Republicans Scramble to Assert Their Leadership in Destroying Obamacare

Washington Post: “To be the Republican who sponsors the bill that dismantles a key pillar of Obamacare is worth powerful bragging rights in some circles. So it’s no wonder there would be a little competition to have that honor.”

“A staffer for Rep. Renee Ellmers (R-N.C.) tried to lay claim, sending an e-mail Thursday night to an internal list of GOP staffers that she would be introducing a bill to repeal [Obamacare’s employer mandate.] He hoped their bosses would sign on as co-sponsors.”

“But the next morning, GOP staffers received an e-mail from the office of Rep. Charles Boustany (R-La.), letting them know that, lest there be any confusion, he would be introducing the legislation to repeal the employer mandate, as he had the previous two Congresses.”

“’Given that Congressman Boustany sits on [Ways and Means], which has jurisdiction over this issue, has been a long time champion of this issue, and has already built a coalition of interested stakeholders, we look forward to having your boss join as a cosponsor this Congress,’ the Boustany staffer wrote.”

“That’s passive aggressive Capitol Hill speak for: Hands off my bill, Ellmers.”

Jindal Says Goal Should Not Be Universal Coverage

Greg Sargent reviews Louisiana Gov. Bobby Jindal’s comments to conservatives on the Republican party’s health care policies.

Said Jindal: “I don’t think conservative health care reform is about, we’re going to compete with [the left] in terms of how many people we see have an [insurance] care. That not the ultimate goal.”

He later elaborated: “If we start with the premise that we’ve gotta give every single person a card, and that’s the only way we can be successful, we’re done. We’ve adopted their metric of success…if the metric of success is gonna be which plan can say ‘we’ve given people more cards,’ they always win. Because they will always spend more, they will always disrupt more.”

He also put it this way: “I do think it’s a mistake if we argue we can’t take back what Obama has already given.”

Republican Obamacare Bill Would Increase Deficit and Uninsured Rate

Sarah Kliff: “The Congressional Budget Office analysis plays out the chain reaction that would happen if Obamacare’s definition of a work week moved from 30 hours per week, up to 40.”

“The agency thinks that 1 million fewer people would get health insurance at work.”

“Some of these people would just be out of luck — a bit fewer than 500,000 people, CBO says, would end up uninsured. More would end up on government programs … after losing their employer coverage.”

“As a result, CBO estimates that the federal government would end up spending $53.2 billion more on the Affordable Care Act.”

Matthew Yglesias: “It turns out that the authors of the ACA weren’t idiots. As Yuval Levin explained in a recent National Review item, the 30 hour threshold was established ‘in part to limit the degree to which employers cut worker hours by putting the cut-off well below the number of hours that most workers put in.’ Sherry Glied and Claudia Solis-Rosman have shown that while working slightly more than 40 hours is common, working slightly more than 30 hours is rare. In other words, few workers are at risk of having hours slashed from 31 per week to 29, but many could be cut back from 41 to 39.”

Americans Are Vastly Underestimating Their Future Long-Term Care Needs

Jason Millman: “Americans are strongly underestimating their future needs for long-term care, a potentially costly oversight that could hurt them in their retirement years.”

“A major reason people are too optimistic is that they think their families will take care of them. Almost 75 percent expect their families will provide long-term care, which was about seven times more than those expecting to need a home health agency, nursing facility or assisted living facility, according to the Health Affairs study, which analyzed responses from the 2012 National Health Interview Survey.”

“However, about 37 percent of people over 65 will need at least some facility-based care and 42 percent will need some formal care at home, the earlier Georgetown study found.”

“Attractive long-term care insurance options are sparse. An estimated 7 million to 9 million American adults purchased private long-term care coverage.”

“Meanwhile, Medicare’s nursing home benefit is pretty limited, a surprise to those who may be counting on the seniors’ health care program to provide more comprehensive coverage. “

Over 96% of Vermont Residents are Insured

Rutland Herald: “The rate of Vermonters without health insurance has dipped to 3.7 percent, the second-lowest in the nation, according to figures released Monday by the Shumlin administration.”

“The data is the product of a statewide survey conducted every two years. The new results are the first since the inception of the federal Affordable Care Act and Vermont Health Connect, the online state health insurance marketplace that was the result of the federal law.”

“The main driver for this significant and precipitous drop in Vermont’s uninsured rates is the increased eligibility in Medicaid that was made possible by the Affordable Care Act, and obviously the subsidies that Vermont gives to Medicaid beneficiaries as well as others in the exchange.”

Vermont has moved from a 6.8 percent uninsured rate in 2012 to a 3.7 percent uninsured rate in 2014.

Uninsured Rate Sinks to 12.9%

Gallup: “The uninsured rate among U.S. adults for the fourth quarter of 2014 averaged 12.9%. This is down slightly from 13.4% in the third quarter of 2014 and down significantly from 17.1% a year ago. The uninsured rate has dropped 4.2 percentage points since the Affordable Care Act’s requirement for Americans to have health insurance went into effect one year ago.”


‘The Affordable Care Act has accomplished one of its goals: increasing the percentage of Americans who have health insurance coverage. The uninsured rate as measured by Gallup has dropped 4.2 points since the requirement to have health insurance or pay a fine went into effect. It will likely drop further as plans purchased during the current open enrollment period take effect.”

Reaction to Harvard Professors’ Whining About Obamacare

Megan McArdle: “The deepest irony is, of course, that Harvard professors helped to design Obamacare. And Obamacare is the reason that these changes are probably necessary.”

“Unfortunately, this is what cost-control actually looks like, which is to say, like people not being able to spend as much on health care.”

“Instead, they persist in our mass delusion: that there is some magic pot of money in the health-care system, which can be painlessly tapped to provide universal coverage without dislocating any of the generous arrangements that insured people currently enjoy. Just as there are no leprechauns, there is no free money at the end of the rainbow.”

Jonathan Chait notes that “the reforms currently roiling the Harvard faculty are moderate versions of the reforms conservatives themselves not only have championed but continue to champion.”

“Indeed, Harvard’s reforms show that in some ways, Obamacare has pushed the health-care system moderately in the direction conservatives favor, by encouraging employers to shift more of the cost of care onto employees.”

“The Harvard story demonstrates two things. First, Obamacare is implementing some versions of conservative ideas. Second, even moderate versions of this reform tend to upset consumers.”

Harvard Faculty in Uproar Over Health Care Fixes

“For years, Harvard’s experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost. But those remedies will now be applied to the Harvard faculty, and the professors are in an uproar,” the New York Times reports.

“Members of the Faculty of Arts and Sciences, the heart of the 378-year-old university, voted overwhelmingly in November to oppose changes that would require them and thousands of other Harvard employees to pay more for health care. The university says the increases are in part a result of the Obama administration’s Affordable Care Act, which many Harvard professors championed.”

“The faculty vote came too late to stop the cost increases from taking effect this month, and the anger on campus remains focused on questions that are agitating many workplaces: How should the burden of health costs be shared by employers and employees? If employees have to bear more of the cost, will they skimp on medically necessary care, curtail the use of less valuable services, or both?”

How Obamacare Fell Short

Malcolm Gladwell reviews Steven Brill’s new book, America’s Bitter Pill: Money, Politics, Back-Room Deals, and the Fight to Fix Our Broken Healthcare System.

“Brill’s intention is to point out how and why Obamacare fell short of true reform. It did heroic work in broadening coverage and redistributing wealth from the haves to the have-nots. But, Brill says, it didn’t really restrain costs. It left incentives fundamentally misaligned. We needed major surgery. What we got was a Band-Aid.”

“At the end of America’s Bitter Pill, Brill offers his own solution to the health-care crisis. He wants the big regional health-care systems that dominate many metropolitan areas to expand their reach and to assume the function of insuring patients as well… A system like this, Brill estimates, based on a few back-of-the-envelope calculations, could slice twenty per cent off the private-sector health-care bill.”

“It’s at moments like this that Brill’s book becomes problematic. The idea he is describing is called integrated managed care. It has been around for more than half a century—most notably in the form of the Kaiser Permanente Group. Almost ten million Americans are insured through Kaiser, treated by Kaiser doctors, and admitted to Kaiser hospitals. Yet Brill has almost nothing to say about Kaiser, aside from a brief, dismissive mention. It’s as if someone were to write a book about how America really needs a high-end electric-car company that sells its products online without being the least curious about Tesla Motors.”

Obamacare on Track to Hit 2015 Goals

National Journal: “Obamacare is easily on track to beat the administration’s enrollment targets, with more than 6 million people already signed up for coverage.”

“Health and Human Services Secretary Sylvia Mathews Burwell said … that 6.4 million people have either selected new plans or automatically renewed their coverage through the law’s federally run insurance exchanges.”

“That total encompasses just the first month of Obamacare’s second open-enrollment period, which runs through Feb. 15. It doesn’t include sign-ups from state-run exchanges. With those states included, the total would be considerably higher.”

“The figures indicate that the administration is likely to hit its goal covering 9 million to 10 million people, total, in 2015.”

Don’t Get Your Medical Advice from TV

A new British Medical Journal report examined the health claims showcased on randomly selected episodes of the two most popular internationally syndicated health talk shows, The Dr Oz Show and The Doctors.

Vox: “They identified 479 recommendations from The Dr Oz Show and 445 recommendations from The Doctors, finding that on average, each episode contained about a dozen bits of health wisdom. By randomly selecting the episodes, instead of cherry picking the worst offenders, their findings give us a true picture of the quality of the health claims that are being made.”

“And what they found was disappointing but not exactly surprising: about half of the health recommendations had either no evidence behind them or they actually contradicted what the best-available science tells us. That means about half of what these TV doctors say to their millions of satellite patients is woo, and potentially harmful and wasteful woo at that.”


Medicaid Rolls Surge Under Obamacare

Margot Sanger-Katz: “In Idaho, the number of people who signed up for Medicaid has jumped by 13.4 percent. In Georgia, it’s up 12.9 percent. In North Carolina, the rate has climbed 12.4 percent. None of those states opted to expand their Medicaid programs as part of the Affordable Care Act, but all have seen substantial enrollment increases in state health insurance.”

“The explanation for the change is a phenomenon sometimes called the woodwork effect or the “welcome mat effect.” I’ve written about the idea before: Essentially, people who were always eligible for a public program will often enroll when there’s publicity about an expansion. That’s what appears to have happened with the Affordable Care Act. Even though state policy wasn’t changing everywhere, all the talk about new health insurance options and the resources devoted to helping people sign up led to a surge among people who had always been eligible for the program.”

“Altogether, enrollment in the nonexpansion group of states has increased by 6.8 percent, or about 1.5 million people.”

Number of Uninsured Americans Near Historic Low

“New federal government data shows the percentage of Americans without health insurance was at or near historic lows this year following the roll-out of the Affordable Care Act, and appears certain to fall to record levels next year,” Time reports.

“The data released Thursday from the National Center for Health Statistics’ National Health Interview Survey found that 11.3 percent of Americans were without coverage in the second quarter of 2014, down from 13.1 percent in the first quarter and 14.4 percent throughout 2014. An analysis by the White House Council of Economic Advisers finds the drop in the uninsured to be the largest in nearly five decades, amounting to roughly 9.7 million Americans getting insurance, consistent with other Affordable Care Act estimates.”

“The new data does not include the nearly 2.5 million who have already selected coverage in the latest round of open enrollment which began last month, or the 400,000 who’ve gained coverage in Medicaid or the Children’s Health Insurance Program from September to October, according to new data from the Centers for Medicare & Medicaid Services, as more states expand access to the program with federal money under the law.”