Health

Obamacare: An Example of How Politics Makes Smart People Stupid

Ezra Klein argues that five years after its passage, Obamacare is “increasingly, evidence of much that’s right” with American politics.

“Much of what Americans know about Obamacare is simply wrong. A plurality, for instance, think the law is costing more than originally estimated. Only 5 percent know it’s actually costing quite a bit less:”

“Obamacare is an example of a depressing fact of American politics: more information doesn’t change minds … The more information partisans get, the deeper their disagreements become. When it comes to politics, people reason backward from their conclusions. Politics makes smart people stupid.”

“Even as it is often irrational for elected officials to look at the facts and come to a conclusion that puts them at odds with their party, it is rational for them, when in power, to come to conclusions that will help them govern well.”

“Governing has feedback loops that press releases don’t. Parties that want to stay in power — and they all do – have an incentive to do a good job.”

“In that way, voters discipline the system even if they don’t know much about individual policies, and even if they don’t regularly update their opinions on how various laws are working. Most people aren’t experts on politics, but they are experts on their lives and the lives of their loved ones … They eventually punish the politicians they think responsible.”

Obamacare’s Survival Threatened by a ‘Drafting Error’

Robert Pear in the New York Times: “They are only four words in a 900-page law: ‘established by the state.’”

“How those words became the most contentious part of President Obama’s signature domestic accomplishment has been a mystery.”

“The answer, from interviews with more than two dozen Democrats and Republicans involved in writing the law, is that the words were a product of shifting politics and a sloppy merging of different versions. Some described the words as ‘inadvertent,’ ‘inartful’ or ‘a drafting error.’ But none supported the contention of the plaintiffs, who are from Virginia.”

“The plaintiffs say the law allows subsidies only where marketplaces have been ‘established by the state.’ It is a distinction that those who drafted the law say they did not intend to make.”

“At the Finance Committee, which thrashed out its version of the bill in September and October 2009, senators initially assumed that all states would set up exchanges, so they added a section to the Internal Revenue Code to provide subsidies, in the form of tax credits, for insurance purchased through an exchange.”

“Senators authorized a backup plan to allow the federal government to establish an exchange in any state that did not have its own, but they failed to include that language in the section of the tax code providing subsidies. ‘We failed to include a cross-reference to the federal exchange,’ [Christopher Condeluci, Republican staff lawyer] said. ‘In my opinion, due to a drafting error, we overlooked it.'”

 

Medicaid Expansion Contributes to Decline in Uninsured Rate

Kaiser Health News: “The health law’s expansion of Medicaid coverage to adults with incomes over the poverty line was key to reducing the uninsured rate among 50- to 64-year-olds from nearly 12 to 8 percent in 2014, according to a new analysis.”

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“The study found the uninsured rate for people between age 50 and 64 who live in states that haven’t expanded Medicaid was twice as high—11 percent—as for those who live in states that have done so.”

“More than 2 million people between 50 and 64 gained coverage between December 2013 and December 2014, according to the study.”

“During the same time period, the uninsured rate among all adults between age 18 and 64 fell from 17.5 percent to 12.8 percent.”

Hefty Insurance Rate Increases May Be on the Horizon

Wall Street Journal: “Major insurers in some states are proposing hefty rate boosts for plans sold under the federal health law, setting the stage for an intense debate this summer over the law’s impact.”

“In New Mexico, market leader Health Care Service Corp. is asking for an average jump of 51.6% in premiums for 2016. The biggest insurer in Tennessee, BlueCross BlueShield of Tennessee, has requested an average 36.3% increase. In Maryland, market leader CareFirst BlueCross BlueShield wants to raise rates 30.4% across its products. Moda Health, the largest insurer on the Oregon health exchange, seeks an average boost of around 25%.”

“All of them cite high medical costs incurred by people newly enrolled under the Affordable Care Act.”

“Insurance regulators in many states can force carriers to scale back requests they can’t justify. The Obama administration can ask insurers seeking increases of 10% or more to explain themselves, but cannot force them to cut rates. Rates will become final by the fall.”

“Health-cost growth has slowed to historic lows in recent years, a fact consumer groups are expected to bring up during rate-review debates. Insurers say they face significant pent-up demand for health care from the newly enrolled, including for expensive drugs.”

The SCOTUS Obamacare Case: Who Will Blink First?

Jeffrey Toobin: “Sometime next month, the Supreme Court will decide King v. Burwell, and the conventional wisdom about the stakes in the case appears to have shifted.”

“It has come to seem that Obamacare’s Republican opponents are most at risk if the decision goes their way. They have the most to lose by winning … So that’s the theory: millions will suddenly be uninsured, and will blame Republicans.”

“No, it’s not. If the Obama Administration loses in the Supreme Court, the political pain will fall almost exclusively on the President and his Party … President Obama will have broken health care, so he owns it. To the vast mass of Americans who follow politics casually or not at all, Obamacare and the American system of health care have become virtually synonymous. This may not be exactly right or fair, but it’s a reasonable perception on the part of most people. The scope of the Affordable Care Act is so vast, and its effects so pervasive, that there is scarcely a corner of health care, especially with regard to insurance, that is unaffected by it. So if millions lose insurance, they will hold it against Obamacare, and against Obama. Blaming the President in these circumstances may be unfair, but it’s the way American politics works.”

“Playing chicken with the Justices only works if it works. If the Supreme Court strikes down the subsidies, the Administration will also have to answer for why it didn’t prepare for this possibility.”

GOP’s Obamacare Plan? ¯\_(ツ)_/¯

New York Times: “At precisely 3:56 p.m. on Thursday, Senator Chris Murphy, Democrat of Connecticut, introduced a popular Internet symbol for a careless shrug of the shoulders — ¯\_(ツ)_/¯ — into the Congressional record, holding it up on a placard and describing it as ‘a pretty good summary of what the Republicans’ plan is,’ if the Supreme Court strikes down the Affordable Care Act this summer.”

Jonathan Chait points out that a lack of a Republican plan has “induced a wave of panic … among Republicans. The chaos their lawsuit would unleash might blow back in a way few Republicans had considered until recently, and now, on the eve of a possible triumph, they find themselves scrambling to contain the damage. It is dawning on the Grand Old Party that snatching health insurance away from millions of helpless victims is not quite as rewarding as expected.”

King v. Burwell “works more on the level of an elaborate prank than as a serious reading of the law. And yet it stands at least some chance of success … That prospect has grown suddenly unnerving because, unlike previous Republican efforts to strangle the law, the current one comes as Obamacare is functioning extremely well.”

“The party remains doctrinally committed to the complete destruction of Obamacare … This doctrine will now put Republicans in the position of endangering the lives of sick Americans who will lose access to their medical treatment.”

States Contemplate Obamacare Exchange Mergers

The Hill: “A number of states are quietly considering merging their healthcare exchanges under ObamaCare amid big questions about their cost and viability.”

“Many of the 13 state-run ObamaCare exchanges are worried about how they’ll survive once federal dollars supporting them run dry next year.”

“Others are contemplating creating multi-state exchanges as a contingency plan for a looming Supreme Court ruling expected next month that could prevent people from getting subsidies to buy ObamaCare on the federal exchange.”

“The idea is still only in the infancy stage. It’s unclear whether a California-Oregon or New York-Connecticut health exchange is on the horizon.”

“But a shared marketplace — an option buried in a little-known clause of the Affordable Care Act — has become an increasingly attractive option for states desperate to slash costs. If state exchanges are not financially self-sufficient by 2016, they will be forced to join the federal system, HealthCare.gov.”

Majority of Enrollees Are Satisfied With Their Obamacare Plans

Kaiser Family Foundation: “Following the Affordable Care Act’s second open enrollment period, most people enrolled in marketplace plans report being satisfied with a wide range of their plan’s coverage and features, finds a new Kaiser Family Foundation survey of people who buy their own health insurance.”

“A large majority (74%) of those in marketplace plans rate their coverage as excellent or good, the survey finds. Most (59%) also say their plan is an excellent or good value for what they pay for it, though the share rating the value as ‘excellent’ declined somewhat from 23 percent last year to 15 percent in the current survey.”

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“In spite of high overall satisfaction levels, a significant minority of enrollees report challenges and worries related to the affordability of coverage and care.”

“The survey finds most (57%) of those in ACA-compliant plans feel financially well-protected by their insurance, though nearly four in ten (38%) feel vulnerable to high medical bills.  A similar share (34%) of those with non-compliant plans reports feeling vulnerable to high medical bills, as do 28 percent of people with employer coverage interviewed as part of a separate survey.”

More Americans Benefit from Obamacare Than They Realize

Drew Altman: A less appreciated reason the Affordable Care Act gets mixed reviews is “simply that many more people benefit from the ACA than may realize it.”

“More than half of Americans say the health reform law has had no impact on them or their family, Kaiser Family Foundation Health Tracking Polls have found. As the chart above shows, that’s true of Democrats (60%), independents (54%), and Republicans (55%).”

“But the ACA benefits more people than say it has affected them and far more than the approximately 23 million more people who have signed up for a marketplace plan or Medicaid as a result of the law.”

“ACA-related insurance reforms affect many Americans, and these provisions are popular with the public. But as the Kaiser poll findings show, Americans don’t always connect the benefits with the law. It’s likely that many people just don’t know that the law is responsible for their free flu shot, or contraceptive coverage, or their ability to get coverage if they have a pre-existing condition. These new benefits are provided by insurers or employers without a promotional label reading ‘brought to you by the ACA.’”

Obamacare Enrollment Numbers Threaten Repeal Efforts

Philip Bump: “For the first time, the number of people who have signed up for a health-care plan under the Affordable Care Act has reached 12 million, according to Charles Gaba of ACAsignups.net. The milestone is significant largely because it ends in six zeroes. But it’s significant for a political reason, too: It means that 3.7 percent of the country has selected a plan in the politically contentious system.”

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“OK. So if we combine the 10.1 million people with active coverage under an Obamacare exchange (federal or state) with the 12.4 million enrolled in Medicaid, that’s 22.5 million people with health coverage under the Affordable Care Act. That’s about 7 percent of the population of the country. A lot may not know that they’re enrolled in an Obamacare program, but it still creates a lot of friction for any politician that wants to start pulling aspects of the program away. Which was always the Democrats’ political plan, of course.”

CBO Director: Obamacare Subsidies Were Meant For All States

The Hill: “The man who led the Congressional Budget Office when ObamaCare was being constructed said Tuesday it was the ‘common understanding’ at the time that subsidies would be available in all states — a crucial question in a looming Supreme Court case.”

“The challengers in the case of King v. Burwell argue subsidies are only available in states that established their own exchanges, as opposed to a federally-run exchange, citing language in the law referring to an exchange ‘established by the state.’
Part of the challengers’ argument is that Congress could have intended to bar the subsidies from federally-run exchanges as an incentive for states to create their own.”
“’It was a common understanding on the Hill, again on both sides of the Hill, on both sides of the aisle, in late 2009 and early 2010, that subsidies would be available through the federal exchange as well as through state exchanges,’ Doug Elmendorf said in an interview at the Peterson Foundation fiscal summit.”
“’And I’m confident in saying that because CBO’s analysis always worked under the view that subsidies would be available under the federal exchange.’”

Obamacare Extension Adds Almost 150,000

The Hill: Nearly 150,000 people signed up for health insurance during ObamaCare’s extra enrollment period this spring, the federal government announced Tuesday.

People who lack insurance were given an extra month and a half to buy coverage through the federal marketplace to avoid next year’s penalty, which will rise to at least $325 a person.

This year is the first time that ObamaCare’s individual mandate penalty goes into effect.

Republicans Scramble for Obamacare Alternative

The Hill: “About one month before the Supreme Court’s ruling on ObamaCare subsidies, Republican lawmakers are all over the map about what to do about the millions of people who could lose them.”

“Republicans have widely agreed they need a plan if the high court strikes down a subsidies next month. But the GOP does not agree about how to help people who’d lose access to healthcare — and even whether to help them at all.”

“’There is one view that Congress can leave the subsidies in place for a short period of time until there are alternative solutions available,’ Rep. Bill Flores (R-Texas), chair of the conservative Republican Study Committee, said.”

“There’s another view that says, ‘Look, this problem was created by the way the Democrats wrote the law. Why should Republicans suddenly wind up with ownership over that problem?’”

Rep. Bruce Poliquin (R-Maine) argued “If [the subsidies] are ruled unlawful, it will be incumbent upon Congress to help create a thoughtful free market replacement for ObamaCare, and an off-ramp for the six million individuals who have in good faith purchased ObamaCare policies.”