Obamacare Done Good!

The open enrollment deadline has passed and it looks like about 7 million people have enrolled through the healthcare exchanges set up by the Affordable Care Act.  There was a huge surge in the last days and, in spite of a couple of system shutdowns yesterday, Obamacare appears to have reached it's original (i.e., before the website problems of last October) goal of 7 million signups.

It's bound to be a major topic in the midterm elections.  Up to the end, Republicans have tried to deny the real good that it has done and, in November, they will run on a platform whose centerpiece is to repeal it.  They have nothing else to show for their most recent term.  Well I guess they can say "Hey, we only shutdown the government once!" 

It being April Fool's Day, I thought I'd present a few of the egregious and ridiculous comments recently emitted from the mouths of politicians and political commentators on the subject and then give some facts. 


With 7 million people signed up for Obamacare, Republicans are hard pressed to continue to call it a disastrous failure.   That doesn't stop them from continuing the assault against the Affordable Care Act.  On Sunday, "Sen. John Barrasso (R-Wyo.)...dismissed the White House's recent announcement that Obamacare enrollment had reached more than 6 million people, calling it a meaningless figure. 'I don't think it means anything. ... I think they're cooking the books on this,' said Barrasso on  Fox News Sunday."[Huffington Post, March 30]

Fox News “Medical A-Team” contributor Dr. Manny Alvarez, “explaining” the purpose of the Affordable Care Act: “We did it for nothing. We did it to confuse America. We did it to create a false tax. We did it to create an environment of punitive damages to people that don’t follow what the federal government tells them to do.”
Read more at http://www.newshounds.us/fox_news_outrageous_quote_of_the_week_poll_3_16_14_3_22_14_03242014#7E0Jh72SwkT5Uyq1.99

Fox News “Medical A-Team” contributor Dr. Manny Alvarez, “explaining” the purpose of the Affordable Care Act: “We did it for nothing. We did it to confuse America. We did it to create a false tax. We did it to create an environment of punitive damages to people that don’t follow what the federal government tells them to do.” [Newshounds website, March 24]

No discussion of Republican blathering would be complete without an entry from Michelle Bachmann.  Here's her take on the Administration decision to extend the deadline for people who started but did not complete their applications before midnight March 31.  "Unfortunately, it is the continuation of lawlessness from the administration,” Bachmann told Fox News’s Neil Cavuto on Wednesday. [Daily Kos, March 27]

I guess you notice a theme here.  These inane comments are all from commentary on Fox "News" shows.

Now for some facts.

In addition to the 7 million sign-ups, the ACA provided numerous improvements to health care insurance in our country- including provisions that

• Let young adults stay on their plan until 26
• Stop insurance companies from dropping you when you are sick or if you make an honest mistake on your application
• Prevent against gender discrimination
• Stop insurance companies from making unjustified rate hikes
• Do away with life-time and annual limits
• Give you the right to a rapid appeal of insurance company decisions
• Require all insurers to cover people with pre-existing conditions  
• Require that all non-grandfathered health insurance plans cover preventive services (including yearly check-ups, immunizations, counseling, and screenings) at no out-of-pocket costs 
• Essential health benefits (including emergency care, hospitalization, prescription drugs, maternity, and newborn care) must be included on all non-grandfathered plans with no annual or lifetime dollar limits.

For more information on the Affordable Care Act, see the Obamacare Facts website.

Conservative groups spent millions trying to dissuade people, especially young and healthy people,  from signing up.  The Republican-controlled House of Representatives voted 50 times to repeal it or change it.  Misleading Obamacare horror stories filled the airwaves.  States refused to help people understand the law.  For nearly a month at startup, the healthcare.gov site was basically non-functional.  Still 7 million people cut through the crap thrown at them and applied.  In addition to the health exchange signups, there are millions of working poor who will now qualify for Medicaid thanks to the Medicaid expansion provision of the law.

But still the work for health care coverage is not done.

The main driving force for the ACA was to provide health care coverage for those who could not afford it.  An important provision in achieving this was the Medicaid expansion.  The intent was to cover the gap between Medicaid recipients and those who could still not afford health care insurance even with a subsidy.  State expansion of Medicaid was made voluntary by the Supreme Court in its decision on the constitutionality of the Affordable Care Act.  This decision was a game-changer

Republican governors and state legislatures, for the most part, prevented Medicaid expansion from taking effect in their state.  They did this despite the fact that the Federal government would cover about 93% of the costs for the first nine years of the expansion (2014-2022).  The CBO estimated that if all states expanded Medicaid coverage under the provisions of the ACA, 17 million people would be eligible.  

With many red states refusing to expand Medicaid at this time, between 7 and 8 million people will still not be able to afford health insurance.  States can decide to expand Medicaid at a later date.  Let's hope they do so and that public pressuring such as MoveOn.org's billboard campaign will help bring this about.  For the cost to expansion-denying states will be more than lost Federal dollars.  It will be lives. 

If the Republicans bring up their "death panel" lies again, I suggest we direct them to the January 2014 Harvard Medical School researcher's study: "Opting Out Of Medicaid Expansion: The Health And Financial Impacts."  The study estimates from 7,000 to 17,000 needless deaths per year because of these state decision to keep the working poor uninsured. [Daily Kos, March 30]

So to those GOPer's who want to make Obamacare "the issue" in the mid-terms, I say "Bring it on!"

State Of Obamacare

I've been fortunate . I've been covered by health insurance since the day I was born. To me it seems natural and more necessary than almost any other type of insurance. Why anyone would want to deny this to their fellows is beyond my comprehension. Health care is a right, not a privilege. And don't say that we, the richest nation on the planet, can't afford it. With some adjustments to the military budget and the tax laws, we could have universal health care as does every other advanced industrial nation.

The Patient Protection and Affordable Care Act was a step in the right direction. At the time it was signed into law, nearly 50 million Americans were uninsured - many or most because they could not afford it. Single payer or some public-private mix to get truly universal coverage would have clearly been better. But the ACA is perhaps the most we could have hoped for in light of the rabid opposition to the expansion of access to medical insurance.

It's been a hard road so far. Opponents have successfully hampered its implementation (25 Republican-controlled states decided not to expand Medicaid). The startup of the government website was beset with problems. The confusion over health insurance plans that did not meet the new standards was stunning and people were ill informed to deal with the "we're cancelling your insurance" notices sent out by insurance companies.

And it is not going to get any easier. Massive amounts of money are being spent to defeat vulnerable Democrats who supported the ACA in the upcoming 2014 elections. Since September, just one group, the conservative Americans for Prosperity, has spent $20 million on anti-ACA-supporter TV ads. [NY Times, Jan. 15] There are ongoing ad campaigns aimed at convincing younger, healthier Americans not to sign up. Should they be convinced by this onslaught of negativity, premiums will necessarily go up and the rabid opponents of the ACA, who poured millions into these campaigns will say "I told you so."

Here then are some thoughts on the Affordable Care Act at the start of its first fully operational year.

The healthcare.gov rollout was inexcusably botched... The single most important piece of legislation enacted during Obama's first five years relied on a website whose development appears to have been rushed and that lacked adequate pre-startup testing. This one is on Obama and his staff. All IT projects run into problems and, as red state after red state declared their intentions not to set up state health care exchanges, the writing was on the wall. This website would be overwhelmed. Progressives should be angry with Obama for this lack of oversight. The Affordable Care Act is an acid test of the most distinguishing feature between the political philosophies of the two main political parties: Does government have a role in improving the lives of its ordinary citizens? As the title of the History Channel presentation on the NASA space program says "Failure is not an option." The botched rollout was more than what any red blooded Tea Partier or supporter of the corporate oligarchy and the 1% could have hoped for.

...but things are looking up for the healthcare.gov website. After 400 fixes, the downtime was less than 5% by the end of November and it is even better now. "Ping time" (the round-trip delay time for a computer signal) is down to 15- 50 milliseconds. The site can now handle an estimated 800,000 visits per day.

After the fixes, enrollments surged. The LA Times reported on January 13: "More than 2.1 million Americans signed up for health insurance in the last three months of 2013 through new online marketplaces created by President Obama’s health law, as a December surge in enrollment helped the initiative recover from its disastrous launch." Don't forget that one of those last three months was October which saw very few enrollments. So it appears that ACA is enrolling new customers at a rate of about 1 million per month. And there are 3 million more who "have not yet selected a plan but have filled out applications for coverage on the new insurance marketplaces since Oct. 1 and have been deemed eligible for a plan." Finally, in October and November alone approximately 3.9 million people signed up for Medicaid.  If one of the prime purposes of expanding health insurance coverage is to cover those who could not afford it, this surely has to count as a success.

Cancellation of existing policies provided another black eye for the rollout... I don't think the Administration had a clue as to the extent that insurance companies would choose to cancel policies that did not meet Affordable Care Act standards. Rather than enact the necessary provisions (e.g., coverage for prescriptions, hospitalizations and emergency room care), many insurers chose to cancel the policies.  What could have been done to prevent this from bollixing up the works at the eleventh hour as people went to a malfunctioning website after being told they would no longer have health insurance after the end of the year? Several things come to mind: grandfather policies from say January 1, 2013; a notification period of no less than 6 months that your policy was being cancelled; a clear explanation by the President as to what "if you are happy with your existing policy" actually meant (policies in effect as of March 2010 were "grandfathered") ; and, of course, a fully functioning website.

 

...but Obamacare success stories are getting some press.

The Daily Beast, Oct.23 - "The Obamacare Success Stories: From a retired business owner in Arkansas to a young freelance filmmaker in Hollywood, Eleanor Clift highlights a few of the people the media has found who are happy to have Obamacare."

The Daily Kos, Nov. 4 -"Obamacare 'rate shock' victim changes her mind, calls the law a 'blessing in disguise'

TPM,Nov.25 - looks at how "Kentucky Uninsured React To SecuringHealth Care Coverage Under Obamacare"

TheDaily Kos, Dec. 10 -"What Republicans don't want: Florida woman cries tears of joyafter getting $3.19 Obamacare policy"

The Hill, Dec. 29 - "Five states with ObamaCare success"

The most obvious, but surely not the last attempt to defund, repeal or sabotage the Affordable Care Act was the phony debt-ceiling crisis manufactured last year by Republicans. The government was shutdown by the extremists who control the Republican Party. Though it failed miserably, people have a short memory and Republicans' approval ratings are increasing. There's a well-funded campaign in the run-up to the 2014 elections aimed at defeating Democratic legislators who supported the ACA.

There are the advertisements urging young people to opt out. A Yahoo News November 11 headline of an article reporting the shenanigans at the University of Miami read "Anti-Obamacare group entices students with models and a boozy party." What's the reasoning here? As the Yahoo post explains "You see, in order for the health care law to function, lots of healthy, young people must sign up for the exchanges to subsidize older, sicker insurance seekers. So conservative groups are spending a lot of money to convince them not to sign up." Now this logic should outrage any fair-minded person. The absence of a healthier cohort in a health insurance plan raises the rates for everyone. Expect an all-out blitz on this front in the coming months.

Legal challenges may cripple the legislation yet.   It's not over yet in the courts as several legal challenges wend their way towards the Supreme Court.  As reported in the LA Times "The new suits take aim at the parts of the law that offer subsidies to those who are above the poverty level but still may struggle to pay for insurance." 

The most threatening of these lawsuits borders on nit-picking insanity - whether insurance obtained on the Federal health care exchange (as opposed to State exchanges) is eligible for subsidies.  Wording issues such as this one would usually be ironed out between the Administration and Congress.  But in today's hyper-partisan environment, no cooperation can be expected. If this law suit succeeds, then no state without its own exchange would be able to participate in the Federal subsidies. There are 36 states without their own exchanges. Such a ruling would effectively dismantle the Affordable Care Act in these states.

Now for the good news. On January 15, a Federal District Court judge ruled in favor of the Affordable Care Act.  Reuters reports that the judge "upheld subsidies at the heart of President Barack Obama's healthcare overhaul, rejecting one of the main legal challenges to the policy by conservatives opposed to an expansion of the federal government. A ruling in favor of a lawsuit brought by individuals and businesses in Texas, Kansas, Missouri, Tennessee, West Virginia and Virginia would have crippled the implementation of the law by making health insurance unaffordable for many people.  In his ruling, U.S. District Judge Paul Friedman in Washington D.C. wrote that Congress clearly intended to make the subsidies available nationwide under the 2010 Patient Protection and Affordable Care Act. 'There is evidence throughout the statute of Congress's desire to ensure broad access to affordable health coverage,' the judge wrote." 

The respite might be temporary if the plaintiffs take the case to the Supreme Court. But for now, the greatest legal challenge has been overcome.  Stay tuned.  As a great philosopher once said, "It ain't over 'til it's over."

Other Links

Medicaid expansion is going forward in just half of the states.  If every state agreed, more than 20 million Americans could be insured in the next decade.  Here's a link to the Medicaid expansion webpage on the ObamaCare Facts website.