Obamacare and you

[KRonn]

From what I heard, the subsidy was defined as an "employer contribution".

Well that makes sense then. Reid should have corrected it when asked the question about subsidies, tell what it was referring to. Sheesh....

[merithyn]

Oh noes! You can't just have the gravy train without feeling a pinch?

No shit.

Did they think they were somehow immune to the problems that come with the ACA just because they voted for Obama?

[derspiess]

Oh noes! You can't just have the gravy train without feeling a pinch?

No shit.

Did they think they were somehow immune to the problems that come with the ACA just because they voted for Obama?

Seems like some did.

[Phillip V]

[jimmy olsen]

I basically agree with this. Now that the government has gotten involved in the insurance business, it's inevitable that it's role will continue to expand. I think it will take longer though then this guy expects.

   http://www.newrepublic.com/article/116105/obamacare-will-lead-single-payer-michael-moore

How Obamacare Actually Paves the Way Toward Single Payer

Last week the liberal documentary-maker Michael Moore prompted indigestion across the progressive wonk community by pronouncing Obamacare "awful." In a New York Times op-ed, he bemoaned the way the president's law preserved the health insurance industry rather than replacing it with a Medicare-for-all style single-payer system. The good news, Moore conceded, is that the previously uninsured (and often previously uninsurable) can get finally get coverage. The bad news is that their coverage will often be lousy and pose an enormous financial burden. He ended by calling for activists to lean on state politicians in an effort to beef the law up.

I happen to agree with Moore's basic sentiment. For-profit health insurance is on some level morally offensive—at least when it's practiced the way we Americans practice capitalism. With a few tantalizing but mostly unrepresentative exceptions, the longstanding aim of health insurers has been to weed out sick people, and to weasel out of paying for treatment if they somehow get insurance, so that the companies could boost their share price, lavish income on their executives, and plow money into annoyingly saccharine TV ads. To its everlasting credit, Obamacare genuinely tries to whip the insurers into shape—making it illegal to deny coverage to sick people, or to withdraw coverage when healthy people get sick, among other much-needed reforms. But you still have to be skeptical of middlemen who historically spent a mere 60 cents of every dollar individual policy-holders sent them on, you know, health care.1

And yet I'm still much more sympathetic to Obamacare than Moore. He thinks it's awful. I consider it a deceptively sneaky way to get the health care system both of us really want.

How? Allow me a brief digression: In 1991, Congress created the National Breast and Cervical Cancer Early Detection Program, which funded screenings for women who earn up to 250 percent of the poverty level. What Congress didn't do is provide money to pay for treatment if the tests came back positive. The policy seemed sadistically cruel: Suddenly thousands of women would discover they had a life-threatening illness while realizing they could do nothing about it. Both Moore and I would have surely denounced the law. But it soon proved to be a shrewd, if unintentional, opening move. "Almost from the moment it was implemented, there was pressure to take the next step," says Harold Pollack, a professor of social policy at the University of Chicago. "They constructed a sympathetic and organized constituency ... with an actionable grievance." Congress approved the money for treatment in 2000.

In some sense, Obamacare is the breast-and-cervical-cancer story writ large. In order to move the law through the Senate, the White House had to make all sorts of noxious compromises, like keeping the overall spending under $1 trillion, which limited the subsidies available to people buying insurance. Hence the kind of horror-stories Moore cites in his op-ed: A 60-year old couple with an annual income of $65,000 who could end up spending $25,000 on health care in a single year. And that's with Obamacare. (This is something of an outlier, but not that much of one.) But the flip side is that the law also created potentially millions of hard-working Americans who will have some health insurance; just maddeningly insufficient health insurance. What are the chances politicians stand up and take notice when these Americans complain? 

In the heat of the political back-and-forth with Republicans bent on the program's destruction, this whole Obamacare adventure can feel a little hopeless. But when you look at the big picture, the underlying political logic is clearly toward more generous, more comprehensive coverage over time. Once the previously uninsured start getting insurance, the natural upshot of cataloguing the law's shortcomings isn't to give them less insurance, as my colleague Alec MacGillis pointed out last fall. It's to give them more. Republicans are in some sense playing into the trap Obamacare laid for them. And a few of them seem a bit concerned about it.2

Medicaid expansion is a case in point. Under Obamacare, uninsured people who earn up to 138 percent of the poverty level (just under $16,000 for a single person in 2013), can qualify for Medicaid, at least in states that opt into the law.3 This has a few key political consequences, as Pollack notes. First, it transforms the political constituency for the program. Historically, Medicaid has served extremely poor, frequently minority, patients who either don't vote or support Democrats when they do. That meant the GOP had no hang-ups about squeezing it. But there will likely be millions of white working-class voters on Medicaid in the coming years. (Even in some conservative states, like Arkansas, Kentucky, and West Virginia.) Once that happens, something tells me Republicans will become more charitably-disposed to the program.

Then there's the likelihood that, one day soon, especially if Medicaid becomes more generous, the working-class person who makes 175% of the poverty level will look at his working-class neighbor making 130% of the poverty level and think, wow, his health insurance seems a lot better than my private Obamacare plan. How long can it be before most people earning 175% or 200% of the poverty level are allowed to buy in, too?4

The same goes for Medicare. Many health-care reformers believe some version of Obamacare—government-subsidized private insurance—will eventually replace Medicare, something that will surely become more likely if voters feel warmly toward Obamacare and demand to keep it when they turn 65. But if private Obamacare plans stay stingy, the opposite may happen: As people age out of Obamacare and into that single-payer program we all love and support, their fondness for Medicare will only increase. Before long, their slightly younger friends and family members will be clamoring to join Medicare, too. How long before some opportunistic pol proposes that everyone on Obamacare who's 55-and-up can enroll in Medicare? Not very long, I'd guess. In wonk terms, progressives are likely to get their beloved public option one way or another, and probably not too far in the future.

The basic point is that, by pooling millions of people together in one institutional home—the exchanges where customers buy insurance under Obamacare—the Affordable Care Act is creating an organized constituency for additional reform. And since threadbare coverage is the only affordable option under Obamacare for many of these people, the law is giving them a whole set of grievances to get exercised about.

Granted, all this prophesizing assumes the exchanges will work, something Republicans seem determined to prevent. (For that matter, so did the Obama administration for a few months last year.) If the sick and old make up the overwhelming majority of enrollees, or if the back-end of HealthCare.gov never gets ironed out, the whole project could collapse. But if we do clear those thresholds in the next year or so—and the recent data points are encouraging—the relentless logic of the exchanges will be hard to stop. More and more people will be covered through the exchanges. (And not just the uninsured: The Congressional Budget Office estimates that three million people will move from employer-based coverage to the exchanges over the next five years.) Which means the constituency demanding better insurance will get bigger and more powerful each year.

In the end, I'll bet liberals like Moore develop a grudging respect for the administration on this front. (And believe me, I understand the tendency to second-guess.) Moore writes as though Obama created a complete dog of a program, then shrugged off any responsibility to improve it: "Obamacare can't be fixed by its namesake. It's up to us to make it happen." But flawed as Obamacare is, it has at least one great virtue: laying the groundwork for its own fixing.5 That's not bad for such an "awful" piece of legislation.   

[Fate]

The government has been involved in the insurance business long before the ACA.

[Admiral Yi]

I happen to agree with Moore's basic sentiment. For-profit health insurance is on some level morally offensive—at least when it's practiced the way we Americans practice capitalism. With a few tantalizing but mostly unrepresentative exceptions, the longstanding aim of health insurers has been to weed out sick people, and to weasel out of paying for treatment if they somehow get insurance, so that the companies could boost their share price, lavish income on their executives, and plow money into annoyingly saccharine TV ads. To its everlasting credit, Obamacare genuinely tries to whip the insurers into shape—making it illegal to deny coverage to sick people, or to withdraw coverage when healthy people get sick, among other much-needed reforms. But you still have to be skeptical of middlemen who historically spent a mere 60 cents of every dollar individual policy-holders sent them on, you know, health care.

Last time we looked at the numbers here in the runup to the Obamacare vote we determined private insurers were marking up 6% on average and Medicaid was marking up 3%.  The only way this kind of lying journalism is going to stop is if the people this crap is targeted at start demanding accuracy.

Fate: the government has been in the check writing business, not the insurance business.

[DGuller]

I happen to agree with Moore's basic sentiment. For-profit health insurance is on some level morally offensive—at least when it's practiced the way we Americans practice capitalism. With a few tantalizing but mostly unrepresentative exceptions, the longstanding aim of health insurers has been to weed out sick people, and to weasel out of paying for treatment if they somehow get insurance, so that the companies could boost their share price, lavish income on their executives, and plow money into annoyingly saccharine TV ads. To its everlasting credit, Obamacare genuinely tries to whip the insurers into shape—making it illegal to deny coverage to sick people, or to withdraw coverage when healthy people get sick, among other much-needed reforms. But you still have to be skeptical of middlemen who historically spent a mere 60 cents of every dollar individual policy-holders sent them on, you know, health care.

Last time we looked at the numbers here in the runup to the Obamacare vote we determined private insurers were marking up 6% on average and Medicaid was marking up 3%.  The only way this kind of lying journalism is going to stop is if the people this crap is targeted at start demanding accuracy.

Are you saying that 94% of healthcare premiums were spent on medical care?     That figure is almost impossible to believe.

[Fate]

I happen to agree with Moore's basic sentiment. For-profit health insurance is on some level morally offensive—at least when it's practiced the way we Americans practice capitalism. With a few tantalizing but mostly unrepresentative exceptions, the longstanding aim of health insurers has been to weed out sick people, and to weasel out of paying for treatment if they somehow get insurance, so that the companies could boost their share price, lavish income on their executives, and plow money into annoyingly saccharine TV ads. To its everlasting credit, Obamacare genuinely tries to whip the insurers into shape—making it illegal to deny coverage to sick people, or to withdraw coverage when healthy people get sick, among other much-needed reforms. But you still have to be skeptical of middlemen who historically spent a mere 60 cents of every dollar individual policy-holders sent them on, you know, health care.

Last time we looked at the numbers here in the runup to the Obamacare vote we determined private insurers were marking up 6% on average and Medicaid was marking up 3%.  The only way this kind of lying journalism is going to stop is if the people this crap is targeted at start demanding accuracy.

Fate: the government has been in the check writing business, not the insurance business.

Tricare, Medicare, Medicaid, county (indigent) insurance plans, CHIP - that's not the government involved in insurance business?

What would constitute the government being in the insurance business?

[DontSayBanana]

Are you saying that 94% of healthcare premiums were spent on medical care?     That figure is almost impossible to believe.

That figure is impossible to believe.  Any 501(c)(3) organization can mark up 7-8%.  You expect me to believe these guys are keeping from shuttering when they're making less money than a nonprofit?

[KRonn]

http://www.examiner.com/article/washington-examiner-walmart-s-health-plans-are-better-than-obamacare

On Jan. 7, 2013, The Washington Examiner released the results of an investigation finding Walmart's employee health insurance is "significantly better" than Obamacare. Walmart has come under mega union labor union criticism as a retailer whose employees are both underpaid and mistreated. Like many insurance plans which have been canceled as a result of Obamacare benefit regulations, Walmart's health insurance has been called "substandard."
However after an in-depth comparison, the watch dog team of the Washington Examiner discovered employees of Walmart receive a better bang for the buck than Obamacare. In comparison to Obama care, it was discovered that Walmart plans were a whopping five to nine times less expensive. Full-service individual coverage in a Walmart HRA plan is available through a Blue Cross Blue Shield preferred provider organization for as little as $40 a month while family coverage averages $160 a month.
Some Walmart health insurance benefits for employees and their families include:
•   no eligibility requirements
•   age nor gender is a consideration
•   a much larger doctor network
•   a larger hospital network which includes some of the most renowned academic hospitals
•   free heart surgery at four hospitals
•   free spinal surgery at four hospitals
•   free knee replacement at four hospitals
•   free hip replacements at four hospitals
•   free screenings for colorectal cancer, cervical cancer, chlamydia, diabetes, and depression
•   free special counseling for diet and obesity
•   free for children, more than 20 preventive services including but not limited to genetic disorders, autism and developmental problems to obesity, lead poisoning exposure and tuberculosis
•   free for children, 12 vaccinations plus free hearing and vision testing
According to Business Insider, Walmart employs one percent of the nation's work force. Generally, the higher the number of potential insurees, the better leverage a company has negotiating a deal with insurance companies. Walmart's insurance negotiating leverage is certainly far less than that of the United States government who is hoping to insure seven million by March. It begs the question: How can Walmart get a better insurance deal, at better prices with better benefits than government?

[Admiral Yi]

Tricare, Medicare, Medicaid, county (indigent) insurance plans, CHIP - that's not the government involved in insurance business?

What would constitute the government being in the insurance business?

I was trying to make a trivial and pedantic point about the difference between setting aside reserves to pay future claims and just writing checks to cover them.

[DGuller]

Tricare, Medicare, Medicaid, county (indigent) insurance plans, CHIP - that's not the government involved in insurance business?

What would constitute the government being in the insurance business?

I was trying to make a trivial and pedantic point about the difference between setting aside reserves to pay future claims and just writing checks to cover them.

In the post Fate replied to?

[Admiral Yi]

Yes. 

[DGuller]

Oh, right, it had a second sentence.  I was so floored by the implied claim that 94% of premium dollars were used for medical care that I didn't read further.

Now that I read it, I would still disagree with you.  The reason private insurance companies have to reserve is that their existence in the future is not guaranteed, and they also need to give an accurate account of their profitability, which can't be determined without reserving.  Those reasons don't apply to the federal government, so it doesn't reserve.  It's still in insurance business, if you go by the definition of insurance.