Browsing the archives for the Health Care category.


New Bullshit Anti-Obamacare Court Decision

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Health Care

When I first saw this headline I felt genuine panic — Court Rules That Subsidies in Obamacare’s Federal Exchange are Illegal, Dealing Huge Legal Blow to Health Law. That’s the headline at Hit & Run, where the Koch-funded libertarians probably are doing cartwheels around their desks. You can look it up if you want to read it.

Here’s the story on Talking Points Memo. The two Republican judges on the three-panel D.C. Circuit Court of Appeals decided that the state insurance exchanges run by the federal government may not offer subsidies, or the tax credits offered by the IRS. The one Democrat called this bullshit.

“This case is about Appellants’ not-so-veiled attempt to gut the Patient Protection and Affordable Care Act,” Edwards wrote in his dissenting opinion. He called said the majority’s reading of the statute amounts to “a poison pill to the insurance markets in the States that did not elect to create their own Exchanges. This surely is not what Congress intended.”

My initial panic was mollified somewhat by the realization this decision does not affect the New York exchange, which is run (somewhat clumsily) by New York. Still, it’s a hell of a mess, and it’s not clear to me if this will go into effect immediately. If so, a lot of people are about to lose the insurance they’ve had for less than a year.

The White House is going to ask the full panel to rule on the decision, which could possibly reverse it.

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Health Care Makes People Healthier! Who Knew?

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Health Care, Obama Administration

A study published in the Annals of Internal Medicine yesterday said that after the 2006 “Romneycare” law went into effect in Massachusetts, mortality rates in Massachusetts dropped by about 3 percent.

The study tallied deaths in Massachusetts from 2001 to 2010 and found that the mortality rate — the number of deaths per 100,000 people — fell by about 3 percent in the four years after the law went into effect. The decline was steepest in counties with the highest proportions of poor and previously uninsured people. In contrast, the mortality rate in a control group of counties similar to Massachusetts in other states was largely unchanged.

A national 3 percent decline in mortality among adults under 65 would mean about 17,000 fewer deaths a year.

There have been a number of estimates of how many people die in the U.S. every year because they lack insurance. I think that’s a hard thing to quantify, and some people (Megan McCardle, actually) denied that access to health care made any difference to mortality rates at all, based on some standard McCardle-style reasoning that makes sense only if you don’t think about it.

The estimates have ranged from a low of 18,000 deaths per year to a high of 45,000 (analysis here), and the new study comes closer to supporting the lower figure. However, I postulate that the effects might be larger in poorer states, especially over a longer period of time (the study only covered 2006-2010). I believe Massachusetts already had lower mortality rates than much of the rest of the country, mostly because it is more affluent overall. Also, it’s going to take a few years before the effects of long years of neglect fade away. But they’re not going to fade so much in “Medicaid gap” states.

See also interesting comments from The Incidental Economist.

Meanwhile Gallup reports that the percentage of uninsured Americans has dropped to the lowest point since they began measuring the percentage of uninsured Americans.

Also meanwhile, some whackjob Republican is comparing Obamacare to the Holocaust. And a majority of Americans still think Obamacare is a failure.

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The Evil Rich

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Health Care

In some states, the poor have been avoiding “Obamacare” because of the political stigma:

Health professionals, state officials, social workers, insurance agents and others trying to make the law work for uninsured Americans say the partisan divisions and attack ads have depressed participation in some places. They say the law has been stigmatized for many who could benefit from it, especially in conservative states like West Virginia that have the poorest, most medically underserved populations but where President Obama and his signature initiative are hugely unpopular.

These are also states with the most competitive Senate and House midterm election campaigns, so the right-wing super PACs have poured millions into advertisements demonizing the ACA and the Democrats who support it. As a result, the poor have been convinced that Obamacare is evil on steroids.

Other problems stymied the introduction of the law, notably the initially dysfunctional federal website. But the political polarization “complicates our efforts to enroll people and to educate people about the Affordable Care Act, there’s no question,” said Perry Bryant, head of the advocacy group West Virginians for Affordable Health Care, based in Charleston, the capital.

“Literally, people thought there would be chips embedded in their bodies if they signed up for Obamacare,” Mr. Bryant said.

Far to the east, at a branch of the Shenandoah Valley Medical System in Martinsburg, Sara R. Koontz, a social worker, said she had heard people express fears about chip implants as well as “death panels” as she sought to enroll uninsured residents. Some told her that they would rather pay a penalty than sign up for insurance, she said, and even people who did enroll paused in their excitement to ask, “Wait — this isn’t that Obamacare, is it?”

The wealthy people spending money to discourage people from getting health insurance get great health care, I’m sure.

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The Real Death Panels

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Health Care, Obama Administration

Health and Human Services Secretary Kathleen Sebelius resigned yesterday, which the Right heralds as a sign of victory. Some guy at the Federalist already is salivating over the grand fight they’re going to have nominating her replacement –

In any case, it appears that this resignation presents Republicans with a golden opportunity to reignite their crusade against Obamacare with Sylvia Burwell’s nomination as a proxy for all the problems with the law. Burwell is a political loyalist and a veteran of the shutdown fight with no record on health care, and will likely be coached to avoid answering questions about specific challenges with implementation at HHS. Senate Republicans actually have an advantage here in the wake of the Nuclear Option’s implementation: they can easily come up with a list of facts they claim the administration has hidden, details kicked aside, statutes ignored, and a host of other challenging questions on accountability over the implementation (and non-implementation) of the law. A list of every question Sebelius has dodged over the past several years would suffice. By demanding answers before the HHS nomination moves forward and refusing to rubber stamp the president’s pick, Republicans could force more vulnerable Democrats to take a vote that ties them both to the Nuclear Option and Obamacare six months before a critical election.

I understand Rachel Maddow was bothered that the resignation stepped on a week of good news about the ACA. But by November, it may not matter. I do not think most folks give a hoo-haw about the nuclear option, and who knows what public opinion of the ACA will be by November? If Republicans grandstand overmuch over the nomination hearings, they risk overplaying their hand, as they are prone to do.

Krugman writes,

When it comes to health reform, Republicans suffer from delusions of disaster. They know, just know, that the Affordable Care Act is doomed to utter failure, so failure is what they see, never mind the facts on the ground.

Thus, on Tuesday, Mitch McConnell, the Senate minority leader, dismissed the push for pay equity as an attempt to “change the subject from the nightmare of Obamacare”; on the same day, the nonpartisan RAND Corporation released a study estimating “a net gain of 9.3 million in the number of American adults with health insurance coverage from September 2013 to mid-March 2014.” Some nightmare. And the overall gain, including children and those who signed up during the late-March enrollment surge, must be considerably larger.

However, we still have the huge injustice of the refusal to expand Medicaid.

What’s amazing about this wave of rejection is that it appears to be motivated by pure spite. The federal government is prepared to pay for Medicaid expansion, so it would cost the states nothing, and would, in fact, provide an inflow of dollars. The health economist Jonathan Gruber, one of the principal architects of health reform — and normally a very mild-mannered guy — recently summed it up: The Medicaid-rejection states “are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.” Indeed.

And while supposed Obamacare horror stories keep on turning out to be false, it’s already quite easy to find examples of people who died because their states refused to expand Medicaid. According to one recent study, the death toll from Medicaid rejection is likely to run between 7,000 and 17,000 Americans each year.

There’s your death panels, folks. They’re called “Republican governors.”

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Silver Linings

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Health Care

Among other things I’m still messing around trying to get a cheaper health insurance policy through the New York exchange. In December I gave up and paid my old premium for January. (I did finally get a notice from New York about my eligibility, dated December 26, advising me to be sure and sign up by December 23.)

Since I do qualify for a subsidy, there are four or five plans that would save me considerable money on premiums, and I’ve calculated I would still come out ahead even if I end up paying all of the deductible. And if I don’t need much medical care this year I could come out way ahead. Only one of them lists my doctor as a provider, though, and I just need to get hold of someone at my doctor’s office to confirm they are in that network. And no one’s ever there when I call. It’s always something. I’ve got to sign up by tomorrow, I understand, to be covered in February.

There’s still a lot of bitching and moaning about Obamacare in the headlines. Jonathan Cohn writes that the actual enrollment data isn’t that bad.

Ed Kilgore summarizes,

The long-awaited breakdown on the age of young enrollees (defined as under 34) came in at 24%, not catastrophic but well below the target of 40%. But as Cohn points out, the Massachusetts precedent showed that young-uns tend to enroll in this kind of scheme quite late, so let’s wait a while before panicking over the age mix.

Cohn also notes that about 79% of enrollees are qualifying for premium tax credits, a.k.a. purchasing subsidies, which is very much in line with CBO predictions.

The real news to me in his post is which of the coverage levels is proving to be most popular. For 60% of enrollees, it’s the “silver plans,” which are distinguished by protection from really large out-of-pocket costs. Health reforms of all varieties should take notice of that (particularly conservatives who think shifting more health purchasing from insurance to self-payment is the key to controlling costs).

The silver plans are the ones you can get with a subsidy, so that’s probably accounts for a lot of their popularity.

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Forward on Obamacare

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Health Care, Obama Administration

In mid-December I was able to make a not-too-rough calculation of what my net income was in 2013, and with that information I got on the New York health insurance exchange website to see what I could get. Granted, the site was getting slammed by then, but beside being slow it was also confusing and badly thought out, I believe.

At one point I had absolutely no idea how to proceed and had to call the help phone number, which turned into its own adventure. At one point I was on hold for 45 minutes, then a real person answered. But she couldn’t hear me and hung up.

I left a message for New York to call me back. The next day I got a call back with a recorded message to stay on the line for the next available representative. Then the call disconnected.

When I finally did get to the page showing my options, I learned I was eligible for a decent subsidy, and with that there are a couple of plans that have considerably lower premiums than what I am paying now. But the website gave me few details, and when I tried to find my doctor in the companies’ networks I got zero.

I have a decent insurance policy that is inexpensive by New York standards, but it’s still a challenge to pay for it. But I decided to pay the old premium one more time so that I’m covered for January and try to make a decision when I have more information. I have since determined that my doctor is indeed in the network of at least one of the companies, so this may be a good deal for me. The new policy would have a higher deductible than my old one, and I have to work out if the difference in premiums would still be a good deal if I have to pay all the deductible, and I haven’t gotten to that yet. But I have hope.

I bring this up because I think there must be a huge backlog of people who are either still stymied by the system or who haven’t even tried because they’ve heard it doesn’t work. I’m pretty comfortable with the Web, you know, so if I had trouble navigating the New York website there must have been a lot of people who were completely defeated. A shame.

Jonathan Cohn writes that the rate of enrollment has picked up dramatically, but it’s still short of Obama Administration projections. “While lower-than-predicted enrollment could be a sign consumers don’t like the new policies, they could also represent the lingering effects of the site’s technical problems,” he says.

I’m betting it’s more the latter than the former, although it’s possible a lot of people thought they were going to get free insurance and were unpleasantly surprised when they learned they had to pay something. (Support single payer!)

And we know now that 5 million people have fallen into the “wingnut hole” — they are eligible for Medicaid but can’t get it because they live in wingnut states.

There is speculation whether someday, before the Apocalypse, Republicans will accept that Obamacare is here to stay and perhaps be willing to negotiate to make it more to their liking. I agree with Kevin Drum

Medicaid is more than half a century old, and Republicans still aren’t willing to cut deals that might strengthen it in return for some conservative policy advances. In fact, they’re still dead set on block granting Medicaid as a way of slowly starving it to death.

Obamacare could be different if it becomes widely used by the middle class, not just the poor. Republicans would have a hard time resisting middle-class demands to improve the program. But that’s what it will take. And I’d guess that 2017 is about the earliest likely date for Republicans to give up their dream of total repeal.

The thing is, though, Republicans aren’t interested in a law that works better. Ultimately they don’t care if it works or doesn’t work. It’s a government program that helps the less fortunate. That’s all they need to know to be against it.

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Advice for the Utterly Screwed

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Health Care

Regarding Obamacare — if your income is below the federal poverty line (FPL- $11,490 for an individual), you aren’t eligible for subsidies on the exchanges, because you qualify for Medicaid. That is, unless you live in a state that has not expanded Medicaid. Then you’re probably just screwed.

However, according to this article — if you overestimate what you actually think you will earn in 2014 so that you can get the subsidy you won’t be penalized for it later. In some cases the subsidies can cover the entire cost of the insurance. So if you know anybody who might be in this boat, give them this tip.

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Crocodile Tears

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Health Care

An article in the Financial Times warns us of a shortcoming in policies purchased through the insurance exchanges:

Amid a drive by insurers to limit costs, the majority of insurance plans being sold on the new healthcare exchanges in New York, Texas, and California, for example, will not offer patients’ access to Memorial Sloan Kettering in Manhattan or MD Anderson Cancer Center in Houston, two top cancer centres, or Cedars-Sinai in Los Angeles, one of the top research and teaching hospitals in the country. …

…It could become another source of political controversy for the Obama administration next year, when the plans take effect. Frustrated consumers could then begin to realise what is not always evident when buying a product as complicated as healthcare insurance: that their new plans do not cover many facilities or doctors “in network”. In other words, the facilities and doctors are not among the list of approved providers in a certain plan.

(I had to check to be sure the article was written recently, and not in the 1990s, when “networked” policies were the new new thing. Yep, the date on it is December 8, 2013.)

OK, so the concern here is that people buying insurance through the exchanges, the majority of whom have no isurance whatsoever now, will not have access to some big-name facilities, which they don’t have access to now, either. Also, people might have to get used to dealing with “networked” health care, which apparently will be a new experience for lots of people even though the majority of us have been limited to some network or another for at least the past 20 years. Is that the issue?

Elsewhere, righties are snarking because the cheapest exchange policies come with high deductibles. These are the same people who have touted high-deductible policies as the answer to affordable insurance for years.

Many of these crocodile tears are being shed by people who’ve been on employee-paid group plans all their lives and have no idea how much insurance really costs. Ryan Cooper writes that maybe members of Congress will learn something –

Right now, one of the primary ways Congressional Republicans are attacking Obamacare is to cite the sob stories of Congressional staffers — and lawmakers themselves — who are having a bad experience with the law. Thanks to a bit of Republican legislative trolling that forced Members and their staffs onto the exchanges to make a political point, some are discovering that premiums are higher than they would have expected, having previously enjoyed the protection of government benefits that essentially shielded them from reality.

But if anything, the fact that Members of Congress are now having an unpleasant brush with the American health care system is a good thing. These Members are experiencing the same American health care system that the uninsured and people with preexisting conditions have been experiencing for many years. They are being forced to face the fact that American health care costs a lot, which, of course, is one of the reasons reform is so hard.

I say they won’t learn a damn thing. They’ll just assume everything was fine before the ACA passed.

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The PR War Over the ACA

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Health Care, Obama Administration

By now you may have seen this chart showing that about 3 percent of Americans are expected to have to pay a higher premium for insurance next year because of the ACA. This was not unexpected. But I fear the rightie noise machine has pumped it up to a BIG BLEEPING DEAL. See, for example, this Wall Street Journal op ed by a cancer patient whose policy was canceled, and none of her new options will let her see all of her doctors.

That’s very sad. However, it turns out, the cancellation wasn’t because of the ACA.

(Update: Looks like that’s not the only thing the subject of the article left out.)

Sundby shouldn’t blame reform — United Healthcare dropped her coverage because they’ve struggled to compete in California’s individual health care market for years and didn’t want to pay for sicker patients like Sundby.

The company, which only had 8,000 individual policy holders in California out of the two million who participate in the market, announced (along with a second insurer, Aetna) that it would be pulling out of the individual market in May. The company could not compete with Anthem Blue Cross, Blue Shield of California and Kaiser Permanente, who control more than 80 percent of the individual market.

Not that Wall Street Journal readers are likely to find that out.

The Washington Post dutifully reports on the “growing backlash”

Americans who face higher ­insurance costs under President Obama’s health-care law are angrily complaining about “sticker shock,” threatening to become a new political force opposing the law even as the White House struggles to convince other consumers that they will benefit from it.

The growing backlash involves people whose plans are being discontinued because the policies don’t meet the law’s more-stringent standards. They’re finding that many alternative policies come with higher premiums and deductibles.

There aren’t enough of them by themselves to become a “new political force,” of course. What the Washingon Post doesn’t bother to mention, but the New York Times did, is that nobody’s policy was cancelled, strictly speaking, because of the ACA. instead, they were upgraded. A lot of those old “cancelled” policies were junk. (See also.)

Making the “sticker shock” worse, however, is that insurers are hiding benefits from customers and trying to gouge them as well.

Across the country, insurance companies have sent misleading letters to consumers, trying to lock them into the companies’ own, sometimes more expensive health insurance plans rather than let them shop for insurance and tax credits on the Obamacare marketplaces — which could lead to people like Donna spending thousands more for insurance than the law intended. In some cases, mentions of the marketplace in those letters are relegated to a mere footnote, which can be easily overlooked.

The extreme lengths to which some insurance companies are going to hold on to existing customers at higher price, as the Affordable Care Act fundamentally re-orders the individual insurance market, has caught the attention of state insurance regulators.

Making this worse is the fact that a lot of people facing higher premiums can’t get on the website yet to find out what better deals might be out there. So we’re in for a bumpy ride for awhile, I’m afraid.

Update and off topic — Smirking Chimp is holding a fundraiser to help it stay online.

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The State of Crazy

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firearms, Health Care, Obama Administration, Wingnuts Being Wingnuts

Recently several state governments have been outdoing themselves to prove they are buggier than an ant farm. Now my state-of-origin, Missouri, has upped the crazy ante and made some moves that could shove it ahead of even Texas, Florida, and the Carolinas for the honor of leading the Barking Moonbat Parade.

First, the legislature passed a bill nullifying all federal gun law, and even making it a crime for a federal agent to enforce federal gun law. A Missouri citizen could sue a federal agent who arrested him for violation of federal law.

The Democratic governor, Jay Nixon, vetoed the law last month. But the legislature is expected to override the veto when it meets in September.

In the House, all but one of the 109 Republicans voted for the bill, joined by 11 Democrats. In the Senate, all 24 Republicans supported it, along with 2 Democrats. Overriding the governor’s veto would require 23 votes in the Senate and 109 in the House, where at least one Democrat would have to come on board. …

… What distinguishes the Missouri gun measure from the marijuana initiatives is its attempt to actually block federal enforcement by setting criminal penalties for federal agents, and prohibiting state officials from cooperating with federal efforts. That crosses the constitutional line, said Robert A. Levy, chairman of the libertarian Cato Institute’s board of directors — a state cannot frustrate the federal government’s attempts to enforce its laws.

Seems to me what Missouri is doing borders on sedition. And yeah, the New York Times seriously did attempt a “both sides do it too” move by bringing up state marijuana laws.

Gary Marbut, a gun rights advocate in Montana who wrote the Firearms Freedom Act, said that such laws were “a vehicle to challenge commerce clause power,” the constitutional provision that has historically granted broad authority to Washington to regulate activities that have an impact on interstate commerce. His measure has served as a model that is spreading to other states. Recently, the United States Court of Appeals for the Ninth Circuit struck down Montana’s law, calling it “pre-empted and invalid.”

If firearms, which easily move across state borders all the time and are even sold on the bleeping Internet, do not fall under the Commerce Clause, nothing does.

And what about the supremacy clause that says federal law is the supreme law of the land?

This Constitution, and the Laws of the United States which shall be made in pursuance thereof; and all treaties made, or which shall be made, under the authority of the United States, shall be the supreme law of the land; and the judges in every state shall be bound thereby, anything in the constitution or laws of any state to the contrary notwithstanding.

The Tenth Amendment Center finds an out in the words “in pursuance thereof.” Legal experts say that “in pursuance thereof” means that U.S. law is supreme if the law falls within the federal government’s constitutionally enumerated powers. But the Tenth Amendment Center argues, in effect, that states can interpret the U.S. Constitution any way they like. Taken to logical extremes, this means states may respect federal law only when they’re in the mood to do so.

And, anyway, state representative Doug Funderburk says that what Missouri is doing isn’t nullification at all.

“What the bill does is positions Missouri to have standing to protect all Missourians, should the federal government decide to go down the course of people who literally just want to take your guns away,” he said in an interview. “It does nothing to intervene with reasonable regulations.”

But if the bill does nullify all federal gun law, and makes it criminal for federal agents to arrest anybody, this suggests to me that they think no federal regulation is reasonable.

Charles Pierce:

When we talk about modern conservatism’s being the province of reckless vandalism, this is what we’re talking about. Nullification has been tried several times in the country’s history. (During the nullification crisis that marked his presidency, Andrew Jackson called an aging Mr. Madison out of retirement to knock it down.) It always ends badly. The Supremacy Clause is as much a part of the Constitution as the Second Amendment. This is not government by principle. This is government by don’t-give-a-fk.

But there’s more. Missouri also is trying to nullify Obamacare. John Perr writes,

An estimated 877,000 people in Missouri are currently uninsured. But despite Gov. Nixon’s best effort, Republican legislators block the expansion of Medicaid, leaving 267,000 in Missouri stuck in the “coverage gap.” All told, some 5.5 million people in GOP-dominated states, McClatchy explained, will find themselves trapped in “a bureaucratic twilight zone where people with poverty-level incomes don’t qualify for Medicaid and can’t get tax credits to help buy coverage on the new insurance marketplaces.”

But in Missouri, things will be even worse. Republicans there didn’t just refuse to accept billions in federal Medicaid dollars or set up their own state health care exchange. They are actively undermining any outreach or customer service for Show Me State residents seeking information about or help enrolling in new insurance plans made possible by the Affordable Care Act.

The barriers to health insurance erected by Republicans are staggering in their size and scope. Last year, the Washington Post reported, “voters approved a ballot initiative barring state and local government officials from helping to implement the law.” Along with Arizona, Alabama, Oklahoma, Texas and Wyoming, Missouri is refusing to enforce the ACA’s new insurance reforms and prohibitions, such as refusing to cover those with pre-existing conditions, using “rescission” to drop coverage for those who become sick, discriminating against women and setting annual or lifetime benefits caps. And while Colorado, California, Oregon and other blue states are spending hundreds of millions of dollars to fund thousands of customer service “navigators,” in Missouri “local officials have been barred from doing anything to help put the law into place.”

Maybe the feds should stop worrying about Syria and pay attention to Jefferson City instead.

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