Obamacare...(new title): GOP DEATH PLAN: Don-Ryan's Express

[chipwhich]

So, your point is that a persons plan might have a high deductible, but that doesn't COUNT as a high deductible plan unless you say it counts?

Because they just don't know as much about the plan that they're on, as you know about it?

 

Are you really arguing for the sake of arguing?  Wake up on the wrong side of the bed?

[skinsmarydu]

For at least the 3rd time, my husband gets his from his company, I am on his plan &we only have to pay my premium, deducted from his pay. It's Humana.

We each have a $1500 deductible, or $3000 together. That's the deal. Sheesh.

[Jumbo]

It's Bloomberg/leftsiders, so there's that (not to mention the chosen headline)...where's the filler (spin) and where's the beef (reality). 

 

Obamacare Haters Aren't Mysterious

 

Paul Krugman is puzzled:

 

The Affordable Care Act is one of the great comeback stories of public policy: after a terrible start, it has dramatically exceeded expectations. But hardly anyone seems to know that….
 

Over the weekend I had dinner in NYC with some very smart, sophisticated people; yes, all of them liberals. And almost everyone in the group was under the impression that Obamacare is still going badly — they wanted me to tell them whether it could still be turned around….
 

[H]ere we have smart, pro-reform people living in a state where reform is going really well. And they don’t know it!

 

 

 

 

http://www.bloombergview.com/articles/2014-04-14/obamacare-haters-aren-t-mysterious?cmpid=yhoo

 

 

 

the writer also refers back to this piece:

 

 

Obamacare Will Never Be Popular

 

http://www.bloombergview.com/articles/2014-03-26/obamacare-will-never-be-popular

 

 

As Greg Sargent notes in his excellent summary of the Kaiser numbers, they actually contain quite a bit of good news for Democrats. Only a minority supports "repeal" of the ACA, or "repeal-and-replace." A slim majority agrees that it’s time for the country to move on from the issue altogether. Now as ever, most individual provisions of the law (other than the individual mandate) are, as Greg put it, “wildly popular.”

 

Does that mean Obamacare as a whole will soon be popular? No. For one, fewer than one in five believes the ACA has helped them personally and, as I’ve argued, we’re probably at peak awareness of the law's benefits right now. Even if the ACA works as well as supporters hope, many benefits will be either invisible to consumers or difficult for them to trace to the law.

 

For example, many people won't realize that before the ACA they would have been excluded from insurance because of a pre-existing condition -- even a minor one. Meanwhile, anyone who has anything go wrong with their health insurance will find it easy to blame Obamacare.

 

There is also political asymmetry at work. Opponents of the ACA are dedicated (quite sensibly) to highlighting flaws and problems. Their goal is to make the law unpopular. But supporters aren’t mainly interested in making Obamacare popular; their goal is to make the law work well.

 

Likewise, opponents target all voters, arguing the law is bad. Supporters have a different audience and message, targeting a small chunk of the population (the uninsured, mainly) and urging them to buy insurance.

 

The survey data suggest a stalemate in which Obamacare remains unpopular for the long term, but Republicans (and any Democrat tempted to join them) risk a strong negative reaction if they actually try to repeal the law or its key features (other than the individual mandate).

 

What’s most likely? Republican Obamacare-bashing continues for a few years at least. At the same time, health care begins to recover its status as a normal issue, with reforms debated within the established framework of the ACA.

 

 

 

<more traditional political noises at links>

[Duckus]

Bad week for the haters. Guess that is why its on the second page. 

 

1) Obamacare hit 8 million today. Wow. Just crushing projections now.

 

That doesn't include 3 million more have signed up for coverage through Medicaid, 3 million now have coverage by staying on their parents’ plan, and 5 million people have signed up for ACA-compliant plans outside the marketplace.

 

http://thinkprogress.org/health/2014/04/17/3428219/obamacare-enrollment/

 

2) Premiums were 15% below CBO original estimates driving Obamacare costs down. $164 billion less in the next decade on subsidies.

 

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/04/14/lower-premiums-yes-really-drive-down-obamacares-expected-costs-cbo-says/

 

3) 28% of those who signed up through the federal marketplaces were 18 to 34 - very similar to MA rollout (28.3%). A good sign and trends show that it should rise even more next year.

Edited April 17, 2014 by Duckus

[Larry]

pointing out that I wouldn't be ordering the Super Bowl rings, quite yet. 

 

I can think of a few reason why enrollment numbers might be higher than expected, but it's not necessarily good news. 

 

A biggie is that the Obamacare forecasts assumed that all of the working poor would be covered under Medicare expansion. 

 

(Instead, a lot of governors decided that it was their sacred constitutional duty to screw their own citizens, just so they could **** with Obamacare.) 

 

So there's a whole bunch of people who are "exchange eligible" who were supposed to have been already covered by Medicaid, by now. 

 

I also suspect that the Obamacare forecasts didn't predict such large numbers of people would have their insurance cancelled (by their employer or by their insurer), also resulting in the pool of people hitting the exchanges being larger than forecast. 

 

Now, both of those are simply vague impressions, on my part.  I have no clue whatsoever if they're even remotely true. 

[skinsmarydu]

I'm looking forward to seeing the numbers at the end of the year, when the 26-year-olds who are on their parents' policies get their own policies,(and for further years, that number will grow), but there is one thing that does concern me. (Well, it's going back to Larry's point about my governor, Larry's governor, and other mean governors whose sworn sacred constitutional duty is/was/will be to screw their own citizens.(please forgive the ad-lib, we've had a sort of "Moral Monday" movement here with protests in front of the idiot's mansion, and signed petitions delivered to his office.)

There are 17-year-olds whose parents will not be able to afford to keep their children on their policies. Heck, there are parents who could never afford to have their children insured in the first place, and probably still can't, and because of mean governors like mine and Larry's. It just makes me angry.

(I hope I didn't offend, Larry...)

[Duckus]

pointing out that I wouldn't be ordering the Super Bowl rings, quite yet. 

Absolutely. Still a long, long way to go.

But man, what a dramatic shift in the entire frame of the debate. A few months ago we were talking about the botched rollout, government incompetence, lack of folks enrolled, a shortage of young people, health care scare stories (almost all proven to be wildly inaccurate) and more.

I think even the most optimist folks had very grave concerns about how this enrollment period would turn out with such a bad start.

The result have been impressive and the conversation is turning sharply.

[twa]

it is a bit of drama , we will see better when the lights come up though 

 

the cheerleaders sure are putting on a show in the interim.

[skinsmarydu]

At least we've got more to say than Mr. Cruz: "it's hurting Americans". He has yet to say or show how. Just keeps up the redundancy, with the same exact words on a daily basis. You'd think he'd have a better schtick by now, that he COULD at least give an example or two...but it's just "hurting Americans".

[Wrong Direction]

The late enrollment surge is definitely an interesting development. It’s true that the mandate waivers will hurt future enrollment in relation to original promises, but for this year I think there are some victories for the ACA which will be hard to be undone (and probably shouldn't). However, folks shouldn't think the bill is out of the woods yet by any means. Here's what to watch for:

 

1. 2014 satisfaction rates – Does coverage = happy? It's been a few years since I've looked at Kaiser's information on Medicare satisfaction rates, but they are typically in the 90% range. It's anyone's guess how satisfaction rates will be for the exchanges due to the high deductibles, the fact that many enrollees were booted from their previous plans and forced to take these, and significant reductions in provider networks. On the other hand, perhaps the young/healthy people who can get a free physical will be happy, and the old/sick people who badly need insurance will be grateful. We won't know until we start to see data, but anything under 70% satisfaction would be terrible relative to other programs.

 

2. 2015 premiums - Overall, the enrollment mix is better than I expected it would be 4-6 weeks ago. That's good. On the other hand, this will not be uniform across states and plans. It’s a vast new marketplace that is far from settled. Some will do well. Others will not. It'll be interesting to see if we have a trend one way or the other on premiums next year or if some go way up and others stay flat or go down. This is a significant unknown, since premium changes will cause enrollment changes. I suspect the real market correction will come before 2016, when plans have two years of experience to develop a good sense of whether they'll succeed or fail. That's when we'll see consolidation and some more volatility, which is normal in emerging markets. The question is the degree to which this happens.

 

3. 2015 enrollments - The 2014 enrollment story itself is complicated. Who is newly insured versus someone who had to switch to this market? Who actually paid? What is the overall enrollment mix? These questions will be determining factors for premiums in 2015. This is shaking out as we speak, but #'s 1 and 2 (above) will have a lot to do with # enrollment next year. If satisfaction rates are low or premiums spike, overall enrollment could decline. Then there’s the rules-driven factors. On one hand, Obama has waived mandates on employers and grandfathered millions of people into old plans. That will necessarily lower the new enrollments projection for next year. On the other hand, the mandate is still in place and in theory begins to ramp up next year. Still, that was factored into original projections, so given the waivers, future enrollment projections are likely to be lower until the waivers are all removed.

 

4. 2016, stability with modest enrollments? – 8 million signups in year 1 is nice, but Obama’s original longer term goal was for tens of millions of people in the exchanges over time. If premiums in 2015 are stable, he may achieve his goal of expanding coverage for people who really need it and poorer folks. However, because of all of the waivers, it’s unlikely (IMO) that he’ll be able to achieve a massively significant shift into the exchanges. I also suspect Obama or a future congress will eventually waive the Cadillac plan requirement, thus not punishing people whose employers/unions provide great coverage. If so, the forceful movement of people into the ACA seems less likely, and it’s anyone’s guess as to whether this new modest enrollment mix will allow for a stable marketplace over time. With all of this backdrop, I think Obama hopes to achieve a modest victory and will let future presidents and congresses figure out how to transition the critical mass of our healthcare system away from the status quo and into state marketplaces. All of #4 is dependent on premium stability and satisfaction rates over the next 6-24 months. If they’re bad, the bill could fall under its own weight. However, the probabilities of that are diminishing.

 

5. What else?

States may begin to reconsider their plans not to expand Medicaid if it hurts candidates electorally. I suspect this will be real, but slow in unfolding and highly dependent on the details of legislation to fix the bill. Also, will businesses begin to change behavior or will they maintain their existing plans? Over time, the existence of a marketplace will influence more businesses not to offer coverage. I suspect that will be slow in unfolding and highly dependent on whether it’s successful over the next couple of years. Repeal and replace will only be a viable alternative if the premiums shoot up and/or satisfaction rates are low. We will know that before the next presidential election. If my #4 comes true, I suspect the chatter will be all about 1) legislatively ending many mandates Obama is waiving, 2) maybe waiving the personal mandate, 3) changing cost structures of deductibles, 4) attempting to get flexibility on what states can do to get funds to extend Medicaid, 5) purchasing across state lines (now a small point, IMO), 6) generating new options on the exchanges for small businesses and eventually 7) transitioning people from our very fractured overall system into an updated one that works.

[twa]

Patients Say They Can’t See A Doctor

 

http://sanfrancisco.cbslocal.com/2014/04/18/consumerwatch-some-covered-california-patients-say-they-cant-see-a-doctor/

 

 

While open enrollment for coverage under the Affordable Care Act is closed, many of the newly insured are finding they can’t find doctors, landing them into a state described as “medical homelessness.”

Rotacare, a free clinic for the uninsured in Mountain View, is dealing with the problem firsthand.

Mirella Nguyen works at the clinic said staffers dutifully helped uninsured clients sign up for Obamacare so they would no longer need the free clinic.

But months later, the clinic’s former patients are coming back to the clinic begging for help. “They’re coming back to us now and saying I can’t find a doctor, “said Nguyen.

Thinn Ong was thrilled to qualify for a subsidy on the health care exchange.  She is paying $200 a month in premiums. But the single mother of two is asking, what for?

“Yeah, I sign it. I got it. But where’s my doctor? Who’s my doctor? I don’t know,” said a frustrated Ong.

Nguyen said the newly insured patients checked the physicians’ lists they were provided and were told they weren’t accepting new patients or they did not participate in the plan.

And Nguyen says – while the free clinic isn’t technically supposed to be treating former patents they signed up for insurance, they can’t in good faith turn them away.

Dr. Kevin Grumbach of UCSF called the phenomenon “medical homelessness,” where patients are caught adrift in a system woefully short of primary care doctors.

 

 

add

http://www.latimes.com/business/la-fi-health-spending-20140415,0,2739888.story#axzz2yxgjjStB

 

A historic slowdown in U.S. healthcare spending in recent years may be drawing to a close.

An industry report published Tuesday and healthcare experts point to a steady rise in medical care being sought by consumers seeing specialists, getting more prescriptions filled and visiting the hospital. Other factors such as millions of newly insured Americans seeking treatment for the first time and higher prices from healthcare consolidation could also help drive up costs.

Experts aren't predicting an immediate return to double-digit increases in medical spending. But the emerging trend underscores how difficult it will be for policymakers, employers and health plans to control healthcare costs going forward.

"2013 was a rebound year for healthcare," said Murray Aitken, executive director of the IMS Institute for Healthcare Informatics, an industry research firm that released Tuesday's report. "We saw healthcare usage overall up for the first time in three years. We think that is reflective of a strong economy, more patients with insurance and also some pent-up demand for services that may have been delayed or deferred since the economic downturn."

David Gruber, director of healthcare research at Alvarez & Marsal, said he's expecting a similar trend of higher demand coupled with consolidation among hospitals and large physician groups pushing up prices. He said the demand for services is being driven by an influx of Obamacare enrollees, aging baby boomers and people with chronic conditions who can no longer delay care.

"At some point you can't defer anymore," Gruber said. Health spending "isn't going up by double digits, but it could spike to 6% or 7%."

There are other forces at play that could serve as an effective counterweight and bear watching. The growing use of narrow provider networks by employers and health insurance companies and a shift away from conventional fee-for-service reimbursement for medical providers can be potent cost-containment tools, Gruber said.

On Monday, the Congressional Budget Office cited the prevalence of narrow networks as one reason premiums for Obamacare coverage in government-run exchanges will be lower in the next few years than previously expected.

David Axene, a fellow at the Society of Actuaries, estimates that rates for individual consumers under the health law may rise, on average, 6% to 8.5% next year. He cautions that rates will vary across the country, and some health insurers such as industry giant WellPoint Inc. have already warned about double-digit rate hikes in some markets.

"Many exchange health plans got better discounts than anticipated from providers, but there is really a strong pushback now from hospitals and physicians who are concerned about having enough money to cover their costs," said Axene, an actuary in Murrieta. "I hope we can stay south of double digits, but there's no guarantee we will."

From 2009 to 2012, U.S. healthcare spending grew annually at less than 4%, according to federal data. That's been the lowest rate of growth in half a century, and has sparked considerable debate about the underlying reasons.

Many health economists and industry officials have attributed the slowdown primarily to lingering effects of the Great Recession, when millions of Americans cut back on medical care. But the Obama administration and other experts have pointed to fundamental changes in healthcare reimbursement and the delivery of care spurred by the Affordable Care Act.

http://www.latimes.com/business/la-fi-health-spending-20140415,0,2739888.story#ixzz2zOTTLgLP

Edited April 20, 2014 by twa

[Larry]

Wow. 

 

An article claiming that the newly insured under Obamacare can't spend money on health care. 

 

And an article claiming that the newly insured under Obamacare sre spending money on health care. 

 

And a poster who is trying to say (without actually saying a word) that both of these are bad, and that both of them are Obama's fault. 

 

(When the only thing these articles have in common is:  They both agree that there are millions of newly insured, because of Obamacare.) 

[twa]

wow

it is always fun to see what people see.

[Larry]

wow

it is always fun to see what people see.

 

. . . when they actually read what you've posted, instead of what you're trying to hint at. 

[chipwhich]

Everything is going just as I predicted.  You can't find a primary care physician.  You wont be able to get a doctors appointment.  That problem had already existed prior to Obamacare.  Now you are just dumping more fuel on the fire.  The ACA folks are just gonna pay out of pocket anyways due to the high deductibles so they might as well just go to the clinic.

Wow. 

 

An article claiming that the newly insured under Obamacare can't spend money on health care. 

 

And an article claiming that the newly insured under Obamacare sre spending money on health care. 

 

And a poster who is trying to say (without actually saying a word) that both of these are bad, and that both of them are Obama's fault. 

 

(When the only thing these articles have in common is:  They both agree that there are millions of newly insured, because of Obamacare.) 

 

Do you have an opinion on the article posted or do you only post your opinion on posters posts.  It be refreshing sometime to hear your actual opinion on a topic.

[KuNiT21]

wow

it is always fun to see what people see.

 

I agree, it really is fascinating.

[@DCGoldPants]

At least we've got more to say than Mr. Cruz: "it's hurting Americans". He has yet to say or show how. Just keeps up the redundancy, with the same exact words on a daily basis. You'd think he'd have a better schtick by now, that he COULD at least give an example or two...but it's just "hurting Americans".

 

they tried that by taking advantage of a sick and easily manipulated woman...put her on film....and subjected her to be fact checked into the ground.....thankfully she actually saves over a grand a year for her cancel treatment.

 

http://www.washingtonpost.com/blogs/fact-checker/wp/2014/02/20/a-hard-hitting-anti-obamacare-ad-makes-a-claim-that-doesnt-add-up/

 

Its easier to just say "it's bad now".

[Larry]

Do you have an opinion on the article posted or do you only post your opinion on posters posts.  It be refreshing sometime to hear your actual opinion on a topic.

There are whole bunches of topics in the articles posted. Many of them contradictory. (In fact, they actually point this out.)

Do I get the impression that there's a shift going on, whereby health care is being "rationed" (I put that in quotes because the term is accurate, but not in the evil connotations often associated with it.) through narrow networks of physicians, many of whom are "well, we participate, but we won't take new patients"?

Yes, I do.

Although just like you, I've been seeing that trend going on for over a decade, too.

I think it's one of the drawbacks of Obamacare. By putting lots of insurance policies in front of a consumer, with the government at least strongly implying that they're all the same, it really forces insurers to compete on the basis of price, and nothing else.

The exchanges (at least the small portion of them I can see, since the government still seems to have trouble admitting that I really am me) really only give the consumer a few pieces of information, on which to base their decision. Price. And a list of Doctors. And that's about it.

But then, I suspect that primary care physicians have been getting squeezed, for decades. I think they're getting blamed for the predictable consequences of decisions which were made by other people.

I suspect that the market has squeezed them to the point where they can only just barely break even, if their practice is occupied exactly 100% of capacity. Which is very difficult to do, in a field where the need is spontaneous.

But I can't really think of a good way to solve the problem, either.

[Duckus]

they tried that by taking advantage of a sick and easily manipulated woman...put her on film....and subjected her to be fact checked into the ground.....thankfully she actually saves over a grand a year for her cancel treatment.

http://www.washingtonpost.com/blogs/fact-checker/wp/2014/02/20/a-hard-hitting-anti-obamacare-ad-makes-a-claim-that-doesnt-add-up/

Its easier to just say "it's bad now".

Sadly, she is just one if almost two dozen that I have seen completely debunked.

The GOP is smart and very, very good at this. It doesn't need to be a true sorry. News stations will take the story and run with it. Months later it will be debunked (like almost every ACA scare story from the past year) but at that point the hit is complete.

You are seeing it happen again.

The new line on attack are claims that millions will never find a doctor. An epidemic!!! Over the next few months you will sees the GOP find and exploit a dozen or so people to "tell their story."

Media will run with with it. In 3-4 months someone will run fact checking and find holes everywhere. But it's to late. GOP is on the next topic.

Edited April 20, 2014 by Duckus

[twa]

how did that factcheck on you can keep your dr work out?

[@DCGoldPants]

Sadly, she is just one if almost two dozen that I have seen completely debunked.

 

 

You want to believe that she was just suckered into being in that ad. But her background suggests she was in on the deception there. Her response to the insurance company trying to tell her the costs went down was that she didn't believe it. I'm sure she still won't believe it as she is paying less. 

[skinsmarydu]

You want to believe that she was just suckered into being in that ad. But her background suggests she was in on the deception there. Her response to the insurance company trying to tell her the costs went down was that she didn't believe it. I'm sure she still won't believe it as she is paying less.

And the other woman with the reddish hair that doesn't like politics or political ads? A certain Rhodes scholar showed the 5 different commercials for 5 different candidates she's done. What a ditz.

[88Comrade2000]

We don't know the full affects of Obamacare because of all the waivers in effect in year one.  Once those go away we will get a better picture.

 

 

Also, whether it stays or goes depends on who wins in 2016. Dems win the Presidency as expected; then Obamacare will become a permanent fixture of the land.   It will be modified but it will remain.

 

 

The GOP wins full control in 2016, then they repeal it though better have something to replace the popular benefits because by 2017 that will be 3 full years and I don't think people will want gone then.

[skinsmarydu]

The GOP wins full control in 2016, then they repeal it though better have something to replace the popular benefits because by 2017 that will be 3 full years and I don't think people will want gone then.

Good post. The GOP will have a heck of a fight trying to tell folks "We're taking away your health care that has possibly saved your life".

[Larry]

Somehow I don;t think that the public attitude towards Obamacare is going to be "my life depends on it". At least not any time soon, for very many people.

And the Republicans have a plan. They've been proposing it for years.

1) Repeal your state's insurance regulations. (By "allowing insurance to be sold across state lines", without requiring them to comply with the laws in the customer's state.)

2) Make it so that, if your insurance company breaks one of the few remaining regulations, and you successfully prove it, the insurance company is immune from punishment.

3) Get rid of Medicare and Medicaid, and replace then with what's left of private insurance.