Health Site Woes Undermine Obama’s Vow on Government
By MICHAEL D. SHEAR
WASHINGTON — The implicit promise of Barack Obama’s presidency, delivered during the 2008 campaign and again repeatedly since then, was that government would not face a debacle like the recent malfunction of the technology behind the president’s new health care marketplaces.
In his biggest and most important speeches, the president often talks with passion about a “smarter, more effective government.” He has called on Congress to embrace and pay for a “21st century government that’s open and competent.” And he has vowed to work to “rebuild people’s faith in the institution of government.”
But in the pursuit of that lofty goal, Mr. Obama faces determined opposition from conservatives who view government as the problem, not the solution. And to succeed, he must win over an increasingly skeptical public whose trust in government has eroded over decades. A survey last week by the Pew Research Center found that just 19 percent of Americans trust government to do what is right just about always or most of the time.
The breakdown of the federal HealthCare.gov Web site could emerge as a test of Mr. Obama’s philosophy, with potentially serious implications for an agenda that relies heavily on the belief in a can-do bureaucracy. Michael Dimock, the Pew center’s director, said that the longer the problems persist, the more they could bolster what he called the “almost American value that government is inefficient.”
“There is a lingering kind of effect,” he said. “It matters not only because the public may have an inherent skepticism. It puts the ball on the tee for your critics and the late-night comics.”
In the months ahead, Mr. Obama is expected to push for Congress to pass an immigration overhaul in the face of conservative skeptics who doubt that the government can secure borders or verify the status of all workers. He has said he will push to create a Web-based system to rank colleges and universities, with the intention of eventually linking $150 billion in student aid to the results. And he has sketched out a big role for the federal government in an expansion of early childhood education.
To fix the federal health care portal, the president has ordered a “tech surge,” and advisers pledged on Friday that the Web site would be largely fixed by the end of November. They insist that there will be little lasting political damage for Mr. Obama, and they point to previous episodes, including the oil spill in the Gulf of Mexico in 2010 and the Internal Revenue Service scandal last year. In both cases, the political impact faded quickly
Health Insurance Options Aren’t Limited to Government Exchanges
By ANN CARRNS
WITH so much attention being paid to the troubled debut of the Obama administration’s health insurance exchanges, another alternative has largely gone unnoticed: unless you live in Washington, D.C., or Vermont, you can also buy insurance outside the exchanges — by going directly to insurance brokers, agents or company Web sites.
In general, health policies effective Jan. 1, whether sold on the exchanges or off, must comply with the Affordable Care Act. That means they have to offer the same menu of essential benefits, like drug coverage and maternity care, and can’t deny you coverage if you’re already sick. And, insurers who sell policies both on and off the exchanges must sell the same plan for the same price.
Of course, the main attraction of the exchange is that plans sold there may come with subsidies that can substantially lower your monthly premiums. (Premium credits are for people making up to $46,000 for an individual and up to $94,000 for a family of four.)
Web-based brokers, like eHealth, are supposed to be able to help consumers enroll in subsidy-eligible plans by connecting to the federal marketplace to verify the consumer’s income, under government guidelines issued last spring. But that isn’t happening yet at eHealth, in part because the company is still testing its system, said a spokesman, Nate Purpura.
However, the site offers more than a thousand plans from 60 insurance companies that you can buy if you aren’t looking for subsidies.
To have their plans qualified to be sold on exchanges, insurers must follow rules like marketing their plans fairly, and must offer at least one plan in the “silver” and “gold” categories. Such plans have higher premiums, but lower out-of-pocket costs, than plans in the lower “bronze” category.
Plans sold off the exchange are also supposed to follow the same tiers as those used on the public exchanges, to indicate the level of costs you will incur.
But What if Obamacare Works?
By ROSS DOUTHAT
IN last week’s column, I wrote about what might happen if the new health care law’s Web site remained a festering technological sore for months to come. (The answer: Nothing good.) But it’s still more likely that HealthCare.gov will be fixed by Thanksgiving and millions of Americans will (finally) be able to get a real look at what Obamacare is selling them.
What will they find? One way to understand what is being offered is to think in terms of three “mores.” Insurance à la Obamacare will be more expensive, moresubsidized and more comprehensive than what was previously available on the individual market.
This may not be obvious if you’re struggling to log on to HealthCare.gov. But some of the state-level exchange Web sites are working well enough to enable illuminating window shopping.
Take the exchange in my native state, Connecticut. There the “more expensive” part of the new regime is readily apparent. If you look at Connecticut insurance prices for 2013 — that is, pre-Obamacare — on the online clearinghouse eHealthInsurance, monthly premiums for a 30-year-old in good health can start below $100, and under $300 for a healthy 60-year-old.
On the state’s new Obamacare-compliant health care exchange, by contrast, nothing is that cheap. The lowest priced (“bronze”) plan for a 30-year-old Connecticut resident has premiums starting at $224 a month; for a 60-year-old, the cheapest plan starts at $537.
These premium increases, however, don’t tell the whole story, because there are subsidies, which the Connecticut exchange helpfully calculates as well. If our hypothetical 30-year-old makes $30,000 a year, for instance, he or she would be eligible for credits that lower the actual cost of the cheapest plan to $115 a month. A hypothetical 60-year-old making $30,000 would see the cost of the cheapest bronze plan fall to zero. Over all, the premium increases only really bite as subsidies phase out — at incomes above $45,000, or about $62,000 for a family of four.
They bite, in part, because insurance companies now have to take customers with pre-existing conditions, which drives everyone’s rates up. But they also bite because buyers are getting more insurance than the older system’s cheapest plans offered.
Why Not Medicaid For All?
My Sunday column on the potential consequences of Obamacare’s botched rollout ended by sketching a scenario in which the program’s Medicaid expansion is deemed a success while its reform of the individual market leads to much-higher-than-expected costs and much-lower-than-expected participation rates. This combination would no doubt be politically helpful to the Republican Party in the short run, but (I argued) it would actually leave liberals with a fairly clear path forward: Keep pressing the Medicaid expansion on states that haven’t taken it (and look for John Kasich-style Republicans to partner with), return to the Joe Lieberman-killed idea of expanding Medicare to 55-and-overs, and basically try to further shrink the percentage of Americans who aren’t eligible for one or both of those single-payer programs. This wouldn’t amount to the full-on push for single payer that some people expect from the left if Obamacare fails or gets repealed, but it would move the U.S. toward the closest thing to single payer that we’re ever likely to get: A system in which both the late middle-aged and the lower middle class gradually get folded into government-run insurance alongside the poor, the disabled, and the aged; the individual market survives as a kind of de facto high risk pool (overpriced but technically accessible); and the employer mandate helps prop up employer-based health insurance for a shrunken but still substantial share of the population.
In this landscape, the two forms of government-run insurance would presumably converge, because the liberal vision for keeping Medicare solvent without resorting to benefit cuts tends to rely on cutting provider payments toward Medicaid levels. So while the long-term result of this approach wouldn’t be “Medicaid for All,” it would, at the very least, be “Something Like Medicaid For An Awful Lot More People.” And indeed, my colleague Paul Krugman had a post just last month on roughly this possibility — not arguing for a Medicaid expansion per se, but making the case that Medicaid demonstrates that “we can actually control costs pretty well, while maintaining a universal guarantee, by slightly reducing choice and convenience.” (His column yesterday covered some related ground as well.)
It won’t surprise you to learn that I think that “slightly reducing choice and convenience” might slightly understate the case, given what we know about how Medicaid generates its current savings. Instead, I suspect the likely result of a Medicare-into-Medicaid transformation would be something like what The American Interest’s Adam Garfinkle discusses here: Significant access problems for everyone involved in the public system’s varied manifestations, and a sharpening of the incentives for the most successful/talented/credentialed doctors and their better-off patients to opt for various forms of concierge medicine rather than Medicare and employer-provided insurance. The resulting system would indeed offer a universal guarantee of coverage at a potentially reasonable price, but in terms of access and quality of care it might well end up being more stratified — especially between the upper-middle and the lower-middle — than the system we have today.
Some health insurance gets pricier as Obamacare rolls out
Many middle-class Californians with individual health plans are surprised they need policies that cover more — and cost more.
By Chad Terhune
7:42 PM PDT, October 26, 2013
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Thousands of Californians are discovering what Obamacare will cost them — and many don't like what they see.
These middle-class consumers are staring at hefty increases on their insurance bills as the overhaul remakes the healthcare market. Their rates are rising in large part to help offset the higher costs of covering sicker, poorer people who have been shut out of the system for years.
Although recent criticism of the healthcare law has focused on website glitches and early enrollment snags, experts say sharp price increases for individual policies have the greatest potential to erode public support for President Obama's signature legislation.
"This is when the actual sticker shock comes into play for people," said Gerald Kominski, director of the UCLA Center for Health Policy Research. "There are winners and losers under the Affordable Care Act."
Fullerton resident Jennifer Harris thought she had a great deal, paying $98 a month for an individual plan through Health Net Inc. She got a rude surprise this month when the company said it would cancel her policy at the end of this year. Her current plan does not conform with the new federal rules, which require more generous levels of coverage.
Now Harris, a self-employed lawyer, must shop for replacement insurance. The cheapest plan she has found will cost her $238 a month. She and her husband don't qualify for federal premium subsidies because they earn too much money, about $80,000 a year combined.
"It doesn't seem right to make the middle class pay so much more in order to give health insurance to everybody else," said Harris, who is three months pregnant. "This increase is simply not affordable."
On balance, many Americans will benefit from the healthcare expansion. They are guaranteed coverage regardless of their medical history. And lower-income families will gain access to comprehensive coverage at little or no cost.
The federal government picks up much of the tab through an expansion of Medicaid and subsidies to people earning up to four times the federal poverty level. That's up to $46,000 for an individual or $94,000 for a family of four.
But middle-income consumers face an estimated 30% rate increase, on average, in California due to several factors tied to the healthcare law.
Some may elect to go without coverage if they feel prices are too high. Penalties for opting out are very small initially. Defections could cause rates to skyrocket if a diverse mix of people don't sign up for health insurance.
Pam Kehaly, president of Anthem Blue Cross in California, said she received a recent letter from a young woman complaining about a 50% rate hike related to the healthcare law.
"She said, 'I was all for Obamacare until I found out I was paying for it,'" Kehaly said.
http://www.latimes.com/business/la-fi-health-sticker-shock-20131027,0,7448298,print.story
Shopping for better deals on health care? Experts say why not
1:00 AMInsurers, employers and workers alike are all looking – and finding ways – to tame rising costs.
By Tom Murphy
The Associated Press
The Associated Press
Paul Freeman drove 600 miles last year to save himself – and his employer – thousands of dollars on his surgery.
At first, the community bank CEO hesitated because he thought the lower price would mean lower quality. But he knew if he didn’t make the roughly 10-hour roundtrip trek, he’d pay about $5,000 out of pocket.
“You immediately think, ‘Oh they’re going to take me into a butcher shop and it’s going to be real scary,”’ Freeman, 53, says, noting that instead he had a “wonderful experience.”
People shop for deals on everything from cars to clothes to computers. Why not for health care, too?
Insurers, employers and individuals are shopping around for health care as they try to tame rising health care costs. Companies are doing things like paying for workers to travel if they agree to have a surgery performed in another city where the cost is cheaper. They’re also providing online tools to help people search for better deals in their home market.
And some patients are bargain-hunting on their own. Through a website called MediBid, people who pay out of pocket are soliciting doctors, hospitals and medical centers to bid to perform knee surgeries and other non-emergency procedures.
http://www.pressherald.com/news/Shopping-for-better-deals-on-health-care.html?pagenum=full
DC think tank ranks Maine 41st for value of welfare benefits
A poor, single mother of two contacts Maine’s welfare offices looking for help. She qualifies for several of the state’s most well-known aid programs, including those that help her buy food, receive medical care for her children and heat her home.Her potential take-away: just under $19,900 worth of help for the year.
If she lived in any one of 39 other states or the District of Columbia, a new national report shows, that single mother would receive more help — in some states, tens of thousands of dollars more.
The Cato Institute, a Washington, D.C.-based Libertarian think tank, ranks Maine 41st in the country for the value of its welfare benefits.
It’s a new look at an old issue. But people on both sides of Maine’s ever-present welfare debate say the Cato report doesn’t tell the whole story.
Advocates for the poor say many Mainers wouldn’t be eligible for even the $19,900 worth of programs and the state should be doing more to help its neediest residents.
“There are people who are struggling,” said Robyn Merrill, senior policy analyst for Maine Equal Justice Partners. “There are children who don’t have enough to eat. There are people who don’t have a home in our state. So we’re not doing enough to make sure that doesn’t happen. There’s no excuse for that.”
Supporters of tighter welfare restrictions say Maine is doing too much already.
http://bangordailynews.com/2013/10/27/news/state/dc-think-tank-ranks-maine-41st-for-value-of-welfare-benefits/print/
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