Remembering What Matters About the Affordable Care Act

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 was to give people buying insurance on their own the same advantage of pooling large numbers of customers that you get when you're covered through your employer. If it's working, then that's something to celebrate.

Second, as Jonathan Cohn tells us, Wellpoint, one of the nation's largest insurers, is reporting that exchange sign-ups are meeting their expectations; they have 400,000 new customers, and expect the number to rise to a million by the end of open enrollment. Even more critically, although their new customers are slightly older than the population as a whole, they expected this because people with a more pressing need for insurance would be the first to sign up, and they already incorporated that into their rates for this year. That means they're unlikely to lose money, there is unlikely to be a huge rate spike next year, and the dreaded "death spiral" looks less and less likely.

This supports the contention I've had for some time, that in its first few years the Affordable Care Act is going to basically be fine—it may not create a health care paradise, but nor will it be the disaster conservatives are so fervently hoping for.

Before we get to sorting through what matters from what doesn't, let's look at the not-so-good political news. The Kaiser Family Foundation is out with their latest health care tracking poll, and there isn't a lot to be glad about. More people have an unfavorable than a favorable view of the ACA. Most Americans are unaware that almost all the provisions of the law are now in force. And maybe most troubling, nearly half of Americans are still unaware of the law's most popular provision, that insurance companies are no longer allowed to discriminate against people with pre-existing conditions:

Before you say, "Obama should have told people about it!" I must remind you that during the last four years you spent away from Earth, the administration and its allies did in fact repeat over and over and over again that the ACA prohibits insurance companies from denying you coverage if you have a pre-existing condition. There are many reasons why so many people haven't yet understood, but you can't say they didn't try (you can read more about the myth of the bad sales job here).

In any case, here's what we have to remember: On the scales of history, a person with a pre-existing condition who gets health coverage weighs much more than a person who doesn't know that because of the ACA, people with pre-existing conditions can get health coverage. We spend so much time talking about politics that it's easy to forget that politics are not an end in themselves, they're a means to an end. Liberals advocated for comprehensive health insurance reform for so many decades not because it was politically advantageous (at some times it was, and at other times the voters didn't seem to care), but because it was right. The fact that so many millions of Americans had no health security up until now was a moral obscenity. The ACA is beginning to fix things—slower and less completely than we might like, but it is a beginning. And if it never becomes the political boon you were hoping for, it was still the right thing to do.

That isn't to say that political effects don't matter, because they do. If the Republicans take over the Senate this fall, bad things would result, particularly if they also win the White House two years later, and if the ACA's political troubles contributed to that turn of events, it would be unfortunate. But in the long run, what matters most is the effect on Americans' lives. When you get distressed by a story about a Democratic member of Congress who's in a tough race where her opponent is hitting her for supporting Obamacare, you can think of the families who never had health coverage before, but do now. For millions of people it will life-changing, and for many, literally life-saving. Try not to forget.

Comments

Obamacare may be the final blow for a country that is struggling financially, ethically and morally, the governments involvement in the healthcare system is the worst idea any of you social geniuses ever thought up. Unless, of course, your goal is to is to bring America to its knees. Government involvement in anything is bad thing. Our country is full of cowards who would prefer the government take care of them. The government full of officials that want a population that is dependent . What a great way to control people. Get them on the government medical chart. We're screwed people. Wake up!!!!!!!!

Obamacare may be the final blow for a country that is struggling financially, ethically and morally, the governments involvement in the healthcare system is the worst idea any of you social geniuses ever thought up. Unless, of course, your goal is to is to bring America to its knees. Government involvement in anything is bad thing. Our country is full of cowards who would prefer the government take care of them. The government full of officials that want a population that is dependent . What a great way to control people. Get them on the government medical chart. We're screwed people. Wake up!!!!!!!!

Yes, let's end air traffic control and safety regulation, food inspections, drug testing, weather forecasting, and so on. Let's start by ending subsidies to farmers, the leasing of federal land to miners and oil/gas drillers, and medical care to veterans. We will see who the cowards are.

The most shameless tactic of the left is to frame the debate "more government or no government" followed by "more regulations or no regulations." Even though it's obviously a cheap political tactic, amazing how many buy it.

It's not the left that's framing it that way. It was Laddp25 that said "Government involvement in anything is (a) bad thing". He (or she) seems fairly conservative to me. And what is this obsession with thinking that the government is trying to control you? No one wants to control you more than corporations. How about a little consumer protection or a little freedom... as in the freedom not to have to worry about going bankrupt if someone in my family gets sick?

We could pretty easily eliminate the Department of Commerce, Education and Energy that and a Balanced Budget Amendment and Term Limits would fix most of what's broken in Washington D.C.

Note the writer brags about how wonderful the "top tier" plans are. He's full of _rap. The prices are way too high, with NOTHING attractive about them unless you have a big health problem now. You'd have to be crazy to spend your hard earned money on a non-subsidized policy while still healthy. My wife and I will only buy after one of us has a very serious health problem.

Sheer nonsense. This law has hurt far more people than it has helped. What about the cancer patients who lost their doctors or their health plans because of Obamacare? What about the reports of 125 sick children in WA who lost their coverage because of Obamacare? What about all the people who get their insurance from their employers and are now finding out their coverage is worse, and the amount they pay is more, and that their deductibles are much higher, and that they cannot see their regular doctor anymore? This law is a complete failure and is going to get much worse.

What about the cancer patients who lost their doctors or their health plans because of Obamacare?
Name one such patient -- just one.
What about the reports of 125 sick children in WA who lost their coverage because of Obamacare?
Provide link.
What about all the people who get their insurance from their employers and are now finding out their coverage is worse, and the amount they pay is more, and that their deductibles are much higher, and that they cannot see their regular doctor anymore?
How many are there? Provide credible sources.

Lol, you are a joke. You seem to think its all a bunch of lies, the statements that people have lost their plans and their payments have gone up on the new plans. I wasn't going to post on here until I saw your comment. Your attitude is pure crap. Because you don't know anyone, well it must not be real. Am I real enough for you ? Let me get in your grill for a second. All my families policies were cancelled. The new plans premiums were double what we used to pay. The deductible, increased to 8,000 dollars. So when my daughter had a significant accident just recently, we got smacked for Eight grand. The new plans cover none of the costs of doctor visits. My old plan gave me at least 35 percent of the bill covered. There is reality, and then there is the world of propaganda that you are choosing to operate in. Speak your views all you want, but don't lie to yourself for one second and believe your are in touch with reality.

mnjam-

Previous post: "What about the cancer patients who lost their doctors or their health plans because of Obamacare?"
Your reply: "Name one such patient -- just one"

No problem. Here's one that's losing her doctor(s) and hospital(s) that have kept her alive the last seven years as she fights stage 4 cancer:
Edie Littlefield Sundby
http://godfatherpolitics.com/13143/cancer-patient-worries-longevity-losing-doctors-coverage-due-obamacare/
http://online.wsj.com/news/articles/SB10001424052702303936904579177930307493584

Previous post: "What about the reports of 125 sick children in WA who lost their coverage because of Obamacare?"
Your reply: "Provide link."

My pleasure. Here's two of them. Ironically, it's health CARE that's denied, which is quite different from health INSURANCE. They are always being conflated.
http://www.tpnn.com/2014/01/31/sick-children-denied-coverage-in-seattle-due-to-obamacare/
http://www.ironicsurrealism.com/2014/01/31/another-obamacare-horror-story-sick-kids-denied-access-to-specialty-care/

Previous post: "What about all the people who get their insurance from their employers and are now finding out their coverage is worse, and the amount they pay is more, and that their deductibles are much higher, and that they cannot see their regular doctor anymore?"
Your reply: "How many are there? Provide credible sources."

More specifically, it's those losing hours, pay or their jobs due to Obamacare. The employer mandate was illegally/unconstitutionally delayed by Obama all by himself without congressional legislation until next year. However, businesses have already begun to make the needed cuts, while many more await until the fall when more of the costs are revealed and businesses cannot wait any longer. Here's a sample so far of 300 businesses (including government) that have cut hours and jobs because of Obamacare:
http://news.investors.com/politics-obamacare/091913-671677-obamacare-mandate-behind-301-employers-cutting-hours-jobs.htm

The real question for Obamacare's future is whether or not Democrats will entertain changes that make the law more popular. The most obvious would be changing the individual mandate. That should be easy since the solutions are known (they were researched during the Supreme Court case), and even Republicans would be crazy to oppose making the individual mandate more palatable. I suppose the next most obvious ones are the 30 hour work week and the religious objections to contraceptives. The 30hr week is easy, and Republicans probably can't object there either. I'm not sure how to address the religious objections since I honestly haven't paid all that much attention, but it's obviously an area causing passionate opposition.

If Democrats do want to rescue Obamacare, I hope they make those changes this year before the wave of retirements already announced. You're losing Waxman, Baucus, etc. which are some of the most knowledgeable about how HCR works. New members of Congress, even Democrats, have a strong tendency to be less friendly towards Obamacare. So it's only going to get harder to make changes that don't undermine the law.

Paul,

Americans - Republicans, Democrats, Independents, whatever - are itching to show their appreciations for this utopia called Obamacare.

January is already over.
Ten more months.

On November 4, politicians will learn how much their constituents love them for this wonderful gift of Obamacare.

Unfortunately, you people in the media will walk away scratch free from the carnage.
You see, both the Republicans and Democrats are true to their form. Loyal to their core.
Its the media who have lost its responsibility.
Instead of being Government watchdog, you guys have turned in to Government mouthpiece.

I hope this new media will bring your senses back, maybe the hard way.

Wonder if the fact that the CEO's for ABC, CBS and NBC all have family members working for the Administration has anything to do with it. Talk "conflict of interest."

Peoples' lives is exactly what I'm worried about in the the months and years to come.

Obamacare is bringing millions of more Americans into Medicaid. This is worse than the flouting of the president's own 2009 remark that Medicaid is a "broken system" when it comes to financial costs. It is also a prescription for disaster when it comes to our nation's overall health. Here's why:

"People respond to incentives, although not necessarily in ways that are predictable or manifest. Therefore, one of the most powerful laws in the universe is the law of unintended consequences." -From the book "SuperFreakonomics"

Hint:

"Chelsea Byers of Flagstaff is insured for the first time in her life through Healthcare.gov and couldn’t be more pleased. She might even go skiing for the first time, now that any injuries from an accident would be covered." -Arizona Daily Sun, January 21, 2014 - http://azdailysun.com/news/local/15ee088c-80d9-11e3-b40d-001a4bcf887a.html

That in mind, see:

"Obamacare: Making a bad situation worse"
http://relevantmatters.wordpress.com/2012/05/21/obamacare-will-make-a-bad-situation-worse/

Employment based insurance plans are heavily subsidized by the employer. Exchange plans are not. So even if the average premium on the exchange is comparable to the premium cost of employer based insurance, the employee is paying only a fraction of it. I have seen the prices for gold and silver plans, and there is no way that the average employee is paying of can afford to pay that amount for insurance on a monthly basis.

Also, as the Marketplace article that was cited points out (which Waldman fails to mention), prices on the exchange may be comparable only because their provider networks are so narrow. A lot of people who may be forced onto the exchanges if their employers drop or change their coverage in response to ACA will find that they lose their doctors even if they like them.

Yeah, children in Washington State are doing great under Obamacare:

http://www.king5.com/health/Seattle-Childrens-suing-to-be-on-more-state-health-plans-226540591.html

http://www.youtube.com/watch?v=mhx_Xhh9ca8

Searching 38 plans through Washingtonhealthplanfinder, NONE of them had Seattle Children's Hospital as part of the coverage. Here are the facts taken directly from the Seattle Children's Hospital web site:

Seattle Children’s is currently not covered by all of the plans. Children’s is covered only by any plans provided by:
Group Health
Community Health Plan of Washington (Community HealthEssentials)
Molina Healthcare of Washington – Children’s reached a verbal agreement with Molina on Oct. 22, 2013. We expect to become an in-network provider on the Molina Exchange plans.
If you choose an Exchange plan from another company, Children’s is considered “out-of-network” for these Exchange plans, and your plan may not pay for your child’s care here.

It is a ruse, a red herring, a canard, a falsehood, that the web site, the exchanges, the "implementation," or the incompetency of government, is the problem with Obamacare. These are small things compared to the constitutional abomination that is the program itself. The president and his fellow democratic leaders are either evil or stupid. Most republican leaders are either stupid or cowardly. The Tea Party is an improvement. Libertarians offer some hope. Peggy Noonan's WSJ editorial today sheds some light on the fundamental problem. God save this country.

There an old adage: "Statistics can lie and liars ALWAYS use statistics."
The author's very first statement is another ObamaCon half truth. "The average PRICE for an ObamaCare plan is LESS than the private market." Well, yeah but the deductible is three times higher. Higher the deductible, lower the cost.
To keep our health insurance cost at about the same price, we went from a "Cadilac" plan to a "catastrophic" (hospitalization only) plan. Even then our deductible is, in fact, THREE TIMES higher.
This is just lie piled on top of lie piled on top of "The Lie of the Year."
This whole program needs to go away.

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