Health insurance

Eight Months Until the End of Job Lock

Flickr/walknboston

For years, even before Barack Obama was elected, one of the many complaints liberals (mostly) had about the current employer-based health insurance system was "job lock"—if you have insurance at your job, particularly if you or someone in your family has health issues, then you're going to be hesitant to leave that job. You won't start your own business, or join somebody else's struggling startup (unless they provide insurance), and this constrains people's opportunities and dampens the country's entrepreneurial spirit.

That this occurs is intuitively obvious—you probably know someone who has experienced it, or have experienced it yourself. And today there's an article in that pro-Democrat hippie rag The Wall Street Journal entitled "Will Health-Care Law Beget Entrepreneurs?" Amid the worrying about the implementation of Obamacare in January, and the quite reasonable concern that the news could be filled with stories of confusion, missteps, and dirtbags like that Papa John's guy cutting employees' hours rather than give them insurance, to avoid the horror of increasing the cost of a pizza by a dime, it's a reminder that there will probably be lots of stories like this one in the news too, stories about people whose lives have been changed for the better by the fact that Americans will have something they've never had before: health security.

How Low Can Part-Timers' Hours Go?

AP Images/Adam Richard

Say you’re an employer with an employee who works 30 hours a week. If you have 50 employees or more come next year, you’ll be required either to provide her with health-care coverage, which the Affordable Care Act will by then mandate for all employees who work at least 30 hours a week, or you’ll have to pay a $2,000 penalty for failing to cover her.

Or, you could just cut her weekly hours to 29. That way, you won’t have to pay a dime, in either insurance costs or penalties.

Five Things Government Does Better Than You Do

We know a lot less about how to manage money than we think.

(Flickr / Sheffield Tiger)

When Wisconsin Congressman Paul Ryan and other hard-line conservatives talk about cutting the government’s budget, their primary rationale is that individuals can make better decisions with their own money than the government can. As Ryan himself said to an audience at Georgetown University, “We put our trust in people, not in government. Our budget incorporates subsidiarity by returning power to individuals, to families and to communities.” It sounds reasonable—of course we want individuals to have power, and of course we want communities to take care of their neediest members. And since conservatives have done a fine job of portraying the government as full of heartless, inept bureaucrats, allowing people to make their own decisions sounds better than the alternative.

Five Things to Know about Paul Ryan's Plan

(AP Photo)

Long before he won the Republican presidential nomination, Mitt Romney had enthusiastically endorsed the budget of Wisconsin Representative Paul Ryan as the template for his own proposals. As I detailed in the Prospect's print magazine, Romney promises to extend the Bush tax cuts, cut income-tax and capital-gains rates, and reduce corporate taxes. 

Political Procrastination

Republican legislators keep pushing back plans to create health-care exchanges, and the HHS contemplates fudging the deadline.

For nearly two years, Republicans have railed against the Affordable Care Act (ACA), with many a state-level politician going so far as to call for nullification. But even after the Supreme Court voted to uphold the ACA on June 29, state legislatures and governors in states from Florida to Wisconsin are refusing to implement the law's health-care exchange provisions, while other states are running far behind schedule.

A Test of Ideology

Flickr/Gage Skidmore

Texas has a higher proportion of its population living without health insurance than any other state. But like many other states with lots of poor people, it has the misfortune of being governed by Republicans, which explains why yesterday, Governor Rick Perry announced that the state will refuse to accept the money the federal government is offering to expand Medicaid eligibility to everyone who makes up to 133 percent of the federal poverty level. Perry says that this expansion of Medicaid, which is almost entirely paid for by the federal government, will nevertheless bankrupt the state and put the oppressive boot on the necks of Texans. So he's happy to keep 25 percent of his population uninsured.

In case you're wondering, Texas currently sets eligibility for Medicaid at 26 percent of the federal poverty level, which means that if you earn more than $6,000 a year for a family of four, you're not eligible. That's not a typo. Six thousand dollars a year for a family of four is what the state of Texas considers too rich to get on Medicaid. Look down the list of eligibility levels, and you find that only Alabama, Arkansas, Indiana, and Louisiana set their eligibility lower. It is just so weird how those poor Southern states are the stingiest with health care benefits, isn't it?

It's possible that eventually, Texas and the other states will come around to the expansion of Medicaid. Sarah Kliff explains how this happened with Medicaid's enactment in the 1960s and the Children's Health Insurance Program (CHIP) in the 1990s; conservatives initially resisted, but the money and the opportunity to insure their population eventually became irresistable. One of the key factors then and now is the presence of organized, influential interest groups—particularly the hospitals that have to deliver uncompensated care to the uninsured, costing them billions—that can exert their influence on the government's decisions.

But the Republicans who resisted and then gave in were different from the Republicans of today, and this will be a test of just how far they'll go to make a statement about their hatred of the federal government in general and their hatred of Barack Obama in particular. Today's Republicans are the ones who would turn down a deal offering ten dollars of spending cuts for one dollar of tax increases. But that was a hypothetical question, and this question is very real. There are actual human beings whose lives are at stake. I'd love to hear someone ask Rick Perry this question: Which do you think is worse, someone living without health insurance, or someone getting health insurance through a government program? I'm not sure what he'd say, but his actions say quite clearly that he'd prefer that the person have no health insurance. Of course, we're not talking about him personally, or his kids, or anybody he knows having to go without insurance. We're talking about poor people. So screw them.

Failures of Spin

Flickr/Gage Skidmore

Republican Senate leader Mitch McConnell is ordinarily a spinner of unusual skill. He's relentlessly focused on his message and doesn't let any interviewer frame a question in a way he (McConnell) doesn't like. Which is why it was a little odd to see Fox News' Chris Wallace catch him without a handy talking point when it came to covering the uninsured. This excerpt is a little long, but you have to see the whole thing:

Peggy Noonan Feels the News

She's feeling something. (Flickr/kylebogucki)

When he began his still-brilliant show a few years ago, Stephen Colbert said, "Anyone can read the news to you. I promise to feel the news at you." And there's nobody who feels the news quite like Peggy Noonan, America's most unintentionally hilarious columnist. Pretty much every time she writes a column or goes on television, Noonan can be counted on to tell us about a feeling out there in the land. It's seldom a powerful feeling; instead, it's more often a stirring, an inchoate emotion still in the process of crystallizing. It might be a yearning, or an unease, or a doubt or a fear, but it lingers just out of our perception until Peggy Noonan comes along and perceives it for us.

Did you think the impact of yesterday's Supreme Court ruling was that millions of uninsured Americans will now be able to get health insurance, and after 2014 none of us will ever need to fear the words "pre-existing condition" again? Nay, good-hearted Americans:

Supreme Surprise

(AP Photo)

The verdict of the Supreme Court upholding nearly all of the Affordable Care Act is a victory to be savored in the full knowledge that it may be only temporary and includes potentially damaging changes in constitutional interpretation.

It is a victory, first of all, for the millions of people excluded from health insurance who stand to gain protection despite their medical history or low incomes.

It is a victory for the rule of law in the face of a group of partisan conservative justices who want to immobilize federal power in social policy.

It is a victory for the millions of people who have struggled for decades to achieve equal access to health care.

On Medicaid, Republicans Explore New Moral Depths

Florida governor and aspiring Bond villain Rick Scott, looking forward to denying poor Floridians health insurance. (Flickr/Gage Skidmore)

As the lawsuits challenging the Affordable Care Act worked their way up to the Supreme Court, I always found the challenge to the expansion of Medicaid to be the strangest part. Quick context: the program provides insurance for poor people, splitting the cost between the federal government and the states. But the current rules say that each state gets to set its own eligibility standards, which meant that if you live in a state run by Democrats and you're poor, you can get Medicaid, but if you live in a state run by Republicans, you have to be desperately poor to get Medicaid. For instance, in Mississippi, a family of four has to have a yearly gross income below a princely $9,828 to qualify. Because if a family is living high on the hog with their $10,000 a year, they aren't really poor, right?

Fortunately, the Affordable Care Act fixed this, by changing Medicaid so that everyone with up to 133 percent of the federal poverty level ($30,657 for a family of four) would qualify. And to make things easier on the states, the bill provided that the federal government would pick up almost all of the tab. The federal government pays 100 percent of the cost of paying for the new enrollees through 2016, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent from then on. In other words, the federal government is saying to states, "Here's a bunch of free money to insure a whole lot of your citizens, which will make them healthier and more productive." And almost every state run by Republicans replied, "How dare you do such a thing to us! It's unconstitutional! We're suing!"

Romney's Other Health-Care Contradiction

The health-care law either kills jobs or will cost employees their insurance—it can't do both.

(AP Photo/Charles Dharapak)

In vowing this morning to do what the Supreme Court didn’t—repeal Obamacare—Mitt Romney trotted out all his arguments against the newly constitutionally sanctioned health-care law. Among them were these two points: First, that Obamacare would cause 20 million Americans to lose their health insurance, and second, that it would be a job-killer to boot.

Problem is, these two arguments directly contradict each other.

The Benefits of Medicaid

The Affordable Care Act

In tomorrow's New York Times, Annie Lowrey has an interesting story about a study researchers were able to do in Oregon when the state had to hold a lottery to give people Medicaid coverage, leading to the perfect conditions for a randomized field experiment on what effect obtaining insurance could have. The results were pretty encouraging:

In a continuing study, an all-star group of researchers following Ms. Parris and tens of thousands of other Oregonians has found that gaining insurance makes people healthier, happier and more financially stable...

What Will Conservatives Say If Only the Mandate Is Struck Down?

Looking forward to the FreedomLibertyCare plan. (Flickr/Speaker John Boehner)

There seems to be a consensus building that the most likely outcome from the Supreme Court on the Affordable Care Act is that it will strike down the individual mandate but leave most of the law in place. Just how disruptive this will be to the near future of health care in America is open to debate (see Sarah Kliff for the optimistic take), but there's another question I'm wondering about: How are conservatives going to react?

Losing on Health Reform

An anti-Obamacare ad, in which a D-Day veteran explains how universal health insurance is as great a threat to our freedom as Nazism was.

When the Supreme Court issues its ruling on the constitutionality of the Affordable Care Act, we'll begin a new chapter in this saga, one that will probably (well, maybe) involve sorting through how the law's implementation will work once the individual mandate is struck down. But we've reached the point where there's no denying that the fight over public opinion has been lost, and that ground may never be regained no matter how hard the Obama administration or progressives might try.

Facts? We Don't Need No Stinking Facts.

The New York Times does Mitt Romney a favor.

People like me often complain about "he said/she said" reporting, which treats all claims by competing political actors as having equal validity, and doesn't bother to determine whether one side or the other might not be telling the truth. There are lots of reasons why that kind of reporting is harmful, but it's important to understand that it doesn't just keep people soaking in a lukewarm bath of ignorance, it can actively misinform them, leading them to believe things that are false.

Today's New York Times has a textbook example of what happens when political reporters can do when they refuse to adjudicate a factual dispute between candidates. In the story, Michael Barbaro doesn't just allow Mitt Romney to deceive, he actively abets that deception in the way he constructs his narrative. Here's the key excerpt:

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