Editors Note The HCRA blog for November 25 evidently had a corrupted file. I am re-sending yesterday's clippings as part of the November 26 blog.
- SPC
Single payer: a powerful tool for better care, better health and reduced costs
By Donald M. Berwick, M.D.
The following is an unofficial transcript of the remarks delivered by Dr. Donald Berwick to the Annual Meeting of Physicians for a National Health Program on Nov. 15, 2014, in New Orleans. Dr. Berwick spoke to the assembly via live video.
Greetings, everyone,
I wish I were there in person, but I’m very grateful you’re letting me join you in this way. Obviously I’m talking to people who have had the vision and leadership and energy on this crucial issue for longer than I have, and I feel flattered you’ve asked me to share my thoughts.
As Gordy [Dr. Gordon Schiff] said, I just ran for the Democratic nomination for governor in Massachusetts. Unfortunately, I did not win the primary election. But in that experience I got much closer, face-to-face, with public policy and social justice issues – not just health care, but more than a dozen other issues – housing, homelessness, education, transportation, environment, energy, support for the arts, criminal justice, and frankly everywhere, poverty and immense debt, disparity, and inequality in our society, including in the state of Massachusetts.
And in the course of that campaign, and partly as a result of speaking to that very wide range of issues, I did take a clear stand – for the first time in my career – in favor of single-payer health care, Medicare for All, in Massachusetts.
I did it openly, I did it as forcefully as I possibly could, and I said it to no matter whom I was talking to. And I want to explain in a few minutes why I did that, what I’ve learned from that campaign, and then a few thoughts about what I think is next, although I have to defer to you and your colleagues gathered at your meeting today on the latter.
First: Why did I do this?
I want to frame something first: single-payer health care is important in terms of policy, but it is not, in and of itself, a moral commitment. Social justice and equality, ending poverty and hunger: those would be moral aims. But how we pay for the care we want, and how we get that care, isn’t a matter of morality; it’s just a mechanism.
The test of the value of single payer as a policy isn’t whether or not it is self-evidently or ethically right, but only whether it’s a smart way to achieve quality of care, and I think it is. And I want to tell you why that is.
How to Arrive at the Best Health Policies
By Donald M. Berwick, M.D.
The following is an unofficial transcript of the remarks delivered by Dr. Donald Berwick to the Annual Meeting of Physicians for a National Health Program on Nov. 15, 2014, in New Orleans. Dr. Berwick spoke to the assembly via live video.
Greetings, everyone,
I wish I were there in person, but I’m very grateful you’re letting me join you in this way. Obviously I’m talking to people who have had the vision and leadership and energy on this crucial issue for longer than I have, and I feel flattered you’ve asked me to share my thoughts.
As Gordy [Dr. Gordon Schiff] said, I just ran for the Democratic nomination for governor in Massachusetts. Unfortunately, I did not win the primary election. But in that experience I got much closer, face-to-face, with public policy and social justice issues – not just health care, but more than a dozen other issues – housing, homelessness, education, transportation, environment, energy, support for the arts, criminal justice, and frankly everywhere, poverty and immense debt, disparity, and inequality in our society, including in the state of Massachusetts.
And in the course of that campaign, and partly as a result of speaking to that very wide range of issues, I did take a clear stand – for the first time in my career – in favor of single-payer health care, Medicare for All, in Massachusetts.
I did it openly, I did it as forcefully as I possibly could, and I said it to no matter whom I was talking to. And I want to explain in a few minutes why I did that, what I’ve learned from that campaign, and then a few thoughts about what I think is next, although I have to defer to you and your colleagues gathered at your meeting today on the latter.
First: Why did I do this?
I want to frame something first: single-payer health care is important in terms of policy, but it is not, in and of itself, a moral commitment. Social justice and equality, ending poverty and hunger: those would be moral aims. But how we pay for the care we want, and how we get that care, isn’t a matter of morality; it’s just a mechanism.
The test of the value of single payer as a policy isn’t whether or not it is self-evidently or ethically right, but only whether it’s a smart way to achieve quality of care, and I think it is. And I want to tell you why that is.
How to Arrive at the Best Health Policies
by Margot Katz Sanger
When the 48-year-old man from Oregon didn’t have insurance, he felt he had no place to go but the emergency room. The man, who hasdiabetes, went to the emergency room often when he suffered from kidney stones. “Emergency rooms, from what I understand, they can never turn you away,” he said. “I mean, you don’t have much options when you don’t have insurance.”
Then, when he enrolled in the state of Oregon’s Medicaid plan, that all changed. He started seeing doctors in their offices, and stayed away from the emergency room: “I have had five appointments with my primary, one with the diabetic because they had me go to a diabetic educator, and then an appointment with my pharmacist, and then he does a phone-in thing with me every two weeks.”
His experience confirms common assumptions about how health care works. If we can just invest in preventive care, we can reduce the use of the emergency room and lower health care costs, the thinking goes. But it turns out that his experience wasn’t typical. He was part of a giant social policy experiment that randomly assigned some eligible people to get Medicaid and others to remain uninsured. Over all, the study found that people who got insurance actually used the emergency room more than their uninsured peers.
Collecting data that can trump a powerful anecdote is the value of the randomized controlled trial, says Amy Finkelstein, an M.I.T. professor and a leader of the Oregon study, which has published a series of papers, most recently on emergency room use.
That’s why this type of study — which randomly assigns some people to a new treatment and others to a placebo or an old approach — is the gold standard in evaluating the effectiveness of drugs: It can provide results that are both surprising and persuasive. But despite medical science’s long history with such studies, when it comes to the best way to design health care delivery, the randomized evaluation is still an incredibly rare approach.
That may be starting to change.
When the 48-year-old man from Oregon didn’t have insurance, he felt he had no place to go but the emergency room. The man, who hasdiabetes, went to the emergency room often when he suffered from kidney stones. “Emergency rooms, from what I understand, they can never turn you away,” he said. “I mean, you don’t have much options when you don’t have insurance.”
Then, when he enrolled in the state of Oregon’s Medicaid plan, that all changed. He started seeing doctors in their offices, and stayed away from the emergency room: “I have had five appointments with my primary, one with the diabetic because they had me go to a diabetic educator, and then an appointment with my pharmacist, and then he does a phone-in thing with me every two weeks.”
His experience confirms common assumptions about how health care works. If we can just invest in preventive care, we can reduce the use of the emergency room and lower health care costs, the thinking goes. But it turns out that his experience wasn’t typical. He was part of a giant social policy experiment that randomly assigned some eligible people to get Medicaid and others to remain uninsured. Over all, the study found that people who got insurance actually used the emergency room more than their uninsured peers.
Collecting data that can trump a powerful anecdote is the value of the randomized controlled trial, says Amy Finkelstein, an M.I.T. professor and a leader of the Oregon study, which has published a series of papers, most recently on emergency room use.
That’s why this type of study — which randomly assigns some people to a new treatment and others to a placebo or an old approach — is the gold standard in evaluating the effectiveness of drugs: It can provide results that are both surprising and persuasive. But despite medical science’s long history with such studies, when it comes to the best way to design health care delivery, the randomized evaluation is still an incredibly rare approach.
That may be starting to change.
Change in Health Care Law Would Take Aim at Consumer Inertia
Margot Sanger-Katz
People who bought Affordable Care Act health plans for 2014 but who don’t go back to shop again for 2015 will automatically keep the plan they first chose, even if its price goes way up.
Now the federal government isproposing that when people sign up, they should get a choice of defaults for future years: to stay in the same plan, or switch to a cheaper one in the same category if theirs gets too pricey.
The proposed regulation, published Friday, suggests phasing in the additional choice, first giving states with their own exchanges the option of offering it.
By 2017, if the proposal becomes final, everyone who buys a plan through the federal system will be subject to such a policy of having a choice of defaults.
Of course, customers who shop every year will get to pick whatever plan they want. And The Upshot has beenrecommending that everyone buying insurance through the system do just that, because there are big price differences in many markets between the most popular plan from 2014 and the cheapest possible alternative plan in 2015.
The proposal highlights a key feature of the Affordable Care Act’s marketplaces, which has both benefits and drawbacks. It relies on competition between private health plans to keep prices low. That means that shoppers in many markets can find good deals, but only if they’re willing to stomach the disruption of switching insurance every year.
People who bought Affordable Care Act health plans for 2014 but who don’t go back to shop again for 2015 will automatically keep the plan they first chose, even if its price goes way up.
Now the federal government isproposing that when people sign up, they should get a choice of defaults for future years: to stay in the same plan, or switch to a cheaper one in the same category if theirs gets too pricey.
The proposed regulation, published Friday, suggests phasing in the additional choice, first giving states with their own exchanges the option of offering it.
By 2017, if the proposal becomes final, everyone who buys a plan through the federal system will be subject to such a policy of having a choice of defaults.
Of course, customers who shop every year will get to pick whatever plan they want. And The Upshot has beenrecommending that everyone buying insurance through the system do just that, because there are big price differences in many markets between the most popular plan from 2014 and the cheapest possible alternative plan in 2015.
The proposal highlights a key feature of the Affordable Care Act’s marketplaces, which has both benefits and drawbacks. It relies on competition between private health plans to keep prices low. That means that shoppers in many markets can find good deals, but only if they’re willing to stomach the disruption of switching insurance every year.
National health insurance, supported by kids who share
And more surprising insights from the social sciences
By Kevin LewisGLOBE CORRESPONDENT
IS YOUR KINDERGARTNER good at sharing? If so, he or she might grow up to be an adult who believes in public benefits for society. In a new study, a psychologist analyzed data from an earlier study that followed individuals from their preschool years in Berkeley, Calif., through to adulthood. Sharing at age 5—as measured by the number of treats the child offered to another child for collaborating on a task—was associated with support for national health insurance in adulthood, even controlling for political identity in adulthood, gender, race, and childhood socioeconomic status, personality, and parent attitudes.
Dunkel, C., “Sharing in Childhood as a Precursor to Support for National Health Insurance,” Basic and Applied Social Psychology (forthcoming).
By Kevin LewisGLOBE CORRESPONDENT
IS YOUR KINDERGARTNER good at sharing? If so, he or she might grow up to be an adult who believes in public benefits for society. In a new study, a psychologist analyzed data from an earlier study that followed individuals from their preschool years in Berkeley, Calif., through to adulthood. Sharing at age 5—as measured by the number of treats the child offered to another child for collaborating on a task—was associated with support for national health insurance in adulthood, even controlling for political identity in adulthood, gender, race, and childhood socioeconomic status, personality, and parent attitudes.
Dunkel, C., “Sharing in Childhood as a Precursor to Support for National Health Insurance,” Basic and Applied Social Psychology (forthcoming).
Anthem’s 13.4 percent rate hike to hit more than 11,000 Mainers
The state’s insurance superintendent approves the increase for ‘legacy’ policies that predate the Affordable Care Act, but rejects Anthem’s request for 18.32 percent.
BY EDWARD D. MURPHY STAFF WRITER
Usually, “legacy” implies something positive left behind.
But that’s not the case for holders of Anthem Blue Cross and Blue Shield’s “legacy” individual health insurance policies, those that predate the Affordable Care Act. For them, the legacy tag means a big rate hike.
The Maine Bureau of Insurance approved an average premium increase of 13.4 percent for the insurer’s legacy block of 7,110 policies, which cover about 11,350 people in the state. Eric A. Cioppa, the superintendent of insurance, approved the increase after rejecting as excessive Anthem’s request for an average hike of 18.32 percent on its “legacy individual products.”
The policies are those left behind after the adoption of the ACA, said Mitchell Stein, an independent health policy consultant in Maine.
Stein said the law allows some individual policies written before the law went into force – and even a few that were written afterward – to continue for people who want to keep them, even if they don’t meet legal requirements for covering essential health conditions and out-of-pocket maximums.
Most individuals, he said, find a better deal on the ACA website, healthcare.gov, especially with subsidies that can help people with the cost. He said in some cases, families with a lot of children can get some subsidies even if their income is as high as $90,000.
But there are still some people who aren’t helped by the law and the selection of policies.
Jay Cox, who runs The Old Farm Christmas Place in Cape Elizabeth and runs a fishing boat in Alaska four months of the year, said he wasn’t able to find a better plan on healthcare.gov even though his premium on his Anthem individual policy will rise $800 this year, to $8,136, with a $2,500 deductible.
He has helped family members sign up for insurance on healthcare.gov and believes many got good deals. But when he searched for himself, the cost, co-pays and deductibles were higher than his Anthem plan.
The state’s insurance superintendent approves the increase for ‘legacy’ policies that predate the Affordable Care Act, but rejects Anthem’s request for 18.32 percent.
BY EDWARD D. MURPHY STAFF WRITER
Usually, “legacy” implies something positive left behind.
But that’s not the case for holders of Anthem Blue Cross and Blue Shield’s “legacy” individual health insurance policies, those that predate the Affordable Care Act. For them, the legacy tag means a big rate hike.
The Maine Bureau of Insurance approved an average premium increase of 13.4 percent for the insurer’s legacy block of 7,110 policies, which cover about 11,350 people in the state. Eric A. Cioppa, the superintendent of insurance, approved the increase after rejecting as excessive Anthem’s request for an average hike of 18.32 percent on its “legacy individual products.”
The policies are those left behind after the adoption of the ACA, said Mitchell Stein, an independent health policy consultant in Maine.
Stein said the law allows some individual policies written before the law went into force – and even a few that were written afterward – to continue for people who want to keep them, even if they don’t meet legal requirements for covering essential health conditions and out-of-pocket maximums.
Most individuals, he said, find a better deal on the ACA website, healthcare.gov, especially with subsidies that can help people with the cost. He said in some cases, families with a lot of children can get some subsidies even if their income is as high as $90,000.
But there are still some people who aren’t helped by the law and the selection of policies.
Jay Cox, who runs The Old Farm Christmas Place in Cape Elizabeth and runs a fishing boat in Alaska four months of the year, said he wasn’t able to find a better plan on healthcare.gov even though his premium on his Anthem individual policy will rise $800 this year, to $8,136, with a $2,500 deductible.
He has helped family members sign up for insurance on healthcare.gov and believes many got good deals. But when he searched for himself, the cost, co-pays and deductibles were higher than his Anthem plan.
Commonwealth Fund report reveals stark comparison to 10 industrialized countries with universal health coverage
By Steven Reinberg
HealthDay News, Nov. 19, 2014
Seniors in America have more chronic health problems and take more medications than seniors in 10 other industrialized countries do, according to a new global survey.
The United States also stood out among the 11 nations surveyed by The Commonwealth Fund for having more seniors struggling to get and afford the health care they need.
Eighty-seven percent of U.S. adults who are 65 and older suffer from at least one chronic illness, and 68 percent have at least two illnesses, which were the highest rates found, the survey showed. Also, 53 percent of older Americans take at least four medications, another record high, and 21 percent spend at least $2,000 in yearly out-of-pocket health care costs, which was second only to Switzerland.
"The retirement of baby boomers means pressure on Medicare will intensify," Dr. David Blumenthal, president of The Commonwealth Fund, said during a news briefing Tuesday to announce the study findings, which were published online Nov. 19 in the journal Health Affairs.
Despite the moderating of health care costs in recent years, Blumenthal added, "Costs are still going up too fast to be sustainable over the long term, and this will be exacerbated by increasing numbers of elderly individuals."
The study's lead author and Commonwealth Fund vice president, Robin Osborn, noted at the news briefing: "Those over 65 in the U.S. will almost double from 2005 to 2030. These sicker adults will likely put a strain on the health care system [which] will need to transform to meet the challenges of an aging population."
For the survey, the researchers collected responses from more than 15,000 older adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.
Most all of the other countries have some form of universal health insurance, and American seniors have Medicare, but Osborn said striking differences emerged in the survey:
- Although the U.S. senior group was the youngest of all the countries in the report, they were also among the sickest: 25 percent of older Americans saw at least four doctors in the past year, second only to Germany at 39 percent.
- In addition, more Americans (19 percent) said they skipped essential health care because they could not afford it, and 11 percent said they had trouble paying their medical bills. In France, only 3 percent of seniors said they skipped health care because of cost, and in Norway only 1 percent said they had trouble paying medical bills.
- In terms of out-of-pocket costs, only the Swiss spent more than Americans. In the United States, 21 percent spent $2,000 or more a year, compared with 22 percent in Switzerland and 2 percent in the United Kingdom. In France, on the other hand, virtually no one spent out-of-pocket costs.
- Only 57 percent of U.S. seniors said they were able to see their doctor the same or the next day when they were sick, compared with 83 percent in France and New Zealand, and 81 percent in Germany.
- Americans use of emergency rooms was one of the highest, at 39 percent. Thirty-five percent of these visits were for conditions their doctors could have dealt with had they been available, the researchers found.
- When a specialist was needed, 86 percent of U.S. seniors and 82 percent of seniors in Switzerland were able to see one within four weeks -- the highest rates in the survey. Seniors in Canada (46 percent), Norway (46 percent) and Sweden (50 percent) were the least likely to get appointments that quickly.
- U.S. seniors, like seniors in the other countries, appear to suffer from poorly coordinated care or gaps in communication between doctors: 35 percent of U.S. seniors reported having such problems, as did 41 percent in Germany and 37 percent in Norway. In France, only 7 percent said they had these problems. But, the survey showed, American seniors also had better doctor/patient relationships than seniors in many other countries.
By Steven Reinberg
HealthDay News, Nov. 19, 2014
HealthDay News, Nov. 19, 2014
Seniors in America have more chronic health problems and take more medications than seniors in 10 other industrialized countries do, according to a new global survey.
The United States also stood out among the 11 nations surveyed by The Commonwealth Fund for having more seniors struggling to get and afford the health care they need.
Eighty-seven percent of U.S. adults who are 65 and older suffer from at least one chronic illness, and 68 percent have at least two illnesses, which were the highest rates found, the survey showed. Also, 53 percent of older Americans take at least four medications, another record high, and 21 percent spend at least $2,000 in yearly out-of-pocket health care costs, which was second only to Switzerland.
"The retirement of baby boomers means pressure on Medicare will intensify," Dr. David Blumenthal, president of The Commonwealth Fund, said during a news briefing Tuesday to announce the study findings, which were published online Nov. 19 in the journal Health Affairs.
Despite the moderating of health care costs in recent years, Blumenthal added, "Costs are still going up too fast to be sustainable over the long term, and this will be exacerbated by increasing numbers of elderly individuals."
The study's lead author and Commonwealth Fund vice president, Robin Osborn, noted at the news briefing: "Those over 65 in the U.S. will almost double from 2005 to 2030. These sicker adults will likely put a strain on the health care system [which] will need to transform to meet the challenges of an aging population."
For the survey, the researchers collected responses from more than 15,000 older adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.
Most all of the other countries have some form of universal health insurance, and American seniors have Medicare, but Osborn said striking differences emerged in the survey:
- Although the U.S. senior group was the youngest of all the countries in the report, they were also among the sickest: 25 percent of older Americans saw at least four doctors in the past year, second only to Germany at 39 percent.
- In addition, more Americans (19 percent) said they skipped essential health care because they could not afford it, and 11 percent said they had trouble paying their medical bills. In France, only 3 percent of seniors said they skipped health care because of cost, and in Norway only 1 percent said they had trouble paying medical bills.
- In terms of out-of-pocket costs, only the Swiss spent more than Americans. In the United States, 21 percent spent $2,000 or more a year, compared with 22 percent in Switzerland and 2 percent in the United Kingdom. In France, on the other hand, virtually no one spent out-of-pocket costs.
- Only 57 percent of U.S. seniors said they were able to see their doctor the same or the next day when they were sick, compared with 83 percent in France and New Zealand, and 81 percent in Germany.
- Americans use of emergency rooms was one of the highest, at 39 percent. Thirty-five percent of these visits were for conditions their doctors could have dealt with had they been available, the researchers found.
- When a specialist was needed, 86 percent of U.S. seniors and 82 percent of seniors in Switzerland were able to see one within four weeks -- the highest rates in the survey. Seniors in Canada (46 percent), Norway (46 percent) and Sweden (50 percent) were the least likely to get appointments that quickly.
- U.S. seniors, like seniors in the other countries, appear to suffer from poorly coordinated care or gaps in communication between doctors: 35 percent of U.S. seniors reported having such problems, as did 41 percent in Germany and 37 percent in Norway. In France, only 7 percent said they had these problems. But, the survey showed, American seniors also had better doctor/patient relationships than seniors in many other countries.
'Family Glitch' Locks Mainers Out of Health Insurance Marketplace
By PATTY WIGHT • NOV 24, 2014
ABOUT SEVEN MILLION PEOPLE SIGNED UP FOR INSURANCE LAST YEAR THROUGH THE AFFORDABLE CARE ACT. BUT THERE WERE TWO TO FOUR MILLION MORE WHO WERE ESSENTIALLY LOCKED OUT DUE TO SOMETHING CALLED THE "FAMILY GLITCH." IT HAPPENS WHEN A SPOUSE GETS AFFORDABLE COVERAGE THROUGH WORK, BUT IT'S NOT EXTENDED TO FAMILY MEMBERS. THOSE FAMILY MEMBERS ALSO BECOME INELIGIBLE FOR SUBSIDIES. THE RESULT IS THAT SOME MODERATE- TO LOW-INCOME MAINERS CONTINUE TO STRUGGLE FOR ACCESS TO HEALTH CARE.
IF ANYONE WAS ANTICIPATING SIGNING UP FOR HEALTH CARE COVERAGE LAST YEAR, IT WAS KAMI, A STAY-AT-HOME MOM IN WASHINGTON COUNTY, WHO DOESN'T WANT HER LAST NAME USED. HER HUSBAND IS A STORE MANAGER. AND WHILE HE HAS HEALTH INSURANCE THROUGH HIS EMPLOYER, TO ADD KAMI, IT WOULD COST MORE THAN TWICE AS MUCH. "BECAUSE WHAT IT WOULD BE FOR HIM AND I WOULD BE APPROXIMATELY 30 PERCENT OF HIS INCOME," SHE SAYS.
BUT KAMI NEEDS COVERAGE. SHE'S CONSIDERED HIGH RISK FOR BREAST CANCER. SHE HAS ANXIETY AND DEPRESSION. SO, SHE EAGERLY LOOKED FORWARD TO ENROLLING THROUGH THE ACA'S ONLINE MARKETPLACE. "SO ONE OF THE QUESTIONS IS, 'DOES YOUR EMPLOYER PROVIDE AFFORDABLE HEATH CARE?' I HAD CHECKED, 'NO,' BECAUSE LOOKING AT WHAT MY HUSBAND'S EMPLOYER OFFERS, WE COULDN'T AFFORD IT," SHE SAYS.
BUT IT TURNS OUT THAT HER HUSBAND'S INSURANCE IS CONSIDERED AFFORDABLE BECAUSE IT COSTS LESS THAN 9.5 PERCENT OF HIS INCOME. AND UNDER THE ACA, IF INSURANCE IS AFFORDABLE FOR ONE FAMILY MEMBER, IT'S DEEMED AFFORDABLE FOR ALL FAMILY MEMBERS. THAT MEANS KAMI DIDN'T QUALIFY FOR SUBSIDIES TO BUY COVERAGE FOR HERSELF. SHE FELL INTO THE FAMILY GLITCH. "TO FIND OUT WE DON'T QUALIFY, I'M LIKE, 'OK - NOW WHAT DO I DO?' IT WAS STRESSFUL. IT'S STRESSFUL."
By PATTY WIGHT • NOV 24, 2014
ABOUT SEVEN MILLION PEOPLE SIGNED UP FOR INSURANCE LAST YEAR THROUGH THE AFFORDABLE CARE ACT. BUT THERE WERE TWO TO FOUR MILLION MORE WHO WERE ESSENTIALLY LOCKED OUT DUE TO SOMETHING CALLED THE "FAMILY GLITCH." IT HAPPENS WHEN A SPOUSE GETS AFFORDABLE COVERAGE THROUGH WORK, BUT IT'S NOT EXTENDED TO FAMILY MEMBERS. THOSE FAMILY MEMBERS ALSO BECOME INELIGIBLE FOR SUBSIDIES. THE RESULT IS THAT SOME MODERATE- TO LOW-INCOME MAINERS CONTINUE TO STRUGGLE FOR ACCESS TO HEALTH CARE.
IF ANYONE WAS ANTICIPATING SIGNING UP FOR HEALTH CARE COVERAGE LAST YEAR, IT WAS KAMI, A STAY-AT-HOME MOM IN WASHINGTON COUNTY, WHO DOESN'T WANT HER LAST NAME USED. HER HUSBAND IS A STORE MANAGER. AND WHILE HE HAS HEALTH INSURANCE THROUGH HIS EMPLOYER, TO ADD KAMI, IT WOULD COST MORE THAN TWICE AS MUCH. "BECAUSE WHAT IT WOULD BE FOR HIM AND I WOULD BE APPROXIMATELY 30 PERCENT OF HIS INCOME," SHE SAYS.
BUT KAMI NEEDS COVERAGE. SHE'S CONSIDERED HIGH RISK FOR BREAST CANCER. SHE HAS ANXIETY AND DEPRESSION. SO, SHE EAGERLY LOOKED FORWARD TO ENROLLING THROUGH THE ACA'S ONLINE MARKETPLACE. "SO ONE OF THE QUESTIONS IS, 'DOES YOUR EMPLOYER PROVIDE AFFORDABLE HEATH CARE?' I HAD CHECKED, 'NO,' BECAUSE LOOKING AT WHAT MY HUSBAND'S EMPLOYER OFFERS, WE COULDN'T AFFORD IT," SHE SAYS.
BUT IT TURNS OUT THAT HER HUSBAND'S INSURANCE IS CONSIDERED AFFORDABLE BECAUSE IT COSTS LESS THAN 9.5 PERCENT OF HIS INCOME. AND UNDER THE ACA, IF INSURANCE IS AFFORDABLE FOR ONE FAMILY MEMBER, IT'S DEEMED AFFORDABLE FOR ALL FAMILY MEMBERS. THAT MEANS KAMI DIDN'T QUALIFY FOR SUBSIDIES TO BUY COVERAGE FOR HERSELF. SHE FELL INTO THE FAMILY GLITCH. "TO FIND OUT WE DON'T QUALIFY, I'M LIKE, 'OK - NOW WHAT DO I DO?' IT WAS STRESSFUL. IT'S STRESSFUL."
Chuck Schumer Is Trash Talking Obamacare Again—And He's Still Not Making Any Sense
by Brian Beutler
Chuck Schumer Is Trash Talking Obamacare Again—And He's Still Not Making Any Sense
Senator Chuck Schumer copped to something Tuesday morning a lot of frustrated Democrats privately believe.
“Democrats blew the opportunity the American people gave them,” Schumer told reporters at a press event in Washington. “We took their mandate and put all our focus on the wrong problem—health care reform.”
Given the immediate context—a big GOP midterm win, the twilight of Barack Obama’s presidency, the wind up to 2016—people will understandably interpret Schumer’s comments as an attempt to turn the page—to give Hillary Clinton space to run on the promise that she’ll finally get things right, and to implore the liberal intelligentsia to get cracking on a fresh agenda. There is truth to all of that, and it’s reflected in the unequivocal nature of Schumer’s mea culpa.
But there are two important caveats to this story, both of which take a lot of punch out of his words. First, his views in this case aren’t new; and second, they are wrong—both politically and substantively.
It’s forgotten now, but Schumer was always skeptical of the idea that Democrats should cash in all their post-Bush Administration capital on the project of universal health care. He's made it known at various intervals. In 2010, Schumer told the New Yorker’s Jeffrey Toobin, “if I were President I might not have [pursued health care reform].” Most Americans had health care and were satisfied with it, he observed, and most of those who didn’t weren’t dependable voters.
In the Senate, Schumer was the Finance Committee’s point man on the public option—a factoid that appears at odds with the idea that he was a reform skeptic. But the purpose of that role was to build as much popular support for the project as possible and keep the liberal coalition united behind it. To make the best out of what he ultimately viewed as a mistake. As it turned out, the public option was probably doomed from the beginning. The administration had traded it away for industry acquiescence.
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