Don’t Dare Call the Health Law ‘Redistribution’
By JOHN HARWOOD
WASHINGTON — Rebecca M. Blank was a top candidate in 2011 to lead President Obama’s Council of Economic Advisers, but then the White House turned up something politically dangerous.
“A commitment to economic justice necessarily implies a commitment to the redistribution of economic resources, so that the poor and the dispossessed are more fully included in the economic system,” Ms. Blank, a noted poverty researcher, wrote in 1992. With advisers wary of airing those views in a nomination fight, Mr. Obama passed over Ms. Blank, then a top Commerce Department official and now the chancellor of the University of Wisconsin. Instead he chose Alan Krueger, a Princeton economist.
“Redistribution is a loaded word that conjures up all sorts of unfairness in people’s minds,” said William M. Daley, who was Mr. Obama’s chief of staff at the time. Republicans wield it “as a hammer” against Democrats, he said, adding, “It’s a word that, in the political world, you just don’t use.”
These days the word is particularly toxic at the White House, where it has been hidden away to make the Affordable Care Act more palatable to the public and less a target for Republicans, who have long accused Democrats of seeking “socialized medicine.” But the redistribution of wealth has always been a central feature of the law and lies at the heart of the insurance market disruptions driving political attacks this fall.
“Americans want a fair and fixed insurance market,” said Jonathan Gruber, a health economist at the Massachusetts Institute of Technology who advised Mr. Obama’s team as it designed the law. “You cannot have that without some redistribution away from a small number of people.”
Mr. Obama’s advisers set out to pass the law in 2009 fully aware that fears among middle-class voters sank President Bill Clinton’s health initiative 16 years earlier. So they designed the legislation to minimize the number of people likely to be hurt.
Instead of a sweeping change to a government-run “single-payer” system favored by Democratic liberals, members of the administration sought to preserve the existing system of employer-provided health insurance while covering the uninsured through the expansion of Medicaid and changes to the individual insurance market.
They also added benefits available to any family, such as the ability of children up to age 26 to remain on their parents’ health plans.
But throughout the process, they knew that some level of redistributing wealth — creating losers as well as winners — was inescapable.
Bill Nemitz: Maine governor’s welfare-cutters are experts at helping conservatives
The Alexander Group will get almost $1 million from taxpayers to make LePage look tough on aid programs.
Gary D. Alexander, the former secretary of public welfare for Pennsylvania, has has been hired by Maine to conduct a $925,000 review of Maine’s Medicaid program and the potential effects of expanding it through the federal health care law.
But we digress.
Click on The Alexander Group’s website (www.alexandergroupco.com) and you’ll see, scrolling across the screen, the cities “Providence, Rhode Island; Philadelphia, Pennsylvania; Washington, D.C.” Yet nowhere will you find a physical address, a phone number, not even a post office box to support the hammer-to-the-forehead implication that the firm actually operates out of any of those places.
On we go to the “Our Team” link, which lists Alexander and 13 associates – almost of all of whom have ties to either Rhode Island or Pennsylvania and whose bios appear in a number of cases to fall somewhat short of what Commissioner Mayhew calls “a knowledgeable group of experts.”
There’s Tania A. Alexander, “an occupational therapist and also a certified physical therapy assistant with over 17 years of experience in the therapy field.” She’s now co-director of the Alexander Group’s therapy and special education practice.
There’s Sharon D’Antuono, “a licensed speech language pathologist (who) brings over ten years experience working as a speech pathologist in the public schools and fourteen years of grant writing experience.” She’s co-chair of the Alexander Group’s therapy and special education practice and as lead grant writer.
But my absolute favorite is Robert W. “Bob” Patterson, who doesn’t appear to have an actual title with The Alexander Group but worked as a $104,000-a-year senior adviser to Alexander in Pennsylvania’s Department of Public Welfare.
That is until Patterson resigned in early 2012 amid media reports about the faith-based journal The Family in America, which he wrote and edited on the side. It seems Patterson penned, among other gems, a piece advising women that having sex with a man who uses a condom “robs” the woman of the mood-and-mind-enhancing benefits of direct exposure to semen.
Feeling suddenly squeamish about this bunch getting paid just under a million bucks to “overhaul” Maine’s welfare system?
Relax. As wowed as Commissioner Mayhew may be by this stunning array of expertise (hey, it’s all relative), The Alexander Group is not here to talk Maine’s Democrat-controlled Legislature into enabling the Republican Party’s war on the poor.
Rather, they’re here to lay the groundwork for what in a few short months will be an endless, mind-bending series of LePage re-election TV ads.
They’ll go something like this:
In face of website rollout, keep perspective on Obamacare
Posted Nov. 24, 2013, at 12:50 p.m.
The young man sitting on the exam table before me was breathless, pale and distressed. We had never met, but he asked for me at the clinic desk. Staff at another hospital where he had received care for nearly 20 years gave him my name when they saw he was uninsured.
Despite having a significant congenital heart condition, he had been reasonably healthy. Married, with two children, he was an independent plumber. It provided a decent living but not enough to be able to afford insurance — even if he could have qualified for coverage. With his pre-existing condition, no insurer would accept him.
For years he did what people who are uninsured do — defer regular doctor visits and hope he was lucky enough nothing bad happened. But his luck ran out. Now he was unable to work and could barely walk.
After receiving a new heart valve, he returned to his business, pledging to pay what he could for his care.
Hospitals see lots of “charity cases,” but it’s become harder and harder to balance margin with mission to care for the increasing number of uninsured. The most recent Census (2012) found 48 million Americans were effectively shut out of our health care system because they lacked basic health insurance coverage.
As the public (and political) furor over the Affordable Care Act failings dominate the headlines, it’s important to keep perspective about what this complicated health reform law is trying to accomplish. There are some real problems, but there are many things Obamacare is doing right.
For the young plumber who couldn’t qualify for a health plan, under Obamacare, insurance companies can no longer turn him away, even with his pre-existing condition. Now, health plans must offer coverage to everyone who applies.
As part of the ACA, he could now qualify for lower cost (or even no cost) monthly premiums if his plan was purchased through the new Health Insurance Marketplace. Under Obamacare he might qualify for financial assistance if his annual earning was under $94,200 (for his family of four). Such financial help could finally put health insurance coverage within reach for his modest income.
Now, when someone signs up for health insurance, Obamacare requires that the plan provide a standard set of benefits that we all want to have in our plan. Most importantly, there are no out-of-pocket costs for people to get early, preventive care that can detect problems early on so patients can avoid more significant illnesses and treatment costs.
Currently, the media is focusing on the “outrage” of the public at the administration and federal agencies that failed to adequately oversee the development of the Health Insurance Marketplace (www.HealthCare.gov) and the rollout of some provisions of the law. However, I suspect much of the public anger is a reflection of the intense anxiety that millions of uninsured and underinsured Americans feel as they are confronted by yet another barrier to finding affordable health insurance for themselves and their families.
Upset about Obamacare cancellations? Check out this study
With all the news about insurers canceling health plans due to the Affordable Care Act, including in the BDN, a national health consumer organization is calling for a little perspective.
First, let’s revisit the population that’s caught up in all this controversy, fueled by President Obama’s remarks that those who liked their health plans could keep them. These cancellations affect people who buy their own health insurance, rather than get coverage the way most of us do, through work or government programs like Medicaid and Medicare. It’s a small portion of the population, about 5.7 percent or 15.2 million people, according to a study released Thursday by Families USA. (That figure accounts specifically for people under 65, the age to qualify for Medicare and not have to worry about buying your own insurance. All of the study’s figures I cite here refer to these “nonelderly” people).
The study reports that in Maine, about 56,000 people under age 65 are covered by this insurance, called private “individual” or “nongroup” insurance. That’s 5.1 percent of the state’s population.
Nationally, almost three-quarters of these 15 million Americans who buy their own health insurance have family incomes that will make them eligible for substantial subsidies or for Medicaid under the Affordable Care Act, the study found. In other words, they earn less than four times the federal poverty level, or approximately $46,000 in annual income for an individual or $94,200 for a family of four. A tiny fraction, less than one percent of them, are at risk of losing their coverage and paying more, the study says.
The numbers also hold true in Maine. Three-quarters of those who currently buy their own coverage, or 40,000 people, can expect to qualify for subsidies or Medicaid, according to the study. Just half a percent face losing coverage and paying more.
Obamacare fail isn’t the site — it’s the law
THINK TANKS devote endless hours to analyzing “crisis response” — those moments when politicians collectively stare into the proverbial abyss. There is a spectrum of possible responses to any crisis: On one end is George Costanza from “Seinfeld,” who smells smoke at a birthday party and shoves aside children and grandmothers as he flees the room. On the other is Dan Aykroyd playing Julia Child, who treats a severed artery like a casual teaching moment, enthusiastically dispensing first-aid tips and cooking instructions — “Save the liver!” — until she gracefully passes out.
Obamacare is in crisis, but as the blood flows and the patient becomes ever more lightheaded, the president desperately pretends it’s all intentional. As with Aykroyd’s grisly “Saturday Night Live” sketch, we know it won’t end well, but it’s impossible to look away.
And as the president haplessly tries to reassure everyone that things will work out just fine, Democrats in Congress look more like George Costanza every day. Their problem is: Where’s the door?
Snarls in retooled Mass. insurance site
Changes are tied to US health law
Sean Kimball of Windsor had a retort ready when friends expressed their objections to the Affordable Care Act. “It’s worked out well for us,” he would say. The 2006 Massachusetts health law, later a model for the national one, provided his family with affordable coverage following a layoff.
But lately the state’s online insurance marketplace has not been working for Kimball — or for many other consumers. He spent two weeks trying to enroll in a new plan, without success, he said.
Since the state relaunched its insurance website Oct. 1 to comply with the national law, it has had persistent problems: links lead nowhere, technological failures lock users out or deliver inexplicable error messages, and consumers endure long wait times to speak with customer service representatives, who sometimes offer little more than a suggestion to try again later.
The Connector’s Facebook page is full of complaints from consumers, many of whom said they support the state and national health care laws ideologically but are incensed by an uncooperative website and by the fact that the old, functional state system is gone.
Medicaid Expansion Faces Major Logistical Challenges Among the Homeless
By ANNIE LOWREY
CHICAGO — In a back room at the Franciscan House of Mary and Joseph, one of the largest homeless shelters in Chicago, a social worker named Sheena Ward guided Terry Cannon through a Medicaid application.
A wet cough punctuated Mr. Cannon’s often wry answers to Ms. Ward’s questions about his disability status, military service and marital history. “I have glaucoma, I’m going blind. I have lung disease, I’m dying,” he said. “How can they deny me? If they do, give me a couple years and I’ll be gone.”
Today, most state Medicaid programs cover only disabled adults or those with dependents, so Mr. Cannon and millions of other deeply impoverished Americans are left without access to the program. But starting Jan. 1, President Obama’s health care law will expand Medicaid coverage to adults with incomes under 138 percent of the federal poverty line, and enrollment is expected to increase by about nine million next year. Thousands of homeless people will be among the newly covered.
Housing advocates say they believe that the Medicaid expansion has the potential to reduce rates of homelessness significantly, both by preventing low-income Americans from becoming homeless as a result of illness or medical debt and by helping homeless people become eligible for and remain in housing.
“We really feel like this is the last piece of the puzzle that we need to end chronic homelessness,” said Steve Berg, the vice president for programs and policy at theNational Alliance to End Homelessness.
But signing up homeless people for Medicaid is a huge logistical challenge, as housing advocates acknowledge. Homeless individuals often do not have an email address, phone number or permanent address. Many are unaware of the health care law or are skeptical of public programs.
Housing advocates and social workers across the country are now on a major push to inform impoverished and homeless people that they are eligible for Medicaid in the 25 states that are expanding the program and in the District of Columbia, and to enroll them.
For homeless people, experts said, the Medicaid expansion will mean more consistent treatment for medical conditions, including alcoholism, drug addiction, chronic pain and depression. For states and cities, they said, it will mean a more effective safety net, and perhaps even a cheaper one.
California, Here We Come?
By PAUL KRUGMAN
It goes without saying that the rollout of Obamacare was an epic disaster. But what kind of disaster was it? Was it a failure of management, messing up the initial implementation of a fundamentally sound policy? Or was it a demonstration that the Affordable Care Act is inherently unworkable?
We know what each side of the partisan divide wants you to believe. The Obama administration is telling the public that everything will eventually be fixed, and urging Congressional Democrats to keep their nerve. Republicans, on the other hand, are declaring the program an irredeemable failure, which must be scrapped and replaced with ... well, they don’t really want to replace it with anything.
At a time like this, you really want a controlled experiment. What would happen if we unveiled a program that looked like Obamacare, in a place that looked like America, but with competent project management that produced a working website?
Well, your wish is granted. Ladies and gentlemen, I give you California.
Now, California isn’t the only place where Obamacare is looking pretty good. A number of states that are running their own online health exchanges instead of relying on HealthCare.gov are doing well. Kentucky’s Kynect is a huge success; so is Access Health CT in Connecticut. New York is doing O.K. And we shouldn’t forget that Massachusetts has had an Obamacare-like program since 2006, put into effect by a guy named Mitt Romney.
California is, however, an especially useful test case. First of all, it’s huge: if a system can work for 38 million people, it can work for America as a whole. Also, it’s hard to argue that California has had any special advantages other than that of having a government that actually wants to help the uninsured. When Massachusetts put Romneycare into effect, it already had a relatively low number of uninsured residents. California, however, came into health reform with 22 percent of its nonelderly population uninsured, compared with a national average of 18 percent.
For beleaguered IRS, a crucial test still awaits after troubled rollout of health-care law
By Tom Hamburger and Sarah Kliff,
The success of the Affordable Care Act could ultimately turn on the performance of an agency that has so far eluded the public spotlight amid the program’s tumultuous rollout.
Whether the new law can be enforced will be up to the Internal Revenue Service, an already beleaguered agency charged under the act with carrying out nearly four dozen new tasks in what represents the biggest increase in its responsibilities in decades. None is more crucial than enforcing the requirement that all citizens secure health insurance or pay a penalty.
But those efforts have been hampered by a one-year delay in applying new insurance regulations to large employers. Those employers had been expected to provide insurance coverage information that the IRS would use to help identify who has insurance and who does not.
While failures in launching the federal insurance Web site and online exchanges have thrust the Department of Health and Human Services to the center of public attention, the IRS also has a huge role in carrying out the law, including helping to distribute trillions of dollars in insurance subsidies and penalizing people who do not comply.
The fine is intended to encourage healthy people to enroll even if they do not have an immediate need for care. If the elderly and the sick dominate the ranks of those who sign up, it could lead to what health economists call an “ insurance death spiral” of rapidly escalating costs, premium hikes and declining enrollment.
Besides lacking coverage information that would help the agency enforce the “individual mandate,” the IRS also is hamstrung in penalizing those who do not sign up. The lawmakers who drafted the health-care law intentionally barred the IRS from using its customary tools for collecting penalties — liens, foreclosures and criminal prosecution. The only means of collecting the fine is to essentially garnish tax refunds for people who overpaid their taxes.
Enforcing compliance with the law is just part of what one Treasury Department official calls “the largest expansion of IRS responsibilities in recent history.” And the increased workload comes as the IRS is suffering from high turnover of senior managers, years of budget cuts and congressional inquiries into the alleged politicization of the agency.
“This is really quite a heavy lift,” former IRS commissioner Mark W. Everson, who served under President George W. Bush, said in recent testimony on Capitol Hill, adding that he was concerned about the agency’s ability to fulfill the wide-ranging demands of the Affordable Care Act.
The Singular Waste of America's Healthcare System in 1 Remarkable Chart
The U.S. spends far, far more per person than any other rich country on healthcare. We don't get more for it.
We are an exceptional nation. At least when it comes to healthcare spending.
We spend much more than any other rich country, but we certainly don't get more for it. We get less. We get about the same health outcomes, but don't cover everybody like other rich countries do. Now, there are a lot of statistics that show how singularly wasteful our healthcare system is, but the chart below, via Aaron Carroll, is maybe the most visually arresting. It compares life expectancies with healthcare spending per capita for rich and near-rich countries. There's a pretty predictable relationship, with diminishing returns for more spending—and then there's the U.S.
See that dot that's almost off the chart? We spend more than four times as much as the Czech Republic does per persona, and live about just as long.
The problem is everybody wants the system to change, but nobody wants their corner of it to change. Doctors don't want their pay to change. And patients don't want their coverage to change. Obamacare tries to change both at the margins, and even that is politically fraught.
A perspective on the relationship between national and state single-payer efforts
By Steffie Woolhandler, M.D., and David Himmelstein, M.D.
PNHP note: The following article was among the materials distributed to participants at PNHP’s Annual Meeting in Boston on Nov. 2, 2013.
Virtually all single-payer supporters aspire to a nationwide reform. Absent a national solution, many regions with the gravest problems in access to care will lag further and further behind. Living in New York or Massachusetts doesn’t lessen our sense of responsibility for millions in the Deep South and other “red state” areas for whom national legislation is the only realistic option for health care progress.
Yet with the Congress currently tied in knots, prospects for the passage of a national single-payer bill are dim for the next few years. Meanwhile, in a number of states the political environment offers more openings for single-payer work, in no small part due to years of work by local PNHP members and other activists. These efforts are educating and pressuring many state legislators, and even governors, to embrace single payer – at least rhetorically. We outline below our views of the opportunities and obstacles to state-based work.
http://www.pnhp.org/print/news/2013/november/a-perspective-on-the-relationship-between-national-and-state-single-payer-efforts
PNHP note: The following article was among the materials distributed to participants at PNHP’s Annual Meeting in Boston on Nov. 2, 2013.
Virtually all single-payer supporters aspire to a nationwide reform. Absent a national solution, many regions with the gravest problems in access to care will lag further and further behind. Living in New York or Massachusetts doesn’t lessen our sense of responsibility for millions in the Deep South and other “red state” areas for whom national legislation is the only realistic option for health care progress.
Yet with the Congress currently tied in knots, prospects for the passage of a national single-payer bill are dim for the next few years. Meanwhile, in a number of states the political environment offers more openings for single-payer work, in no small part due to years of work by local PNHP members and other activists. These efforts are educating and pressuring many state legislators, and even governors, to embrace single payer – at least rhetorically. We outline below our views of the opportunities and obstacles to state-based work.
http://www.pnhp.org/print/news/2013/november/a-perspective-on-the-relationship-between-national-and-state-single-payer-efforts
IRAN’S SUPREME LEADER HOPES NUKE DEAL DISTRACTS ATTENTION FROM OBAMACARE
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