Health Care

Remembering What Matters About the Affordable Care Act

Flickr/Laura Smith
On the Affordable Care Act front today, there's very good practical news, and not-so-good political news. That gives us an excellent opportunity to remind ourselves to keep in mind what's really important when we talk about health care. Let's start with the good news. First, as Marketplace reported this morning, a new report from PriceWaterhouseCoopers shows that the average health insurance premium on the exchanges is actually lower than the average premium in employer-sponsored plans. And it isn't because the coverage is inadequate; according to a spokesperson, "even when you factor in all the out-of-pocket costs, the average top tier gold and platinum plans are similar to employer ones." It's hard to overstate what a success this is. If you've ever bought health insurance on the individual market before now, you know that if you could get covered at all, you were likely to get a plan that was expensive but had lots of gaps and lots of cost-sharing. The whole point of the exchanges...

The Six Constituencies the State of the Union Actually Mattered To

AP Images/Charles Dharapak
AP Images/Charles Dharapak I t was a strange State of the Union Address—mixing emotional tugs on the heartstrings with anodyne rhetoric that made it seem like everyone from Barack Obama to the angriest Tea Party Republican was bored with the annual exercise. The speech had no over-arching theme save (yawn) America’s enduring greatness. There were hard-hitting sentences and paragraphs, but no dramatic policy proposals nor even bold, if unattainable, dreams. The State of the Union address was unlikely to anger anyone whether it was financial titans fearing economic Kristallnacht or Bashar al-Assad. For all of Obama’s rhetorical gifts, it was another speech that was mangled beyond recognition by the State of the Union sausage grinder. Before the speech, the agony of White House wordsmiths struggling with the State of the Union was memorably captured by Jeff Shesol, a Bill Clinton alum, who described the standard text as “written by a flash mob—a sudden aggregation, inside and around the...

GOP to Working Poor: Drop Dead

AP Images/Charles Dharapak
In one of the better lines in last night's State of the Union address , President Obama chided House Republicans for their endless series of votes to repeal the Affordable Care Act: "[L]et's not have another 40-something votes to repeal a law that's already helping millions of Americans ... The first 40 were plenty." He followed up by observing that "we all owe it to the American people to say what we're for, not just what we're against." As it happens, last week three Republican senators outlined a plan that can be fairly described as a Republican plan to replace Obamacare. (The basic features of the plan are clearly described by Sarah Kliff of Wonkblog here .) Because most of the Republican Party convinced themselves in 2009 that a tax penalty for people who don't carry health insurance was a grave threat to the American constitutional order, the plan does not include an individual mandate. But otherwise, in its general priorities the plan strongly resembles the Heritage Plan of the...

Vaccine Fear Mongers Are Wrong, But They're Not Ideological

President Obama possibly being injected with Kenyan socialist nanobots. (Flickr/ Rene Najera)
It's been true for some time that conservatives are far more likely that liberals to hold a number of false beliefs about the world, some of which were always political (e.g. Saddam had weapons of mass destruction, evolution is a myth) and some which became more political over time, particularly the belief that the planet is not warming and its subsidiary beliefs, which include the idea that there is a great deal of disagreement among climate scientists as to whether warming is occurring. Sometimes when this is brought up, someone will mention that liberals believe some demonstrably false things too, like the idea that childhood vaccines cause autism. The trouble is, there has never been anything other than anecdotal evidence for this contention. Yes, there may be a parent at your kid's organic vegan locally sourced small-batch co-op nursery school who thinks it's true, and dangerous lunatic Jenny McCarthy, the nation's most prominent propagator of this theory, is a Hollywood...

The GOP, Guardians of Health Security

Mitch McConnell chats with some folks about health care 'n stuff.
This morning, Greg Sargent calls our attention to this new ad for Mitch McConnell, in which a man who got cancer from his job at a uranium enrichment plant in Paducah. The man testifies that it was McConnell, fierce advocate of worker safety and health security, who made sure that workers got cancer screening and compensation: That'll never work, a liberal might say. McConnell is not only one of the nation's foremost opponents of any and all regulations to protect worker safety, but he wants to repeal the Affordable Care Act, which would take away the health coverage tens of thousands of Kentuckians just got. As you may know, Kentucky has been more aggressive in taking advantage of the ACA than probably any other conservative state. They set up their own exchange, and it has proven to be one of the best in the country; they also accepted the Medicaid expansion (these developments can be attributed mostly to the fact that the governor is a Democrat). According to this site tracking...

The Penultimate Watergate Baby

georgemiller.house.gov
The 1974 midterm elections, held in the wake of Watergate, were a Democratic landslide. The party increased its strength in the House of Representatives by more than 50 new members, many from suburban districts that had previously elected Republicans. The Watergate Babies, as the new members were called, were a different breed of Democrat than the veterans who represented more urban districts. They were not only more liberal on cultural issues and more committed to environmental causes than many more senior Democrats, but many of them were also less committed to the kind of bread-and-butter New Deal economic policies with which the party had been identified. In 1974, Jerry Brown was first elected governor of California preaching that the nation had entered an “era of limits,” by which he meant, limits to social spending. Gary Hart was first elected senator from Colorado, disparaging the politics of old labor Democrats. Today, just two Watergate babies remain in Congress, both from...

Rebuffing the Zones?

AP Images/Steven Senne O utside Planned Parenthood’s clinic in downtown Boston, a painted yellow line swoops across the sidewalk and into the well-trafficked street, marking a 35-foot half-circle around the entrance. Most days, anti-abortion demonstrators gather on the edge of the line, holding signs and rosaries, and clutching bundles of pamphlets. As women approach the half-circle, the demonstrators spring into action. The goal is getting the women to pause and talk to them before they cross into the “buffer zone” on the other side of the line, which Massachusetts law declares a protest-free space. The Supreme Court will hear oral arguments about the constitutionality of these buffer zones tomorrow, in McCullen v. Coakley . The arguments won’t tackle the polemical question of whether abortion should be available; instead, the justices will be asked to consider whether the buffer zones violate anti-abortion demonstrators’ First Amendment rights. The petitioners are a small group of...

New York’s Pot Legalization Is Still Kinda Square

J ust days after the first state-regulated marijuana shops opened in Colorado—to the delight of everyone who loves a good pot pun in their morning newspaper—reports began to circulate that New York’s Democratic governor, Andrew Cuomo, was poised to bring his state into line with the 20 others that have legalized marijuana for medical use. This week, according to the New York Times , Cuomo will announce an executive action allowing 20 New York hospitals to prescribe marijuana to patients with glaucoma, cancer, and a handful of other chronic diseases, to be determined by the Department of Health. The governor is skirting the state legislature, where four medical marijuana bills, including one that passed the House last spring, perished in the Republican-controlled Senate. The legislative proposals would have allowed patients with a dozen illnesses, including epilepsy, post-traumatic stress, diabetes, and arthritis, to possess two and a half ounces of cannabis, and set up a system for...

Why Medicaid Patients Using the ER More Isn't a Bad Thing

Flickr/Rob Nguyen
As they argued that we needed to get coverage for the millions of Americans without health insurance, one of the problems advocates pointed to was the fact that many of the uninsured ended up showing up at the emergency room with relatively minor ailments, because they don't have regular doctors they can see and they know the hospital will have to treat them regardless of whether they'll be able to pay. This leads to crowded ERs and lots of uncompensated care, which is bad for everybody. So what happens when you give a bunch of formerly uninsured people Medicaid? According to a new study from the Oregon Health Insurance Experiment, a unique data set around a randomized experiment made possible a few years back when the state of Oregon distributed new Medicaid enrollments by lottery, people went to the ER more once they got on Medicaid. Liberals might find this disheartening. But not only is it not all that surprising, it doesn't undermine the case for Medicaid expansion at all. Keep...

No, Obamacare Wasn't a "Republican" Proposal

flickr/Ralf Heß
The filmmaker Michael Moore has, through his fine documentary Sicko and other public arguments, done a great deal to bring attention to the deficiencies of the American health-care system. His New York Times op-ed on the occasion of the first day of the Affordable Care Act's exchanges repeats some of these important points. However, his essay also repeats a pernicious lie: the idea that the Affordable Care Act is essentially a Republican plan based on a Heritage Foundation blueprint. This argument is very wrong. It is both unfair to the ACA and far too fair to American conservatives. Before explaining why a central premise of Moore's argument is wrong, let me emphasize our points of agreement. It is true that the health-care system established by the ACA remains inequitable and extremely inefficient compared to the health-care systems of every other comparable liberal democracy. Moore, unlike some critics of the ACA from the left, is also careful to note that the ACA is a substantial...

Health Reform's Next Test

AP Photo/Jim Mone
AP Photo/Jim Mone In St. Paul, Minnessota, for shoppers scramble to finalize health coverage before the new year. F ailure, flop, fiasco—however you describe it, the Obama administration’s rollout of Healthcare.gov will go down as one of the most embarrassing episodes of public mismanagement in recent history. In principle, the defects of the website have nothing to do with the merits of the Affordable Care Act. As a practical matter, however, the two have become intertwined, and the big question is how much damage the flawed rollout will do to the political survival of the ACA as well as those in Congress who voted for it. In the short run, Healthcare.gov’s problems have undermined trust in both the law and liberal government. They have created a general impression not just of incompetence but of failed promises, obliging the president to adopt an apologetic tone and shaping the media narrative about the ACA. Public approval of the law has dropped significantly as support has fallen...

Say Thanks to a Republican Idea Day

Don't be afraid. (Flickr/House GOP Leader)
When John McCain ran for president in 2008, he offered up a health-reform plan. Nobody paid all that much attention to it, because it was pretty clear that health care was an issue McCain didn't care about at all, and much like the "patient's bill of rights" George W. Bush had touted when he ran for president eight years earlier, it would be forgotten as soon as he took office. Four years later, Mitt Romney had something resembling a health-care plan too, but once again, nobody paid much attention to what it contained, because any time health care came up, the only question was how Romney could square his stated position that the Affordable Care Act was a poisonous hairball of misery coughed up by the Prince of Darkness himself, while the plan it was modeled after, often referred to as "Romneycare," was a wonderful thing that everyone in the state where it was implemented seems to like. Both McCain's and Romney's plans were mostly an amalgam of ineffectual half-measures and truly...

The Year in Preview: Pot's Uncertain Future

A fter the triumphs of marijuana reform in 2012—culminating in two successful ballot initiatives which made Washington and Colorado the first places in the world legalize the possession and sale of small amounts of weed—it was almost inevitable that 2013 would be a let-down. It wasn’t an unproductive twelve months for supporters of more lenient marijuana politics: New Hampshire and Illinois legalized pot for medical use, and Vermont decriminalized the possession of small amounts of marijuana. The residents of cities in Maine and Michigan also cast (mostly symbolic) votes in favor of pot legalization. But a third state has yet to join the two earliest adopters in sanctioning the possession and sale of pot, which remains illegal under federal law. Part of the problem was that so few state elections were held this year. For the past fifteen years, voter initiatives have set the tone for marijuana reform, beginning with the passage of ballot measures legalizing medical pot in the late...

Out of Birth Control—At Least the Long-Term Kind

Press Association via AP Images
Beleaguered fans of the Affordable Care Act (ACA) got some encouraging news on Wednesday morning: The contraceptive mandate is working. A study released by the Guttmacher Institute, a think tank that supports abortion rights, revealed that the number of privately insured women who paid nothing out of pocket for birth-control pills nearly tripled since the fall of 2012, from 15 percent to 40 percent. More women are also getting the vaginal ring at no cost. This financial bonus is courtesy of an ACA rule requiring private insurance companies to cover preventive care—like contraceptive products, procedures, and counseling—at no cost to the patient. Although some insurance plans are still “grandfathered in,” which means they don’t need to conform to the ACA’s requirements for now, millions of women became eligible for no-cost birth control at the beginning of the year, and they’re taking advantage of it. There is some bad news sandwiched in with the good. Although the number of women who...

The Year in Preview: Taking the Offensive on Reproductive Rights

(AP Photo/Pablo Martinez Monsivais
Read our earlier "Year in Preview" pieces on the media and voting rights here. Check back tomorrow for previews on the 2014 Supreme Court schedule and poverty politicking from the right. AP Photo/Eric Gay T he four horsemen haven’t appeared on the horizon yet, nor has the sea turned to blood, but you’d be forgiven for thinking that when it comes to reproductive justice in the United States, the end times are just around the corner. In 2013 alone, states enacted gobs of restrictions on early access to abortion. From Texas to Ohio to Iowa, dozens of clinics shut their doors. The courts are abortion-rights advocates’ best hope for stemming the tide of regressive legislation, but as Scott Lemieux has extensively documented here at the Prospect , their judgments have been decidedly mixed. In this ever-growing maelstrom of incursions on abortion rights, pro-choice politicians have stayed on the defensive, clinging to the standards established by Roe v. Wade even as conservatives whack...

Pages