When Barack Obama made the decision to design a universal health-care program based on the private-insurance market, he faced one key problem. If you require insurance companies to accept anyone regardless of pre-existing conditions—as everyone wanted—you face the threat of "adverse selection," in which only those who are sick (and therefore expensive) get insurance. Just as the system of car insurance needs those who go long periods without having an accident to pay premiums so there's enough money to fix the cars of those who do have accidents, the health-insurance system needs the currently healthy to keep paying to support the currently sick. The answer was the individual mandate, which pulls people into the system and expands the risk pool. And especially critical to expanding that risk pool is getting as many young, healthy people as possible to get insured.
A number of policymakers on both sides of the aisle cheered when, in April, the Arkansas Legislature passed a law both expanding Medicaid and transforming it into a service available in a marketplace of insurance options, a move known as the “private option.” Similar cheers erupted in June when Iowa Governor Terry Branstad approved a similar measure. The legislation marked a major accomplishment—not because the policies are necessarily improvements over traditional Medicaid but because they establish politically palatable paths for conservatives who want to increase access to health care. In Pennsylvania, GOP Governor Tom Corbett—who was against Medicaid expansion and this week announced he is is tepidly for it—has pointed to the these new plans as a model he might consider (among other, more controversial changes.) The private option may be a way to make comprehensive health-care coverage viable in other Republican states—but that depends largely on what happens in Arkansas and Iowa over the next several months.
As we approach the full implementation of the Affordable Care Act at the end of the year, confusion still reigns. Most Americans don't understand what the ACA does or how it works, which is perhaps understandable. It is, after all, an exceedingly complex law, and from even before it passed there was an aggressive and well-funded campaign of misinformation meant to confuse and deceive Americans about it, a campaign that continues to this day and shows no sign of abating. To undo uncertainty and banish befuddlement, we offer answers to a few questions you might have about Obamacare.
If you're a regular reader of conservative blogs, you may have gotten an appeal in the last few days to make a donation to help Caleb Howe, a contributor to the popular blog RedState.com. Howe, who is married with two children, is suffering from liver failure but has no health insurance to pay for his treatment. His page on GoFundMe has logged over $27,000 in donations (the original goal was $25,000), many of which came from those alerted to his situation in a post on DailyKos.com.
The Obama Administration’s decision to delay for a year the penalty that employers (in firms of 50 or more employees) must pay if they don’t provide health insurance to their workers shines a light on a problem that may be even more profound than getting health coverage for every American: that is, the decline of the American job.
The employer mandate was designed for an economy in which American workers were employed in what had been normal jobs. In firms of 50 or more, all workers who put in at least 30 hours a week were either to receive coverage from the firm or else the firm would have to pay the government a $2,000 yearly penalty.
This week the Obama administration announced that it was delaying implementation of the "employer mandate" part of Obamacare, so companies won't be required to cover their workers until the beginning of 2015 instead of the beginning of 2014. Their stated reason is that they need more time to work with employers to implement the somewhat complex reporting requirements, and they're trying to be flexible and respond to employers' concerns. Which is probably true, but it's also true that the issue has become something of a political headache, with lots of news stories profiling employers saying the mandate is going to destroy their businesses or lead them to lay off workers and cut back their hours so they don't have to comply.
We'll get to what's true and false about those news stories in a moment, but it's important to understand that the "mandate"isn't really a mandate at all.
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...
Maybe Republicans aren't so opposed to health care reform after all. After grandstanding against the Affordable Care Act for the past few years, Republicans aren't ready to let the entire bill die should the Supreme Court overturn the law later this summer. Congressional Republicans are crafting a contingency plan to reinstate some of the popular elements of the bill in that scenario, according to Politico. It's a clear indication that the GOP has learned the same lesson as Democrats: while the all-encompassing idea of Obamacare may fair poorly in the polls, voters typically support individual elements of the bill.
The wise Harold Pollack has argued that health care reform is in some ways the best covered social policy story in the history of American journalism. That isn't to say there hasn't been plenty of crappy coverage, but there has never been the same volume of informed and insightful reporting and analysis available in so many places on a pressing policy debate.
And yet it's easy to get depressed about the impact all that good work didn't have...
HELENA - Gov. Brian Schweitzer said Wednesday he will ask the U.S. government to let Montana set up its own universal health care program, taking his rhetorical fight over health care to another level.
As the House prepares to vote on the "Repeal the Puppy-Strangling Job-Vivisecting O-Commie-Care Act," or whatever they're now calling it, the White House and its allies actually seem to have their act together when it comes to fighting this war for public opinion. The latest is an analysis from the Department of Health and Human Services on just how many people have pre-existing conditions, and thus will be protected from denials of health insurance when the Affordable Care Act goes fully into effect in 2014:
The number of small businesses offering health insurance to workers is projected to increase sharply this year, recent data show, a shift that researchers attribute to a tax credit in the health law. Many small businesses, however, remain opposed to the law.
Some small businesses are benefiting from portions of the law, which includes a tax credit beginning this year that covers as much as 35% of a company's insurance premiums.
As you no doubt remember, much of the Affordable Care Act doesn't go into effect until 2014. In order to deal with the problem of people whose pre-existing conditions make insurance companies uninterested in giving them coverage, the act provides for the creation of high-risk pools for people who have been uninsured for over six months. States can establish the high-risk pools themselves (some states already have them), or they can let the federal government do it for them.
Last week, I commented on some Republican senators who pretended that you could outlaw denials of health coverage for pre-existing conditions without having an individual mandate by suggesting that they just don't care enough about the policy dilemma to bother making sense. Not so Roy Blunt, a Missouri congressman running for Senate. This is a guy unconcerned with saying what's politically popular (via Think Progress):
You don't have to expect every politician to be a serious policy wonk to believe that he or she ought to have a grasp of at least the basics of the key issues they debate. And if they don't have that grasp at the beginning of a debate, then they ought to by the end of it. If there's one thing we can say about the last year, it's that we all learned a lot about health-care policy. Or at least most of us did.