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Republicans Are Determined to Destroy Health Safety Nets, Whether or Not Their Latest Effort Passes

Republicans Are Determined to Destroy Health Safety Nets, Whether or Not Their Latest Effort Passes

Reprinted with permission from Alternet.

 

Political resistance mounted to the House Republican leadership’s Obamacare repeal legislation Tuesday, with 12 Republican senators criticizing elements of House Speaker Paul Ryan’s plan as too draconian—especially the proposal’s cuts affecting Medicaid, which covers the poor, children and senior long-term care.

Meanwhile, progressive economists and others digging into the Congressional Budget Office’s analysis of the House bill found even more dire predictions that were obscured by Monday’s stunning announcement that the bill, if passed as currently written, would lead to upwards of 24 million people losing coverage within a decade. (The CBO estimated 14 million would lose coverage next year via individuals losing subsidies, and another 10 million would lose their coverage by 2026 due to cutbacks in state-run Medicaid programs. Politico reported Tuesday that the White House’s internal estimate was 26 million.)

Of particular interest to the economists was an unexplained footnote in the CBO report on page 33, predicting Social Security would pay out $3 billion less in the next 10 years if the House bill becomes law. While there was debate about whether the law’s passage would mean employees might see higher wages but stingier benefits—meaning more Social Security taxes would be generated—their interpretation was millions of people would be forced to keep working and postpone taking Social Security because they’d need the money for escalating medical costs.

There were similarly stark second-day analyses, such as the bill’s impact on veterans. While most military veterans are covered by Veterans Administration healthcare, not all of them are—just as their family members aren’t—meaning another key constituency, military families, would be hurt by an Obamacare repeal.

“Not all veterans are eligible to receive health care through the VA,” explained VetVotes.org’s Will Fischer. “The Affordable Care Act has resulted in the number of veterans in this country going without insurance to drop drastically. Next, while many veterans are eligible, and do receive high quality health care at the VA, spouses, children—they can’t go to the VA. If we see a repeal of the Affordable Care Act we will also see the number of veteran family members in this country going without insurance to increase.”

Analyses like these prompted a growing number of Republican senators to distance themselves from the House bill by early Tuesday—a gesture that isn’t quite saying they would vote no, but signaling that Ryan’s Obamacare repeal wasn’t going to fly in the Senate. With 52 Republican senators, Obamacare’s defenders need only three Republican defectors to block any repeal bill. Vox counted 12 Republicans expressing a range of doubts as of Tuesday.

Republicans Still Have Ways To Gut Safety Nets

So the question that emerges is not just whether the House repeal effort will be stopped in wholesale fashion, as was the case when Democrats controlled the Senate and held the White House veto pen, but what can Republicans do to modify the House’s draconian approach and pass GOP Senate muster?

In the short run, it is possible GOP infighting could kill the repeal effort outright, as arch right-wingers, those in the House Freedom Caucus and ideologues like Sen. Rand Paul, R-KY, are saying Ryan’s repeal doesn’t go far enough. As the Washington Post reported, “most of the changes that the White House seems to be talking about to get House Freedom Caucus members onboard will worsen the coverage numbers and make it harder to win over GOP senators.”

But that scenario is perhaps too wishful for this Congress and administration. There are other ways hardcore right-wingers whose professed desire to rein in spending—regardless of real-life harms—might come on board.

It’s important to remember that Ryan’s bill isn’t only about gutting Obamacare, which extended health coverage to 19 million people. As CBO noted, within a decade 24 million people would lose coverage. That additional 5 million figure comes from cutting Medicaid, whose beneficiaries include children, the elderly on long-term care and other poor people. Ryan’s bill will bring down the federal deficit by nearly half a trillion dollars, CBO’s analysis said, including $880 billion in Medicaid cuts over the next decade.

There are other ways to eviscerate this safety net program that could become part of any Senate “fix” of the House’s errant repeal bill. On Monday, the Senate confirmed Seema Verma as the next administrator of the federal Centers for Medicare and Medicaid Services, the agency that allocates $1 trillion annually for health care for one-third of all Americans. Verma previously restructured Indiana’s Medicaid program—under then-governor Mike Pence—by imposing punitive private-sector practices on that state’s program which “cut” costs: requiring recipients to pay premiums, contribute to private health savings accounts and lose their coverage if a payment was late.

Speaking from the floor Monday, Sen. Maria Cantwell, D-WA, noted that Verma “made millions of dollars in consulting fees by kicking poor, working families off of Medicaid for failure to pay monthly contributions similar to premiums,” the New York Times reported. Weeks before at her Senate confirmation hearing, Verma suggested that insurance not be required to include maternity care. The new Secretary of Health and Human Services, Tom Price, has praised that approach as giving states “greater flexibility.”

What this means is that the Republican war on safety nets is really just beginning. The House’s cruel Obamacare repeal bill is an opening shot in a much longer and larger political battle—as if kicking 19 million people off Obamacare isn’t enough. The Republicans holding the real reins of powers—in Congress via lawmaking and executive branch via rule making—aren’t considering human needs first. Where they aren’t citing ideological goals like federal debt reduction to cut off safety net subsidies, they’re looking to destroy these programs by penalizing their participants—as Verma did in Indiana—and they’re also allowing their political sponsors to make money by privatization, as Verma also did by requiring state Medicaid recipients to contribute to health savings accounts.

The Republican effort is needlessly preying on the most vulnerable among us while enriching GOP allies (by repealing Obamacare taxes on the wealthy and medical industries, or though privatization). No matter what happens to Ryan’s Obamacare repeal legislation, this political struggle to preserve social safety nets is only beginning.

This article was made possible by the readers and supporters of AlterNet.

Young Adults Healthier After Passage Of Obamacare, Study Finds

Young Adults Healthier After Passage Of Obamacare, Study Finds

By Noam N. Levey, Tribune Washington Bureau

WASHINGTON — Expanding the number of young adults with health insurance appears to have improved their health and saved them money, according to a new study that is among the first to measure the effect of the health care law that President Barack Obama signed four years ago.

Starting in 2010, the Affordable Care Act allowed adults under age 26 to remain on their parents’ health plans, the first coverage expansion to take effect under the law.

Previous surveys have indicated that this provision, which remains among the law’s most popular, allowed millions of young adults to get health insurance over the last several years.

The new study, published in the Journal of the American Medical Association, suggests the coverage expansion also measurably increased the number of young adults who reported that they are in excellent physical and mental health.

Researchers also found a significant drop in how much young people were paying out of pocket for their medical care after the law went into effect.

“The health insurance that people are gaining seems to be doing what it is supposed to do,” said Dr. Kao-Ping Chua, a pediatrician at Boston’s Children’s Hospital and the lead author of the study.

The question of whether giving people insurance makes them healthier, in addition to protecting them against financial risk, has remained controversial as debate over the federal health law rages. The new research from Harvard University adds to growing evidence about the positive effects of insurance.

Last month, a study of Massachusetts’ trail-blazing 2006 health law found a decline in mortality rates after the state began guaranteeing health insurance. That study’s lead author, Dr. Benjamin Sommers, also co-authored the new paper.

In the study of young adults, researchers used survey data from the federal Agency for Healthcare Research and Quality to compare the experiences of young adults, ages 19 to 25, who were eligible for coverage under the law, to those 26 to 34, who were not. The study covered the eight years before passage of the health law and one year after.

Insurance coverage increased markedly among the young adults, while declining slightly among the older group.

At the same time, young adults’ annual out-of-pocket medical expenses, including copays and deductibles, declined from an average of $546.11 in the period before the health law to $490 in 2011.

By contrast, annual out-of-pocket medical costs for the older group increased from an average of $626.66 to $644.82.

Younger adults also reported feeling better, with nearly 31 percent reporting themselves in excellent physical health after passage of the law, compared to nearly 27 percent giving that rating before.

The older group experienced a decline in self-reported health, with 21 percent reporting excellent physical health after passage of the law, compared 23 percent before.

How insurance may have contributed to the apparent health improvements remains unclear. The researchers did not detect any meaningful increase in the use of health care services among young adults after 2010. Their use of primary care remained constant, while it declined among the older group in 2011.

Chua speculated that the additional protections from having health coverage may contribute to a greater sense of security and health, a phenomenon that other research on coverage expansions has detected.

Tracking the young adult population over more years after they gained coverage may further explain the health effects of insurance.

Photo: LeDawna’s Pics via Flickr

Many Newly Insured Still Face Health Coverage Upheaval

Many Newly Insured Still Face Health Coverage Upheaval

By Tony Pugh, McClatchy Washington Bureau

WASHINGTON — As procrastinators rushed to buy health insurance Monday by the Affordable Care Act’s official enrollment deadline, new research estimates that about half of those with subsidized coverage obtained from federal or state marketplaces will lose it within a year because of changes in their incomes or other family circumstances, such as divorce, relocation or the births of children.

The same is true for about half of new Medicaid recipients, who are likely to lose program eligibility at some point over the next year for a variety of reasons, said Benjamin Sommers, an assistant professor of health policy and economics at the Harvard School of Public Health.

When people lose, drop or change health coverage for unforeseen reasons, it’s known as “churning.” It’s a common occurrence for consumers with individual coverage bought outside the workplace, as well as for those with Medicaid, the state-federal health program for poor people and those with disabilities.

Along with being a bookkeeping headache for insurers and Medicaid administrators, churning undermines the continuity of care between doctors and patients by causing patients to miss treatments and sometimes seek new caregivers.

It also has a financial impact, as coverage lapses may lead to costly emergency room visits when primary physicians could have provided treatment for far less.

In the 25 states that expanded eligibility for Medicaid under the Affordable Care Act, churning probably won’t leave people without coverage because there’s no gap between the income thresholds for Medicaid and subsidized marketplace coverage. Instead, millions will move between eligibility for both as their incomes are periodically updated and verified.

“It’s not exactly that they’ll lose coverage,” Sommers said in an interview. “It’s that they may have to change the coverage they have.”

But for people in states that so far have declined to expand Medicaid, “then they’re worse off,” he said. If they lose their eligibility for subsidized coverage when their incomes fall too low to qualify, “they will probably have no option for coverage,” Sommers said.

That’s because the income limits to qualify for Medicaid in non-expansion states are far below the levels at which subsidized marketplace insurance is available. That creates a “coverage gap” in which millions of people earn too much to qualify for Medicaid but not enough for federal subsidies to help them buy marketplace insurance.

“In other words, most adults who lose marketplace subsidies in non-expanding states will become uninsured,” Sommers and three other researchers wrote in their report on churning in the April edition of Health Affairs magazine.

Expansion states with lower poverty rates and higher per-capita incomes will see more churning because they have more adults with incomes near the eligibility line for Medicaid and subsidized coverage, Sommers said in the interview.

Half of Americans with individual health insurance churned in and out of coverage in 2010, according to recent congressional testimony by Medicaid Administrator Marilyn Tavenner. The reasons were myriad: Some couldn’t afford it, some switched to different plans and others may have dropped their coverage after obtaining job-based insurance.

The average Medicaid recipient loses coverage for 20 percent of the year — nearly 10.5 weeks — because of administrative violations, clerical errors, income changes or other factors that make him or her ineligible, according to researchers at George Washington University.

“The implication is that eligibility changes are likely to be a major challenge for every state as implementation of the ACA continues,” according to the Health Affairs article.

Photo via HealthCare.gov

Obamacare Has Led To Health Coverage For Millions More People

Obamacare Has Led To Health Coverage For Millions More People

By Noam N. Levey, Tribune Washington Bureau

WASHINGTON — President Barack Obama’s health care law, despite a rocky rollout and determined opposition from critics, already has spurred the largest expansion in health coverage in America in half a century, national surveys and enrollment data show.

As the law’s initial enrollment period closes, at least 9.5 million previously uninsured people have gained coverage. Some have done so through marketplaces created by the law, some through other private insurance and others through Medicaid, which has expanded under the law in about half the states.

The tally draws from a review of state and federal enrollment reports, surveys and interviews with insurance executives and government officials nationwide.

The Affordable Care Act still faces major challenges, particularly the risk of premium hikes next year that could drive away newly insured customers. But the increased coverage so far amounts to substantial progress toward one of the law’s principal goals and is the most significant expansion since the creation of Medicare and Medicaid in 1965.

The millions of newly insured also create a politically important constituency that may complicate any future Republican repeal efforts.

Precise figures on national health coverage will not be available for months. But available data indicate at least 6 million people have signed up for health coverage on the new marketplaces, about one-third of whom were previously uninsured.

A February survey by consulting firm McKinsey & Co. found 27 percent of new enrollees were previously uninsured, but newer survey data from the nonprofit Rand Corp. and reports from marketplace officials in several states suggest that share increased in March.

At least 4.5 million previously uninsured adults have signed up for state Medicaid programs, according to Rand’s unpublished survey data, which were shared with the Los Angeles Times. That tracks with estimates from Avalere Health, a consulting firm that is closely following the law’s implementation.

An additional 3 million young adults have gained coverage in recent years through a provision of the law that enables dependent children to remain on their parents’ health plans until they turn 26, according to national health insurance surveys from the federal Centers for Disease Control and Prevention.

About 9 million people have bought health plans directly from insurers, instead of using the marketplaces, Rand found. The vast majority of these people were previously insured.

Fewer than a million people who had health plans in 2013 are now uninsured because their plans were canceled for not meeting new standards set by the law, the Rand survey indicates.

Republican critics of the law have suggested that the cancellations last fall have led to a net reduction in coverage.

That is not supported by survey data or insurance companies, many of which report they have retained the vast majority of their 2013 customers by renewing old policies, which is permitted in about half the states, or by moving customers to new plans.

“We are talking about a very small fraction of the country” who lost coverage, said Katherine Carman, a Rand economist who is overseeing the survey.

Rand has been polling 3,300 Americans monthly about their insurance choices since last fall. Researchers found that the share of adults ages 18 to 64 without health insurance has declined from 20.9 percent last fall to 16.6 percent as of March 22.

The decrease parallels a similar drop recorded by Gallup, which found in its national polling that the uninsured rate among adults had declined from 18 percent in the final quarter of last year to 15.9 percent through the first two months of 2014. Gallup’s overall uninsured rate is lower than Rand’s because it includes seniors on Medicare.

Gallup Editor in Chief Frank Newport said that March polling, which has not been released yet, indicates the uninsured rate has declined further.

“While it is important to be cautious, the logical conclusion is that the law is having an effect,” he said.

Although estimates vary, about 45 million to 48 million people are believed to have been uninsured before the marketplaces opened last year.

The survey data are bolstered by the experiences of insurance companies and state governments, which are tracking enrollment in public and private coverage.

“We are on target to exceed what was estimated,” Lisa Sbrana, counsel for New York’s insurance marketplace, said on a recent call organized by Families USA, a Washington-based advocacy group that supports the law. About 70 percent of New Yorkers signing up for coverage through the marketplace or Medicaid were previously uninsured, Sbrana said.

In Kentucky, about 75 percent of the state residents signing up on that state’s marketplace or for Medicaid had no insurance, a state study indicates. As of Friday, more than 280,000 new people had enrolled in Medicaid in Kentucky, or nearly 91 percent of the residents officials estimated would become eligible for the program this year.

“We expect a huge net gain” in coverage, said Bill Nold, deputy executive of the state’s marketplace.

In Nevada, state officials this month reported that Medicaid enrollments are on pace to hit 500,000 by this summer, a total that was not expected until 2015.

Even states such as Tennessee that are not expanding their Medicaid programs are reporting a flood of unexpected enrollments from previously eligible people who had not signed up before.

Insurers also are reporting gains across the country.

In California, Health Net and Blue Shield of California, two of the state’s largest insurers, are on track to substantially increase their number of customers, according to company officials.

“It’s way beyond our projections,” Blue Shield spokesman Steve Shivinsky said.

Florida Blue, that state’s dominant insurer, also now expects to gain customers after sign-ups were initially slowed by problems with the federal HealthCare.gov site last fall.

Around Philadelphia, Independence Blue Cross has more than doubled its customers since last year. The company’s New Jersey subsidiary, AmeriHealth New Jersey, has seen a nearly sevenfold increase.

Some insurers are finding that most of the new customers are coming through direct sales to individuals, not the law’s new marketplaces. Blue Cross Blue Shield of Minnesota, for example, says more than 90 percent of its sales have not been on the state marketplace. Wellmark Blue Cross and Blue Shield, the dominant insurer in Iowa and South Dakota, is seeing growth, even though it elected to stay off the marketplaces this year.

Regardless of whether consumers buy through the marketplaces or directly from insurance companies, they form part of the same risk pool, so both groups are crucial to the law’s sustainability.

Long-term stability could be undermined if newly insured people do not pay their bills or drop coverage in coming months because they are unhappy about the high deductibles or narrow doctor and hospital networks some plans offer.

Some consumers have been forced to pay higher premiums to replace old plans that did not comply with the law’s consumer standards.

More ominously, some insurance industry officials are warning they may raise rates substantially next year. Major rate hikes could push out healthy consumers, undermining the law’s marketplaces and recharging political opposition.

“The real question is, have they built a system that is sustainable?” said Caroline Pearson, senior vice president at Avalere Health. “Premiums will be the single most important thing that will determine that.”

But the solid enrollment in the first year has built a foundation that for now appears robust enough to support more growth next year.

In several states, including Rhode Island, Connecticut, Kentucky, Iowa and South Dakota, more insurers are looking to join state marketplaces when second-year enrollment begins this fall, according to marketplace and insurance industry officials.

And after initial resistance, a growing number of states with GOP governors or legislatures are looking to expand coverage further.

New Hampshire’s Legislature just voted to expand its Medicaid program. Utah, Indiana and Pennsylvania are looking for ways to do the same.

Photo: Will O’Neill via Flickr