Thursday, January 30, 2014

Cleaning Out the Obamacare Schadenfreude Freezer

We were in single digit temperatures again this morning when we wok up, but the sky is blue, and the forecasts are calling for a warm up.  I think we need to clean out the bread heels out of the freezer so we can get that caribou that wandered into our yard one morning off the back deck and safely frozen.

Similarly, we need to get a few juicy morsels of Obamacare Schadenfreude out of the "special folder" where the get stored until use:

Found at Wombat-socho's Live at 5: 1.29.14: President Ignores Obamacare Stumbles While Taunting GOP
from Theo's
But, he said, the overhaul here to stay and it is time to move on.
But Mr. Obama made no mention of the extensive glitches that marked the debut of the law’s federal portal,, which serves 36 states.

Rather than dwell on the law’s struggles, Mr. Obama rebuked House Republicans for holding dozens of votes to repeal all or part of his main domestic achievement.
Move on?  Isn't that phrase reserved for use in getting the people to overlook the affair you've lied under oath about, or the four men you let die in one of our foreign embassies?, the liberal leaning "independent" fact checking agency, fact checks the Preznit's SOTU Obamacare statements:
The president said that “because of the Affordable Care Act … more than 9 million Americans have signed up for private health insurance or Medicaid coverage.” But that total includes Medicaid renewals, not just new recipients that gained Medicaid coverage because of the health care law.

The 9 million figure includes three groups: 2.1 million Americans who have chosen insurance plans on the federal or state marketplaces, 3.9 million who were determined eligible for Medicaid and the Children’s Health Insurance Program, and an estimated 3.1 million young adults under age 26 who joined their parents’ plans as a result of the Affordable Care Act’s requirements. Obama specifically referenced that last number:
Obama: Already, because of the Affordable Care Act, more than 3 million Americans under age 26 have gained coverage under their parents’ plans. More than 9 million Americans have signed up for private health insurance or Medicaid coverage.
But the Medicaid category includes more than just those signing up “because of the Affordable Care Act.”

As Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services, said in announcing that 3.9 million “learned they’re eligible” for Medicaid or the Children’s Health Insurance Program in October and November: “These numbers include new eligibility determinations and some Medicaid and CHIP renewals.” So not everyone was a new enrollee who gained Medicaid coverage because of the law. Some of the Medicaid numbers reported by the states included those renewing their already existing coverage.

Also, Obama didn’t claim that all of those signing up for coverage had been uninsured, and, in fact, we know that not all of them were. For instance, members of Congress and their staffs signed up for exchange plans, as required by the law, instead of continuing to get coverage through the program for federal employees.
Would you be shocked that Jeffrey Sing from National Review gave him harsher reviews:
In his State of the Union address Tuesday night, President Obama repeated one of the biggest lies behind the Affordable Care Act (ACA), and it wasn’t that you could keep your health-care plan or your current doctor. In fact, most people don’t even know it’s a lie. That became obvious when he received a standing ovation after saying it: “Because of this law, no American can ever again be dropped or denied coverage for a preexisting condition like asthma, back pain, or cancer.” The president and his supporters keep pretending that, before the ACA, an insurance company could drop individual policyholders, when in reality it could not.

Comes as a shock, doesn’t it? But the truth is that for decades there have been safeguards in our health-insurance system to protect people just like the physician’s assistant, Amanda Shelley, mentioned by the president.

Before 1996, if you purchased individual health insurance through a broker, you would have been offered a “guaranteed renewability” option. This would guarantee that your policy could not be canceled if you developed an expensive and chronic condition. The insurance company would also have to renew the policy on its anniversary date without charging a higher premium because of the chronic condition. This option was so popular that, by 1996, 75 percent of people buying individual health insurance also bought the guaranteed-renewability option.

Then, in 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). Among HIPAA’s many mandates was the requirement that all individual insurance plans have guaranteed renewability. It also prohibited all group health-insurance plans sold to businesses from denying coverage to individuals because of preexisting conditions. And so, for the past 18 years, all insurance companies have been legally forbidden from dropping an individual policyholder who developed a chronic illness and have not been able to raise anyone’s rate because of it.
Sometimes what you say isn't so much the lie as the assumptions behind the statement.  But it's OK if you get to ruin the healthcare system as a consequence of your oversight.  You've got get everybody into your system, beating and dragging them the whole way.

Democratic  senators intervene in Hobby Lobby case, urge justices to deny ObamaCare exemption
Democratic senators intervened Tuesday in the Supreme Court fight over whether ObamaCare can force the company Hobby Lobby to provide contraceptive coverage to workers, arguing that "secular" businesses should not be exempt from the mandate.

The 19 senators planned to file a brief before the court, which is still weeks away from considering the closely watched case. Sen. Patty Murray, D-Wash., who planned to make her case on the Senate floor, adamantly defended the Obama administration's side.

"What's at stake in this case before the Supreme Court is whether a CEO's personal beliefs can trump a woman's right to access free or low-cost contraception under the Affordable Care Act," she said in prepared remarks.

But Republican senators returned fire, jumping to Hobby Lobby's defense in a brief of their own.

"The ability to practice the faith we choose is one of our great constitutional rights. The Obama administration's contraceptive mandate stomps on that right," Sen. David Vitter said in a statement. He joined Sens. Ted Cruz, R-Texas; John Cornyn, R-Texas; and Mike Lee, R-Utah in the brief.
Tom McGuire, at Just One Minute, demolishes Paul Krugmann's attack on the woman featured in the Republican response to the SOTU:
. . .Paul Krugman is deeply interested in this, presumably as long as we can show the Congresswoman to be lying or misinformed:
I’d be interested, by the way, to know the details about the constituent described in the official GOP response, who supposedly faced a $700 a month rise in premiums. What kind of plan did she have? Did that number include subsidies? The ACA is supposed to keep health costs to 8 percent of income, so the only way you could get numbers like that is if the individual (a) had a really bare-bones policy offering hardly any protection and (b) has an income well over $100,000.
As to "an income well over $100,000", I am surprised that such an authority would fail to grasp that for unmarried individuals the subsidies disappear at $46,000. That said, a Silver Plan in Washington for a single mom age 58 (per and no kids with no subsidy would be $6,226 per year, which at $519/month is less than the $700/month premium hike we are examining.
But Krugman has embedded a second major misunderstanding:
The ACA is supposed to keep health costs to 8 percent of income...
"Health costs"? Come again? The subsidies are meant to keeppremiums at (or near) 8 percent of income. Wait'll he gets a lod of the deductibles and co-pays!
The ObamaCareFacts site refers people to the Kaiser-Permanente subsidy calculator, so here we go: a family of four (non-smokers, national average, mom and dad are forty) earning $55,125 (taken from ObamaCareFacts site as 250% of Federal Poverty Line although Kaiser disputes that):
The premium, pre-subsidy: $9,700. Subsidies of $5,569 per year bring the premium cost down to $4,130 per year. That is 7.5% of $55,125. So far, so good.
However! The fine print, which I recall was initially obfuscated by the ObamaCare website, includes this, on deductibles and co-pays:
Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $10,400. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.
If the family does spend $10,400 and hit the out-of-pocket cap I am pretty sure that will represent more than 8% of total income. Hey, insurance is complicated to buy.
While I believe in cheap insurance with high deductibles, what Obamacare got was expensive insurance with high deductibles, especially for the young.

One reassurance to gay couples that just got married and found high Obamacare costs,  they may be able divorce and save money.

How A Divorce Can Boost Health Insurance Subsidies
What happens with premium tax credits if a couple gets divorced? If the premium tax credit is based on the previous year's income when the couple filed taxes jointly, many wouldn't qualify. But once someone is divorced, one individual might have little income. What is the subsidy based on in that situation?

If a couple divorces, each person's eligibility for premium tax credits will generally be based on his or her own annual income. The former spouse's income won't be counted, even if the couple filed taxes jointly the previous year. Premium tax credits are available to people with incomes up to 400 percent of the 2013 federal poverty level ($45,960 for an individual).

During the application process, people are asked to project their income for the year. If someone estimates income that's more than 10 percent lower than the previous year's taxes or wage information or Social Security data would suggest, the system will flag it.  At tax time next year, the Internal Revenue Service will reconcile an individual or family's actual income against the amount that was projected. People who received too much in tax credits may have to repay some or all of it.

The situation may be different for couples that are separated but not yet divorced, however. If each files taxes as "married filing separately" neither will be eligible for premium tax credits on the exchange.
How Republican Plan Could Replace Obamacare
The combined effect of its changes, the plan’s authors say, would be revenue neutral and competitive with Obamacare in terms of coverage. No independent entity has scored the plan, however, and a reasonable assumption is that in the long run, the plan would leave more people uninsured than Obamacare.

By design, the plan is less ambitious than Obamacare. And it is less ambitious than a Republican plan that might have been proposed had Obamacare never passed: It leaves the tax exclusion for employer-sponsored coverage in place, capping it rather than ending it. And it does away with most of the health care payment and delivery system reform that Obamacare’s authors and supporters hoped would slowly reshape the system.

What the proposal’s authors are betting, however, is that at this point the public does not want grand ambition so much as attainable, practical improvement. And they are willing to bend, if necessary, to get there. The plan has not yet been turned into legislation, and at least some of its details remain subject to change and negotiation. It’s designed as a conversation starter rather than a final proposal, a starting point meant to build consensus rather than the final word.

Because the conversation is happening now, following years of blistering attacks on Obamacare, the plan works within the confines of the GOP’s criticism of that law: For political and practical reasons, it’s designed to minimize disruption to the health system rather than transform it, even where bigger disruptions might make for better policy. It’s a necessary and productive starting point, but it also reveals how much the Republican party has limited its options by waiting so long to start talking about its own ideas. The plan sheds some light on Republican ideas about health policy—but also serves as a reminder that those ideas remain in Obamacare’s shadow.
Well, that's all for today. Oh, George Will has a column out, and it's old but good. All clean, and ready for a new batch.

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