‘I Had Nothing to Do With That!’ Obama Dodges Blame For Skyrocketing Premiums

[homersapien 11,353]

http://nymag.com/daily/intelligencer/2016/10/obamacare-is-a-policy-triumph-and-a-political-failure.html

Obamacare Is a Policy Triumph and a Political Failure

For all its recent difficulties, of which there are more below, Obamacare has made American health care both dramatically more affordable and humanitarian. Its various cost reforms have helped bring medical inflation to decades-low levels, and it has given access to basic medical care to 20 million Americans who lacked it before. And yet public opinion has never reflected these realities. The law’s advocates assumed that perception would eventually catch up with reality, but this has not happened, and there is little reason to believe it will anytime soon. And if there is a single overarching flaw in Obamacare, it is a failure to account for politics.

The recent news of higher premiums is a good place to begin to understand Obamacare’s travails. The average premium in Obamacare’s state exchanges next year will be about what the Congressional Budget Officeprojected when the law was passed. Insurers, having to guess what the brand-new market would look like and eager to scoop up market share, initially set premium levels far below expectations (and, as it turned out, far too low). Now rates are jumping back up to expected levels. The coming reversion to expectations is receiving screaming headlines, while the initial well-below-expectations premiums did not. Why is that?

One reason is that journalists naturally, and in some sense properly, gravitate toward bad news. Holding powerful figures accountable means spotlighting failures and problems in need of correction. But a side effect of this form of covering mostly bad news is a public whose worldview is systematically skewed toward bad news. Broad positive trends are generally invisible — for instance, while violent crime has plummeted over the last two decades, most Americans believe it has risen.

A second reason is the distortions imposed by the partisan imbalance in media coverage of the issue. The conservative media has been engaged in a campaign to discredit and destroy Obamacare, while liberal analysts reporting on the law are both far less numerous and far more restrained by intellectual honesty. News of initially low premiums never broke through in part because conservatives spent the last several years creating a pseudo-narrative in which the opposite was happening. The imbalance between the drumbeat of doomsaying from the right and the caution from the left aggravated the normal bad-news bias.

The law’s demonstrable successes are mysteries to the vast majority of the public. A mere 26 percent of the public correctly stated that the uninsured rate has fallen to an all-time low — as opposed to 46 percent who incorrectly believe it is about the same, or 21 percent who, astonishingly, think it has hit an all-time high. A pathetic 5 percent of Americans realizethe law has cost the government (which has revised the program’s cost downward numerous times since its enactment) hundreds of billions of dollars less than originally forecast.

This is not merely a problem of optics or political credit. Perception can create its own reality. The exchange markets need enough customers who don’t have dire health needs to enroll in order to maintain a healthy ratio that can maintain affordable premiums. The initial 2017 price correction is not a threat to the system’s viability. The threat is the prospect that the belief that the law is unaffordable drives away customers, creating a cycle of lower enrollment and higher premiums. But the cycle is almost certainly not going to result in a “death spiral” that drives all healthy customers out, for the simple reason that most customers in the exchanges are heavily subsidized. They’ll stay in the market because higher sticker prices will cost them little or nothing.

The good and bad news is that the Obamacare exchanges are not a single market, but 50 individual ones. Some of them are functioning extremely well, which itself demonstrates that the law’s design is perfectly sound. Others are functioning badly. To take one example, states that refused to take federal dollars to cover the law’s Medicaid expansion — that is, states with Republican governors or legislatures who are willing to inflict punishment on their poorest citizens in order to sabotage Obamacare — have more expensive premiums in their exchanges.

The law’s worst-case scenario is not that it falls apart, but that it falls apart in red states whose Republican governors and legislators are committed to its failure. That won’t lead to Obamacare collapsing or being repealed, but to a patchwork system of universal coverage in blue states and a dysfunctional market in red ones. That is not an outcome liberals should cherish — after all, nobody deserves to be deprived of medical care just because Republicans win elections in their state.

But it also means that the law’s architecture will remain in place, and the main questions surrounding it will be when and where Democrats can assemble working majorities to implement fixes. It is completely routine for large social policy reforms to have technical changes afterward. What’s abnormal is the Republican boycott of any measure that might improve the law’s function. Technical fixes to Obamacare are conceptually easy and, given the law’s surprisingly low costs, very affordable.

Political will is another matter altogether. Assembling the necessary elements for an Obamacare patch at the national level will require Democrats to not only hold the presidency, which is very likely, and win back the Senate, which is probable but uncertain, but also win the House, a dire long shot even if the party commands a strong majority of all ballots cast in House elections. The politics look even more daunting at the state level, where legislative districts are also gerrymandered and voter information and turnout is even lower.

Liberals believed that Republican opposition to Obamacare would eventually come at a high political price. As people became accustomed to the benefits of having insurance, they would resist proposals to take them away, just as they resist plans to cut Medicare and Social Security. But the Republicans’ strategy of denouncing the law, sabotaging its function at every turn, and endorsing unspecified alternatives remains about as effective now as it ever has been.

 

[homersapien 11,353]

https://tcf.org/content/report/key-proposals-to-strengthen-the-aca/

Key Proposals to Strengthen the Affordable Care Act

Executive Summary

Though not yet six years old, the Affordable Care Act (ACA) has accumulated a record of remarkable accomplishments. Despite uncompromising political opposition; widespread public misunderstanding; serious underfunding; numerous lawsuits, three of which have so far made it to the Supreme Court; and major technological failures at launch, the ACA has largely succeeded in its principal task—enrolling tens of millions of people in health insurance coverage. Indeed the period from 2010 to 2015 may be the most successful five years in the modern history of health policy.

The ACA has already achieved many significant accomplishments:

• The ACA has reduced the ranks of the uninsured by anestimated 17.6 million since it was adopted in 2010.¹ This is a striking reduction, especially in light of the refusal of twenty states to implement the ACA’s Medicaid expansion, one of the ACA’s core coverage strategies.² The percentage of Americans under the age of 65 who lack health insurance is now lower than at any point in the past five decades (see Figure 1).

Figure 1.

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• Hospital expenditures for uncompensated care have plummeted by $7.4 billion, with the decline particularly great in states that embrace the ACA’s Medicaid expansion.³
• Health care prices have grown at an annual rate of 1.6 percent since the ACA was adopted, roughly in line with overall inflation and the slowest rate for any comparable period for the past half century.⁴ Economic conditions have contributed to this favorable trend, but the ACA also played a helpful role.
• Public health care expenditure growth has markedly slowed, which suggests the change extends beyond transient economic patterns associated with the Great Recession. The ACA is now projected to reduce budget deficits far more than was projected at the bill’s passage.⁵ Between January and March 2015 alone, the Congressional Budget Office (CBO) and the Joint Committee on Taxation reduced their estimated costs of ACA’s 2015–2025 coverage provisions by $142 billion.⁶Medicare expenditure growth has fallen markedly below original projections. In 2008, for example, CBO’s projected that Medicare’s net mandatory outlays would be $759 billion in calendar year 2018. CBO now projects that Medicare will spend only $574 billion in that same year, 24 percent less than predicted before the ACA (see Figure 2). State expenditures associated with the ACA have also been restrained, with lower Medicaid expenditure growth observed within states that embraced the ACA’s Medicaid expansion than in their non-expansion counterparts.

Figure 2.

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• Average monthly premiums on the new marketplaces are proving reasonable, with manageable premium growth in most major markets since the ACA’s enactment.⁷ Between 2014 and 2015, the population-weighted national average premium increase in the lowest-cost silver plan was 2.9 percent.⁸ Although 2015–16 premium growth varies by location and plan, average premium growth for the benchmark second-lowest cost silver plan was 7.2 percent,⁹well below average premium growth in the three years preceding the ACA.¹⁰
• Recent data on hospital infection, preventive care, and avoidable hospital readmission (alongside continued striking progress in age-adjusted survival) suggest that American medical care is better¹¹ and safer¹² than it has ever been. Incentives and new payment arrangements enacted under the ACA played an important part in these improvements.

Despite these accomplishments, our health care system continues to face serious challenges, some traceable to flaws and weaknesses in the ACA. The ACA undertook from the beginning an ambitious reform agenda, but some of its approaches have turned out to be ineffective, poorly targeted, or not ambitious enough to address deeply rooted problems.

Many of the remaining challenges in health care reform reflect the inherent complexities and path-dependency of the American system and were beyond the reach of any politically feasible reform. Perhaps the most serious problem—which this report will address repeatedly—is the inadequacy of the ACA’s subsidies and regulatory structures to address the problems of low-income Americans, for whom merely meeting the costs of day-to-day essentials is a continuing challenge, and for whom even modest monthly insurance premiums and cost-sharing are often serious barriers to health coverage and care.¹³

This report identifies problems and suggests potential solutions. Some solutions would require federal legislation. Others could be implemented by the administration, state law, or by private parties.

Some of our solutions are concrete and practical. Others are intended to provoke further thinking and debate. We have not precisely estimated costs and benefits, something that should be done before implementation. We understand that many of our proposals are not immediately politically viable. We believe it is important to think now about what should be done, and what the most important choices will be when political opportunities present themselves.

The first and second sections of our report describe steps to expand health care coverage and improve its affordability, particularly for low- and moderate-income Americans. The third section deals with improving the health care shopping experience for those who use health insurance marketplaces. The final section recommends improvements in the Medicaid program, which covers the lowest-income Americans.

In all, we propose nineteen steps that could help fix recognized flaws in the ACA as well as build on its accomplishments. Taken together, these proposals would further improve the access and affordability of health care under the ACA, create more robust provider networks, enhance competition among insurers, improve the consumer experience, and strengthen the Medicaid program. We understand that in the current political climate, improvements to the ACA that require congressional action are unlikely. Yet an administration committed to improving access could take some of the actions we recommend without new legislation, while other proposals could be implemented by the states, marketplace, or simply by insurers.

Read the rest of the report at: https://tcf.org/content/report/key-proposals-to-strengthen-the-aca/

[SaltyTiger 7,764]

27 minutes ago, icanthearyou said:

You are a liar.  I have caught you twice attempting deceit.  You knew better.

You are confusing 2015 data and, the expected rise in 2016.  Sorry to burst your bubble.  Nice try though!

I understand your contempt for this very imperfect program(very imperfect program is a joke).  However, every American should have access to healthcare(Every American has had access to healthcare ICHY).  This is a beginning.  We should all work together to make it happen.- After this crap was shoved down our throats. You'll never come up with anything convincing me that most Americans wanted this. I am sure that St. Hillary will work with us.

 

[channonc 466]

Very good analysis of the situation, thanks @homersapien

[AURaptor 1,121]

24 minutes ago, channonc said:

Very good analysis of the situation, thanks @homersapien

Yes, Pravda would be proud.

[icanthearyou 4,462]

1 hour ago, SaltyTiger said:

 

You should probably discuss with someone else.  For me, this is not a political argument.  Access to healthcare is about who we fundamentally are.  This is about whether or not we are decent human beings.  

The money is already there.  Unfortunately, the requisite sense of human decency is not.  

[AURaptor 1,121]

13 minutes ago, icanthearyou said:

You should probably discuss with someone else.  For me, this is not a political argument.  Access to healthcare is about who we fundamentally are.  This is about whether or not we are decent human beings.  

The money is already there.  Unfortunately, the requisite sense of human decency is not.  

Hogwash. This exceeds the proper function of govt, and it's not even close. 

[Auburn85 432]

Health insurance plans should offer asthma medications without deductibles and co- pays.

[icanthearyou 4,462]

2 hours ago, AURaptor said:

Hogwash. This exceeds the proper function of govt, and it's not even close. 

Your opinion and, lack of human decency are noted. 

The proper role of our government is whatever we the people decide it should be. Sorry but, your extreme right wing ideology will have to comply with our democracy.  The "conservatives" may attempt to do to our country, what they have done to the GOP but, I doubt a majority will stand for that sort of destruction.

[wdefromtx 3,159]

2 hours ago, icanthearyou said:

You should probably discuss with someone else.  For me, this is not a political argument.  Access to healthcare is about who we fundamentally are.  This is about whether or not we are decent human beings.  

The money is already there.  Unfortunately, the requisite sense of human decency is not.  

They could have done it in a way that didn't screw up everybody who had good healthcare coverage. People who had good coverage at a decent price completely got hosed.

[icanthearyou 4,462]

2 minutes ago, wdefromtx said:

They could have done it in a way that didn't screw up everybody who had good healthcare coverage. People who had good coverage at a decent price completely got hosed.

I agree.  Unfortunately, it became a political football.  Unfortunately, political implications and rhetoric continue to hinder improvement.  

"They", IMO, is not the Democrats.  "They" are the people in congress who should be working together, respecting democracy, and creating a better country.  "They" need to be more concerned with the United States than, party, ideology, self interests.

[wdefromtx 3,159]

2 minutes ago, icanthearyou said:

I agree.  Unfortunately, it became a political football.  Unfortunately, political implications and rhetoric continue to hinder improvement.  

"They", IMO, is not the Democrats.  "They" are the people in congress who should be working together, respecting democracy, and creating a better country.  "They" need to be more concerned with the United States than, party, ideology, self interests.

I agree. I blame republicans for it as well. They went along with it and wouldn't block it and offer a better solution. However, I think that it was Obama's and the dems intention to eventually force us into a single payer system or some sort of government run system from the beginning. I looked at what was in some of the plan when it passed and could tell it was designed to penalize good health care plans and eventually force almost everyone into an expensive plan that doesn't do anything good. And that has been happening to myself and a lot of people I know. 

[japantiger 4,051]

6 hours ago, icanthearyou said:

You are a liar.  I have caught you twice attempting deceit.  You knew better.

You are confusing 2015 data and, the expected rise in 2016.  Sorry to burst your bubble.  Nice try though!

I understand your contempt for this very imperfect program.  However, every American should have access to healthcare.  This is a beginning.  We should all work together to make it happen.

Well you just confirmed my supposition above...you really didn't know what the hell you were posting....this is the title of the article you posted from KFF.org cut and pasted below...literally the title of the article is expected 2016 increases...so, I guess that only leaves me with one unavoidable conclusion...you are a steaming-lying sack-of-s*** who is also too lazy to read his own posts....(I guess technically that's two conclusions)....

Analysis of 2016 Premium Changes in the Affordable Care Act’s Health Insurance Marketplaces

 

[icanthearyou 4,462]

12 minutes ago, japantiger said:

Well you just confirmed my supposition above...you really didn't know what the hell you were posting....this is the title of the article you posted from KFF.org cut and pasted below...literally the title of the article is expected 2016 increases...so, I guess that only leaves me with one unavoidable conclusion...you are a steaming-lying sack-of-s*** who is also too lazy to read his own posts....(I guess technically that's two conclusions)....

Analysis of 2016 Premium Changes in the Affordable Care Act’s Health Insurance Marketplaces

 

You are somewhat correct.  I did express that incorrectly.  Still, you are incorrect by virtue of comparing different years.  The article I posted reflects 2015/2016 comparison.  The Bloomberg article refers to anticipated cost increases in 2017.

No need to apologize.  Incorrect "conclusion" in your first reply, two in your second.  That would be three strikes.  You are out.

Again though, nice try!

[channonc 466]

Dr. Aaron Carroll has a quick analysis here. 

[kd4au 1,145]

I would like to see a show of hands of the people backing Obama care, how many pay for their own health insurance?If you like it now, you will love it even more as your premiums keep rising.

[icanthearyou 4,462]

12 minutes ago, kd4au said:

I would like to see a show of hands of the people backing Obama care, how many pay for their own health insurance?If you like it now, you will love it even more as your premiums keep rising.

Rising premiums is a somewhat weak argument.  The trajectory of cost increases has not changed in the past 50 years.  It is not a new phenomenon.  

IMO, the real problem is not Obamacare.  The real problem is that the pharmaceutical industry and the insurance industry spend a ton of money manipulating democracy.  One other problem we have is, our per capita spending rises dramatically (compared to the rest of the world) at age 55.  That might suggest that we, as a society, aren't very health conscious.  No system will work until these fundamental problems are addressed.

 

[SaltyTiger 7,764]

16 hours ago, icanthearyou said:

You should probably discuss with someone else.  For me, this is not a political argument.  Access to healthcare is about who we fundamentally are.  This is about whether or not we are decent human beings.  

The money is already there.  Unfortunately, the requisite sense of human decency is not.  

ICHY, I honestly believe that most people, at least most people that I know and most people on this type of board are decent human beings and believe in human decency. This is a political argument because it was rammed down our throats under the pre-tense of human decency. Which was and is BS and you know it.

[kd4au 1,145]

10 hours ago, icanthearyou said:

Rising premiums is a somewhat weak argument.  The trajectory of cost increases has not changed in the past 50 years.  It is not a new phenomenon.  

IMO, the real problem is not Obamacare.  The real problem is that the pharmaceutical industry and the insurance industry spend a ton of money manipulating democracy.  One other problem we have is, our per capita spending rises dramatically (compared to the rest of the world) at age 55.  That might suggest that we, as a society, aren't very health conscious.  No system will work until these fundamental problems are addressed.

 

I will ask you again do you pay 100 % of your own health insurance?

[Auburn4life 24]

My insurance is provided by my company 100%, 7 employees and 1 owner. We were on the BCBS platinum plan, this year we are on BCBS gold (because cost went up). Now the owner is talking about dropping us (2017) because of cost. For all 8 of us it cost him around $200,000 in 2016 and going up again for 2017.

I have only been here 4 years. The other guys have been here 20 yrs and always had BCBS covered 100% with no premium cost (owner paid).

[SaltyTiger 7,764]

7 minutes ago, Auburn4life said:

My insurance is provided by my company 100%, 7 employees and 1 owner. We were on the BCBS platinum plan, this year we are on BCBS gold (because cost went up). Now the owner is talking about dropping us (2017) because of cost. For all 8 of us it cost him around $200,000 in 2016 and going up again for 2017.

Barry has nothing to do with that, or Pelosi, or....

[icanthearyou 4,462]

1 hour ago, SaltyTiger said:

ICHY, I honestly believe that most people, at least most people that I know and most people on this type of board are decent human beings and believe in human decency. This is a political argument because it was rammed down our throats under the pre-tense of human decency. Which was and is BS and you know it.

No.  I do not believe that at all.  

[icanthearyou 4,462]

47 minutes ago, kd4au said:

I will ask you again do you pay 100 % of your own health insurance?

I do.

[SaltyTiger 7,764]

19 minutes ago, icanthearyou said:

No.  I do not believe that at all.  

I did not ask you what you believed. are saying you don't believe most people are decent human beings?

[quietfan 233]

11 hours ago, icanthearyou said:

Rising premiums is a somewhat weak argument.  The trajectory of cost increases has not changed in the past 50 years.  It is not a new phenomenon.  

IMO, the real problem is not Obamacare.  The real problem is that the pharmaceutical industry and the insurance industry spend a ton of money manipulating democracy.  One other problem we have is, our per capita spending rises dramatically (compared to the rest of the world) at age 55.  That might suggest that we, as a society, aren't very health conscious.  No system will work until these fundamental problems are addressed.

 

My feelings also.

Health care costs were already rising precipitously before the Affordable Care Act.  Since we have no way of knowing how bad things might be without Obamacare, we have no basis on which to conclude Obamacare made it worse.