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The Health Care Bill Nobody Wants to Talk About
Tuesday August 31, 2010
As Jay Cost of Real Clear Politics notes, it's pretty obvious that the Democrats' electoral woes are directly tied to the passage of the health care bill. But somehow horserace analysts like Jonathan Alter, Jim Vanderhei and Mike Allen don't want to talk about that.
Well, we've been talking about it for months now.
Nate Silver describes Jay Cost as an "outstanding analyst." Looking at the generic ballot average, Cost says:
Partisans on both sides tell themselves stories about why they're up, why they're down, and why the other side is where it is. These stories usually contain at least a grain of truth, but they also help encourage ideologues in the face of an impending rejection by the electorate. Democrats ignored the political problem of health care in the fall and winter arguing that Martha Coakley and Creigh Deeds were bad candidates, that voters had been turned off by the health care bill because of the process, and that they would come around once the many benefits kicked in. Now, they're pointing to the economy as the only significant reason why the party is in trouble.
It would be difficult for any strong partisan to admit that such an accomplishment was so deeply unpopular. Yet the polling is pretty unequivocal on the relationship between the Democrats' fortunes and the health care bill. It was during the health care debate that the essential building block of the Democratic majority Independent voters began to crumble. It was evident in the generic ballot. It was evident in the President's job approval numbers. It was evident in Virginia, New Jersey, and Massachusetts.
Reconstructing the Democrats' meme, we can fairly say that the economy is a huge problem for the party. Of this, there can be no doubt. We can also say that the stalled recovery denied the Democrats a chance to win back the voters they lost over health care. But the process and passage of health care reform were crucial elements in the story. That's when the party started losing the voters it needs to retain control of the government.
VanderHei and John Harris recently wrote a piece criticizing "liberal bloggers" who were obsessively naval gazing about the Dave Weigel/Journolist incident, and didn't care about the fact that Democrats could lose seats in the House this fall.
In fact, FDL did polling at the first of the year that indicated that the health care bill was extremely unpopular with independents, and warned that the Democrats were living in la-la land to ignore it.
January 14, 2010: FDL commissions SurveyUSA to do polling in swing districts to try and ascertain how the health care bill (particularly the individual mandate) will affect Democratic incumbents.
January 14, 2010: The first SurveyUSA poll finds that Vic Snyder is trailing GOP challenger Tim Griffin by 56% to 39%, and that the individual mandate is unpopular with 3 out of 4 voters. If Snyder votes for the health care bill with the individual mandate, he loses another 6 points to Griffin.
January 15, 2010: Our second SurveyUSA poll finds that Steve Driehaus trails Steve Chabot in a rematch of their 2008 race, 39%-56%. When asked if their opinion of Driehaus changes if he votes for the health care bill, 55% of Independents say that their opinion of him would go down.
January 20: SurveyUSA polls one of the suburban districts that will be key to the Democrats' ability to hold the House in 2010, this time Tim Bishop in (NY-01). Bishop holds a 2 point lead over potential GOP challenger Randy Altschuler, who was already up on the air with ads. Unlike Snyder and Driehaus's GOP-leaning districts, Bishop's district has a +3 PVI Democratic advantage. Party affiliation in the district is 27% GOP, 33% Democratic and 39% Independent. When asked how they feel about a health care bill which forces them to buy insurance or pay a penalty, 66% of Independents say they are opposed and 48% say they are strongly opposed.
January 21, 2010: SurveyUSA finds that Baron Hill is trailing Republican Mike Sodrel by 8 points if they matched up once again. Again, 60% of Independents say that their opinion of Hill goes down if he votes for a health care bill forcing them to buy insurance or pay a penalty.
February 16, 2010: Rather than thank us for the head's up that their caucus is going to be slaughtered if they vote for the health care bill, Mark Ambinder reports that "Already, the Democratic Congressional Campaign Committee is blasting Democratic activist Jane Hamsher for using Survey USA to essentially poll-pressure Blue Dog Democrats into retirement."
March 13: I talk with a Democratic operative, who tells me that by forcing Congress to vote for the health care bill, Democratic leadership and the White House are like the generals in Paths of Glory, "firing on their own men in the trenches."
March 17: I wrote "There are currently 36 resolutions in states across the country to ban the mandate which forces people to buy private insurance, or face a penalty of up to 2% of their income that the IRS will collect the very thing that Obama campaigned against. It will become a rallying cry for the right."
July 21: A new SurveyUSA poll shows Tom Perriello trailing his GOP opponent by 23 points. Prior to voting for the health care bill, a PPP poll showed Perriello essentially tied with Hurt:
This confirms what FDL has been saying for months: forcing members of Congress like Tom Perriello to vote for the health care bill was truly a Paths of Glory move by House leadership and the administration. As our SurveyUSA polling indicated at the time, the health care bill was hugely unpopular in swing districts.
August 4, 2010: 71% of Missouri voters support Proposition C, which "would prohibit the government from requiring people to have health insurance or from penalizing them for not having it." It's a non-binding initiative, but a clear indication of where public sentiment is in a bellwether state.
The DCCC was very good at getting not-so-savvy poll analysts to try and discredit the SurveyUSA polling. (Those same pollsters, ironically, didn't see anything weird in the Research 2000 polls they were quoting authoritatively at the time, which many now find suspect though Jerome Armstrong spotted it). Somehow Democratic members of Congress engaged in magical thinking and believed Rahm's BS about the popularity of the health care bill increasing if it passed.
Rather than focus on jobs creation in a country with climbing unemployment rates, Obama spent the better part of a year focused on passing a health care bill that looks like it will play no small part in the Democratic Party's upcoming electoral woes.
Well, we warned you.
Obama Aims Barbs at Liberals, But Catches Moderates in the Crossfire
By: Blue Texan
Sunday September 19, 2010
Although Jane, Glenn and Digby have already weighed in smartly on this little tantrum from the President, I think it's worth revisiting.
"Democrats, just congenitally, tend to get to see the glass as half empty. (Laughter.) If we get an historic health care bill passed oh, well, the public option wasn't there. [...] And gosh, we haven't yet brought about world peace and (laughter.) I thought that was going to happen quicker. (Laughter.)"
This is of course, terrible politics. Ridiculing your base when you're at you're most vulnerable right before the midterms in your first term is just criminally stupid.
But even leaving that aside, Obama's chosen poor issues to flog liberals with. He's unfortunately highlighted areas where the administration has lost the center.
The health care bill is unpopular. And it's not unpopular because of the "professional left." It's unpopular because people really hate insurance companies and they're now being forced to buy their shitty product, which they can't afford. The public option, which was a workaround that problem, had broad, popular support not just among glass-half-empty liberals. Doesn't take a genius to figure out what happened.
As for mocking the idea of "world peace" again, this is an area where the White House has lost the middle. The President's choice to double-down in Afghanistan is deeply unpopular. Unless you think 57% of the country are pacifist peaceniks, it's absurd to blame "Democrats" for the fact that your central national security initiative is failing with the public.
Americans simply don't like health care reform and they don't like the war. By using these two to chastise liberals, the President is also wagging his finger at the majority of the country.
Pre-Existing Condition Insurance Plan Out of Reach
Friday September 17, 2010
I don't think the site has addressed this in a while, but the new Preexisting Condition Insurance Plan has been rolled out across the country now, and the more I look into it, the more I think this is emblematic of everything that was wrong with Obama's health care reform bill. Remember, this is the temporary high risk pool to act as a holdover until the exchanges kick in in 2014. I had high hopes for this, as my Mother is a 61 year old widow who has low income but is too young for Medicare and who we (my brother and I) have been paying $1,000+/mo for Anthem Blue Cross individual market insurance for the last three years to keep her insured. I thought the new high risk plan was going to be standardized with a 4-1 age ratio and also "affordable" for people who cannot get affordable coverage in the individual market. I looked up the rates for California where she lives, and her premium will be $799/mo with no subsidy under the new plan . Meanwhile, the premium for a child under 15 is $142/mo how is that 4-1? How is that even remotely affordable?
Instead of imposing a unified structure with standardized rates, the bill gave extreme leeway for each State to set up its own program using private contractors guided only by very loose language regarding premiums and coverage structure. This has resulted in some states charging $600/mo for 60+ and areas of California charging $800 or more.
I'm so dejected at this point. I had such high hopes for this program and I feel like I've been kicked in the stomach. I cheered this bill, telling my brother, "help is on the way," and soon we will be able to get coverage at a more reasonable rate compared to the way Anthem was ripping us off. We just can't afford to pay $800+ per month in health insurance when we are already completely financially supporting our Mother. You mean to tell me that all this bill is going to save us for the next 4 years is 200 bucks a month? That we still have to pay 800/mo not including cost sharing? My Mom doesn't even have a super-serious preexisting condition she doesn't have cancer, hasn't had any debilitating illnesses. She is a smoker who gets episodic panic attacks.
I know there are lots of horror stories worse than this, but this type of disappointment is going to keep happening as each new element of this bill is rolled out. When 2014 hits and the means-tested subsidized rates are still going to be unaffordable for anyone but the poorest of the poor, the bill's popularity will continue to tank.
And they wonder why there is an enthusiasm gap!
The Half-Empty Glass: Connecticut Insurance Rates Soar to Pay For Health Care Bill Provisions
Monday September 20, 2010
I still can't quite wrap my head around the fact that Obama thought it was a good idea, in midst of 9.6% unemployment, and on the day after the census bureau announces that 1 in 7 Americans are living in poverty, to show up at the gated Connecticut mansion of a guy named Rich Richman and tell a privileged few at a private $30,000 a plate fundraiser that people who see their glass "half empty" are pessimists and that the health care bill represents "the most productive, progressive legislative session in at least a generation."
The people in Connecticut who couldn't afford $30,000 to attend an event that raised $1 million for the DNC might not see it that way:
Sept. 19 Connecticut regulators in recent days approved increases of more than 20 percent on some health plans starting Oct. 1, including a series of rates requested by Anthem Blue Cross & Blue Shield, by far the largest health insurer in the state...
The higher prices, however, are a glimpse of what may be in store later this year when insurers propose new rates for 2011.
The major difference between rising prices this year and years past is the cost of new benefits added to health plans starting Thursday as mandated by the sweeping reform approved by Congress in March.
Insurers say the cost of new benefits will increase prices more than 20 percent for certain plans.
When Obama was selling his health care plan to the public on June 22, 2010, he said that the changes mandated by the health care bill this year meant that people would be seeing benefits immediately:
[S]tarting in September, some of the worst abuses will be banned forever. No more discriminating against children with preexisting conditions. No more retroactively dropping somebody's policy when they get sick if they made an unintentional mistake on an application. No more lifetime limits or restrictive annual limits on coverage. Those days are over.
He also said "we've got to make sure that this new law is not being used as an excuse to simply drive up costs."
But that's exactly what's happening in Connecticut.
Anthem Blue Cross Blue Shield, the largest insurer in Connecticut, has already requested and received increases on individual market plans to cover the cost of new benefits mandated by the health care bill that start this year:
4.8% increase related to the mandate about pre-existing conditions for children
up to 8.5% increases for mandated preventive care with no deductibles
Anthem has also said that removing annual spending caps would cause the cost of individual market plans to "rise by as much as 22.9 percent."
Obama, the Urban Institute and others were relying on estimates made by the Department of Labor that were used to calculate the impact of the health care bill's 2010 mandates:
Removal of annual spending caps: "The Departments estimate that the transfer would be three-quarters of a percent or less for lifetime limits and one-tenth of a percent or less for annual limits, under a situation of pure community rating where all the costs get spread across the insured population."
Mandates for preventive care: "There will likely be negligible transfers due to this provision given no changes in coverage or cost-sharing."
Coverage for children with preexisting conditions: "Even in States with community rating, the cost and transfer effects will be relatively small, at most a few tenths of a percent over the next few years."
But Connecticut isn't the only place this is happening. As the Wall Street Journal reported last week, the health care bill is being used as an excuse by insurance companies to jack up rates all across the country.
It's clear that the rate increases are far in excess of what these reform provisions actually cost. And there is nothing in the health care bill that stops them from doing so. In a free market, other insurance companies would be able to enter the market and provide a better product at a lower price. But health insurance companies are exempt from anti-trust regulation, and can legally operate as monopolies and engage in monopolistic practices. The health care bill did nothing to stop that.
That's why the people Obama now mocks wanted a public option. If the government is going to assign its right to collect taxes to private companies (which is what they did when they passed the mandate), and allow the IRS to be used as an enforcement mechanism, people wanted to feel like there was an alternative. Faced with looming rate increases far in excess of anything they were told when the bill was being sold to them, in the wake of rising economic insecurity and high unemployment, people are justifiably anxious.
Single mother Susie Madrack explains why people like her found Obama's comments upsetting:
[T]hose of us left living on a wing and prayer thanks to your "half full," half-assed economic policies just don't have a sense of humor about our continuing plight. I know it's been a long time since your mom got food stamps, but you might want to give that empathy thing some thought."
The usual suspects are cheering Obama's comments, including the American Prospect, who call them "justified mockery." But those who enjoy a "subsidized existence vomiting up flabby consensus received opinions within the federal zone" generally aren't the working class single moms who have to worry about things like rising health insurance premiums. So it's no surprise they wouldn't understand why someone might feel their glass is "half empty" these days.
Big health insurers to stop selling new child-only policies
Anthem Blue Cross, Aetna Inc. and others say they will make the move as soon as Thursday when parts of the new healthcare law take effect. They cite potentially huge and unexpected costs for insuring children.
Duke Helfand, Los Angeles Times
September 21, 2010
Major health insurance companies in California and other states have decided to stop selling policies for children rather than comply with a new federal healthcare law that bars them from rejecting youngsters with preexisting medical conditions.
Anthem Blue Cross, Aetna Inc. and others will halt new child-only policies in California, Illinois, Florida, Connecticut and elsewhere as early as Thursday when provisions of the nation's new healthcare law take effect, including a requirement that insurers cover children under age 19 regardless of their health histories.
The action will apply only to new coverage sought for children and not to existing child-only plans, family policies or insurance provided to youngsters through their parents' employers. An estimated 80,000 California children currently without insurance and as many as 500,000 nationwide would be affected, according to experts.
Insurers said they were acting because the new federal requirement could create huge and unexpected costs for covering children. They said the rule might prompt parents to buy policies only after their kids became sick, producing a glut of ill youngsters to insure. As a result, they said, many companies would flee the marketplace, leaving behind a handful to shoulder a huge financial burden.
The insurers said they now sell relatively few child-only policies, and thus the changes will have a small effect on families.
"Unfortunately, this has created an un-level competitive environment," Anthem Blue Cross, California's largest for-profit insurer, said in a statement declaring its intention to "suspend the sale of child-only policies" on Thursday, six months after the healthcare overhaul was signed.
The change has angered lawmakers, regulators and healthcare advocates, who say it will force more families to enroll in already strained public insurance programs such as Medi-Cal for the poor in California.
The White House weighed in Tuesday, condemning Anthem corporate parent WellPoint Inc. and others that plan to stop selling child-only policies.
"It's obviously very unfortunate that insurance companies continue to make decisions on the backs of children and families that need their help," White House Press Secretary Robert Gibbs said at a news briefing.
The Obama administration had told insurers they could solve the problem by issuing policies only during designated enrollment periods. Some White House officials, however, noted that families who can't find policies might be able to sign up for high-risk pools being set up around the country as part of the new healthcare law.
In California, the stakes may be particularly high for insurers who abandon child-only policies. A bill awaiting Gov. Arnold Schwarzenegger's signature would bar such companies from selling insurance in the lucrative individual market for five years. A Schwarzenegger spokeswoman said the governor had not yet taken a position on the measure.
Assemblyman Mike Feuer (D- Los Angeles), the bill's author, voiced frustration over the insurers' plans and singled out Anthem Blue Cross, whose corporate parent notified brokers nationwide Friday of its decision to exit the child-only business in 10 states, including Colorado, Connecticut, Missouri, Nevada and Georgia as well as California.
"At a time when we are launching a national approach to ensure that all children have access to healthcare, Anthem's actions represent a step backwards," Feuer said. "By threatening to drop child-only policies in California, the company jeopardizes the health of families and children. I call on Anthem to reconsider its plan."
Other regional and national insurers also plan to stop selling insurance policies exclusively for children. Among the companies is UnitedHealth Group Inc., the nation's largest insurer by revenue. It did not say which states would be affected.
"We continue to believe that regulations can be structured that will enable child-only plans to be offered, and we are working toward that goal," spokesman Tyler Mason said.
Aetna said that effective Oct. 1 it would no longer offer policies in the 32 states where it conducts business, including California, Florida, Illinois, Virginia and Pennsylvania.
Cigna Corp. will halt the policies in 10 states, including California, Arizona, Colorado, Tennessee and Texas.
"We made a decision to stop offering child-only policies to ensure that we can remain competitive in the 10 markets where we sell individual and family plans," Cigna spokeswoman Gwyn Dilday said. "We'll continue to evaluate this policy and could reconsider changing this position as market dynamics change."
The explanations left healthcare advocates fuming. They accused insurers of trying to skirt the law's new requirement to cover children with health problems.
"Insurers need to decide if they are in the business of providing care or denying coverage," said Anthony Wright, executive director of Health Access California, a consumer group. "In California, we hope our insurers come to an equitable compromise that allows access for all children and affordability for those with preexisting conditions."
In Colorado, regulators and insurance carriers are trying to work out such a compromise. The state's insurance commissioner met Friday with several insurers, including Anthem, Cigna and Aetna. The two sides did not reach an agreement, but officials remain hopeful they can broker a deal before Thursday.
"Obviously this deadline looms large," said Jo Donlin, director of external affairs for the Colorado Division of Insurance. "The commissioner wants families to have access to the insurance they need. Both sides of this want to find a solution."
Noam N. Levey in the Washington bureau contributed to this report.
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Obamacare Constitutional but Still Sucks
Robert Sterling, Konformist.com
In a last minute reversal by Chief Justice John Roberts, Obamacare was ruled constitutional by the Supreme Court. It is important to note that in upholding the law, the Supremes rejected the usage of the Commerce Clause to justify the individual mandate, which is a victory for those who found such an argument to be insidious. Obviously, include myself in that group.
The claim that mere existence made one involved in commerce (which was central to the Commerce Clause argument) had no historical precedent, as even judges who had previously upheld the law had agreed in unanimty. Even worse, any precedent that was even close to this was one that no self-respecting progressive should ever embrace. (The most notable precedent being written by Antonin Scalia, where he argued that due to the Commerce Clause, the War on Drugs trumps the power of states to legalize marijuana for medicinal purposes.) It was disappointing to see so many so-called liberals, in their desperation to defend Obamacare, to be totally oblivious and dismissive of such concerns. It shouldn't be surprising, as in the last four years what has passed for liberalism has bottomed out to merely mean being a pathetic shill for Barack Obama rather than represent any coherent philosophy.
Of course, that Obamacare is constitutional should be the minimum standards one should expect for a law. (Alas, in the age of torture and the Patriot Act, such minimum standards is increasingly becoming a norm.) Another standard is how popular it is with the public. On this score, Obamacare has been a major flop since its inception. A June 2012 NY Times/CBS News poll before the Supreme Court ruling underscored this: 41 percent of all polled believed the entire law should be overturned, while 27 percent wanted an overturn of the mandate. Only 24 percent wanted the law to be upheld. This was despite a relentless push by the White House, Democratic Party and the media establishment to sell the public on the law as some sort of progressive victory. While there was a slight increase in approval of Obamacare after the ruling (a bump that is normal in terms of how polling goes) the general trend on Obamacare is unpopular with a bullet downward.
That Obamacare is unpopular shouldn't be too surprising, and I for one am someone who warned of this when the law passed. And the establishment liberal response to this unpopularity, merely dismissing the opposition to ignorant dupes, is not only false but highly insulting to voters. In this case, the public rightfully smells a loser here. While Obamacare is sold as a progressive law, all its origins come from from right-wing think tanks, and its premises are all based on snide contempt for the poor and working class. It's solutions are based on slashing funds to Medicare (a fact which proves the widely mocked "death panels" cry to be not completely off-base) and the individual mandate is based on the premise that poor young people are somehow cheating the system by not purchasing health insurance they can't afford. It is a Marie Antoinette solution to our health care crisis, except cake is a lot cheaper and not manufactured by parasitic oligopolies that rip off its customers at every opportunity. (The opportunities, thanks to Obamacare, will soon radically increase.) The worst thing about Obamacare isn't Obamacare itself, which I assume will eventually fail and die due to its fundamental flaws. The worst thing about Obamacare is whenever a real progressive reform is ever proposed in the future, it will be called Obamacare II, and it will be that much harder for it to pass. Sadly, any such skepticism will be deserved, as the liberal apologism for the reactionary law known as Obamacare should rightfully discredit any supporters further arguments on the issue of health care.
Poll URL source:
John Roberts, evil genius
ROBERT E. MALCHMAN
Chief Justice John G. Roberts is an evil genius. The ruling to uphold the Affordable Care Act is, on its face, a win for President Obama both because the media are saying it is and because it is the signature piece of legislation of his first term. But it may turn out to be a pyrrhic victory, as Roberts accomplished numerous, subtle victories for conservative Republicans.
First, remember that "Obamacare" and the individual mandate started out as a proposal from the conservative Heritage Foundation as a counterproposal to the Clinton administration's health care plan. The only reasons Republicans are now opposed to it is because Obama proposed it and is getting credit for it. Before it was Obamacare, the program was known as Romneycare in Massachusetts and if the 2008 election had gone the other way, it might be known as McCaincare today.
Meantime, the survival of the Affordable Care Act eliminates any clamor for real, progressive health care reform, whether universal Medicare or for the creation of a public insurance option. Such programs are anathema to conservatives who want most things privatized either for ideological reasons or so that their corporate masters can further enrich themselves.
The effect of the law will be to drive millions of people to buy insurance from insurance companies in many cases with federally subsidized funds, lining the pockets of those corporations with the public's money. Is it any surprise that health care stocks were surging in the wake of the ruling?
MLRs: Obamacare Silver Lining
Let's give Obamacare credit where it does deserve some: with the inclusion in the law of Medical Loss Ratio. From NBC News:
Affordable Care Act means $1.1 billion insurance rebate
Herb Weisbaum, The ConsumerMan
The nation's health insurance companies will refund approximately $1.1 billion to their customers this summer. It's one of the new benefits of the health care reform law.
The U.S. Health and Human Services Department expects 12.8 million Americans to get some of this money although in the majority of cases that refund will be sent to employers.
Under the Affordable Care Act, health insurance companies are required to disclose how much of your premium dollar they actually spend on health care and how much they spend on administration, such as salaries and marketing. In the past, consumers did not have a right to this information.
But here's the real game-changer: The 80/20 rule. If the insurance company spends less than 80 percent of premiums on medical care it must rebate the excess. For large group plans (the kind provided by companies that employ 50 people or more), health insurance companies must spend 85 percent of the premiums on medical care...
The new law also requires health insurance companies to tell customers whether they hit, exceeded or missed the 80/20 mark. If they missed the goal, they must say by how much and what percentage of your premium will be rebated. This new transparency is unprecedented...
Health and Human Services says it expects the average rebate for a family that buys its own insurance to be $151. The states with the highest average rebates per family in the individual market are: Mississippi ($651), Alabama ($582), Maryland ($496), Delaware ($461) and West Virginia ($383). The average rebate in the individual insurance market is zero for families in Arkansas, Hawaii, Iowa, Maine, New Mexico, Rhode Island and Vermont...
The bottom line:
The new 80/20 rule is a major step forward in making health insurance companies responsible to their policy holders. It is hoped it will motivate insurers to lower prices and/or improve their coverage to meet the new standard.
So what about this summer's rebates? Any way you look at it, a billion dollars is a lot of money. But it won't solve the problem of skyrocketing medical bills. It's just a drop in the bucket...