Seven questions – and answers – about ObamaCare’s future

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Nationwide, news that rates for the benchmark ObamaCare “silver” plan will rise an average of 25 percent next year — in Georgia, it’s more like 15 percent, and 13 percent in metro Atlanta — have once again inspired conservative claims that the program’s long-predicted demise is finally upon us.

QUESTION ONE: Is that true?

No. Once again, that isn’t close to being true. The increase in rates for 2017 represents the market correcting itself, as necessary, and for the vast majority of people buying insurance through the federal marketplace, the financial impact will be minimal. In Georgia, for example, 89.4 percent of those buying individual coverage through the marketplace are eligible for federal subsidies that will offset the rate hike.

That means that in the Atlanta market, a 40-year-old nonsmoker making $30,000 a year would see a monthly rate decrease of $1 after subsidies in 2017, according to data compiled by the Kaiser Family Foundation.

QUESTION TWO: “So ObamaCare isn’t a failure?”

Hardly. Again, let’s use Georgia as an example. By the end of 2015, we had almost 900,000 more working-age Georgians with health insurance than when ObamaCare was enacted back in 2010, according to Census Bureau and Department of Health and Human Services statistics. (While a fraction of that growth is from population increase, the vast majority is due to ObamaCare). The number of additional insured would be closer to 1.5 million if Georgia had accepted federal funding for Medicaid expansion instead of grandstanding on its ideological opposition, a goal that state leaders are now awkwardly lurching toward.

Providing health insurance for that many people, within or even below projected costs, with no adverse impact on the deficit according to the GOP-run Congressional Budget Office, is not a failure. It faces challenges, but overall it is working as intended.

QUESTION THREE: “OK, but doesn’t a rate increase of this magnitude mean that costs are spiraling out of control, with huge unexpected costs to the federal government?”

Again, no. As both private and government health-care experts point out, ObamaCare rates in the first few years of the program came in considerably below initial projections by the Congressional Budget Office, and annual rate hikes were also well below longtime historic trends. (People forget that annual rate hikes of 25 to 30 percent drove passage of ObamaCare in the first place.) In the early years of ObamaCare, insurance companies competing for business set their rates too low for the costs that they would incur, and they are now correcting for it. The rate hikes announced this year — while large in some instances — bring rates back to the level that experts had predicted from the beginning.

QUESTION FOUR: “So the program is fine, then? No need to worry?”

No, it needs some work. Any program of this complexity and importance is going to require legislative adjustments over time. It was true of Social Security, Medicare, Medicare Part D and Medicaid, and it is true of the Affordable Care Act as well. We have now gone six years since the Affordable Care Act was signed into law, and we’re getting a better idea of what those adjustments should be.

The biggest problem is that to date, ObamaCare has not drawn as many healthier, younger people into the insurance pool as expected. So some relatively simple fixes are needed:

  • We have to make it harder for people to pick up insurance when they need it and drop it when they don’t. I know people who have gamed the system that way, and you probably do too. And while I’m personally glad that they got the care they needed, a system generous enough to allow that isn’t going to be financially sustainable. The Obama administration has tightened up some of that, but legislative changes would be useful in doing more.
  • The income tax penalty for going without health insurance has to be toughened, both to account for the cost to taxpayers of treating the uninsured when they do need care and to alter their financial calculations about whether to get insurance.  The whole idea behind insurance is that you pay into it when you’re healthy so it’s there for you when you’re not.
  • In addition to a bigger stick in the form of a tax penalty, we need a somewhat larger carrot in the form of subsidies for younger people to make coverage more attractive. The more healthy people people we can draw into the pool, the lower the per-person cost.
  • We have to do something about soaring pharmaceutical costs, as the pricing scandals involving the EpiPen, Daraprim and other drugs illustrate. It’s ridiculous that Americans often have to pay several times as much for the same drug as people in Europe and Asia, particularly when those drugs were developed in part through research funded by U.S. taxpayers.
  • In some rural areas without much competition among health-care providers or insurance companies, the cost of an insurance policy is skyrocketing,  leaving those who don’t qualify for subsidies facing unaffordable rates.  That problem also has to be addressed.

QUESTION FIVE: “Do you really believe Congress is going to enact the changes needed?”

Unfortunately, no. We’ll see how the election plays out and how the Republicans handle their internal divisions, but the GOP’s strategy of refusing to help govern unless they get to call all the shots will probably continue to play out in ObamaCare as well. They would far prefer to see the program struggle than to see it improve, even if their own constituents suffer as a result.

For example, rates are rising in 2017 in part because in 2014, Republicans succeeded in killing a provision of the Affordable Care Act that helped to compensate insurance companies if they end up with a disproportionate number of extremely sick, expensive customers.  At the time, Sen. Marco Rubio and others celebrated that as a big political success, because they knew what the consequences would be higher rates.

QUESTION SIX: “So if Republicans refuse to allow adjustments to ObamaCare, we’ll at least finally see the GOP’s long-promised plan to replace it with something better, right?”

You are so funny.

Republicans have a “plan” to replace ObamaCare in much the same way that Donald Trump has a “plan” to defeat ISIS. It amounts to flowery promises of “empowering patients” and “slashing costs,” with no level of detail of how much it would cost, how it would work, what impact it would have or how many Americans it would leave uninsured.

As you know, House Republicans alone have voted more than 60 times to repeal ObamaCare, with not so much as a subcommittee vote on a replacement bill. Why? Because House Speaker Paul Ryan has a dirty little secret that he would prefer to keep hidden as long as possible. He knows, based on previous failures, that any replacement plan that he would bring to the House floor would get voted down by his own Republican colleagues, many of whom are flatly opposed to any federal role whatsoever in the health-insurance market.

The entire GOP health-insurance strategy — all their rhetoric and legislative posturing over the past six years — has been an elaborate attempt to hide that basic, fundamental reality from the American public.  Their true alternative to ObamaCare is, well, nothing.

QUESTION SEVEN: “So you’re saying we’re screwed?”

Well, I wouldn’t put it that way, but kinda, yes.  ObamaCare isn’t going to be repealed, in part because doing so would strip insurance from more than 700,000 people in Georgia alone. It isn’t going to be replaced, because any plan ambitious enough to have an impact on the problem will be too ambitious for House Republicans to accept. And our broken political system won’t enact the basic adjustments that simple logic tells you would be required in a new program after a few years of operation.

Things will have to get worse before they have a chance to get better.

 

 

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822 comments
Donnie_Pinko
Donnie_Pinko

philo fer a farthings worth

Obama runs the DOJ, so he greenlighted this.

Why does obama hate Hillary so much?

-

Yeah, maybe, but WHY.

If there is evidence that's come to light. the FBI could have felt its hand was forced. To have sat on evidence right before the evidence sure would raise the specter of wrongdoing. Careers could be at stake. 

Just because they greenlighted it doesn't mean they're after Hillary.


rmitch788
rmitch788

Maybe Wiener and Clinton were swapping selfies. If so, Wikileaks, please don't release them.

StraightNoChaser
StraightNoChaser

Somebody popped the champagne too early.


“A total bombshell,” said Rep. Peter T. King (R-N.Y.), member of the House Homeland Security Committee.

Wascatlady
Wascatlady

We have seen on the pages of this paper a guy in SC who did not buy the insurance, then was losing his sight, and somehow got around the deadline.  So yes, the loopholes DO need to be closed.


We need people who don't have insurance to be paying for their use of the hospital as medical care, if they do.  Automatic deductions or whatever, but they do need to pay.  And if they come in for something clearly non-life=threatening, they should be triaged out and pay for their use of the ERs time.  Once I was in the ER and a couple was there because one had a sore throat and did not want to have to sit and wait at the doctor's office.  That has to be stopped!


Women on Medicaid should be paying for their pregnancy and childbirth, even if it is $5 per week plus their EIC for the rest of their lives, and the father of the child should be required to be named so he shares the cost, if necessary, for the rest of his life. (I know this isn't Obamacare, but it needs to be addressed).


Drug costs must be addressed. I went for a month's prescription of an antiviral yesterday and the price was over $3,000.  Needless to say I will not get it. Even with insurance it was over $100.  I asked the doctor for something low tech and got it for $45.  There is NO GOOD reason for this!

elgrunir
elgrunir

ONE NOTHINGBURGER TO GO!

DIA wants a burger with zip

As long as they indict at a clip

Thinks he tastes onions

But they’re Rush Limbaugh’s bunions

On the radar ya ain’t got a blip

rimsky
rimsky

Trump’s Campaign Might Not be Winning, But His Hotels Sure Are New campaign filings show big payments to Trump properties in New York, Las Vegas and Washington.

Now Trump is a true capitalist bidness man.

F@#k the country as long as he is making money out of the schmucks who bought into his BS.

DownInAlbany
DownInAlbany

Biden tells Hillary, "...thanks, but, you can shove it..."

elgrunir
elgrunir

DIA nothingburger limerick (with onions) comin' up!

Philo_Farnsworth
Philo_Farnsworth

Obama runs the DOJ, so he greenlighted this.

Why does obama hate Hillary so much?

elgrunir
elgrunir

@Philo_Farnsworth  And didn't the Senate confirm the appointment?  Oh, so that be on y'all Republicans. Oopsie.

Philo_Farnsworth
Philo_Farnsworth

Obama is his boss. He did what he was told to do, by his boss.

Not hard to understand. Duh.

elgrunir
elgrunir

@Philo_Farnsworth  I thought the head of the DOJ was the Attorney General, who is a woman.  Besides, you can't do what the Democratic boss tells you to do until you're hired by the Republican Senate.  Oh, and what of the investigation?  Nada.  "Duh," yourself.

rimsky
rimsky

Republicans know the study has been done about Hillary and her Emails.

The study shows Hilllary's negative numbers go up when the email thing is in the news.  This is election time.  

Republicans will cause as much mischief as they can to hold on to the Congress.


Paul42
Paul42

Amazing how cons won't even congratulate House Republicans on their 'plan' to replace Obamacare.

It's like they know it's just not worth the effort.  

DownInAlbany
DownInAlbany

@Paul42  Not with Obama's promise to veto it, you are correct.  Not worth the effort.

Paul42
Paul42

@DownInAlbany

Yep.  It does appear they are not flexible enough  to introduce parts that would actually help correct problems instead of going for repeal.  Ideologues to the bitter end.

Paul42
Paul42

@elgrunir

Now, now, elgrunir.  You should know better.  That's just a lie put out by 'the media.'  The fact one can confirm it by reading the legislative history in records maintained by Congress is irrelevant.

DownInAlbany
DownInAlbany

@Paul42 @DownInAlbany  Ideology is what brought us the steaming pile of excrement, aka, Obamacare.  Selective memory is not flattering on you.

elgrunir
elgrunir

@DownInAlbany @Paul42  Ideology is what brought moronic, posturing delays, demands that need to be fixed, and wasteful attempts at repeal.

rimsky
rimsky

Emailghazi Part mono

The the moron brigade were dancing how Hillary will be behind bars.  What happened  BIG fat nothinburger.

Emailghazi Part duo

Same as Part mono.

Philo_Farnsworth
Philo_Farnsworth

Take it up with Obama's DOJ.

Congress had nothing to do with this.

elgrunir
elgrunir

@rimsky  QUIZ TIME !!!  Which is higher:  the number of "GHAZI'S," or the number of times Republicans will try to repeal the PPACA?

elgrunir
elgrunir

YUUUUUM, YUM!

Try the new NothingBurger: no truth!

Where the filling is “Just be uncouth”

It turns off the people

Even some under steeple

Trump needs Superman and a phone booth

elgrunir
elgrunir

One nothing burger, comin' up!  And just for DIA, I won't hold the onions.

DownInAlbany
DownInAlbany

OK, let's peel the onion a little....IF (with emphasis) Huma and Anthony have confidential information on their cell phones (devices), where did it originate?

StraightNoChaser
StraightNoChaser

@DownInAlbany @StraightNoChaser She had to have one to work for the state department, even if it was just a confidential one.  I use to work for a Navy contractor, that's why I know that it's a requirement.

StraightNoChaser
StraightNoChaser

@DownInAlbany @StraightNoChaser It's pretty hard to get around those clearance people, they do a thorough investigation into your back ground.  You can't just waltz into an office that handles national security and not expect to be investigated while doing so.

Donnie_Pinko
Donnie_Pinko

Hillary needs to work on her point at the crowd and beam move when she comes out at rallies and public events. It's borderline parody material as it is. Just doesn't look natural for her.

Philo_Farnsworth
Philo_Farnsworth

SNC makes the case this whole FBI letter thing was one big misunderstanding.

I look to an immediate FBI retraction, subject: oopsie.

Lol

StraightNoChaser
StraightNoChaser

@Philo_Farnsworth They did not find anything on her server or sent by her.  Huma worked for the state department too and also held a security clearance. 

McGarnagle
McGarnagle

@StraightNoChaser


If this is the case why so vague about details in re-opening the investigation. Is Comey so dense to not see the hysteria this will cause?