Health

3 Signs That Healthcare.gov is Working

The National Journal lists the three indicators that prove Healthcare.gov is really working:

  1. Republicans have mostly stopped attacking the website: House Republican talking points shared with National Journal … barely touches on the website.
  2. Democrats have calmed down: The White House has moved into sales mode on the health care law, while the Democratic Congressional Campaign Committee and others have transitioned—if tepidly at first—into offense.
  3. The media has started to move on: In mid-November, the Washington media narrative was entirely dominated by problems with the website … Since the website relaunch Sunday, coverage has been more diverse … and more nuanced when it comes to Obamacare.

Young Invincibles Disapprove of Obamacare

One of Obamacare’s key target groups – the ‘young invincibles’ – remains “skeptical of the healthcare reform law,” according to The Hill.

“A poll released Wednesday by Harvard University’s Institute of Politics found that more than half of 18- to 29-year-olds disapprove of ObamaCare and believe it will raise their healthcare costs.”

“Insurance coverage of any kind remains a tough sell for people in their twenties, many of whom are eligible to stay on their parents’ plans through age 26.”

“Critics have long charged the Affordable Care Act is a dramatic transfer of resources to older people, and many young people might not see enrollment as being in their financial interest.”

“The architects of the healthcare law had hoped that the individual mandate, which requires most people in the country to either obtain insurance or pay a fine by 2014, would help avoid the ‘death spiral.'” Many young people are choosing to simply pay the low first-year penalty of $95.

“Supporters and opponents of the healthcare law have long seen the enrollment of young people as a central battleground, and both sides are laying the groundwork for an ad war.”

The Biggest Legal Challenges to Obamacare

The Wire outlines the biggest legal challenges to Obamacare:

Federal exchange states aren’t eligible for tax subsidies: Because the Affordable Care Act only specifically mentions subsidies for exchanges “established by the state,” the federal exchange can’t grant subsidies.

Tax laws should be introduced in the House, not the Senate: The argument was that Obamacare violated the Origination Clause of the Constitution, which says that bills for raising revenue have to originate in the House and basically piggy backs off the conservative talking point that Obamacare is a tax, not a law.

Contraceptives coverage defies religious freedom: The contraceptives mandate doesn’t make or break the law, but it’s a blow to women and women’s rights activists.

If religious employers are exempt, nonprofits like schools should be as well: The University of Notre Dame re-submitted a lawsuit over Obamacare that was originally rejected in January.

Obama might be “rewriting his own law”: Technically this isn’t a legal case, but the House Judiciary Committee will review those arguments, as well as the legal case against subsidies.

Obamacare May Finally Cut Health-Care Costs

James Surowiecki makes a convincing argument that Obamacare is helping to usher in “deeper structural changes in the health-care system” that ultimately will control costs for all.

“Hospitals and doctors have typically been paid on a fee-for-service basis … Insured patients have paid only a small fraction of the cost of their care, and insurers have just passed costs along to their customers. Employers and the government, meanwhile, have been left to foot the bill.”

Said investor Jason Yeung: “What we’re moving toward instead is a world in which everybody in the system is sharing financial risk … And therefore everybody has an incentive to control costs.”

“The Affordable Care Act is also helping hold down costs by changing incentives for hospitals and doctors.”

“What all these initiatives have in common is the idea that health-care providers are going to be paid based on the value they deliver, rather than on the services they perform.”

More Good News for Obamacare

According to the National Journal, “a new report released by the Centers for Medicare and Medicaid Services Tuesday shows that more than 1.46 million people were determined in October to be eligible to enroll in Medicaid or the Children’s Health Insurance Program.”

The good news: “In states that are expanding Medicaid, applications jumped 15.5 percent.”

And the better news: An increase in Medicaid applications even in states that are not expanding Medicaid. “Applications to Medicaid and CHIP agencies increased 4.1 percent in October over the previous few months.”

Enrollment Surges on HealthCare.gov

About 29,000 people signed up for health insurance through HealthCare.gov on Sunday and Monday — a figure that surpasses the total for the whole month of October, an official familiar with the program told Politico.

“The preliminary numbers for the two-day period provide the clearest evidence yet that the federal exchange is on the mend. About 26,000 people selected a health plan during the October and about 100,000 people did so in November.”

Young Americans Least Familiar With Obamacare

According to a new Gallup poll, “Americans younger than 30, a key group targeted by the Affordable Care Act, continue to be the least familiar with it. Another important group, those with lower incomes, are less familiar with the healthcare law than are those with higher incomes.”

“Republicans across the country are significantly more familiar with it than are Democrats. This could reflect the desire among those who are most emotionally opposed to the law to know more about it, or underlying differences in attention to news across party groups.”

“Those who are familiar with the healthcare law are significantly more likely to oppose it [(40% approving; 59% disapproving)] than those who are not familiar with it.”

“Those who are unfamiliar with the law are evenly divided, with 41% approving and 43% disapproving.”

One in Four Uninsured Prepared to Pay Fine

According to a new Gallup poll, “a substantial minority [of Americans], currently 28%, say they are more likely to pay the government fine imposed for not having insurance. The percentage planning to pay the fine has changed little in the last month, even as the 2014 deadline for having insurance draws nearer.”

“Importantly, the percentage planning to pay the fine is not skewed toward younger uninsured Americans — 26% of the uninsured under age 30 say they are more likely to pay the fine, compared with 30% of those aged 30 and older.”

“The biggest differences appear by party identification — 45% of uninsured Republicans plan to pay the fine, compared with 31% of independents and 15% of Democrats.”

Implications: “The biggest challenge to achieving universal coverage … may not be in making Americans aware of the requirement or in getting younger uninsured Americans to sign up. Rather, it may be getting those likely to oppose the law, namely Republicans, to overcome their ideological opposition to the law and sign up for insurance.”

Five Key Questions on Obamacare's Future

Sean Sullivan lists the five biggest political questions for the next phase of the Obamacare battle:

  1. Can Obama be an effective advocate for his law anymore? Obama knows he needs to regain the public’s trust and good will gradually. It’s not going to happen overnight.
  2. Will the Republicans stay out of their own way? If the Web site problems fade from the forefront, the policy discussion will dominate once again. The question then becomes whether conservatives will restart their crusade to repeal the law.
  3. Will congressional Democrats begin to fall in line or move further away from the law? What the White House needs is a unified party with a consistent message regarding the health-care law. That’s not what they have now.
  4. Will enrollment bolster the Democratic case or the Republican one? [Low enrollment numbers] will fuel Republican arguments that the law is a disaster. [High numbers] will bolster the administration’s case that people want the new coverage options. Young people in particular are a crucial demographic.
  5. Will the GOP embrace an alternative? The fact that [House Speaker John] Boehner isn’t committing to [a GOP alternative] right now suggests the GOP believes its best play is to keep the focus on the Affordable Care Act.

Is it Fair to Compare Healthcare.gov With Amazon.com?

Acknowledging that one way to assess Healthcare.gov’s progress is to compare its performance to commercial websites, Jonathan Cohn provides “two very important caveats”:

One is an acknowledgment of the huge, fundamental difference between what the two types of systems must do. Innovative companies like Amazon are … still engaging consumers, producers and retailers in a series of relatively straightforward transactions. And they are using technology that, for the most part, has been around for a long time.”

“Healthcare.gov, by contrast, must perform a whole series of complex transactions [and] communicate with multiple government agencies, at both the federal and state levels, as well as private insurers.”

Two: “If we’re going to compare the process of buying health insurance at healthcare.gov to the process of buying books at Amazon, we should also compare it to the process of buying health insurance before Obamacare came along … Without the law’s requirements on essential health benefits and simple use of metal tiers to describe plan generosity, there was always the risk of buying plans with major gaps in coverage—the kind that only relatively sophisticated consumers understood to check.”

Obama Links Obamacare With Economic Security

Selecting one of the poorest Washington D.C. neighborhoods to deliver today’s speech, President Obama intends to highlight income inequality and wage stagnation as a threat to this nation’s economic security.

The White House statement: “President Obama will discuss the twin challenges of growing income inequality and shrinking economic mobility and how they pose a fundamental threat to the American dream, [and he will detail] the steps … taken to help reverse these trends, restore mobility and increase economic security for every American, including the economic benefits of the Affordable Care Act.”

The New York Times: “After being on the defensive for weeks about the health care program’s malfunctioning website and his own faulty promises, Mr. Obama previewed his economic case for the Affordable Care Act.”

Obama: “For too long, few things left working families more vulnerable to the anxieties and insecurities of today’s economy than a broken health care system … Now that the website is working for the vast majority of people, we need to make sure that folks refocus on what’s at stake here, which is the capacity for you or your families to be able to have the security of decent health insurance at a reasonable cost.”

Latest Obamacare Stats Are Positive

Sarah Kliff gives us the latest on Obamacare:

  • “There were 1 million visitors to HealthCare.gov Monday, [and] 380,000 visitors as of noon today,” a slight increase from Monday’s 375,000 visitors.
  • “Approximately 13,000 shoppers Monday ended up in the queuing system,”  with 60% choosing to return to Healthcare.gov.
  • “Still no 834 error rate,” despite the “Washington Post’s report this morning that approximately one-third of the 834s sent so far had errors.” Medicare spokeswoman, Julie Bataille, replied, “I can tell you that does not reflect an accurate picture of what is happening right now…we’ve made tremendous progress and will certainly work to fix any standing issues.”

On the Obamacare To-Do List

TPM provides a list of Obamacare ‘to-do’ items:

  • Fix the Back-end of Healthcare.gov: These could be big problems if they persist, leaving people thinking they’ve enrolled in coverage when they haven’t.
  • Roll Out the Spanish Language Version: Latinos make up a significant portion of the country’s uninsured [and] are among the President’s most dedicated demographic groups.
  • Get the Small-Business Marketplace Ready for 2015: More than 20 million uninsured people are part of the small business community.
  • Prepare to Enforce the Employer Mandate in 2015: A million fewer people will be covered through their employer because of the delay and the government will lose $12 million in revenue, mostly because it won’t be collecting a penalty from companies that don’t comply.
  • Start Getting the Word Out: The public relations side of Obamacare has been notably muted since the disastrous Oct. 1 launch

The Next Thing to Worry About with Obamacare

Now that technical glitches are being addressed, Matthew O’Brien gives us a few more Obamacare worries to add to the list of concerns:

“We’ve moved on from asking whether anyone will even be able to sign up for Obamacare. Now the concern is whether people will actually get the plans they sign up for.”

“The administration has fixed most of Healthcare.gov’s front-end problems, so people can pick a plan. But it hasn’t fixed all of the back-end problems, so insurers can know who has picked what plan. That customer data isn’t always getting through.”

If the last month has taught us anything, it’s that the administration will probably jury-rig some kind of back-end fix that’s just good enough to work … Then the concern will be …whether enough healthy people will buy insurance to keep premiums from spiraling up and up. And we probably won’t know that until open enrollment ends in March, since healthier people tend to procrastinate when it comes to buying coverage.”