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Obama Touts 8 Million Exchange Sign Ups

By: Thursday April 17, 2014 1:34 pm

Now that the official open enrollment closed last month and the extended quasi-open period ended a few days ago President Obama held a rare press conference to tout  the final numbers for Obamacare this year. The big number is 8 million people have selected a plan on the new exchanges created by the Affordable Care Act.

It is worth noting that probably around 10 percent of these won’t end up paying their premiums to actually get insurance, but even with that factored in, it is safe to assume around 7 million now have private insurance coverage via the exchanges. The President also said 28 percent of people who selected plans on the exchanges were in the coveted 18-34 age group.

It appears the exchanges will have a large enough and relatively healthy risk pool to function mostly as the Congressional Budget Office predicted they would since 2010. This new final total is remarkably close to the CBO’s longstanding estimates and I suspect they will continue to be a very good guide of how things will unfold in the next few years.

In addition to promoting the exchange numbers Obama used the event to attack local Republicans for refusing “out of political spite” to take part in the Medicaid expansion, even though the cost would be mostly covered by the federal government. According to the White House 5.7 million more people will be uninsured in 2016 as a result of this refusal. Expect the Republicans’ political decision to oppose Medicaid expansion to become a frequent line of attack in 2014.

Will Bad Policy Turn People Against Technology?

By: Thursday April 17, 2014 11:37 am

Technological Change and the FuturePew Research has an interesting new poll about people’s opinions on technology and the future, but I think the question most relevant to current policy debates is how optimistic people are about technological advancement. By a margin of two-to-one Americans think technological changes will make people’s lives mostly better, yet if you look into that number you will find a large income divide.

67 percent of Americans making $75,000 or more are optimistic about the power of technology while only 52 percent of people making less than $30,000 are. You might attribute some of this divide to educated people being more inclined to read news about promising new scientific research, but the income divide on this question is actually larger than the education divide. That would imply there is an economic element at play.

I suspect we are seeing the results of decades of bad policy. With good policy a rising tide should lift all boats. Improvements in technology that increase efficiency could easily make everyone better off, but that is not what we have been seeing. Wages have been stagnant even as we have become much more productive. Technology in the form of outsourcing and computerized efficiency has resulted in some at the lower end working harder for less.

At the same time, these big gains in wealth created by technology are being captured by a very small group of people at the top. Technology is significantly growing the overall wealth of the country, but few people are getting any of it. Lower income people being less optimistic is a natural response to the current situation.

I fear the anger that should be focused on politicians, corporatism policies, and a corrupt political system will be misdirected at science and technology in general. People may start thinking this is a natural result of technological advancement instead of being the product of specific policies that wealthy people lobbied to have put in place. That would be very unfortunate for the country given how much promise technology holds to improve lives.

GOP Can’t Help But Take Their Obamacare Attacks Too Far

By: Thursday April 17, 2014 9:53 am

McCarthy’s office couldn’t help but take their debunk from political distortion to completely made up balderdash.

The Affordable Care Act will not fulfill many of the bigger promises President Obama once made. If Republicans would just focus on how the law falls short of Obama’s benchmarks they would have plenty of political fodder, but they seem compelled to push their attacks so far they become completely unhinged from reality.

A perfect example is the post from the office of House Majority Whip Kevin McCarthy (R-CA) “Debunking Obamacare’s 7 million Enrollment Success Story.” The piece starts with a few relatively legitimate data points about how some people won’t pay their premiums, but concludes with totally disapproval nonsense.

According to a survey by the Blue Cross Blue Shield Association, about 15-20% of the enrollees have failed or will fail to continue payment of their required premiums. McKinsey & Co. found that “More than three-quarters of those who reported having obtained coverage also said they had paid their premium” and Goldman Sachs estimated that about 80% of people who are “enrolled” will actually effectuate enrollment. [...]

Applying these estimates, less than 6 million people will have signed up and paid. And of the enrollees, only 1/3 are estimated to be newly insured.  Meaning, after spending $2 trillion dollars Obamacare will have only signed up an additional 2 million people through the exchanges. Is this the Administration’s definition of success?

This number sounds insane because it is entirely not true. The $2 trillion number likely comes from the estimated amount that will eventually be spent on all Obamacare programs over the next ten years. While significantly more money than was necessary was spent on expanding coverage through the exchanges, so far the total comes nowhere close to $2 trillion. So McCarthy’s office shows themselves to be idiots or liars. Either way, any sane person would see this “debunk” has been discredited.

The truly bizarre thing is that if they used the actual numbers for total ACA spending by the end of this year, which is roughly around $50 billion, it still would make the law sound wasteful. Instead though, McCarthy’s office couldn’t help but take their debunk from political distortion to completely made up balderdash.

Grading Exchange Premiums on a Curve

By: Thursday April 17, 2014 7:56 am

Significant premium growth should be unacceptable when we have the most overpriced health insurance on the planet.

Some new analysis of enrollment on the exchanges predicts about a 7 percent increase in premiums next year. From USA Today:

Statisticians working with insurers to project next year’s insurance premium rates say they expect to see an average increase of about 7%, well below the feared double-digit increases making recent headlines.

“The double-rate increases we’ve been hearing are probably exaggerated,” says Dave Axene, a fellow with the Society of Actuaries, adding that there would be wide variation across the country. “That’s not what we’re seeing from the actuarial organizations — I guess we’re being a little bit more optimistic.”

I find this to be a classic example of the ever changing curve Obamacare is graded on. As the article points out this is good news if you compare it to the doomsday predictions some Republicans highlight. When the story became about comparing reality to the dystopia Republicans claim the law will create it comes away looking good. The GOP has helped set the bar for success really low.

Yet if you compare it to Democrats’ bold promises of big individual savings when they pushed through the law or with international standards this is objectively a very disappointing number. A 7 percent increase is well above the rate of inflation or the growth rate of the economy. That is as bad as the situation was before the law was enacted. It is still unsustainable.

Significant premium growth should be unacceptable when we already have, by far, the most overpriced health insurance on the planet. Premiums should be flat or even dropping after a real reform.

Medicaid Works Well at Expanding Coverage

By: Wednesday April 16, 2014 7:13 am

That should be the simple conclusion from this new Gallup data. They found that there was a noticeable drop in the uninsured in states that took part in the Medicaid expansion as part of the Affordable Care Act –  but a much slower drop in the states that did not. From Gallup:

Changes in States' Uninsured Rates Between 2013 and Quarter 1, 2014

Looking at the enrollment data for the individual states the impact of whether or not a state decided to build their own exchange is probably very minor. Almost all the difference can likely attributed to whether or not a state took advantage of the Supreme Court decision making the Medicaid expansion optional.

This shouldn’t come as a surprised to anyone. If you want the uninsured to have health insurance, the most direct and efficient way to do that is just to have the government automatically give them insurance. That is why Medicaid expansion has always been one of the best aspects of the law.

CBO Again Lowers Cost Estimates for Obamacare Coverage Provisions

By: Monday April 14, 2014 9:12 am

Now that the Congressional Budget Office has some real enrollment numbers to work with they have again lowered the projected cost of Affordable Care Act coverage expansion provisions. They now assume these provisions will only cost $1,383 billion from 2015-2024. That is $104 billion less than their estimates from February of this year. From the CBO:

Budgetary Effects of the Insurance Coverage Provisions of the Affordable Care Act, 2015 to 2024

There are several reasons the cost of the coverage provision have been reduced again. One important factor is the CBO projects that future premiums on the exchanges will be slightly lower than their past estimates. The CBO also assumes the total population of the country will be a few million smaller based on the last census.

Over the years the CBO’s cost estimates for the ACA have continually been revised modestly downward mainly because health care costs have grown slower than in the past. Most of this slowdown in healthcare spending can likely be attributed to a weaker than expected economy.

The CBO now believes the exchanges will eventually cover about 25 million starting in 2017. Without the ACA the number of uninsured in 2024 would have been 57 million but now it is projected to be 31 million.

That is not exactly universal heath insurance.

Democrats’ Best Hope Is That Obamacare Simply Becomes Boring

By: Friday April 11, 2014 11:37 am might be working well and the Obama administration was able to hit their 7 million sign up goal on the exchanges, but that has had almost no impact on the law’s popularity. Support for the law continues to remain low and impressively stable, according to Gallup.

Currently, just 43 percent of Americans approve of the law while 54 percent disapprove. Overall support is basically the same or slightly worse than it was a year ago and there is little reason to believe there is going to be a big swing in the near future.

The one silver lining for Democrats is we could see a drop in how much people actually care about the law. The number of people who say the law will have no effect on their family’s health care situation is a a record high.

healthcare law affect you and your family's heathcare situation

The Affordable Care Act was mainly just an expansion of our broken system. For better or worse it will have very little direct impact on the majority of Americans.

This means the law is probably never going to provide real benefits to most people which could potentially win them over. But it also means that it is quickly becoming clear that the implementation of “Obamacare” is going to noticeably affect most Americans. Some of the more bizarre horrors Republicans have made up aren’t happening.

The law is unlikely to become popular in the near term but there is a decent chance it could become boring and unimportant to many voters. During the 2014 election what “victory” on the ACA probably looks like for Democrats is that for voters the feelings on the law goes from feared to a detached dislike.

Like a Stopped Clock Republicans Were Right About Sebelius Resignation

By: Friday April 11, 2014 7:27 am

Kathleen Sebelius

HHS’s Kathleen Sebelius was right to resign

It is tough to take a party’s criticism of ACA implementation issues seriously when they are in total opposition to the underlying policy from the start and actively tried to sabotage it at every turn.

The Congressional Republicans attacked Health and Human Services Secretary Kathleen Sebelius for problems with the federal exchanges but it is hard to believe many of the Republicans were really unhappy about it. Most of them wanted the exchanges to fail, that is why they didn’t help by providing extra funds even after it became clear the federal government’s job was going to be bigger than originally planned. That is why so many Republican states refused to set up their exchanges or expand Medicaid.

From the Republican perspective Sebelius performed the way they wanted her to. For Republicans to then call for her resignation over problems they helped create is deeply cynical and self-serving, but they also weren’t technically wrong.

Ultimately, while her department eventually fixed after several months there is no reason it shouldn’t been working in the first place. They had three years to build it, that is plenty of time to test it before the rollout. There was no excuse for what happened. Sebelius had a job and she failed. When you fail miserably you should lose your job.

Sebelius should have resigned and I’m glad to see that she has. Our government has a disturbing lack of accountability.

Congressional Republicans were “right” about the fact she should resign, but only to the extend a stopped clock happens to be right twice a day. If you choose to blindly oppose everything, you will sometimes happen to be right.

The Bureau of Prisons Will Either Keep Their Promise or Keep Whistleblower John Kiriakou From His Family

By: Thursday April 10, 2014 10:32 am

The Bureau of Prisons is threatening to keep CIA whistleblower John Kiriakou from his wife and kids by refusing to honor their deal to transfer him to a halfway house by May 1st.

John’s struggle with the Bureau of Prisons comes on the heels of news that the Senate Intelligence Committee has voted to declassify part of a far-reaching report on CIA torture. The agency is currently under fire after Senator Feinstein alleged they hacked her committee’s private network to remove documents pertaining to the investigation. With the media’s attention focused on the torture program, we must remind the public and members of Congress that it was John who blew the whistle and rally them to his defense.

Many Americans probably don’t even realize the only person to go to prison over CIA torture is the man who pulled back the curtain on it; let alone that the same man is currently suffering reprehensible indignities while serving out that sentence. With your help, we can work to make sure John’s story is part of the critical debate over CIA torture.

Firedoglake has reported on the conditions of John’s imprisonment since the beginning, publishing his ‘Letters from Loretto,’ visiting him in prison and raising the profile of his case in the media. We’ve also been working to organize activists to write letters, make over 1,500 phone calls and lobby their own members of Congress to support John.

But with time running out, we need to escalate our efforts. We are working on bringing together community allies to make sure the Bureau of Prisons grants John the full 9 months in a halfway house that he was promised. In order to do bigger and more impactful actions, we need to broaden our base of support across the country.

Can you please donate $15+ to recruit activists in support of John Kiriakou?

Those who have been following John’s story already know the abuses he’s suffered while in prison: Officials have conducted surprise searches of his cell, attempted to remove his writing desk and threatened him with ‘diesel therapy.’

Later this month, the Bureau of Prisons is set to formally decide on how much time he will get in a halfway house, where he can be closer to his friends and family.

But after reporting that the BOP was going back on their deal, FDL’s Kevin Gosztola and Jane Hamsher visited him at Loretto and found the bureau was going even further by threatening to reduce John’s halfway house time to a mere 86 days in a location far from his family.

The BOP appears to be ramping up the pressure on Kiriakou, which means we need to double down in his defense. Please donate today to recruit more activists to this important campaign so we can do more to help John Kiriakou.

The High Cost of Going with a Health Care Exchange Model

By: Wednesday April 9, 2014 10:34 am

If progressives want to make the case for government programs they need to prove they are good stewards of the purse. Cheering needlessly complicated and wasteful systems is not the way to do that.

There is clearly a significant direct financial cost created by going with a private health insurance exchange model to expand coverage instead of just automatically providing people with a government policy.

To begin with there was of course the one time cost of building the exchanges, which is a totally unnecessary bureaucratic middleman layer to help people select another middleman.

There was also the cost of getting people to sign on to the exchanges once built since they are not automatically enrolled. That included a large advertising campaign by the government, companies and non-profits.

In addition there is the expense of helping people figure out the exchanges once they log on. A significant number of navigators were hired to play this role. While setting up the exchanges is a one time cost, advertising them and helping people to use them will be a recurring cost.

Finally, there is the huge added expense which stems from private insurance being a significantly more expensive way of providing care than public insurance. The CBO determined the government run policy could provide similar coverage for noticeably less money.

The Policy Cost

Beyond the financial cost though there is a significant policy cost of going with an inherently less direct and more inefficient system. The law was passed in 2010 but took years to set up. President Obama was extremely happy to get 7 million people to use the exchanges this year but it is important to remember that is only a small fraction of the people who “should” be using them. Because getting people to actively sign up is inherently slow, less effective and less comprehensive it is assumed that it will take several years for enrollment to ramp up to its final goal of around four times the current number.

A simple system that automatically just gives the population government insurance could have increased coverage much sooner and by a greater amount. We could have exceeded the ACA’s final coverage goal a year ago.

If progressives want to make the case for government programs they need to prove they are good stewards of the purse. Cheering needlessly complicated and wasteful systems is not the way to do that.

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