In Defense of Obamacare’s High Deductibles

Megan McArdle comes to the defense of the high deductibles of the exchange policies that most people are buying.

“Health-care wonks have started to see health insurance less as a way to ensure health, and more as a way to avoid financial disaster. (As one health-care economist told me … Insurance is a financial product, and what it does really well is give people financial protection.) In other words, the alternative to buying health insurance may not be ‘dying young’; it may be bankruptcy, or at least, a trashed credit report after you’ve negotiated settlements on all your medical bills.”

“It’s not Obamacare’s fault that it didn’t manage to do the impossible: provide cheap, nearly comprehensive health-care coverage without ballooning the deficit. No other reform could have done it either, without tackling provider prices — and no politically feasible reform could have tackled provider prices, because America’s 12 million health-care workers would have been marching on Washington with pitchforks, or at least running tear-jerking ads to great popular effect.”

“You can’t really blame Obamacare for the fact that the most ‘affordable’ insurance offers rather scanty coverage for the average user. Though of course, you can blame the law’s architects for overpromising. They should have been more honest, with themselves and with voters, about the limits of what they could actually do. But of course if they had been, the law probably would never have passed.”


Medicare Premiums to Increase by 16% not 52%, as Initially Projected

According to the most recent Kaiser Family Foundation newsletter, as a result of the recently enacted budget deal in Congress, “the 2016 Medicare Part B monthly premium will be $121.80, increasing by 16 percent over the 2015 amount—far lower than the increase initially projected by the Medicare actuaries, a new brief from the Kaiser Family Foundation explains. The Part B premium increase will affect 3 in 10 Medicare beneficiaries. The remaining 7 in 10 beneficiaries will pay the same $104.90 monthly premium in 2016 as they paid in 2015, thanks to protections in Social Security law that exempt them from the increase.”

Figure 1: Medicare Part B Monthly Premiums, 2015-2016

“The brief describes how the Medicare Part B premium and deductible are affected for 2016 by the Bipartisan Budget Act of 2015, including a new $3 per month fee for some beneficiaries to offset federal spending. It also lays out the connection between the Medicare Part B premium, the Social Security COLA, and the so-called ‘hold-harmless’ provision, and why, without the change in law, Medicare premiums would have increased by 52 percent for the 30 percent of beneficiaries not protected by the hold-harmless provision.”

Despite Bad Politics, GOP States Are Sticking With Medicaid Expansion

Washington Post: “Republican-led states that expanded Medicaid are sticking with the change, despite qualms and intense political pressure within the GOP about embracing a key part of President Obama’s health-care law.”

“GOP governors and legislators have balked at repealing expansion partly because of the benefit of providing federally funded health insurance to large numbers of constituents, analysts say.”

“They also wish to keep the billions of dollars of federal funds that … gives states that broaden Medicaid.”

“Of the 10 states in which Republican governors expanded Medicaid, none has backed out in the face of frequent efforts by GOP legislators to reverse the decision.

“’Once you step over the threshold and have tens or hundreds of thousands of people getting coverage, it’s very hard to go backward, which is why for opponents it’s a battle to the death to make sure it doesn’t happen in the first place,’ said Sara Rosenbaum, a professor of health law and policy at George Washington University.”

Uninsured Rate Hits a Record Low

The Hill: “The uninsured rate has fallen to a new low of 9 percent, marking 16.3 million more people with health insurance since ObamaCare’s coverage expansion took effect in 2013, according to data released Thursday.”

“The survey from the Centers for Disease Control and Prevention (CDC) finds that the uninsured rate was 9 percent in the first six months of the year, corresponding to 28.5 million people, ticking down from 9.2 percent in the first three months of the year.”

“But those changes seem major when compared to previous years. The 9 percent figure is down from 11.5 percent uninsured in 2014 and 14.4 percent in 2013.”

“That corresponds to 7.5 million more people with insurance compared to 2014 and 16.3 million more compared to 2013.”

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Americans Most Satisfied With Government Health Plans

Gallup: “Americans’ satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance, Medicare and Medicaid, and is lower among those with employer-paid and self-paid insurance. Americans with no health insurance are least satisfied of all.”

Satisfaction With the U.S. Health System Varies by Insurance Type

“Americans who get their health insurance through government-sponsored or assisted plans, such as Medicare and Medicaid or veterans insurance, are more likely to be satisfied with the way the healthcare system is working for them than those who have employer-paid insurance or who pay for insurance themselves. There may be a number of reasons for this, such as government plans being more inclusive and having a lower direct cost to the insured person than employer plans or personally paid-for plans. Additionally, the question asks about healthcare generally, and not cost specifically. Therefore, other aspects of the government plans such as access to more specialists, the availability of different services or ease of scheduling appointments may also factor into the higher satisfaction levels.”

Bevin Already Hedging His Obamacare Repeal Pledge

Politico: “Matt Bevin won the Kentucky governorship on a vow to dismantle Obamacare, but the obstacles he faces rolling back a law that covers nearly one in 10 Kentuckians offers a preview of the struggles that a Republican president would face living up to a ‘repeal and replace’ pledge in 2017.”

“Even before the votes were cast, Bevin had started hedging his repeal bet, saying he would not take coverage away from people who have it. He can give the health law in his state a more conservative veneer. But he can’t scrap it completely.”

“And if he tries to scale back Medicaid too much, he could crash into another complication: an obscure 1966 state law that requires the state to draw on all the federal dollars available for Medicaid. Advocates say any move to leave federal dollars untapped would likely lead to a lawsuit. The federal government is fully funding expansion through 2016, and will pay at least 90 percent in future years.”

“’The ultimate lesson here … is that because so many people have gained coverage already through the Affordable Care Act that legislation is a whole lot more resilient than the rhetoric you hear from its opponents.’”

Could an Upset in Kentucky Herald a Rollback for Obamacare?

Modern Healthcare: “Kentucky’s status as a one of the few Southern states to embrace the coverage expansions of the Affordable Care Act was thrown into question Tuesday with the election of Republican Matt Bevin to succeed Democrat Steve Beshear.”

“The Obama administration has hailed Kentucky’s success at extending health benefits to more residents under the Affordable Care Act. The number of uninsured in the state dropped from 20% in 2013 to about 9% this year.”

Matt Ford in The Atlantic: “The impact on health care in the Bluegrass State would be significant if both programs are reversed. About 400,000 Kentuckians qualified under the ACA’s Medicaid expansion, according to the Huffington Post, and another 100,000 received health insurance through KYnect.”

“Kentucky would be the first state to reverse the expansion after its acceptance. Bevin’s success (or failure) could herald the next wave of political battles to be fought over the implementation of President Obama’s signature domestic legislative achievement.”

Modern Healthcare: “Bevin may face some opposition, however, if he moves to eliminated the programs. In a recent poll, fewer than a quarter of respondents were in favor rolling back the healthcare programs and more than half were opposed.”

Despite Rise in Premiums, Obamacare Enrollees Plan to Keep Coverage

Morning Consult: “Premiums are slated to rise steeply next year for health plans across the board.  Yet almost half of voters who have health coverage under Obamacare say they will keep their current plan through 2016, according to a new Morning Consult online poll.”

“The findings could be a worrying sign for the Obama administration, which is urging people who buy their insurance on state or federal exchanges to shop around for new plans to avoid premium increases. But the results could also be seen as a positive sign for Obamacare, generally. Half of enrollees are satisfied with their current plan and another one-third are comfortable enough with the online exchanges to look for cheaper coverage, as intended.”

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“There has also been a significant drop in the number of voters who plan to visit an Obamacare exchange website this enrollment season. The new poll found that only 24 percent of respondents said they plan to visit an exchange site within the next few months … In Nov. 2013, 65 percent of respondents said they planned to visit or a state online exchange during the first enrollment season.”

Montana Becomes 30th State to Expand Medicaid Under Obamacare

Talking Points Memo: Federal officials Monday approved Montana’s application to expand Medicaid under Obamacare, the AP reported.

“‘This agreement will bring much needed access to health care coverage to more than 70,000 low-income Montanans,’ said Health and Human Service Secretary Sylvia Burwell said in a statement. ‘The administration looks forward to working with other states to expand Medicaid by designing programs that meet state’s needs while providing needed services to residents and significant economic benefits to states.’”

A Startling Rise in Death Rates for Middle-Aged Whites

Wall Street Journal: “White, middle-aged Americans are dying at a rising rate, a new study shows, a startling reversal that suggests addiction and mental-health issues are setting back decades of gains in longevity.”

“Suicide, alcohol abuse, drug overdoses and chronic liver diseases largely drove the rise, which occurred between 1999 and 2013, according to the report published Monday in the Proceedings of the National Academy of Sciences. Those causes of death offset declines in other major drivers of mortality in midlife, such as lung cancer, the study said.”

“No other rich country has seen a similar reversal, and the trend is at odds with falling death rates for black and Hispanic Americans in that age group over the same period.”

“The authors warned that by the time white people in this age group are eligible for Medicare they could be in worse health than the current elderly population. That means they could require more expensive care.”

Majority of Uninsured Are in Red States

Margot Sanger-Katz: “Two years into Obamacare, clear regional patterns are emerging about who has health insurance in America and who still doesn’t.”

“The remaining uninsured are primarily in the South and the Southwest. They tend to be poor. They tend to live in Republican-leaning states. The rates of people without insurance in the Northeast and the upper Midwest have fallen into the single digits since the Affordable Care Act’s main provisions kicked in. But in many parts of the country, obtaining health insurance is still a problem for many Americans.”

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“Politics matters. Though several states with Republican leadership have expanded their Medicaid programs, many have not. Over all, Republican-leaning states continue to have more uninsured people than Democratic-leaning ones. But they also tended to have many more uninsured people at the start.”

What Are Americans’ Health Care Priorities?

Kaiser Family Foundation: “This month’s Kaiser Health Tracking Poll finds that the affordability of prescription drugs continues to be at the top of the public’s priority list for the President and Congress, with ‘making sure that high-cost drugs are affordable to those who need them’ and ‘government action to lower prescription drug prices’ picked as top priorities by majorities across political parties. Issues specific to the ACA, such as repealing provisions of the law or repealing the law entirely, fall much lower on the list. For example, while the public generally opposes the Cadillac tax, a provision of the health care law that has received a lot of attention recently, relatively few (30 percent) say it should be a top priority.”

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Most Uninsured Are Unaware of When Open Enrollment Begins

National Journal: “Only about 15 per­cent of un­in­sured Amer­ic­ans—and 17 per­cent of the gen­er­al pub­lic—know when open en­roll­ment be­gins, des­pite health in­sur­ance mar­ket­places kick­ing off the third open sea­son this Sunday, ac­cord­ing to the Oc­to­ber Kais­er Health Track­ing Poll.”

Figure 15

“Earli­er this month, the Health and Hu­man Ser­vices De­part­ment an­nounced that it an­ti­cip­ated 10 mil­lion Amer­ic­ans will likely have cov­er­age and pay their premi­ums by the end of 2016—a mod­est es­tim­ate that in­cluded 2.8 to 3.9 mil­lion un­in­sured in­di­vidu­als. HHS noted those without in­sur­ance may be harder to reach since it’s the third go-around for open en­roll­ment, and the Kais­er Fam­ily Found­a­tion poll sheds light on just how dif­fi­cult the task may be.”

“Out of those who are un­in­sured, roughly 2 in 10 have been con­tac­ted about the Af­ford­able Care Act in the past six months. About 51 per­cent of those without health in­sur­ance haven’t had cov­er­age for at least two years. Yet those sur­veyed in­dic­ated a will­ing­ness to sign up for cov­er­age; al­most half, when asked if they plan to get in­sur­ance in the next few months, said yes, ac­cord­ing to the poll, which in­ter­viewed 1,203 adults from Oct. 14-20.”