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The Republicans’ “visceral” opposition to fixing ObamaCare [Updated]

Robert Laszewski–an astute observer of health care policy and no fan of ObamaCare–had a post on Monday about the recently proposed Republican alternative to the Affordable Care Act. He writes:

The problem for Republicans is that they have such a visceral response to the term “Obamacare” that they just can’t bring themselves to fix it. The notion that Obamacare might be fixed and allowed to continue as part of an Obama legacy and as a Democratic accomplishment is something they can’t get past.

Bingo. Since November 4, 2008, about the only thing that has united Republicans, aside from cutting taxes for the wealthiest Americans, has been their unrelenting desire to deny President Obama any accomplishment, regardless of the consequences. And exhibit number one is the Affordable Care Act.

This strategy of cynical obstruction originated as early as the transition period leading up to Obama’s inauguration on January 20, 2009. In Michael Grunwald’s book, The New New Deal, he quotes Joe Biden as saying, “I spoke to seven different Republican Senators, who said, `Joe, I’m not going to be able to help you on anything.” “The way it was characterized to me was: `For the next two years, we can’t let you succeed in anything. That’s our ticket to coming back.’” As former senator George Voinovich confirmed to Grunwald, “If [Obama] was for it, we had to be against it. [Mitch McConnell] wanted everyone to hold the fort. All he cared about was making sure Obama could never have a clean victory.”

Then there was the Republican strategy session on the night of the inauguration, in which they agreed to “show united and unyielding opposition to the president’s economic policies,” as well as other objectives designed simply to hurt the president and congressional Democrats. And of course, shortly before 2010 mid-term elections, Mitch McConnell famously stated, “The single most important thing we want to achieve is for President Obama to be a one-term president.”

So it’s been orchestrated obstruction, solely for political gain. There has never been a spirit of cooperation and compromise among Republicans since President Obama was elected. Nevertheless, a stimulus plan was enacted. Financial reforms were signed into law. Health care reform did happen. And President Obama was re-elected to a second term in 2012. What did Republicans get in exchange? The lowest approval ratings in the history of such ratings, and the indignity of repudiating the very things they once supported. Oh, they did win back the House in 2010, which lead to such smart ideas as repeatedly holding the American debt hostage to one silly demand after another. On the whole, it’s been a dismal performance.

My favorite Republican throughout this process was Senator Chuck Grassley, whose hypocrisy was stunningly comical. A member of the “gang of six” that was supposedly negotiating a bi-partisan health care solution in the summer of 2009, he was an unequivocal supporter of the individual mandate going all the way back to legislation he co-sponsored in the 1990s. (Yes, it was a Republican idea in the first place.) Then in September he suddenly disavowed his own long-held positions, completely undermining his own credibility.

All of this brings us to Robert Laszewski’s article about the Republicans’ current predicament vis-a-vie health care. “My sense is that most independent voters––the ones that matter in an election-year––don’t want Obamacare repealed; they want it fixed.”

Bingo again. But as Laszewski writes, Republicans have driven themselves into a ditch because of their unwavering insistence on repealing ObamaCare and starting over.

There is a problem with that strategy. Have you heard the one about, “If you like your health insurance you can keep it?”

It is now 2014. The Affordable Care Act is law. The Republican alternative would mean taking lots of things away the Democrats will quickly pounce on:

Medicaid Expansion – The Republican alternative would “not expand” Medicaid––presumably rolling back the Medicaid expansion in each of the 24 states that have expanded it. By year-end, millions of Americans will have gained coverage. Who wants to tell these people now on Medicaid the Republican alternative only contemplates covering pregnant women, low-income children, and low-income families at the old levels? Twenty-four states that would see benefit cuts equates to 48 U.S. Senators.

Insurance Subsidies – The Republican alternative would offer health insurance premium subsidies for people up to 300% of the poverty level. Far fewer people than expected are buying Obamacare but that number will be well into the millions before long. Obamacare offers subsidies up to 400% of the poverty level meaning that lots of people would lose their subsidies––and they would be the voters who are solidly middle-class.

The Tax Exclusion for Employer-Based Health Insurance – There is no health insurance policy so sacred in America as the one a worker gets from their employer. The Republican alternative would cap the tax exclusion, currently at 100% of whatever the employer gives the worker and their family for health insurance, at 65% of the cost of the “average” cost of a policy. Democrats will quickly jump on this as a huge middle class tax increase and an attempt to undermine employer-based health insurance.

Lower Premiums for Older People – A controversial part of Obamacare was its requirement that older people can’t be charged more than three times the premium of the youngest. That contributed to the rate shock that hit many people in the small group and individual market when Obamacare policies had to comply. Republicans would take people through the same political nightmare once again but in reverse this time. Their plan would cap rating differences at 5:1, thereby forcing older peoples’ premiums up, and younger peoples’ premiums down. Older people tend to vote more often. Ironically, they have also been the ones who so far have more often bought an Obamacare compliant policy.

The Prohibition of Pre-Existing Condition Provisions – As of January 1, 2014, there is no such thing in America any longer. But Republicans would bring the provision back if people did not maintain continuous coverage. That sounds fair. But what happens when someone is forced to drop their expensive coverage when they lose their job for a few months and the Republican tax credits don’t give them enough help maintaining it? Democrats will be able to think of lots of scenarios where a family playing by the rules has no choice but to drop coverage and face pre-existing condition provisions once again.

Each of these Republican proposals is credible and constructive and should be part of any discussion over how to move forward with health insurance reform.

Look, no one thinks the Affordable Care Act was perfect. It was an historic step toward health care reform, but any reform of this magnitude consists of trade-offs and potential missteps. Eventually, improvements are going to be made and trade-offs tweaked. But Republicans have painted themselves into a corner. For years, they’ve insisted that nothing will do other than a full repeal of ObamaCare and a return to the previous status quo. That becomes more infeasible with every passing day. Eventually they’ll be seen as the ones proposing radical disruption as opposed to the Democrats proposing sensible improvements.

Republicans will insist that ObamaCare can’t be fixed and we must start over, “but tell that to the older people who Democrats will be quick to remind will be paying more, the middle class people who would get their health insurance subsidies cut, and the 160 million people who get their health insurance––which they really like––through employer-based plans and will see their taxes go up.”

Ah, the irony. After years of being the party entirely dedicated to obstructing, it will be fascinating to see how Republicans become the party of doing. That is, if they can muster the courage.

[Update]

Jonathan Chait has a similar take in his column today. His conclusion:

Once it was no longer useful as a weapon to stop universal health insurance, the Republican health-care plan had to be abandoned. This was the fate of every Republican health-care plan, a durable pattern I call the Heritage Uncertainty Principle. Republican health-care proposals reside in a state of quasi-existence, and any attempt to summon them into political reality will cause them to disappear. Their purpose is to refute the accusation that Republicans lack a health-care plan. The elusive quasi-plan allows them to claim all the potential benefits of health-care reform without having to defend any drawbacks. The game offers Republicans advantages they are unlikely to forfeit for the rest of the Obama era.

The rapidly approaching dilemma for Republicans is that the endgame of preserving the status quo no longer helps them. Their posture always served the endpoint of preventing the creation of a national health-insurance plan. Whenever Republicans gain political power, they’ll inherit a system that confers rights upon the previously uninsured. Pretending to care about the uninsured won’t get them anywhere. They may have the votes to change the health-care system, but they’ll be forced to reckon with its effects in an actual way, not as a hypothetical they can engage with or ignore as it suits them. The game has been changed. And, as the disintegration of the latest GOP health-care plan shows, the Republican Party is not yet remotely prepared to play it.

 
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Posted by on February 6, 2014 in Current Events, Health Care, Politics, President Obama

 

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An Update on Earlier Stories

An update on a couple of stories from the past week…

You will recall the story about the “next Fox News Obamacare poster victim,” Dianne Barrette. She was the woman who received a notice from her insurance company that her health care insurance premium was going up by a factor of ten, which was made an issue by CBS News. She did make it onto the Greta Van Susteren show on Fox, but by then her story was rapidly deflating, leaving Van Susteren with an awkward interview. Sadly, Ms. Barrette didn’t pass the this-is-a-good-story-for-Fox-News test, so her planned subsequent network appearances were canceled.

Meanwhile, a number of actual reporters followed up on her story, and now Ms. Barrette has changed her tune. Aside from the fact that her so-called insurance is not what most people would even consider to be insurance, she can get coverage via the exchanges for as little as about $100 a month — about $50 more than she pays for her non-insurance.

Jonathan Cohn goes into considerably more detail about Ms. Barrette’s options, including the types of trade-offs people face when weighing various health care options. He summarizes:

Even so, Barrette’s take is a reminder that people can have a longer-view perspective about medical bills than pundits frequently assume. When I gave her a broad description of the plans available, she seemed interested. I noted that she’d be paying $100 or $150 extra a month for policies that still had high cost-sharing, so that she would still be a lot of money out of her own pocket. (I also made very clear that I’m not an insurance agent or broker—that, when she finally goes shopping for insurance, she should talk to a real expert for advice.) Here was her response: “I would jump at it,” she said. “With my age, things can happen. I don’t want to have bills that could make me bankrupt. I don’t want to lose my house.”

Barrette can’t be sure until she sees the numbers for herself. And so far she hasn’t been able to do so, thanks to the technological problems at healthcare.gov. But as she’s become more aware of her options, she said, she’s no longer aghast at losing her plan—and curious to see what alternatives are available. “Maybe,” she told me, “it’s a blessing in disguise.”

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Saturday’s Tweet Of The Day was about the the propensity of Rand Paul and/or his staff to plagiarize the work of others in his writing and speeches. Having this pointed out has made Rand angry. He wishes he could challenge people like Rachel Maddow to a duel. Meanwhile, the instances of plagiarism continue to pile up.

Today, the New York Times published an article after interviewing Paul, who “offered a mix of contrition and defiance. He said that he was not certain whether it would affect his prospects should he decide to run for president in 2016 — he said he would happily return to his Kentucky doctor’s practice — and he asserted that he was being unfairly targeted.” Promising that “that there would be an office ‘restructuring’ to prevent future occurrences,” he told the Times:

“What we are going to do from here forward, if it will make people leave me the hell alone, is we’re going to do them like college papers,” he said. “We’re going to try to put out footnotes. We’re going to have them available. If people want to request the footnoted version, we’re going to have it available.”

This comes on the heels of him whining on “This Week” that “I think I’m being unfairly targeted by a bunch of hacks and haters.”

Meanwhile, The Washington Times has ended Paul’s weekly column. “We expect our columnists to submit original work and to properly attribute material, and we appreciate that the senator and his staff have taken responsibility for an oversight in one column,” Times Editor John Solomon said.

I’ve got a deal for you, Rand. How about if we leave you the hell alone and you leave us the hell alone.

 

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Bills I Wish Would Become Law

So in the middle of September, Michigan Gov. Rick Snyder signed into law Medicaid expansion for his state–the third state to expand Medicaid per the Affordable Care Act that is led by by both a Republican governor and legislature. It is estimated that the expansion will cover up to 470,000 Michiganders, providing them with access to primary care instead of depending on emergency room visits.

“This is about the health of fellow Michiganders,” Snyder said at the time. “The right answer is not to talk about politics, but to talk about our family of 10 million people.”

But that didn’t stop Republicans in the Michigan senate from getting petty and forcing a delay in the implementation such their nearly half a million fellow Michiganders will have to wait until April for the measure to go into effect.

This week, a couple of Democrats introduced House Bill 5114. It reads in full:

A bill to amend 2011 PA 152, entitled “Publicly funded health insurance contribution act,” (MCL 15.561 to 15.569) by adding section 7a.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

Sec. 7a. Until medicaid benefits in this state are extended as provided in section 105d of the social welfare act, 1939 PA 280, MCL 400.105d, state funds shall not be expended to provide health benefits to members of this state’s legislature, the governor, or the lieutenant governor.

Gotta love it. As Electablog reports,

I can’t find one thing wrong with this other than it penalizes the good lawmakers who voted FOR immediate effect on Medicaid expansion. The rest of them can suffer right along with all the working poor who they are forcing to wait for six months before they could obtain health coverage. It would serve them right.

Not that it’ll ever see the light of day, of course.

 
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Posted by on November 1, 2013 in Current Events, Health Care, Politics

 

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The Next Fox News ObamaCare Poster Victim [Updated]

Look for Dianne Barrette to be splashed across the screens of every Fox News show in the coming days. She’s the woman from Winter Haven, Fla. who appeared on CBS today (yes, dirty, liberal mainstream media!), complaining that her insurance is going up by ten times.

From the transcript:

Last month, [Barrette] received a letter from Blue Cross/Blue Shield informing her as of January 2014, she would lose her current plan. Barrette pays $54 a month. The new plan she’s being offered would run $591 a month, ten times more than what she currently pays. “What I have right now is what I’m happy with, and I just want to know why I can’t keep what I have. Why do I have to be forced into something else?” [says Barrette]

Sure enough, I happened to hear about five minutes of the Sean Hannity radio show today and naturally, he’s now repeating the canard, “Insurance rates are rising by ten times!” with no context–a Hannity specialty.

As with the know-nothings who appeared on Hannity’s television show last week, a diligent reporter followed up; in this case, Erik Wemple. As Wemple writes:

More coverage may provide a deeper understanding of the ins and outs of Barrette’s situation: Her current health insurance plan, she says, doesn’t cover “extended hospital stays; it’s not designed for that,” says Barrette. Well, does it cover any hospitalization? “Outpatient only,” responds Barrette. Nor does it cover ambulance service and some prenatal care. On the other hand, says Barrette, it does cover “most of my generic drugs that I need” and there’s a $50 co-pay for doctors’ appointments. “It’s all I could afford right now,” says Barrette.

In sum, it’s a pray-that-you-don’t-really-get-sick “plan.” When asked if she ever required hospitalization, Barrette says she did. It happened when she was employed by Raytheon, which provided “excellent benefits.” Ever since she left the company and started working as an independent contractor, “I haven’t been hospitalized since then, thank God.” Hospitalization is among the core requirements for health-care plans under Obamacare.

As Wemple notes, Ms. Barrette’s current coverage doesn’t cover hospital stays at all; even a short stay could well bankrupt her under her current insurance.

But let’s look a little further. From Wemple’s article, we know the county Ms. Barrette lives in (Polk County), her age (56) and her income (about $30,000 annually). That’s enough to go shopping for health insurance for her. According the results at healthcare.gov, she could get a catastrophic plan for $235 per month, a bronze plan for $327, and a silver plan for $371. All of these are cheaper than the $591 she claims her new insurance would cost her.

Furthermore, she is eligible for subsidies because her annual income is less than $46,000. Plugging in her data into the Kaiser Family Foundation Subsidy Calculator, we find that, yes indeed, she is eligible for a subsidy. That Silver plan would actually cost her $209 per month, a Bronze plan $97 per month. The Silver plan would pay 70% of her health care costs (the Bronze plan, 60%), and her maximum out-of-pocket would be $6350. She’s not likely to go bankrupt with either plan if her appendix bursts.

Listening to Hannity today, these subtleties are completely lost in favor of repeating the headline, “Under ObamaCare rates are increasing by as much as ten times!” I don’t expect much better from Fox News.

UPDATE: An article at DailyKos has more details about Ms. Barrette’s current plan:

We can see from the video that Dianne Barrette has “GoBlue plan 91”. This is a ‘limited benefit’ plan. It is widely understood that these plans are not replacments for comprehensive health insurance plans, and it’s easy to see why. If Ms. Barrette incurs $30,000 worth of medical care, the plan will pay somewhere between $50 and $500 depending on the services. There are two things you get from these plans: a provider to negotiate down rates for you, and a small amount covered by the insurer themselves. You can see the supporting documentation for this plan here:

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Posted by on October 28, 2013 in Current Events, Health Care, Politics

 

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Lovin’ Me Some ObamaCare

In a previous post, Cluster wrote:

Now don’t get me wrong, if the ACA would have increased competition and allowed me to shop from a cafeteria menu of coverages and policies at lower premiums and reasonable deductibles – I would be for that. But that would have been a free market approach. As it is, the ACA is a Statist approach, so choices will fewer and costs will be higher. At least for most of us.

I wonder if Cluster has actually investigated coverage on ObamaCare.

I am currently semi-retired, meaning I work 20 hours a week. A nice thing about this is that I retain all of my employer-provided benefits, including health care. (And you thought all employers were cutting out health care for their part-timers, didn’t you. :-)) Of course, I’ve been thinking of retiring completely for a while.

One of the biggest concerns related to retiring early is health care. Typically, an early corporate retiree will go on COBRA in order to continue their company-provided health care coverage for as long as possible. The retiree enjoys the exact same health care he had as an employee, but must pay all of the costs, including the portion that was previously paid by the employer. In my case, the monthly cost to continue health care via COBRA would be $907 per month. (This is the cost to cover myself only.)

COBRA lasts a maximum of 18 months. Once COBRA eligibility is used up, a retiree younger than age 65 must seek out health care on the individual market. Prior to ObamaCare, this was a somewhat daunting task filled with unknowns. The problem was that in California, where I live, insurance companies were under no obligation to provide individual insurance, regardless of costs. People in their fifties and early sixties are exactly the kinds of people that insurers avoided on the individual market. For example, the Kaiser Permanente website explained,

“[T]hese plans [individual and family coverage] do go through medical review and those with serious pre-existing health conditions are often denied. The only automatic denial stated by Kaiser underwriters is current pregnancy, but those with serious health conditions such as cancer, HIV, heart problems, obesity, etc. are often denied. If denied, your only chance of getting healthcare coverage may be to find employment (for you or your spouse) that offers a group medical plan or to apply for Medicare or Medi-Cal.”

It’s hard to reach the age of 55 or 60 without some history that would be deemed a pre-existing condition. And most retirees need to consider both their own health as well as that of their spouse.

Acknowledging the uncertainty of the individual market for retirees, my company has for the past several years offered a retiree health care plan through Aetna for retiring employees 55 years of age or older. The main selling point of the plan is that there is no medical underwriting. All retiring employees are accepted regardless of their current health status or their history.

The cost of the Aetna plan is $1538 per month with an annual deductible of $3950 and maximum out of pocket of $6250 in-network, $10,000 out-of-network. After the deductible has been paid, I would then generally pay 20% of the services provided, though for some services I would pay 40%. This is just to cover myself. Sounds like a good deal, doesn’t it?

Now we have ObamaCare. I live in California, which set up its own exchange, Covered California. I went to coveredca.com and checked out the plans. Several insurance companies offer them; There are 26 plans available to someone my age living in my area. The most expensive coverage is a Platimum 90 plan. No deductible at all. Maximum out of pocket of $4000. $20-$40 copay, though no copay for preventative care. (Aetna would charge me 40% for preventative care.) I can get a Platinum 90 plan for $785 per month–about half the cost of the Aetna plan. This is sounding pretty good.

But let’s look for a plan with similar characteristics to the Aetna one. That would roughly be a Bronze 60 plan with a deductible of $5000 and maximum out-of-pocket of $6350. I can get one of those for as little as $464 per month. All of these plans have the same main selling point of that Aetna one–no one can be denied coverage. They just cost a lot less. I’m liking this. A lot.

Now let’s look at Cluster’s situation. I happen to know in which state and county Cluster lives. That state chose not to set up its own exchange, so I shopped for Cluster plans on healthcare.gov. Assuming Cluster is age 50 or over, there are 119 plans available available to him, ranging in price from $178 to $567 per month. What were you saying about competition, Cluster?

There are a lot of choices, but Cluster could get a Platinum plan with $20/$40 co-pays and a deductible of $2000 for $348 per month. A Bronze plan can be had for $237 a month. These prices assume that Cluster would not qualify for any subsidies. Only Cluster could tell us how that compares to his current plan, but as a Californian, I’m thinking I should move into Cluster’s old house when he leaves the country.

I notice they’ve been making improvements to healthcare.gov. A couple of weeks ago, it wasn’t possible to shop for plans without going through the application process. Now you can. It’s actually quite easy and I was able to find 119 plans for Cluster in about a minute.

Apparently, a minute is too long for many people to learn about their options. Instead, they’d rather go on television and demonstrate their ignorance to the rest of us. An example is a recent piece on Sean Hannity’s show about the ObamaCare “train wreck”–his favorite phrase these days. He interviewed six people who recounted their ObamaCare “horror stories,” including tales of “canceled policies, premium hikes, restrictions on the freedom to see a doctor of their choice, financial burdens upon their small businesses and so on.” As journalist Eric Stern put it upon viewing the segment, “none of it smelled right to me.” So he decided to investigate.

It turns out that none of the folks on Hannity’s show had bothered to look into their ObamaCare options. One couple, Paul and Michelle Cox, who own a small business, complained to Hannity that “they can’t grow their construction business and they have kept their employees below a certain number of hours, so that they are part-timers,” all because of ObamaCare. But as Stern points out in his article,

Obamacare has no effect on businesses with 49 employees or less. But in our brief conversation on the phone, Paul revealed that he has only four employees. Why the cutback on his workforce? “Well,” he said, “I haven’t been forced to do so, it’s just that I’ve chosen to do so. I have to deal with increased costs.” What costs? And how, I asked him, is any of it due to Obamacare? There was a long pause, after which he said he’d call me back. He never did.

None of this matters to Hannity, of course, as he depends upon the ignorance of others for a living. And it may not matter to Cluster, as he may well have perfectly fine health care coverage and no need to shop for something different. I wouldn’t look too hard myself, either, if I wasn’t contemplating leaving the corporate cocoon. But hopefully Cluster has, or will, do his own research so that he can come to an informed opinion. I hardly think he’s in the same category as the Hannity know-nothings. As for me? I’m liking what I see.

 
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Posted by on October 26, 2013 in Current Events, Health Care, Politics

 

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The Gipper

50 years later, and still no one has articulated the downside to big government better than the Gipper.

Folks, since 1964 this country has spent over $15 trillion dollars on eradicating poverty and today, the poverty statistics are the same if not a little worse. It was reported not too long ago that 4 out of 5 American families are one missed paycheck away from poverty, yet every year and every campaign, big government politicians, particularly Democrats, run on helping the poor – do you believe them anymore? Do you really think more money will cure the problem? Do you honestly believe they want to solve the problem?

The other day Mersault understandably was frustrated over the VA health care administration, to which I remind everyone that is what government health care is – a bloated, inefficient bureaucracy ran by bureaucrats focused more on file organization and lunch breaks than the administration of care, and that is what we are all in for with Obamacare. No one has ever been able to explain to me how adding an additional layer of bureaucracy to an industry can bring down costs.

Welfare, disability, unemployment and labor force measurements are all at alarming levels, so my question to big government advocates is – how is this working out for you?

 
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Posted by on August 5, 2013 in Big Government

 

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