America’s Flawed Health System

Ezra Klein: “Americans like to think their health-care system is number one. But a 2014 report from the Commonwealth Fund compared it with 10 other developed nations and found it’s … number 11.”


“Critics of these kinds of studies often argue they miss the point. America may not be where you want to pay a hospital bill or try and buy health insurance, but if you do have health insurance, it’s where you want to get treated if you get very sick.”

“At the Upshot, Carroll runs through a new study looking at cancer mortality in the US and 20 Western European countries. America looks good — if incredibly, insanely expensive — on breast cancer, prostate cancer, and colorectal cancer. But America looks terrible on lung cancer, melanoma, and cervical cancer — all cancers, incidentally, where prevention can have a huge impact, and do so at fairly low cost.”

“This speaks to a larger issue that the American health-care debate doesn’t quite know how to handle: the deficiencies of the health-care system matter, but they’re not the main reason Americans, or anyone else, gets sick. For the most part, health happens outside the walls of hospitals. For all the attention the medical system gets, improving it probably isn’t the fastest or most direct way to improve people’s health.”

A Disconnect Between Republicans and Americans Over Obamacare

Greg Sargent in the Washington Post comments on the new Kaiser Family Foundation poll that shows a positive edge for Obamacare.

“That’s the first time the law has been in positive territory since the last presidential election. More to the point, it’s the first time the law has been in positive territory since implementation of the law began and it suffered hideous roll-out problems, followed by months and months of GOP hyping of every Obamacare horror story Republicans could find (or invent).”

“Perhaps most interesting is the fact that the Kaiser poll demonstrates that GOP priorities for the future of the law are very different from those of Americans overall and independents.”

“The poll finds that 74 percent of Republicans want the law repealed or scaled back. By contrast, 46 percent of Americans overall want to move forward with implementation of it or expand it, versus 41 percent who want it scaled back or repealed. Independents are evenly split.”

“The poll also finds that one of the top priorities for Republican voters is repeal of the individual mandate. 52 percent of Republicans view this as a top priority; only 37 percent of Americans, and the same percentage of independents, agree.”

The Critical Question for the Election: It’s About Obamacare

David Frum: “’Will you take away my health insurance?’”

“That question does not get asked often at Republican presidential forums. Yet it will be the most decisive question in the 2016 presidential election.”

“Obamacare skeptics may disparage [its] benefits as inefficient, counter-productive, and excessively costly. Fine. Those who receive them won’t cherish them any less. The mortgage interest deduction is not exactly a model of economic rationality. Try taking it away. Go ahead. Try.”

“Unless the Supreme Court strikes down subsidies in the federal exchange in the pending case of King v. Burwell, ACA insurance subsidies are paid everywhere in the country … Eligibility for subsidy is concentrated in the red states … Some Republican-leaning voters will feel the hit—and especially in a tightly balanced state like Florida, that hit could have real consequences.”

“For those economically stressed toss-up voters—for the younger voters who sometimes show up and sometimes vote—the tipping point issue won’t be foreign policy. It won’t be ethics. It won’t be healthcare. It won’t even be the overall performance of the economy, which will be better, but still unwonderful. It will be that single haunting question, ‘Will I lose my insurance?’”

“If they don’t hear a clear and convincing ‘No,’ they’re going to assume the answer is ‘Yes’—and most likely, vote accordingly.”

Obamacare is Finally Popular

National Journal: “More Americans like Obamacare than dislike it for the first time since 2012, according to a Kaiser Family Foundation poll released Tuesday morning.”

“But the gap isn’t large—43 percent see it favorably versus 42 percent unfavorably—and it falls within the survey’s margin of sampling error.”

“Opinion still is sharply divided by party, with 70 percents of Democrats viewing the law favorably and 75 percent of Republicans viewing it unfavorably. Independents fall in the middle; 42 percent like it and 46 percent don’t.”

Kaiser: “The public continues to be divided about what they would like to see Congress do next with the law. Just under half want Congress to either expand what the law does (24 percent) or continue implementing it as is (22 percent), while about 4 in 10 want to see Congress either scale back the law (12 percent) or repeal it entirely (29 percent). These shares have remained constant for nearly six months.”

Obamacare Signups Reach 68,000 During Extra Period

The Hill: “More than 68,000 people have signed up for healthcare during ObamaCare’s extra enrollment period so far this year, the federal government announced Monday.”

“Lack of awareness about the ObamaCare penalty has been a major problem for the administration: A survey of uninsured people earlier this year found that about half of people knew nothing or little about ObamaCare’s penalties.”

“The 2014 fee amounts to $95 a person or 1 percent of household income. Next year’s fee will rise to $325 per person or 2 percent of household income.”

Americans: Give Obamacare Time to Work

Bloomberg: “It may come as news to Republican presidential candidate Ted Cruz, but a majority of Americans is not, in his words, dreaming of ‘repealing every word of Obamacare.’”

“Fifty-one percent of U.S. adults say that while the Affordable Care Act may still require small changes, ‘we should see how it works,’ according to a new Bloomberg Politics poll. Twelve percent said President Barack Obama’s signature legislative accomplishment should be left alone, 35 percent said it should be repealed, and two percent said they weren’t sure.”


Waffling on GOP Obamacare Repeal Tactics

Wall Street Journal: “Republicans in control of Congress have a special tool they can use to push legislation to President Barack Obama’s desk with a simple Senate majority. But they are divided on whether to use it on a repeal of the Affordable Care Act.”

“Such legislation would almost certainly be vetoed by Mr. Obama, so some Republicans believe using the legislative maneuver, known as reconciliation, would waste a good opportunity to achieve other budget goals.”

Some “Republicans said it would violate their campaign pledges to not at least send a repeal of the health law to Mr. Obama’s desk. House Republicans have voted repeatedly to repeal the law, but the Senate hasn’t voted on a stand-alone measure just repealing the ACA.”

“The health law can be addressed under reconciliation because it changes spending, revenue or the federal debt limit. Each of those topics can be addressed just once under reconciliation for each budget cycle.”

“Senate Republican Conference Chairman John Thune (R., S.D.) said repealing the health law was still the ‘leading contender’ for how Republicans plan to use reconciliation. Alternatives have included a tax overhaul, but top Republicans on the tax-writing committees have said they would rather try to find bipartisan support for a tax rewrite that Mr. Obama could sign.”

Is Obamacare the Reason for the Dramatic Decline in Health Care Costs?

Derek Thompson in The Atlantic asks whether “healthcare growth is—temporarily? permanently?—slowing down.”

“After a roller-coaster ride through the last quarter of the 20th century, healthcare inflation looks like it’s pumping the brakes to park near the 2 percent line, the lowest mark since the year Medicare and Medicaid were signed into law: 1965.’

‘With slowly growing prices, even rising demand for healthcare has led to less-than-projected spending, in just about every category … Six years ago, the Urban Institute projected that the country would spend $23 trillion between 2014 and 2019. After Obamacare became law, it raised its forecast by half-a-trillion dollars. But the latest projections, published this month, are lighter by $2 trillion and $2.5 trillion, respectively.”

What’s going on exactly? Just about everybody agrees that the answer is “the recession and …” followed by a smattering of variables, such as cost control measures in Obamacare, the rise of high-deductible plans, and reforms undertaken by doctors and insurance companies, independently, to curb over-treatment.

Uninsured Rate Plummets in States That Expanded Medicaid

The Hill: “The number of people lacking health insurance dropped by half in the 29 states that expanded Medicaid under ObamaCare, far more than states that did not agree to the expansion, according to new data.”

“While all states saw major increases in coverage under ObamaCare, the biggest differences were seen in states that accepted federal dollars to expand eligibility for Medicaid, according to new figures from the Urban Institute’s Health Reform Monitoring Survey.”

“The drop in the uninsured rate was about 30 percent in the 31 states that did not expand Medicaid eligibility. Nearly 93 percent of people have insurance in the 29 states that have expanded Medicaid eligibility, the figures show. That compares to about 86 percent of people with insurance in states that have refused the expansion.”

“The data shows that the nation’s uninsured rate has continued to plummet so far this year, with just one in 10 people now lacking coverage.”

Conservatives Backpedal on Obamacare

Jonathan Chait responds to Cliff Asness’ op-ed in the Wall Street Journal in which he tries “to retrench on behalf of the doomsayers.”

“Asness is absolutely right that it was completely obvious that Obamacare would substantially increase insurance coverage. We know this because the same system — regulated insurance plus subsidies plus mandate — was tried in Massachusetts, and lots of people signed up. But Asness is wrong about whether it was in dispute. Despite the blithering obviousness of the fact that Obamacare would bring about a major decline in people lacking insurance, lots of conservatives denied that it would happen. I rounded up a handful of examples the other day, though plenty more can be found.”

“People deny obvious cause-and-effect relationships all the time. People even deny that the massive release of heat-trapping gasses into the atmosphere will trap more heat — people like Cliff Asness.”

Will Obamacare Ever Match Medicare’s Bipartisan Popularity?

National Journal: “Nearly 50 years ago, President Lyndon B. Johnson enacted Medicare and Medicaid amidst passionate opposition to the program that has since become widely ingrained in the fabric of society.”

“The hope for liberals: that the shift in perspective on Medicare foreshadows a shift to eventual popularity for Obamacare.”

“Both the Social Security Amendments—creating Medicare and Medicaid—and the Affordable Care Act created political controversy, and both were passed by large majorities of Democrats in Congress after landslide elections … And both took a long time to fully implement.”

“Both were even debated along party lines, although many Republicans ended up voting in favor of the final Medicare bill, viewing it as a lost cause.”

“On the other hand, perhaps because they were vastly outnumbered, Republicans never seriously talked about repealing Medicare. The program also had a very identifiable group of beneficiaries, while Obamacare targets diffuse populations … And there were no significant court cases brought against Medicare, whereas five years after Obamacare’s passage it awaits yet another Supreme Court decision on the legality of key aspects of the law.”

“Medicare and Medicaid were adopted, to some extent, in a bipartisan way, because the parties were much less aligned along the ideological spectrum the way they are now.”

“That meant the programs’ flaws could be fixed legislatively. Today, there’s little chance of that happening, and solutions instead must come administratively or from the courts.”

Highest Obamacare Enrollment in Rubio’s Backyard

CNN: “During his presidential campaign announcement, Florida Sen. Marco Rubio came out swinging with a punch list that included the popular Republican mantra to ‘repeal and replace Obamacare.’ But the Department of Health and Human Services had already thrown a punch of its own earlier in April.”

“HHS released its updated list of enrollments by zip code and it turns out the top 15 are in Rubio’s backyard – Miami-Dade and Broward counties. In fact, the second highest zip code in the country is 33126, which lies just blocks from the City of West Miami, where Rubio got his political start. That area saw 11,222 people sign-up for the healthcare benefits, in the enrollment period ending in February.”

“That’s roughly 4,000 less than the top Obamacare zip code in the United States, 33012, which is in the heart of Hialeah, a Republican stronghold.”

Will It Ever Be Called ‘ClintonCare?’

National Journal: “Clinton has been openly enthusiastic about [Obamacare] in the weeks leading up to her announcement.”

“She singled out the congressional Republican budget’s repeal of Obamacare for criticism in March 17 comments on Twitter … ‘Our nation’s future—jobs & economic growth—depends on investments made today. The GOP budget fails Americans on these principles … Repeal of the ACA would let insurers write their own rules again, and wipe out coverage for 16 million Americans.'”

“Clinton has run toward the law with arms open. Last year, she urged Democratic congressional candidates to campaign on it.”

Philip Bump analyzes the latest Gallup poll of uninsured Americans, concluding that those gaining coverage are the “Democratic base.” Bump predicts that supporting Obamacare could be an asset for the 2016 elections.

“Polling shows that opposition to the bill fluctuates within a narrow range. It spiked last summer, but in March of this year was only two points higher than approval. It’s important to the Republican base that will vote in primaries, but it doesn’t seem to be getting much more unpopular.”

“The key for any Democrat … is turnout … Whoever ends up being the Republican candidate will likely have pledged at some point to repeal Obamacare — allowing whoever ends up being the Democratic nominee (whoever that might be!) to say, ‘Vote for me or else.'”

The message: “Go vote for the Democrat or risk losing their health-care coverage.”