The GOP’s Obamacare youth hoax
By Matt Miller,
It’s rare for a political party to trumpet a position that unintentionally reveals its myopia, incoherence and expediency. Yet such is the trifecta with the Republican campaign to call attention to Obamacare’s young “victims.”Republicans are obsessed with the supposed injustice being done to some healthy young people who will effectively subsidize their sicker elders when Obamacare’s individual mandate takes effect.
The crusaders are nothing if not convinced of the righteousness of their cause. “The whole scheme is enlisting young adults to overpay, so other people can have subsidies,” Dean Clancy, a vice president at FreedomWorks, told my Post colleague Sarah Kliff. “That unfairness reminded us of the military draft.”
Conservatives are therefore urging young Americans to resist. “I’m burning my Obamacare draft card,” runs one theatrical riff from a group called Young Americans for Liberty, “because I’m too busy paying student loans to pay for somebody else’s health insurance.” Republican policy advisors have urged the party to make such child abuse a big part of their anti-Obamacare message.
Sounds like a sexy argument, except for one thing. Republicans seem to have forgotten where most people aged 19 to 34 get health coverage: from their employer. And at virtually every company, young people pay the same premiums as employees who are much older than they are and who get more expensively sick than they do. In other words, the evil cross-subsidy Obamacare’s foes are storming the barricades to roll back already exists, at vastly larger scale, in corporate America.
These youngsters are already in chains! They’ve been put there by the private sector! And, inexplicably, young employees have entered this servitude of their own volition. (To extend the GOP’s draft analogy, it turns out there’s a voluntary army of health care masochists from sea to shining sea.)
How could injustice on this scale escape the GOP’s searing moral scrutiny?
http://www.washingtonpost.com/opinions/matt-miller-the-gops-obamacare-youth-hoax/2013/08/21/39a5a3a2-0a5a-11e3-8974-f97ab3b3c677_print.html
Taxing Medicare Benefits
By BRUCE BARTLETT
Bruce Bartlett held senior policy roles in the Reagan and George H.W. Bush administrations and served on the staffs of Representatives Jack Kemp and Ron Paul. He is the author of “The Benefit and the Burden: Tax Reform – Why We Need It and What It Will Take.”
In a recent post, I discussed the nontaxation of imputed rent – the income homeowners receive from themselves by virtue of being both landlord and renter – which, judging by the comments, many readers found bizarre. In my continuing series on tax expenditures, this week I want to discuss another form of income that few people recognize as being “income” – the nontaxation of Medicare benefits.
First, few people probably think of any government benefits as income in any sense of the term. But if one gets back benefits far in excess of what one pays into a program like Medicare, then one is receiving income.
Those who acknowledge this point probably think it doesn’t matter, because they themselves are only getting back about the same as they paid into the Medicare trust fund from the Medicare portion of the payroll tax.
That tax is 1.45 percent of wages on both workers and employers (2.9 percent total). Unlike the Social Security tax, there is no wage cap for the Medicare tax. Additionally, starting this year, those with incomes above $200,000 ($250,000 for couples) pay an additional Medicare tax of 0.9 percent.
The payroll tax covers only hospitalization. Doctors’ visits are paid for by Medicare Part B premiums, which recipients have deducted from their Social Security benefits on a monthly basis. Most people pay $104.90 a month, with higher premiums based on income.
The payroll tax covers only hospitalization. Doctors’ visits are paid for by Medicare Part B premiums, which recipients have deducted from their Social Security benefits on a monthly basis. Most people pay $104.90 a month, with higher premiums based on income.
According to a May 2013 poll by the Harvard School of Public Health, two-thirds of people believe their lifetime taxes and premiums at least cover the cost of all their Medicare benefits; 27 percent believe their benefits equal their contributions, while 41 percent think they get back fewer Medicare benefits than they paid for.
In reality, almost everyone gets back far more in Medicare benefits than they ever pay into the system. What follows below are new data from the Urban Institute on lifetime benefits and taxes for those with average lifetime wages. The figures are a “present value” calculation – all future benefits discounted to today – in inflation-adjusted 2013 dollars.
As one can see, even single men, who get back the lowest amount of benefits for their Medicare contributions, receive almost three times what they pay in; single women get back more because of longer longevity; and one-earner couples get back six times what they pay in because they are getting twice the benefits for the same contribution single people make.
For-Profit Online Insurance Brokers Gear Up To Sell Obamacare
When the Affordable Care Act was working its way through Congress, Gary Lauer was nervous. Part of the bill sounded grim. It said people could buy required health coverage online, but only through websites run by state and federal governments.
"That was going to pretty much delete us from the landscape," he says.
That's because his company, eHealth Inc., is the country's biggest online health insurance broker. If he could work with the government, the new requirement for Americans to buy health insurance sounded great. And subsidies would help lower-income people afford the product he sells.
"We're facing a market here that's easily gonna double if not triple in size," Lauer says.
So Lauer made dozens of flights between Silicon Valley and Washington, D.C., lobbying for access to the new market. This summer he got it. The federal government agreed to allow eHealth and five other online brokers to sell plans in the new subsidized marketplaces.
The White House's point person for signing up as many people as possible for health coverage, Marilyn Tavenner, says the government is going to need help.
"It's one more avenue for individuals to access coverage to health insurance. Agents and brokers do a tremendous amount of work, so to that extent they're valued partners and we want to work with them," she says.
Group meetings turn doctor visits inside out
Shared medical appointments grow in popularity as physicians seek to treat larger numbers of patients efficiently. They could be used more frequently under the healthcare overhaul.
By Anna Gorman9:02 PM PDT, September 16, 2013
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Gunny Alford, a 63-year-old with advanced liver disease, took a seat as his doctor listened to his heart as part of a regular checkup.
As the UC San Diego physician explained lab results and asked about Alford's recent symptoms, several other patients and their family members looked on, paying close attention.
A liver transplant specialist, Alexander Kuo, explained to the group that Alford had cirrhosis of the liver from years of drinking but was doing well and would be an excellent candidate for a transplant.
"Your blood works looks good," Kuo told Alford. "This is beautiful."
A growing number of physicians around the nation are turning the traditional medical visit inside out, making what were once one-on-one, private appointments a group experience.
Shared medical appointments are becoming more widespread as physicians look for more efficient and effective ways to treat increasing numbers of patients with chronic diseases. The visits could increase significantly under the nation's healthcare overhaul when millions more Americans gain insurance coverage and need to access doctors. Multi-patient appointments are especially valuable in areas with physician shortages, proponents say.
Group appointments are being offered through UC San Diego to patients with diabetes, HIV and liver disease. Obesity and diabetes patients at the L.A. County-run Martin Luther King outpatient and specialty health clinic also have the option of attending group visits, and similar programs are being rolled out in Massachusetts, North Carolina and Ohio.
Proponents say the model allows patients to get appointments faster and spend more time with doctors. Physicians like not having to repeat themselves several times a day to people with the same ailments. Research shows that for certain patients, group visits can reinforce healthy behaviors and reduce emergency room visits.
"I can tell them until I am blue in the face what they have to do," Kuo said. "The peer pressure of the group does the trick."
Posted Sept. 16, 2013, at 11:48 a.m.
AUGUSTA, Maine — Gov. Paul LePage continued building a case Monday against expanding the state’s Medicaid program under the federal Affordable Care Act by highlighting a study that says thousands of younger men, smokers and heavy drinkers would be added to the program nationwide.
However, the study also showed that overall, the health of Medicaid recipients after the expansion would be statistically better than it is now.
LePage has long stood against expanding Medicaid in Maine, and the debate over whether to do so was one of the top issues of the most recent legislative session.
In a media release, LePage cited a recent edition of a publication called the Annals of Family Medicine, which detailed a University of Michigan study about who would receive health insurance through Medicaid if every state accepts the federal government’s eligibility expansion offer next year.
The study, which relied on a survey by the Centers for Disease Control and Prevention, says the expansion would result in an increased number of young men, smokers and heavy drinkers on Medicaid. The study showed that the average age of Medicaid recipients under the ACA expansion would go from 39 to 36 and there would be an increase in the number of male recipients from 33 percent to 49 percent of total enrollees. The percentage of smokers on the program would go from 38 percent to 49 percent and moderate and heavy drinkers would increase from 10 percent to 17 percent.
The same study estimated that the number of obese people on Medicaid would drop from 43 percent to 35 percent and the number diagnosed with clinical depression would drop from 22 percent to 16 percent.
“Under the ACA, physicians can anticipate a potentially eligible Medicaid population with equal if not better current health status and lower prevalence of obesity and depression than current Medicaid beneficiaries,” reads the Annals of Family Medicine article. “Federal Medicaid expenditures for newly covered beneficiaries therefore may not be as high as anticipated in the short term. Given the higher prevalence of tobacco smoking and alcohol use, however, broad enrollment and engagement of this potentially eligible population is needed to address their higher prevalence of modifiable risk factors for future chronic disease.”
Critics said LePage focused on the aspects of the study that support his argument.
“This study illustrates why we oppose a very costly Medicaid expansion,” said LePage in the release issued Monday morning. “This expansion of welfare would provide services to a younger population, while depleting scarce resources that are critical to care for those who desperately need assistance. We must ensure our neediest Mainers, the elderly and disabled, are put at the front of the line. It is critical for people to know that this is a debate about Medicaid welfare expansion, not Medicare. Those are two different programs.”
Expanding the state’s Medicaid program would provide coverage for about 50,000 adults without children in Maine who earn up to 133 percent of the federal poverty level, or $20,628 for a two-person household. The expansion would also prevent about 25,000 parents and childless adults from losing their Medicaid coverage on Jan. 1, 2014.
Christine Hastedt, public policy director for Maine Equal Justice Partners, one of the state’s most aggressive advocates for the Medicaid expansion, said accepting the federal deal would expand the number of services covered in addition to covering more people. She questioned the validity of LePage’s argument about senior citizens on waiting lists for care because much of that care would be newly covered under the expansion.
“The governor’s take-away from this is really not the principal finding of the report,” she said. “We know from a study that we did that, largely, the people who are going to be helped are people working for employers who don’t offer health insurance. What the governor does by putting this out there is present this false choice that either we help this population or we help people who are seniors on disability.”
LePage: Study backs no broader Medicaid
However, two health care experts say the same study makes the case for expanding the program.
By Joe Lawlor jlawlor@pressherald.com
Staff Writer
Staff Writer
AUGUSTA – Gov. Paul LePage on Monday touted a recent University of Michigan study as bolstering his stand against expanding Medicaid in Maine.
Two health care experts, on the other hand, said the same study actually does the opposite and makes the case for broadening the health insurance program for low-income residents.
"Overall, the study reached different conclusions than the (LePage) press release highlighted," said Mitchell Stein, public policy director for the Maine advocacy group Consumers for Affordable Health Care.
Erika Ziller, a senior research associate at the University of Southern Maine, concluded that the study instead supports expansion efforts.
LePage this year joined other Republican governors in resisting Medicaid expansion, a key component of President Obama's Affordable Care Act. He vetoed an expansion of MaineCare -- as Medicaid is called in Maine -- this spring, effectively denying coverage to more than 70,000 uninsured Maine residents, although the issue will likely come up again when the Legislature reconvenes in January.
LePage, in a news release Monday, pointed out that younger men, smokers and those more likely to drink alcohol would benefit from Medicaid expansion, according to a study by University of Michigan researchers published in the October edition of the Annals of Family Medicine.
"This study illustrates why we oppose a very costly Medicaid expansion," LePage wrote of the study. "This expansion of welfare would provide services to a younger population, while depleting scarce resources that are critical to care for those who desperately need assistance. We must ensure our neediest Mainers, the elderly and disabled, are put at the front of the line."
But under the Affordable Care Act, Medicaid expansion dollars would not be directed toward seniors, so LePage gives an apples-to-oranges comparison, Ziller said. "A 35-year-old carpenter is not going to be taking the place of an elderly person at an assisted living facility," she said.
Covering young adults helps hospitals, reduces unpaid bills
What happened after young adults could stay on their parents’ insurance? This, of course, is a provision of the Affordable Care Act.
Hospitals were helped because there was less uncompensated care. And those twenty-somethings avoided huge medical bills they could not afford.
That’s the conclusion of a study by the RAND Corporation published in the New England Journal of Medicine.
“The change allowing young people to remain on their parents’ medical insurance is protecting young adults and their families from the significant financial risk posed by emergency medical care,” said Andrew Mulcahy, the paper’s lead author and a health policy researcher at RAND, a nonprofit research organization. “Hospitals are benefitting, too, because they are treating fewer uninsured young people for emergency ailments.”http://pollways.bangordailynews.com/2013/09/17/national/covering-young-adults-helps-hospitals-reduces-uncompensated-care/
Wall St. Journal tells Obamacare dead-enders to back off
Less than a quarter of Americans want legislators to try to make Obamacare fail. Even a plurality of non-Tea party Republicans against the Affordable Care Act support legislators trying to make the law work.
Yet a cadre of Republicans in Congress have tried to tie defunding the Affordable Care Act to keeping the federal government funded and/or paying America’s creditors.
Today the very conservative Wall St. Journal editorial page told them to back off, that this approach won’t work and will instead help Democrats.
Yet a cadre of Republicans in Congress have tried to tie defunding the Affordable Care Act to keeping the federal government funded and/or paying America’s creditors.
Today the very conservative Wall St. Journal editorial page told them to back off, that this approach won’t work and will instead help Democrats.
Mr. Obama is never, ever going to unwind his signature legacy project of national health care. Ideology aside, it would end his Presidency politically. And if Republicans insist that any spending bill must defund ObamaCare, then a showdown is inevitable that shuts down much of the government. . .We’ve often supported backbenchers who want to push GOP leaders in a better policy direction, most recently on the farm bill. But it’s something else entirely to sabotage any plan with a chance of succeeding and pretend to have “leverage” that exists only in the world of townhall applause lines and fundraising letters. . .
Americans say: Make Obamacare work
Opponents of Obamacare are far from a united front.
We’ve long seen that, while more oppose than support the law, some opponents think the law “went too far” while others say it “didn’t go far enough.” And when you combine supporters with those who say it didn’t do enough, there are clear majorities for a policy that’s at least as ambitious and robust as the Affordable Care Act.
And now we see opponents again divided, this time between those who want to destroy Obamacare and those who want to make it work.
Note these data from a recent Pew poll:
http://pollways.bangordailynews.com/2013/09/16/national/americans-say-make-obamacare-work/
We’ve long seen that, while more oppose than support the law, some opponents think the law “went too far” while others say it “didn’t go far enough.” And when you combine supporters with those who say it didn’t do enough, there are clear majorities for a policy that’s at least as ambitious and robust as the Affordable Care Act.
And now we see opponents again divided, this time between those who want to destroy Obamacare and those who want to make it work.
Note these data from a recent Pew poll:
http://pollways.bangordailynews.com/2013/09/16/national/americans-say-make-obamacare-work/
Maine health insurance companies say they have won final approval for upcoming marketplace
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Posted Sept. 17, 2013, at 5:36 a.m.
LEWISTON, Maine — Officials from Maine Community Health Options and Anthem Blue Cross and Blue Shield say their companies have both won final approval from the federal government to post health insurance plans on the upcoming Affordable Care Act marketplace.
MCHO, based in Lewiston, is the state’s first health insurance co-op, a nonprofit governed for and by members. Anthem is the state’s largest insurance company and it has partnered with MaineHealth, the state’s largest health-care organization, to offer its plans.
Any individual or small group can buy from the marketplace, also known as an exchange. However, individuals who have federal subsidies can only use them in the marketplace and some small businesses will only get a tax break if they buy through the marketplace.
The Maine Bureau of Insurance approved both MCHO and Anthem for the marketplace in July. Anthem’s plans were controversial because they featured a narrow network that strictly limits which doctors and hospitals patients can use. Anthem has since asked to install a similar narrow network for individual insurance plans sold outside the marketplace as well.
The Centers for Medicare and Medicaid Services must give final approval before plans can be listed on the upcoming marketplace.
The Maine Bureau of Insurance could not confirm federal approval late Monday. A CMS spokesperson said the federal agency has not yet released which plans have been OK’d for the marketplace.
But MCHO and Anthem officials both said Monday that their companies have received approval.
About 124,500 Mainers now have individual or small-group health insurance plans, and another 133,000 have no insurance. Those 257,500 people are the ones most likely to be affected by the marketplace, by choosing it for themselves or working for an employer who chooses it. However, Maine Bureau of Insurance officials believe far fewer people than that will go through the marketplace.
The marketplace is slated to start open enrollment Oct. 1. Insurance plans will go into effect Jan. 1, 2014.
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