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We have written before about King v. Burwell, the case that will be heard before the US Supreme Court to determine whether or not health insurance subsidies can flow to states that refused to establish state-based marketplaces under the Affordable Care Act. As John Stewart has noted, justices would have to be more literal than Amelia Bedelia to find for the plaintiffs, but we live in strange times where anything seems possible.

The next question then is if the Supreme Court strikes down subsidies how many people would it impact? Now Kaiser Family Foundation has a helpful interactive map to estimate an answer. KFF researchers think more than 13 million people nationally, and about 1 million people in North Carolina, would lose tax credits if the Supreme Court denies subsidies to federal marketplace states. For most of these folks insurance would immediately become unaffordable. This is especially true because prices would most likely spiral upward as younger, healthier enrollees lose coverage.

That is a stunning figure. It would be like the Supreme Court cutting the number of North Carolinians receiving Medicare in half.

The cruel truth is that Congress could easily fix this problem by adding a few words to the Affordable Care Act, but they are so obsessed with repealing the legislation that they are unlikely to repair it. The state legislature could also provide a patch by at least establishing a governance structure for a state-based marketplace, but they are also unlikely to move. After all, the federal government stands ready to pay the state to expand insurance to 500,000 more state residents and that hasn’t gained any legislative traction.

So, we wait, while medical care for 1 million North Carolinians hangs in the balance.

Commentary

Notwithstanding the unceasing efforts to undermine and obstruct the Affordable Care Act, America’s health care law continues to pile up an impressive list of accomplishments. The latest was detailed this morning in this post by Tara Culp-Ressler at Think Progress:

“For the first time in a decade, the number of people struggling to pay their medical bills has started to decline, according to a new survey released on Thursday by the Commonwealth Fund. The researchers attributed the historic drop to the number of people gaining insurance under the health care reform law.

Between 2012 and 2014 — as Obamacare’s main coverage expansion took effect — the Commonwealth researchers found that the number of people who had issues paying for health treatment dropped from 41 percent to 35 percent. Over the same time period, the people who skipped out on health services because they couldn’t afford them declined from 43 percent to 36 percent:

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CREDIT: Commonwealth Fund

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CREDIT: Commonwealth Fund”

Commentary

As noted below, Gov. McCrory met with President Obama to discuss flexibility in using Medicaid expansion money to implement a North Carolina specific program that will extend health insurance to more low-income residents. As we have also said, the federal government has shown a tremendous willingness to accommodate governors who request authority to design new and innovative programs. This is all encouraging and kudos to the Governor for sticking his toe in the water.

What is not encouraging is McCrory floating the idea of work requirements as a condition to receive health insurance. As McCrory notes in the article, Utah’s Governor has pushed this idea unsuccessfully. Our Governor feels that President Obama may reconsider his opposition to this idea. That will not happen.

As background, an 1115 waiver allows states to waive some traditional protections in Medicaid to experiment with new ideas that can improve this important health insurance program. Specifically, waivers are meant to promote the ultimate objectives of Medicaid. Several states, for example, now have waivers to purchase private insurance plans for low-income people who would be eligible for Medicaid under expansion. This is an interesting and worthwhile experiment and we will collect important information on outcomes and costs from these state innovations.

Some Governors are abusing this process by applying for 1115 waivers that do nothing but erect barriers for people who need health insurance. A prime example is requesting a waiver that requires people to report to work search programs as a condition of receiving health insurance benefits. This is not innovative. It is not new. We know what happens when you include work requirements as a condition for receiving public benefits. It means many people will not be able to access insurance.

The waiver approved in Pennsylvania includes a provision that automatically refers unemployed people to job programs when they enroll in insurance. That’s fine as long as insurance is not contingent on participation in the work program.

We know, for these reasons, that a work requirement will not be approved by the federal government. There is some concern that Gov. McCrory may use this as a poison pill to sink a Medicaid expansion proposal and then blame the Obama Administration for not showing enough flexibility. Let’s hope that’s not the case.

Gov. McCrory has plenty of room to create a North Carolina specific plan to cover low-income people in the state. He should drop this one idea that everyone knows will never get approved and move forward with an evidence-based, innovative policy.

News

The Tampa Bay Times’ Politifact rounded up a list of the worst lies flying around the Internet last year, a task that no doubt must have seemed endless.

The list (click here) debunked a fair amount of claims from posts that went viral in right-wing chain emails and Facebook posts, including a (false) claim that President Barack Obama was the only president to ever skip out on traveling to Normandy to commemorate D-Day. (He’s actually been twice, including in 2014, and only one of four presidents that has done that in the past 69 years.)

Another “Pants on Fire” distinction went to a photograph of a Black Lives Matter protester in Ferguson, Missouri holding a sign altered to read “No mother should have to fear for her son’s life every time he robs a store.”

The actual photograph of the sign holder (which was published on a newspaper blog) instead read “No mother should have to fear for her son’s life every time he leaves home.”

Go ahead and read Politifact’s full list here.

One of my favorites? An anti-Obamacare “article” from September falsely stating that an Obamacare death panel ordered its first execution – an 86-year-old Chicagoan named Dorothy Zborknak. Not only are there no death panels, there’s no Dorothy Zborknak.

If that name sounds familiar, think Golden Girls, and the character Bea Arthur played with a slightly different spelling, Dorothy Zbornak.

And with that, I’ll leave you with the Golden Girls theme song — what clearly must have been the best sitcom soundtrack to emerge from the 1980s.

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Commentary

Reporter Dylan Scott at Talking Point Memo has the details of another wonky but important way that the Affordable Care Act is succeeding in holding down health care costs:

The medical-loss-ratio requirement mandates that insurance companies spend at least 80 percent of premiums on actual health benefits. It is one of the various provisions intended to help shape the behavior of insurance companies, making the market more efficient and cost-effective for consumers. Administrative costs are kept down, meaning that more of people’s money is going to real care.

“The medical loss ratio requirement and rate review mandated by the ACA put downward pressure on premium growth,” officials from the federal Centers for Medicare and Medicaid Services wrote in their report. Overall private insurance spending, of which premiums are a part, grew at a 2.8-percent rate — the lowest since at least 2007.

As Larry Levitt, vice president at the non-partisan Kaiser Family Foundation, put it to TPM in an email: “That is how it’s intended to work.”

In other words: Still more evidence that the ACA is insuring more people (and thereby saving tens of thousands of lives) and holding down overall health care costs.

Click here to read the entire story.