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The Huge Obamacare Story You Aren't Reading


Leon Troutsky
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Today it’s a few hundred thousand people. By next year, it will be at least a few million. Their health insurance status is changing dramatically: What they have in 2014 and beyond will look nothing like what they had in 2013 and before. For many of these people, the difference will be hundreds or even thousands of dollars a year. In a few cases, it may be the difference between life and death.

You probably think I’m talking about the people getting cancellation notices about their private insurance policies. I’m not. I’m talking about the people getting Medicaid. Both stories are consequences of the Affordable Care Act. But one is getting way, way more attention than the other.

It’s no mystery why. Stories of people losing something are more compelling than stories of people gaining something. The policy cancellation story is also newsier, because fewer people expected it to happen. Obamacare’s expansion of Medicaid was something the advocates of reform advertised. Reform’s effect on people with skimpy or medically underwritten insurance policies they liked was something that few advocates, including the president, even acknowledged. Had Obama pointed out, all along, that some people might lose existing plans or pay more for coverage in 2014, it would seem a lot less shocking.

But there is also a class element to the way this debate has evolved. By and large, the people receiving those cancellation notices and facing large premium increases are at least reasonably affluent. They’re not necessarily rich, particularly if they live in higher cost areas of the country. Many of them sweat monthly bills just like most of the country does. But, by definition, they don’t qualify for huge subsidies that would offset premium increases mostly or completely. By contrast, the people getting Medicaid are poor. They have to be, because it’s the only way to sign up for the program. And as political scientists have shown, the poor don't command the same kind of attention from politicians that the middle class—and particularly the upper middle class—does.

And this fact, I suspect, is also magnifying the impact of those cancellation letters. The best estimates suggest that 12 to 15 million people currently buy coverage on their own—i.e, in what's known as the non-group market. It appears that only a fraction of them will get to keep their current policies. The rest will end up having to get new coverage, or updated versions of their old coverage, that offers greater benefits and/or is available to everybody, regardless of pre-existing condition. That will drive up the price of insurance.

But when you take into account the subsidies, which for many people will knock the price of insurance right back down, and the number of people who would gladly pay more for insurance that offers real protection from financial shock, the number of people who truly end up feeling worse off ends up a lot smaller than 12 or 15 million. And even those people will end up with good health insurance, though they’ll be paying more for it and may not want it.

Meanwhile, the best available projections suggest that 13 million people will eventually sign up for Medicaid. That’s a much larger number of people, most of whom had no insurance—none—before. That doesn’t even include more than ten million presently uninsured people expected to get insurance through employers and the new marketplaces, assuming all of the websites start working better, or the millions of seniors getting extra help with their prescrpition drugs.

Of course, the story of the Medicaid expansion is also one of suffering. But that’s because Republicans governors and lawmakers are blocking expansion of Medicaid in their states. About 5 million people who would be eligible for Medicaid under Obamacare's new guidelines won't be getting it. Here’s a mental exercise. How many stories have cable news and the networks run about people with private insurance getting cancellation notices? And how many have they run about people who would be getting Medicaid if only their state lawmakers would stop blocking expansion?

You can find examples, usually from domestic policy writers in print. My colleagueAlec MacGillis has waged a lonely crusade to remind people about this situation. The New York Times had a terrific front-page story on this in early October, andPolitico's Jen Haberkorn wrote about it a few weeks later. In the Washington Post, Ruth Marcus on Friday wrote about Paul Tumulty, in Texas, who can't get insurance because Governor Rick Perry has blocked that state's Medicaid expansion. Tumulty, who is the brother of Post staff writer Karen, has kidney disease. Wiithout Medicaid he can't get comprehensive coverage, because, as Karen put it, "he is, paradoxically, too poor for subsidies."

But these articles are the exception more than the rule. Obama tried to draw attention to the issue last week, when he visited Texas. But the trip didn't generate much in the way of new coverage of Medicaid.

Should the president have been more candid about the impact his plan would have on people buying their own coverage? Yes. Should we pay attention to those people, particularly when they must now pay more for equivalent coverage? Definitely. Should this put extra pressure on the administration and some states to fix their websites? You bet. But that's not the only Obamacare news right now. The law is making life better for a great many people—and would help even more if only Republican lawmakers would relent. Those stories need attention, too.

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And a related story:

http://www.washingtonpost.com/blogs/plum-line/wp/2013/12/03/medicaid-expansion-becomes-weapon-against-gop-governors/

Medicaid expansion becomes weapon against GOP governors

It’s widely accepted as an article of faith that Obamacare will be uniformly bad politics for Dems in 2014. After all, the rollout is a disaster and majorities disapprove of the law, so how could it possibly be any other way, right?

Here’s something that counter-programs that narrative a bit: Democrats are currently using a major pillar of the health law — the Medicaid expansion — as a weapon against Republican Governors in multiple 2014 races. Many of these Governors opted out of the expansion or have advanced their own replacement solutions, and many are facing serious challenges.

In Florida, Democrat Charlie Crist has excoriated GOP Governor Rick Scott for dragging his feet on the Medicaid expansion, claiming a “million” Floridians “will not get health care” as a result. In Wisconsin, Democrat Mary Burke is campaigning on a pledge to reverse GOP Governor Scott Walker’s decision to turn down $119 million in federal money to expand Medicaid to more low-income Wisconsinites.

In Pennsylvania, multiple Dems looking to run for governor are attacking GOP Governor Tom Corbett for subbing in his own plan to expand Medicaid, arguing it’s a ploy to defuse the issue. In Maine, Dem Rep. Mike Michaud is attacking GOP Governor Paul LePage for refusing to opt in.

Some Dems running for governor in red states, such as South Carolina, may not embrace the Medicaid expansion debate as directly. But the fact that it’s emerging as an issue in some high profile races is a reminder that it’s still good politics for Dems to campaign on components of the Affordable Care Act that directly impact many of the constituents these GOP governors represent. Terry McAuliffe was just elected governor of purple Virginia partly on the Medicaid expansion.

Dems will continue using the Medicaid expansion to paint GOP governors in purple or blue states as hostage to a national Tea Party agenda. “Walker, Scott, LePage, and Corbett have refused to lift a finger to bring their taxpayers’ money home to create jobs and expand health care access,” Danny Kanner, a spokesman for the Democratic Governors Association, tells me. ”It’s the kind of sabotage one might expect from Tea Party Republicans in Congress, but voters will punish those governors for it.”

The larger story is that the Medicaid expansion is emerging as an early Obamacare success — a rare area where the law may already be putting Republicans on the defensive. A new report from the Centers for Medicare and Medicaid Services finds that over 1.4 million people in October were deemed eligible to enroll in Medicaid or CHIP. There was a far larger jump in applications where states are expanding Medicaid than where they aren’t — another sign Obamacare may benefit far more people in states where GOP governors are not trying to block the expansion.

Politico’s Edward Isaac-Dovere has a great piece reporting that multiple GOP governors initially elected in the 2010 Tea Party wave are now in contested races precisely because they continue to pursue the Romney agenda that was roundly rejected by voters two years later. The Medicaid expansion is a good example. Obamacare was heavily litigated in 2012; Dems won; and the law’s benefits are now kicking in across the country. Yet some of these GOP governors — originally buoyed by a movement organized largely around Total War opposition to Obamacare — continue to resist accommodation with its Medicaid expansion, even if so doing means denying expanded coverage to their own constituents. And they will now be pressed by Dems to answer for it.

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It’s widely accepted as an article of faith that Obamacare will be uniformly bad politics for Dems in 2014. After all, the rollout is a disaster and majorities disapprove of the law, so how could it possibly be any other way, right?

Tying into your earlier post, the newsy nature of public opinion is also misleading here in that a significant portion of people polled wish the law were more liberal. So the polling data being utilized to state popularity actually reads differently to anybody who reads to the bottom of the page.

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And while we are talking about Obamacare:

http://www.mediaite.com/tv/consumer-reports-changes-verdict-on-obamacare-website-tells-msnbc-its-time/

"After advising consumers to steer clear of Healthcare.gov in October, Consumer Reports health care expert Nancy Metcalf told MSNBC’s Chuck Todd Tuesday morning that the federal health care exchange website was improved enough following the Obama administration’s frantic month of repairs that users could confidently use it.

Consumer Reports had earlier told its readers not to even bother with the website through the first month, a provisional verdict it later said had been misrepresented.

“Now we’re saying, ‘it’s time,’” Metcalf said, in particular praising the new window-shopping function, in which users can peruse health plans without registering with the site. The requirement to make an account before viewing options was considered one of the main causes for the site’s initial traffic bottleneck. “It’s terrific, I’ve tried it, it was working yesterday through the busiest times,” Metcalf said.

Metcalf stopped short of saying the website was fixed, noting that she was endorsing using it in the context of the short window customers have to access the site, and, more importantly, the subsidies available through it, in order to purchase insurance that takes effect on January 1. Metcalf warned that consumers had no control over the back-end problems, which are giving inaccurate information to insurance providers, and said that if you enroll through Healthcare.gov and don’t hear from your new provider within a week, your best bet is to contact the insurer directly.

She also advised consumers who had created accounts to abandon the old efforts and “start over,” as many earlier were stuck on glitches that had since been repaired, and would be more trouble than they were worth to retrieve.

Watch the full clip below, via MSNBC:"

(Video clip available at link)

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Tying into your earlier post, the newsy nature of public opinion is also misleading here in that a significant portion of people polled wish the law were more liberal. So the polling data being utilized to state popularity actually reads differently to anybody who reads to the bottom of the page.

There's some truth to that. Here's a CNN poll from 11/27:

"As you may know, a bill that makes major changes to the country's health care system became law in 2010. Based on what you have read or heard about that legislation, do you generally favor or generally oppose it?" If oppose: "Do you oppose that legislation because you think its approach toward health care is too liberal, or because you think it is not liberal enough?" Combined responses.

Support: 40%

Oppose (too liberal): 41%

Oppose (not liberal enough): 14%

That said, the negative coverage did considerably shift the numbers in the "oppose" direction, at least according to most polls. The scope of the opposition has definitely been overstated in the news and by conservatives, but we still generally have more people opposed today than in the past.

Here's all of the polling on the issue:

http://pollingreport.com/health.htm

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I don't think we'll be cheering the expansion of Medicaid in 5 years.

Anything that gets more uninsured people covered is welcome at this point to keep the cost of health care down for everyone. I want single payer but if Medicaid expansion is the first step, I'll sing a happy tune about it.

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Anything that gets more uninsured people covered is welcome at this point to keep the cost of health care down for everyone. I want single payer but if Medicaid expansion is the first step, I'll sing a happy tune about it.

And that's precisely why I think it's a mistake. Medicaid does an ok job of controlling the cost aspect of medicine (as long as you think it's ok to pay physicians per procedure rather than per outcome), but fraud is off the charts, to the tune of $80 billion a year. A massive expansion of the program won't help.
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And that's precisely why I think it's a mistake. Medicaid does an ok job of controlling the cost aspect of medicine (as long as you think it's ok to pay physicians per procedure rather than per outcome), but fraud is off the charts, to the tune of $80 billion a year. A massive expansion of the program won't help.

I think your argument is valid. I'm in the "anything is better than nothing" camp with regards to healthcare improvement but I absolutely want/hope/expect a much stronger version of the ACA in a few years. Even if the democrats take back the house in 2014, I doubt anybody moves quickly with a presidential election in 2016 but after Hilary is voted in (an idea I'm not crazy about, by the way) if the current trend holds politically, I expect her to do what she attempted to do in the 90s.

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so I guess the next step is for the government to start forcing doctors to see medicaid patients since more and more of them are refusing to

http://www.forbes.co...-be-seeing-you/

force? naw, i would encourage it though through partial student loan forgiveness (perhaps drop the interest or forgive a portion of principal equal to pct of medicaid/medicare patients seen over a 10 year period), tax incentives, etc.

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I can get doing it because you're a really fast typer, I've done it plenty of times with both your/you're and there/their/they're, but the amount of times that Your an idiot specifically is typed is amazing to me. If you're going out of your way to insult someone, don't you quadruple check your grammar?

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I can get doing it because you're a really fast typer, I've done it plenty of times with both your/you're and there/their/they're, but the amount of times that Your an idiot specifically is typed is amazing to me. If you're going out of your way to insult someone, don't you quadruple check your grammar?

I understand doing it once in a while in situations like you mentioned. But some people make the same mistake repeatedly and it boggles the mind. Also, you're right, "your an idiot" is delicious.

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