How Inequality Hollows Out the Soul
By RICHARD WILKINSON and KATE PICKETT
One of the well-known costs of inequality is that people withdraw from community life and are less likely to feel that they can trust others. This is partly a reflection of the way status anxiety makes us all more worried about how we are valued by others. Now that we can compare robust data for different countries, we can see not only what we knew intuitively — that inequality is divisive and socially corrosive — but that it also damages the individual psyche.
Our tendency to equate outward wealth with inner worth invokes deep psychological responses, feelings of dominance and subordination, superiority and inferiority. This affects the way we see and treat one another.
A few years ago, we published evidence that showed that in developed countries, major and minor mental illnesses were three times as common in societies where there were bigger income differences between rich and poor. In other words, an American is likely to know three times as many people with depression or anxiety problems as someone in Japan or Germany.
http://opinionator.blogs.nytimes.com/2014/02/02/how-inequality-hollows-out-the-soul/?hp&rref=opinion
Method of Study Is Criticized in Group’s Health Policy Tests
The idea seemed transformative. The Affordable Care Act would fund a new research outfit evocatively named the Innovation Center to discover how to most effectively deliver health care, with $10 billion to spend over a decade.
But now that the center has gotten started, many researchers and economists are disturbed that it is not using randomized clinical trials, the rigorous method that is widely considered the gold standard in medical and social science research. Such trials have long been required to prove the efficacy of medicines, and similarly designed studies have guided efforts to reform welfare-to-work, education and criminal justice programs.
But they have rarely been used to guide health care policy — and experts say the center is now squandering a crucial opportunity to develop the evidence needed to retool the nation’s troubled health care system in a period of rapid and fundamental change.
“It’s the greatest irony,” said Gordon Berlin, president of MDRC, a nonprofit organization whose studies have influenced American policies on welfare, job training and education. In health care, of all areas, he said, in which every group that evaluates medical evidence ranks such studies as the most reliable by far, they have rarely been used.
Delusions of Failure
by Paul Krugman
The Republican response to the State of the Union was delivered by Cathy McMorris Rodgers, Republican representative from Washington — and it was remarkable for its lack of content. A bit of uplifting personal biography, a check list of good things her party wants to happen with no hint of how it plans to make them happen.
The closest she came to substance was when she described a constituent, “Bette in Spokane,” who supposedly faced a $700-a-month premium hike after her policy was canceled. “This law is not working,” intoned Ms. McMorris Rodgers. And right there we see a perfect illustration of just how Republicans are trying to deceive voters — and are, in the process, deceiving themselves.
I’ll get back to “Bette in Spokane” in a minute, but first, is Obamacare “not working”?
Everyone knows about the disastrous rollout, but that was months ago. Since then, health reform has been steadily making up lost ground. At this point enrollments in the health exchanges are only about a million below Congressional Budget Office projections, and rising faster than projected. So a best guess is that by the time 2014 enrollment closes on March 31, there will be more than six million Americans signed up through the exchanges, versus seven million projected. Sign-ups might even meet the projection.
But isn’t Obamacare in a “death spiral,” in which only the old and sick are signing up, so that premiums will soon soar? Not according to the people who should know — the insurance companies. True, one company, Humana, says that the risk pool is worse than it expected. But others, includingWellPoint and Aetna, are optimistic (which isn’t a contradiction: different companies could be having different experiences). And the Kaiser Family Foundation, which has run the numbers, finds that even a bad risk pool would have only a minor effect on premiums.
Comparing Obamacare to Its Alternative
by Ezekiel Emmanuel
FROM the moment the ink dried on March 23, 2010, Republicans said they intended to “repeal and replace” the Affordable Care Act. They have voted more than 40 times to wipe the law from the books. But Republicans have never gotten around to describing, in detail, the set of policies they believe should replace Obamacare. That is, until yesterday.
After nearly four years, we finally have a Republican counterproposal: the Patient Choice, Affordability, Responsibility and Empowerment (or Patient CARE) Act.
Senators Tom Coburn, Richard Burr and Orrin Hatch deserve credit for developing this plan. Putting together a proposal to reform the American health care system is hard and politically courageous. And while it is lacking in important details, this plan contains some interesting ideas that might have enabled bipartisan compromises had they been offered in 2009, when I was a health care adviser to the Obama administration and the Affordable Care Act was being debated. For instance, the plan would shift many low-income adults from Medicaid to subsidized private insurance. There are some Democrats who could certainly have supported such a proposal, if it had been offered as part of a deal to enact a bipartisan bill.
Despite all the heated rhetoric from Republicans about Obamacare laying ruin to America, the plan would actually keep some of the law’s key provisions. It would preserve some subsidies for lower-income people to buy private insurance, though it would change the way they are calculated. Those $700 billion worth of Medicare savings Mitt Romney denounced during the 2012 campaign? Republicans would keep them. Allowing young adults to stay on their parents’ plan until age 26? Republicans would keep that, too. And the ban on lifetime insurance caps, so people with very expensive diseases don’t lose insurance? Republicans wouldn’t touch it.
But in other crucial ways, the Republican plan is different. First, Obamacare’s absolute ban on withholding coverage from people with pre-existing conditions would be rolled back. Those who remained continuously insured would stay protected, so they couldn’t be charged higher rates or be excluded entirely. But if their insurance lapsed, health insurance companies could charge more or refuse to cover them.
HealthCare.gov can’t handle appeals of enrollment errors
By Amy Goldstein,
Tens of thousands of people who discovered that HealthCare.gov made mistakes as they were signing up for a health plan are confronting a new roadblock: The government cannot yet fix the errors.
Roughly 22,000 Americans have filed appeals with the government to try to get mistakes corrected, according to internal government data obtained by The Washington Post. They contend that the computer system for the new federal online marketplace charged them too much for health insurance, steered them into the wrong insurance program or denied them coverage entirely.
For now, the appeals are sitting, untouched, inside a government computer. And an unknown number of consumers who are trying to get help through less formal means — by calling the health-care marketplace directly — are told that HealthCare.gov’s computer system is not yet allowing federal workers to go into enrollment records and change them, according to individuals inside and outside the government who are familiar with the situation.
“It is definitely frustrating and not fair,” said Addie Wilson, 27, who lives in Fairmont, W.Va., and earns $22,000 a year working with at-risk families. She said that she is paying $100 a month more than she should for her insurance and that her deductible is $4,000 too high.
When Wilson logged on to HealthCare.gov in late December, she needed coverage right away. Her old insurance was ending, and she was to have gallbladder surgery in January. But the Web site would not calculate the federal subsidy to which she knew she was entitled. Terrified to go without coverage, Wilson phoned a federal call center and took the advice she was given: Pay the full price now and appeal later.
Now she is stuck.
“I hope,” she said, “they really work on getting this fixed.”
The Obama administration has not made public the fact that the appeals system for the online marketplace is not working. In recent weeks, legal advocates have been pressing administration officials, pointing out that rules for the online marketplace, created by the 2010 Affordable Care Act, guarantee due-process rights to timely hearings for Americans who think they have been improperly denied insurance or subsidies.
But at the moment, “there is no indication that infrastructure . . . necessary for conducting informal reviews and fair hearings has even been created, let alone become operational,” attorneys at the National Health Law Program said in a late-December letter to leaders of the Centers for Medicare and Medicaid Services (CMS), the agency that oversees HealthCare.gov. The attorneys, who have been trying to exert leverage quietly behind the scenes, did not provide the letter to The Post but confirmed that they had sent it.
A CMS spokesman, Aaron Albright, said, “We are working to fully implement the appeals system.”
Medi-Cal seen as relief for some, confusing burden for others
Many Californians now qualify for Medi-Cal under Obamacare, but for some embarrassment and complex sign-ups overshadow the aid.
By Eryn Brown
7:33 PM PST, February 2, 2014
| advertisement |
Business owner Lori Golden wasn't looking for charity.
But the 62-year-old Northridge resident said that's what it felt like when she tried to buy an Obamacare health insurance policy through the Covered California exchange — and instead learned that her income was so low it qualified her to receive benefits through California's healthcare program for the poor.
"I'm upset. I sort of feel like I'm being forced to go into Medi-Cal," Golden said.
Supporters of national healthcare reform tout the expansion of Medicaid — called Medi-Cal in California — as one of the great successes of the Affordable Care Act.
For many needy people, learning they're eligible for the usually free program has been a tremendous relief — assurance that, after decades of forgoing care or worrying about medical expenses, they'll now be able to afford medications, see a doctor or seek emergency care without worrying about ending up broke.
But the news isn't wholly welcome for others, who find the complexities of signing up with Medi-Cal bewildering and onerous. And some, like Golden, who don't consider themselves low-income and don't know how Medi-Cal works, also fret over being placed on state healthcare rolls — "on the dole" — and would rather just pay for insurance.
"To me, Medi-Cal sounds like something that's free — and I'm not looking to get a government handout," she said. "That embarrasses me."
Golden, who publishes the free newspaper the Pet Press, used to pay $341 a month for a high-deductible policy through Aetna, which discontinued her coverage when it stopped selling to individuals in California in 2013.
She was sure she could afford a subsidized Covered California plan, which cost less than half as much per month. But such low-priced policies aren't available for Medi-Cal-eligible Californians, who are welcome to buy insurance through the exchange only if they give up any subsidy.
http://www.latimes.com/local/la-me-new-medi-cal-patients-20140203,0,5008456,print.story
Having Trouble Living Up To Its Name
This KHN story was produced in collaboration with 
ALBANY, Ga. — If Lee Mullins lived in Pittsburgh, he could buy mid-level health coverage for his family for $940 a month. If he lived in Beverly Hills, he would pay $1,405.
But Mullins, who builds custom swimming pools, lives in Southwest Georgia. Here, a similar health plan for his family of four costs $2,654 a month.
This largely agrarian pocket of Georgia, where peanuts and pecans are major crops and hunters bag alligators up to 10 feet long, is nearly the most expensive place in the nation to buy health insurance through the new online marketplaces created by the federal health law. The only place with higher premiums are the Colorado mountain resort areas around Aspen and Vail, a high-cost-of-living area unlike Georgia.
"We're not real happy with the way things are going in our neck of the woods," said David Hardin, Mullins' insurance broker.
All the dynamics that drive up health costs have coalesced here in Southwest Georgia, pushing up premiums. Expensive chronic conditions such as obesity and cancer are common among the quarter million people in this region. One hospital system dominates the area, leaving little competition. Only one insurer is offering policies in the online marketplace, and many physicians are not participating, limiting consumer choice.
Until these elements are brought under control, it will be challenging for the Affordable Care Act to fully live up to its name, not just here but in other parts of the country where premiums are high. In addition to this part of Georgia and the Colorado mountains, the most expensive of places include rural Nevada, parts of Wisconsin, most of Wyoming, southeastern Mississippi, southwestern Connecticut and Alaska.
The 10 Most Expensive Insurance Markets In The U.S.
These are the 10 regions of the country with the highest premiums for people buying insurance on the health law’s new marketplaces. The ranking is based on the lowest price “silver” plan, which is the mid-level plan that the majority of consumers are selecting. The listed monthly premiums are for a 40-year-old person and are based on rates listed on the federal and state insurance marketplaces and data collected by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)
These regions, created as part of the health law, range in size from a state to a single county. In each, the price of every policy has to be consistent across all counties, although the insurer does not have to offer each policy in every county. When the least expensive silver plan is not offered in a county, KHN notes the cheapest available silver plan there.
$483: Colorado Mountain Resort Region. Eagle, Garfield and Pitkin counties, home of Aspen and Vail ski resorts. Summit County premiums are $462.$461: Southwest Georgia. Baker, Calhoun, Clay, Crisp, Dougherty, Lee, Mitchell, Randolph, Schley, Sumter, Terrell and Worth counties.$456: Rural Nevada Esmeralda, Eureka, Humboldt, Lander, Lincoln, Elko, Mineral, Pershing, White Pine and Churchill counties.$445: Far western Wisconsin. Pierce, Polk and St. Croix counties, across the border from St. Paul, Minn.$423: Southern Georgia. A swath of counties adjacent to the even more expensive region. Ben Hill, Berrien, Brooks, Clinch, Colquitt, Cook, Decatur, Early, Echols, Grady, Irwin, Lanier, Lowndes, Miller, Seminole, Thomas, Tift and Turner counties.$405: Most of Wyoming. All counties except Natrona and Laramie.$399: Southeast Mississippi. George, Harrison, Jackson & Stone counties. In Hancock County, the lowest price plan is $447.$395: Vermont.*$383: Fairfield, Conn. The southwestern-most county, which includes many affluent commuter towns for New York City.$381: Alaska.
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