasing choice for consumers.
It is not only insurance companies which see the Affordable Care Act as succeeding. The latest Reuters/Ipsos poll shows the number of people who prefer Democrats over Republicans on health care has increased:

Americans increasingly think Democrats have a better plan for healthcare than Republicans, according to a Reuters/Ipsos poll conducted after the White House announced that more people than expected had signed up for the “Obamacare” health plan.

Nearly one-third of respondents in the online survey released on Tuesday said they prefer Democrats’ plan, policy or approach to healthcare, compared to just 18 percent for Republicans. This marks both an uptick in support for Democrats and a slide for Republicans since a similar poll in February.

Not surprisingly, Gallup has found a greater decrease in the uninsured in states which have embraced the Affordable Care Act, such as by setting up their own exchanges and taking advantage of the expanded Medicaid program.

Having Gallup survey the number of uninsured is of value as the Census Bureau is changing how it is surveying the uninsured, with Gallup providing a second set of numbers for comparison. Many Republicans see a conspiracy to make Obamacare look good. Actually this looks like a change to get more accurate results, which might actually show a greater number of uninsured. The changes also started with 2013 so we will still be able to compare the year prior to the exchanges to subsequent years. Sarah Kliff explained further at Vox.

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Coverage Of The Success of Obamacare And Debunking Republican Lies

Obamacare Winning

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.

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Fact Checking Valuable, But Not Always Right

Pinoccio

The Moderate Voice has a post yesterday on the increase in fact-checking in journalism. Fact-checking is preferable to the standard media practice of quoting both sides as if they are equally valid, generally with an implied assumption that the truth is somewhere in the middle. This leads to erroneous reporting when one side is intentionally using misinformation and lying far more than the other. However labeling something fact checking doesn’t necessarily mean it is immune from journalistic problems. Paul Krugman pointed out one problem:

“The people at PolitiFact are terrified of being considered partisan if they acknowledge the clear fact that there’s a lot more lying on one side of the political divide than on the other,” Krugman wrote in 2011.

“So they’ve bent over backwards to appear ‘balanced’ — and in the process made themselves useless and irrelevant.”

As Krugman pointed out, there are fact checkers which label an equal number of statements from Democrats and Republicans as being wrong in order to give the appearance of being impartial. That typically means that outrageous lies from Republicans are called lies but to provide a sense of balance,  statements from Democrats which are generally true but in which there is an exception are also called lies.

The entire idea of calling something true or a lie is often a poor way to handle complex issues which are stated by politicians in brief statements. Sometimes politicians are trying to be truthful, but boiling down a complex issue into a brief statement, or commercial, will result in exceptions where the statement is false. Often it is preferable to look at what is true in what is being said and where it isn’t entirely true and explain the issue rather than just calling it truth or a lie.

While Republicans have been hit far more with big lies on health care, Democrats have been harmed by the problems in how some fact checkers declare something either true or a lie (being a lie if not 100% true in every case). There have been two big examples of this. The first is Democrats saying that the Medicare proposals in the Ryan budget would destroy Medicare. Technically this is untrue as Ryan would replace Medicare with something named Medicare. On the other hand, it is true because the Republican proposals would change Medicare into something fundamentally different with far less protection for seniors. Rather than just calling it a lie, fact checkers would have done more good by explaining why Democrats consider these changes to be destroying Medicare.

The other is the greatly exaggerated “lie of the year” when Obama said people could keep their own doctor under the Affordable Care Act. This was an absurd statement on one level because every year insurance companies and doctors make decisions which can affect this which the government has no  power over. On the other hand, Obama was right in the context where he was speaking, even if worded poorly. Republicans were lying when they claimed that Obamacare would make people join some sort of government run program which would tell them which doctors they can see. The Affordable Care Act actually makes it more likely that people could have insurance which would allow them to keep their doctor than had been the case in the past and does nothing to force people to lose their doctor. People have a better chance of keeping their doctor when protected from losing their insurance. Frequently people are forced to change doctors because of employers changing insurance plans. Employees have a better chance of keeping their own doctor when provided more choice in plans, as under the Affordable Care Act.  Where Obama got it wrong was that the same forces already present which lead to people having to change doctors, while diminished, would still exist. It would be far better to explain this complex issue, where Obama was mostly right, than to just declare it a lie because it is not true one hundred percent of the time.

Cross posted at The Moderate Voice

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Obama Warns Of Threats To Right To Vote

Protect Vote

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cross posted at The Moderate Voice

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Lack Of Information And Misinformation Suppressing Enrollment In Insurance Plans

Recent polls are showing some of the obstacles to extending coverage among the uninsured. A study published Monday by the National Academy of Sciences showed that a substantial number of consumers lack basic knowledge of how insurance works which would be necessary to intelligently purchase coverage. A new Kaiser Health Tracking Poll shows lack of knowledge of the deadline for obtaining coverage and widespread belief in many of the false claims being spread by opponents of the Affordable Care Act.

Many are unaware of next week’s deadline to obtain coverage and avoid potential tax penalties:

A third of those who lack coverage as of mid-March are unaware that the law requires nearly all Americans to have health insurance or pay a fine. When it comes to the specifics, four in ten of the uninsured (39 percent) are aware that the deadline to sign up for coverage is at the end of March, leaving about six in ten unaware of the March deadline.

When reminded of the mandate and the deadline, half of those without coverage as of mid-March say they think they will remain uninsured, while four in ten expect to obtain coverage and one in ten are unsure.

Many plan to not obtain coverage due to cost concerns, unaware of financial assistance available:

While some report trying to get coverage from new options available under the ACA, large shares of the uninsured remain unaware of two of the law’s key provisions that could help them get coverage. About half the uninsured are unaware that the ACA gives states the option of expanding their Medicaid programs, and more than four in ten don’t know that it provides financial help to low- and moderate-income individuals to help them purchase coverage.

The Kaiser poll showed a reduction in the gap between those who see the law unfavorably as opposed to favorably. While more now have a favorable opinion than previously, the majority continue to have an unfavorable opinion. Much of the opposition is based upon misinformation spread by opponents:

“It’s too expensive for regular people.”
“it’s costing too much money. It’s supposed to help people with low incomes and it’s not.”
“Because it’s a financial hardship on the U.S.”

The first two are based upon lack of knowledge of the assistance available which does make coverage more affordable. The third has been shown by the recent non-partisan report from the Congressional Budget Office to be false. Among its other benefits, the Affordable Care Act will reduce the deficit, reduce unemployment, and help stimulate the economy by freeing people from the insurance trap, enabling more people to work for and start small businesses

Opposition also includes a belief that the individual mandate is unconstitutional despite a Supreme Court ruling upholding the law. Some expressed the false belief that the ACA gives government more control over personal health care choices, echoing further scare stories from the right wing as to what the law does.

Despite unfavorable views about the law, a majority still would prefer to see improvement to the law as opposed to repeal or a Republican alternative:

Perhaps reflecting this sense that the debate has gone on long enough, more of the public would like to see Congress keep the law in place and work to improve it (49 percent) or keep it as is (10 percent) rather than repeal it and replace it with a Republican-sponsored alternative (11 percent) or repeal it outright (18 percent).

The poll found that many aspects of the law are popular, even if many people are unaware of these and other benefits:

As previous Kaiser tracking polls have found, many of the ACA’s major provisions continue to be quite popular, including across party lines. For example, large shares of Americans – including at least seven in ten overall and at least six in ten Democrats, Republicans, and independents – have a favorable view of the fact that the law allows young adults to stay on their parents’ insurance plans up to age 26, closes the Medicare “doughnut hole” for prescription drug coverage, provides subsidies to low- and moderate-income Americans to help them purchase coverage, eliminates cost-sharing for preventive services, gives states the option of expanding Medicaid, and prohibits insurance companies from denying coverage based on pre-existing conditions. Nearly as many (including a majority across parties) have a favorable view of the “medical loss ratio” provision that requires insurance companies to give their customers a rebate if they spend too little money on services and too much on administration and profits. Somewhat more divisive is the law’s Medicare payroll tax on earnings for upper-income Americans, which is viewed favorably by about three-quarters of Democrats and just over half of independents, but just a third of Republicans.

The individual mandate remains highly unpopular. Anticipation of this is one of the reasons I opposed the individual mandate prior to passage of the Affordable Care Act, preferring an alternate system to provide incentives to purchase coverage and penalize those who try to game the system by waiting until sick to purchase insurance.

Much of the opposition to the ACA is based upon beliefs about the law which are untrue:

Misperceptions also persist about things the ACA does not actually do. For example, nearly half the public (46 percent) think the law allows undocumented immigrants to receive financial help from the government to buy health insurance, and another two in ten (22 percent) are unsure whether it does. A third of the public (34 percent, including 32 percent of seniors) believe the law establishes a government panel to make decisions about end-of-life care for people on Medicare, with another quarter saying they are unsure (23 percent of the public, 25 percent of seniors).

Unfortunately both lack of information and intentional misinformation being spread by opponents of the Affordable Care Act is likely to cause a substantial number of people to go without coverage this year. The deadline is fast approaching for purchasing coverage on the exchanges. There is no deadline for those who qualify for coverage due to Medicaid expansion, but Republicans in many states are also denying this benefit to residents of their states even though the federal government picks up almost all of the cost.

Cross posted at The Moderate Voice

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

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

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

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

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

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

“Millions of people have lost their health insurance”

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

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

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

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

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

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

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

“Millions are paying more and getting less”

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

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

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

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

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

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

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

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

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

Cross posted at The Moderate Voice

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Three Types Of Obamacare Winners You Might Not Have Thought Of

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“Thank God for Obamacare!” his wife exclaimed.

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

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

Cross posted at The Moderate Voice

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Democrats Need To Go On The Offensive On Health Care

Yesterday I posted in frustration as to how the Democrats managed to allow the Republicans to both sabotage an effort to repeal the Sustainable Growth Formula and use the Affordable Care Act once again as a political pawn. I found that Greg Sargent had interviewed Paul Begala, who had said something similar to my conclusion about Democrats fighting for the Affordable Care Act and added that to the post. In retrospect this message is far too important to leave at the end of the post, and it is well worth repeating (with additional information and commentary).

As I concluded yesterday, despite all of the benefits of the Affordable Care Act, Democrats remain on the defensive politically. The Affordable Care Act is turning into a major success, providing millions with health insurance coverage and ending the ability of insurance companies to abuse the system by finding ways to sell policies and then avoid paying out. No longer are people denied coverage, or have their coverage taken away, due to becoming sick or losing their jobs. In addition,  Obamacare frees people from the “insurance trap” which forced people who otherwise do not need to work to continue working for insurance coverage, along with other overall benefits to the economy. The Congressional Budget Office Report, frequently distorted by Republicans, showed that the Affordable Care Act will reduce unemployment, help decrease the deficit, and allow more people to leave large corporations to start small businesses, further stimulating the economy.

While granted the Republicans have a strong propaganda machine delivering their misinformation, and a media willing to repeat Republican lies as if they are equally valid as statements of fact, Democrats should be able to do a better job of gaining support when the facts are so firmly on their side. The same is true of health care issues in general, as Republicans have managed to put Democrats on the defensive over bogus claims of Medicare cuts while the Republicans seek to turn Medicare into a voucher system which would destroy the program as we know it.

Democrats need to follow the advice of Paul BegalaStop being so damn defensive about the law and show people it’s worth fighting for, already.

Begala thinks Dems can address it with a simple flipping of the script. Dems now debating how to talk about Obamacare seem to be leading defensively with their willingness to fix the law. Instead, Begala says, they should lead with an attack on Republicans that is framed as a medical rights issue – before pivoting to fixing the law — and then wrap it all up in a larger message about how Republicans have no answers to people’s health care or economic problems.

“We should open by saying, ‘my opponent wants to repeal your rights,’” Begala said. “He wants to take away your right to be protected against discrimination because you have a preexisting condition. He wants to take away your right to be protected against discrimination for being older or being a woman. He wants to take away the closing of the Medicare donut hole for seniors.”

“That’s point one,” he continued. “Then you say, ‘look, I’m open to working with everybody to fix the law. But I’ll never let them go back to the days where insurance companies could send letters saying your coverage has been canceled because you have a preexisting condition.’”

And then from there to an economic message: “Repeal is their whole agenda. They have no ideas for giving you a pay raise. No ideas for raising the minimum wage. No ideas about how to create jobs. No ideas about how to get your kid into pre-K. Their entire agenda as a party is repeal — to take away rights that you have won. I’m not going to let them do that.”

Elections have increasingly become about getting one’s base out to vote as opposed to converting others. Many on the far right are angry about Obamacare based upon misinformation they have heard, and this will get them out to vote. Democrats need to mobilize their voters by better informing them of what they stand to lose if the Republicans win. If Republicans can run ads with horror stories which aren’t even true, why aren’t Democrats running ads with actual horror stories of people losing their coverage and going into bankruptcy under the old system? Most people going into bankruptcy from medical expenses were insured at the time they first got sick or injured. Is this the system we want to return to?

Sure the new web site began with serious glitches, but buying insurance on the individual market was never a picnic. Policies were expensive, frequently had high deductibles, and often required seeing a limited panel of doctors. These complaints about insurance are nothing new. What has changed is that previously having a pre-existing medical condition might lead to a policy not being sold, or greatly increase the cost. Policies would have limitations, frequently failing to pay enough to cover serious illnesses such as caps on total coverage. Some policies would only cover inpatient or outpatient services, fail to cover prescriptions, or not cover preventative services.

Democrats should never have been placed on the defensive about bogus Medicare cuts when they are the party which is trying to protect the system, and when the Affordable Care Act benefits seniors by phasing out the donut hole and adding preventative services. Point out that the only cuts under Obamacare are to corporate welfare to Medicare Advantage plans, not cuts in benefits, and that the proposed Republican budgets included the very same cuts. Remind them of what the Republican plan for Medicare really is:

Democrats need to remind people of the benefits they are receiving under Obamacare, and what they risk by Republican calls for repeal. Use the over fifty votes by Republicans to repeal or hinder Obamacare to both mock them and  make voters angry about the Republicans wish to do. Ideally this will both motivate more Democratic voters to turn out to vote this November and  maybe even change the minds of some voters.

Cross posted at The Moderate Voice

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Republican House Plays Politics, Screwing Both Doctors And Medicare Patients

After several years a deal had been reached to permanently repeal the flawed Sustainable Growth Formula but the House Republicans chose to play politics with it. The House Republicans showed a disregard for both physicians and  Medicare beneficiaries. They attached the fix to a five year delay on the individual mandate, knowing that this would be dead in the Senate.

The Sustainable Growth Formula was initially devised to give doctors increased Medicare reimbursement if medical costs go down and decrease reimbursement if costs rise. The formula was quickly found to be flawed. Individual physicians cannot control the overall trajectory of Medicare expenses regardless of the financial rewards or penalties. The formula failed to take into account overall increases in costs we have experienced over the past decade as a result of an aging population and new medical technology. As a result, the formula would reduce Medicare payments to physicians to a level below what doctors could afford to see Medicare patients for. Reimbursement from Tricare, which covers military families, is also tied to Medicare reimbursement. Congress has realized that the cuts were not tolerable and has repeatedly voted for a “doc fix” to circumvent the automatic cuts called for under the Sustainable Growth Formula.

The persistence of this problem over the past decade has eroded confidence in the federal government and the Medicare program, leading some physicians to stop accepting Medicare patients. Even Congress finally realized that something had to be done and an agreement was reached in principle between the federal government and physician organizations for a new payment structure to replace the Sustainable Growth Formula. The House had the opportunity to pass this as a clean bill today, but instead played politics by attaching it to a delay to the individual mandate.

It is getting difficult to keep count but I believe this is now the fifty-first vote to either repeal or greatly interfere with the implementation of the Affordable Care Act.

The individual mandate is a necessary component of the Affordable Care Act as currently structured. If insurance companies are required to provide coverage to everyone applying, they need protection against the problem of people not buying insurance until they become ill. In order for the system to function, insurance companies need the premiums from healthy people coming into the system every year to cover the expenses of those who are ill.

There are potentially other ways to solve the free rider problem but it is not possible to simply eliminate the individual mandate without implementing alternative measures to provide strong incentives for people to purchase insurance coverage while still healthy. While I had preferred using other measures instead of the mandate when health care reform was being considered, unlike the House Republicans I recognize when an issue has been settled and see no sense in continuing to fight the same battle. The Affordable Care Act is established law which has been upheld by the Supreme Court. Congress should be concentrating on making some necessary fixes (as any law of this complexity would require) to smooth its implementation as opposed to trying to sabotage it.

Twelve Democrats voted with the Republicans out of political fears. The Affordable Care Act is turning into a major success, providing millions with health insurance coverage and ending the ability of insurance companies to abuse the system by finding ways to sell policies and then avoid paying out. In addition,  Obamacare frees people from the “insurance trap” which forced people who otherwise do not need to work to continue working for insurance coverage, along with other overall benefits to the economy. The Congressional Budget Office Report, frequently distorted by Republicans, showed that the Affordable Care Act will reduce unemployment, help decrease the deficit, and allow more people to leave large corporations to start small businesses, further stimulating the economy.

Despite all of these benefits, Democrats remain on the defensive politically. While granted the Republicans have a strong propaganda machine delivering their misinformation, and a media willing to repeat Republican lies as if they are equally valid as statements of fact, Democrats should be able to do a better job of gaining support when the facts are so firmly on their side. The same is true of health care issues in general, as Republicans have managed to put Democrats on the defensive over bogus claims of Medicare cuts while the Republicans seek to turn Medicare into a voucher system which would destroy the program as we know it.

Democrats need to follow the advice of Paul BegalaStop being so damn defensive about the law and show people it’s worth fighting for, already.

Begala thinks Dems can address it with a simple flipping of the script. Dems now debating how to talk about Obamacare seem to be leading defensively with their willingness to fix the law. Instead, Begala says, they should lead with an attack on Republicans that is framed as a medical rights issue – before pivoting to fixing the law — and then wrap it all up in a larger message about how Republicans have no answers to people’s health care or economic problems.

“We should open by saying, ‘my opponent wants to repeal your rights,’” Begala said. “He wants to take away your right to be protected against discrimination because you have a preexisting condition. He wants to take away your right to be protected against discrimination for being older or being a woman. He wants to take away the closing of the Medicare donut hole for seniors.”

“That’s point one,” he continued. “Then you say, ‘look, I’m open to working with everybody to fix the law. But I’ll never let them go back to the days where insurance companies could send letters saying your coverage has been canceled because you have a preexisting condition.’”

And then from there to an economic message: “Repeal is their whole agenda. They have no ideas for giving you a pay raise. No ideas for raising the minimum wage. No ideas about how to create jobs. No ideas about how to get your kid into pre-K. Their entire agenda as a party is repeal — to take away rights that you have won. I’m not going to let them do that.”

All Democrats should have also stood up for both physicians and Medicare patients today and demanded a clean vote on the repeal of the Sustainable Growth Formula as opposed to tying it to yet another attempt to thwart Obamacare. If Democrats did something as silly as vote over fifty times to repeal the same thing while otherwise failing to legislate, imagine how the right wing noise machine would be mocking them.

Cross Posted at The Moderate Voice

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