Tag Archives: obamacare

Yes, Healthcare.gov Is A Disaster. No, Obamacare Isn’t Screwed. Yet.

Healthcare.gov User Experience, after Andreas Vesalius

Having absolutely no knowledge about what it takes to fix a huge piece of software like healthcare.gov (the online database for the Affordable Care Act – or Obamacare), I’ve been able to make my way through the mudslide of confusing reports and critiques regarding the website’s disastrous operation. Much to my own surprise, I’ve come to a dual (provisional) conclusion: either in a few weeks time, the website will be working like the Obama administration is claiming (hoping, praying) it will, and everyone will move on and forget this disaster ever happened. Or, it won’t, and Obamacare will be totally screwed.

Suffice it to say, there’s very little middle ground here. That being said, I’m still taking all of the disaster-reports coming from numerous insiders and journalists with a grain of salt. The fact is, very few people know exactly what’s wrong with the system, and being on the outside of that circle (like all of us are), I tend to air on the side that we shouldn’t purport to know more than we do, or speculate to that fact.

What must be noted, however, is that none of this should have come as a surprise to the Obama Administration. Staffers at HHS were warning about the system’s inadequacies long before the October 1 rollout. As reported by Lena Sun and Scott Wilson:

Days before the launch of President Obama’s online health ­insurance marketplace, government officials and contractors tested a key part of the Web site to see whether it could handle tens of thousands of consumers at the same time. It crashed after a simulation in which just a few hundred people tried to log on simultaneously.

The good news – relatively speaking – is that the Obama administration is well aware that the online portal of healthcare.gov is a complete disaster. Whether or not they’ll be able to fix it before this thing capsizes is the question.

Photo: Mike Licht

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Republicans Ready Themselves For Self-Destruction

Rep. John Boehner

According to Robert Costa over at the National Review, the Republican leadership has given up: Boehner will allow the lunatic tea-party bandits in the House to move a resolution to keep funding the government, save for Obamacare. And, once that falls apart in the Democratically controlled Senate, and the next step is a government shutdown, the Republican leadership will try/pray/hope/beg/borrow/steal enough votes from their party in order to keep the government open. If you’re looking for an apt word to summarise this, might I suggest “stupidity”.

From Costa:

Here’s how my sources expect the gambit to unfold: The House passes a “defund CR,” throws it to the Senate, and waits to see what Senator Ted Cruz and his allies can do. Maybe they can get it through, maybe they can’t. Boehner and Cantor will be supportive, and conservative activists will rally.

But if Cruz and company can’t round up the votes, the House leadership will likely ask Republicans to turn their focus to the debt limit, avoid a shutdown, and pass a revised CR — one that doesn’t defund Obamacare.

The really mind-boggling truth to all this is that everyone knows what the deal is here: the bill will survive the House and Tea partiers who have done a really amazing job convincing stupid people that Obamacare is a bad thing will have a day of celebration. Then Harry Reid will light the stupid bill on fire and toss it in the trash in the Senate. In the end, we’ll be right back where we started, only that much closer to a government shutdown.

And unless the Republican leadership — which has pretty much lost all leverage and control over the party — can convince the loons of the far-right to relent and pass a funding bill, the government will indeed shutdown. The silver-lining? If-and-when that happens, only one party will be to blame.

(Photo: Medill DC)

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Obamacare Works Very Well When State Officials Want It To

Obamacare on the steps of the Supreme Court

The emerging pattern is simple: states that aren’t soliciting bids for next year’s healthcare exchanges will have higher premiums than states that do. Via Steve Benen:

In recent weeks, there’s been a proxy war of sorts when it comes to the projected rates on health care premiums. A “blue” state like New York will announce great news, which leads a “red” state like Indiana to announce poor news. Democratic officials in California say residents are going to going to have more money in their pockets thanks to the Affordable Care Act, to which Republican officials in Ohio say the opposite.

The pattern isn’t exactly subtle: if you live in a state where officials want “Obamacare” to work, the law looks great. If you live in a state where officials are actively trying to undermine the law, regardless of what it does to you, your premiums, and your family’s access to quality and affordable care, then — you guessed it — the news isn’t as encouraging.

That said, the emerging pattern nevertheless suggests folks in states like Maryland, New York, California, and other bluer-than-blue states are going to be immediately happier with the results of the federal health care law because they’re living in states where officials actually want the system to work effectively.

My question is, what happens in those red states when residents start looking across borders and they wonder to themselves, “Why aren’t my benefits as great as theirs?” In theory, this should prompt those folks to start asking their state officials to do more of what works.

All signs point to the pattern continuing, but it’ll be interesting to see what the final numbers look like. If the law is effective, I can’t see how this ends any other way than the whole country benefitting from lower healthcare costs, despite the best efforts of Republican politicians and their super-lobby of healthcare insurance corporations. Red-state constituents will eventually see that their blue-state counterparts are paying less, and will demand the same.

(photo by flickr user Will O’Neill)

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Latest Conservative Plan To Derail Obamacare The Most Sinister Yet

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The word contemptible comes to mind:

With the Obama administration poised for a huge public education campaign on healthcare reform, Republicans and their allies are mobilizing a counter-offensive including town hall meetings, protests and media promotions to dissuade uninsured Americans from obtaining health coverage.
(…)
FreedomWorks and Americans for Prosperity, a conservative issue group financed by billionaire brothers David and Charles Koch, known for funding conservative causes, are planning separate media and grassroots campaigns aimed at adults in their 20s and 30s – the very people Obama needs to have sign up for healthcare coverage in new online insurance exchanges if his reforms are to succeed.

We’re trying to make it socially acceptable to skip the exchange,” said Dean Clancy, vice president for public policy at FreedomWorks, which boasts 6 million supporters. The group is designing a symbolic “Obamacare card” that college students can burn during campus protests.

So let me get this straight: they’re not only encouraging young people to get behind killing the law, but they’re trying to make it “socially acceptable” for the uninsured to opt out of buying health insurance? If there’s been a more callous, sinister ploy by conservatives against this federally approved and constitutional law, I’ve yet to hear about it. The fact that a sham organization like FreedomWorks has 6 million supporters is seriously depressing, and indicative of the power and influence of big money and conspiracy advertising. Buying health insurance isn’t a luxury, it’s a necessity — so is wearing a seatbelt, getting vaccinations for kids, wearing a helmet on a bicycle, etc.

If this doesn’t fully reinforce the clearly established axiom that conservative action groups and their hell-spawned Uruk-Hai — posing as Congressmen/women — are knowingly causing undue harm to those they’re meant to serve, I don’t know what will.

Norm Ornstein — congressional expert and scholar at the conservative think tank “American Enterprise Institute” — sums it up best:

“But to do everything possible to undercut and destroy its implementation—which in this case means finding ways to deny coverage to many who lack any health insurance; to keep millions who might be able to get better and cheaper coverage in the dark about their new options; to create disruption for the health providers who are trying to implement the law, including insurers, hospitals, and physicians; to threaten the even greater disruption via a government shutdown or breach of the debt limit in order to blackmail the president into abandoning the law; and to hope to benefit politically from all the resulting turmoil—is simply unacceptable, even contemptible. One might expect this kind of behavior from a few grenade-throwing firebrands. That the effort is spearheaded by the Republican leaders of the House and Senate—even if Speaker John Boehner is motivated by fear of his caucus, and McConnell and Cornyn by fear of Kentucky and Texas Republican activists—takes one’s breath away.”

(photo by Paul Smith)

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Obamacare’s Going To Be Great, Just Not For Democrats

Pro Obamacare Rally

By now most know that the implementation of Obamacare in New York is set to decrease the cost of healthcare in that state a staggering 50%, yet another example of the wide-ranging benefits of the bill most hated by Republicans — maybe ever. So we have genuine examples of why Obamacare is a really great law, and how exactly it helps those states that have taken up the responsibility of fully implementing it (ahem, Texas). But in the rush of excitement, some commentators like Nobel laureate economist Paul Krugman have directed their attention(s) to the political ramifications of Obamacare’s success, noting that:

…unless the GOP finds even more ways to sabotage the plan, this thing is going to work, it’s going to be extremely popular, and it’s going to wreak havoc with conservative ideology.

And over at Slate, Yglesias pulls no punches:

I wanted to once again take the opportunity to lay down a marker and say once again that Obamacare implementation is going to be a huge political success.

But Ezra Klein disagrees with both of them:

I don’t buy it. If I were betting, I’d say stories about various problems in the implementation of Obamacare will be a net negative for Democrats in 2014, and after that, the program will cease to matter much politically at all — even as it works pretty well, and the coverage it offers is pretty popular.

The key thing to remember about how people will experience Obamacare is that most people won’t experience it at all, and those who do experience it will never, ever experience a program named “Obamacare.”

I tend to agree with Ezra: the law is so intensely complex and confusing when it comes to actually knowing whether or not something is or is not covered under the umbrella of Obamacare, that the authors of the bill are unlikely to receive political points for doctoring it. None of this is to say that the successful implementation of Obamacare — and the benefits gleaned from that implementation — won’t translate into substantial improvements from a policy standpoint. Politically, though, the law won’t win very many elections for Democrats.

(photo by Ladawna Howard)

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What Just Happened To Obamacare’s Employer Mandate?

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The surprising — though not unwelcome — news out of the White House is that the controversial employer-mandate provision in the Affordable Care Act is going to be delayed one-year. Ezra Klein argues for getting rid of it all together:

It’s a bad bit of policy. In fact, when it first emerged during the Senate’s negotiations, I called it “one of the worst ideas in recent memory.” … By tying the penalties to how many full-time workers an employer has, and how many of them qualify for subsidies, the mandate gives employers a reason to have fewer full-time workers, and fewer low-income workers.

Tyler Cowen agrees, and sees the administration going there:

My view is you don’t serve up a delay and PR disaster like this, on such a sensitive political issue, unless you really wish to derail the entire provision.

Evan Soltas piles on:

[T]here is a strong case for getting rid of the employer mandate. Employers shouldn’t sponsor insurance in the first place, as it masks the true cost of care to employees and creates incentives for over-insurance. It also increases the cost of hiring, locks employees into their jobs, and splits the market for insurance into one for individuals and one for employers, which impedes risk-sharing in the individual market.

They’re right: the employer-mandate is bad policy. It’s too complicated, too costly, and it should be repealed.

Barro considers the budgetary consequences of the mandate:

One of his key selling points for the law was that it would cut the deficit. Now that the law has passed, his administration is freer to pursue changes that will raise Obamacare’s cost to taxpayers but improve its effects on the economy. Delaying the employer mandate, perhaps indefinitely, is one way to do that. It’s a better reason than “we couldn’t figure out how to do the reporting.” But it’s not one you can say out loud.

And Jonathan Cohn foresees the upcoming political fallout from this decision:

Employers might quiet down a bit, but the law’s doubters will use this as proof the administration doesn’t know what it’s doing. As Sarah Kliff puts it, it’s trading one headache for another. Or maybe two. Already, conservatives like Erick Erickson are saying it’s unfair to delay the mandate on employers without also delaying the mandate on individuals. Erickson won’t be the last to make this argument, just as he already has plenty of company citing this news as proof that Obamacare is a disaster.

(Photo by flickr user Paul Smith)

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Republican intransigence the biggest threat to Obamacare

#protectthelawRally in support of ACA in front of SCOTUS (cc photo by LaDawna Howard)

The key to any good and lasting public policy is knowing what works, and what doesn’t, and implementing new strategies and reforms to account for what doesn’t, while simultaneously expanding what does. That’s how complex laws work in this country, from the alteration of Social Security in 1939 to reforms made on Medicare in the years following its being signed into law, complex policies need a fair bit of trial and error, and time, to work effectively.

But few items have been as controversial, misunderstood, and as politicized than the Affordable Care Act, which is why it’s not so surprising to read today’s story in the New York Times where Jonathan Weisman and Robert Pear report how Republicans plan to block any effort to alter and improve the law going forward:

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California gives Obamacare some very good news

Obamacare on the steps of the Supreme CourtObamacare on the steps of the Supreme Court (cc photo by Will O’Neill)

It was Oregon that gave Obamacare a boost a few days ago when it was revealed that competition among health insurers was reducing the price of health coverage on the Obamacare exchanges. Well, yesterday, the largest state in the union had some more good news for the upcoming health program:

Based on the premiums that insurers have submitted for final regulatory approval, the majority of Californians buying coverage on the state’s new insurance exchange will be paying less—in many cases, far less—than they would pay for equivalent coverage today. And while a minority will still end up writing bigger premium checks than they do now, even they won’t be paying outrageous amounts. Meanwhile, all of these consumers will have access to the kind of comprehensive benefits that are frequently unavaiable today, at any price, because of the way insurers try to avoid the old and the sick.

The core mission of Obamacare is to control for prices. Healthcare is still way too expensive in this country and given the size and bureaucratic complexities we have to deal with, it may always be too expensive. But Obamacare seems to be doing its job at creating competition amongst insurers, thus forcing prices to be made competitive, thus reducing them.

California is a particularly important case-study for Obamacare, which is why its a huge deal to get this news. If by the end of next year California is boasting a – not perfect but certainly successful – universal health-care system after only the first year of implementation, other states that chose to forgo the Medicaid expansion – like Texas – will be looking at a large state like California and will likely wonder what it would have been like to accept and implement a clearly workable and beneficial law – especially since the Texas health-care system in particular is a total mess.

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Why the 37th attempt to repeal the Affordable Care Act matters

The esteemed House of Representatives is set to try – for a 37th time – to repeal the Affordable Care Act, more affectionately known as Obamacare. After say, the 30th attempt, it becomes easy to write off these quixotic efforts as pure spectacle aimed at bringing a smile to otherwise joyless members of the far-right coalition. Republicans can go home and tell their peoples that did everything within their power to repeal the Stalinist attempt to force everyone to have affordable medicine. But there’s a point to all these attempts to repeal ACA: they fundamentally change both the way Americans perceive the measure, and how the law works.

Perhaps motivated by the many attempts to repeal this widely contetious bill, the Kaiser Family Foundation polled Americans last month to ascertain public knowledge regarding whether or not the bill is still in effect. Considering most Americans can’t name their state’s Senators, It’s not all that surprising that twelve percent of the public think that Congress successfully repealed Obamacare. Twenty-three percent didn’t feel up to answering the question.

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Here’s everything you need to know about the Oregon Health Study on Medicaid

First thing first, here is the abstract to the now infamous health study out of Oregon:

This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.

Given that Obamacare significantly increases Medicaid coverage, there’s huge interest in any data analysis that shows whether or not Medicaid is truly effective in improving health. Sarah Kliff summarizes the jumbled results of this study:

The research, published Wednesday in the New England Journal of Medicine, did find that low-income people who recently gained Medicaid coverage in Oregon used more health-care services. New Medicaid enrollees had less trouble paying their bills and saw significant improvements in mental health outcomes, with rates of depression falling by 30 percent. But on a simple set of health measures, including cholesterol and blood pressure levels, the new Medicaid enrollees looked no different than a separate group, who applied for the benefit but were not selected in a lottery.

So here’s what happened: Oregon held a lottery of sorts a few years ago because they cut their Medicaid program so drastically that they found out they had money left over for 10,000 people to receive it. There were roughly 90,000 people who wanted the coverage, hence the lottery. The study basically followed up two years removed with the people that received the Medicaid coverage and the people that didn’t. People that received Medicaid were chosen randomly, and people that didn’t were also chosen randomly. Important point here: this isn’t just the first randomized trial testing the effects of Medicaid against being uninsured. It’s the first randomized-controlled trial testing any kind of health insurance against being uninsured — period.

The reason everyone is going nuts over this whole thing is that the misleading headline result of the study reads, “Medicaid coverage generated no significant improvements in measured physical outcomes.” Besides being perceptively deceiving, it’s a totally bullheaded way to deliver the results of a study like this.

The study did in fact show substantial improvements for Medicaid recipients with depression, high blood pressure, high cholesterol, and high glycated hemoglobin levels (basically diabetes). The results weren’t “massive” by any means, but that’s way different from saying that the coverage had little to no effect.

Aaron Carroll and Austin Frakt on how you should understand the Oregon study:

The good: Medicaid improved rates of diagnosis of depression, increased the use of preventive services, and improved the financial outlook for enrollees. The bad: It did not significantly affect the A1C levels of people with diabetes or levels of hypertension or cholesterol. This has led many to declare (and we’re not linking to them) that the ACA is now a failed promise, that Medicaid is bad, and that anyone who disagrees is a “Medicaid denier”.

So in the end it’s probably true that access to Medicaid did improve health outcomes rather than that it had zero or negative effects. The conveners of the study should have chosen their words a little more accurately, and what we’ll likely see because they didn’t do so are political commentators that aren’t stat geeks or science friendly (yeah, basically Fox News), jump up and down and claim victorious against big bad Obamacare.

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