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Health-Reform-SBAs Adam Linker explained last week when he debunked the latest conservative mythology surrounding the Affordable Care Act, the law continues to succeed despite its imperfections and the endless, hysterical attacks of the President’s political opponents.

Today, there’s still more confirmation of this undeniable reality from Washington state. As The Olympian reported this morning, the state’s uninsured rate has been plummeting:

State insurance officials say fewer than 9 percent of Washington residents still don’t have health insurance.

That’s a significant improvement from numbers before the Affordable Care Act went into effect.

The state Office of the Insurance Commissioner counted 970,000 uninsured Washington residents last year. That number is now 600,000 or about 8.65 percent of the state population.

Agency spokeswoman Stephanie Marquis told The Olympian (http://is.gd/p2XsBG ) two factors are driving the improvement: enrollment in Medicaid and sign-ups for private insurance, but inside and outside of the new state health insurance exchange.

The insurance department reports the individual market has grown to more than 327,000 policies. That represents about 81,000 more insured people than before Oct. 1, when Washington’s Health Benefit Exchange opened.

The exchange also helped sign up nearly 350,000 people for free insurance through Medicaid.

Despite the many successes here, at last check, North Carolina’s uninsured rate remains significantly higher.

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In a new post this afternoon, Jesse Cross-Call at the Center on Budget and Policy Priorities reports the latest confirmation that North Carolina is shooting itself in the foot with its stubborn and shortsighted refusal to expand Medicaid to hundreds of thousands of uninsured people under the Affordable Care Act.

As a growing number of reports increasingly make clear, a state’s decision whether to expand Medicaid as part of health reform has real-life effects on its residents and its businesses.  In the 26 states and the District of Columbia that have expanded Medicaid (see map), the positive benefits are already playing out.  Here’s some of the latest information:

  • Hospitals are providing less uncompensated care.  In Arizona, hospitals reported that the Medicaid expansion is the chief reason for a 30 percent decline in the amount of uncompensated care they have provided so far this year, compared with a year ago.  The Colorado Hospital Association found a similar decline in charity care through April when it surveyed hospitals in 15 states that have expanded Medicaid and 15 that have not.
  • Medicaid expansion is driving large gains in health coverage.  A survey conducted by the Urban Institute finds that while the uninsurance rate is dropping across the country, states that have expanded Medicaid have seen a drop in the percentage of non-elderly adults who are uninsured by more than one-third — a 37.7 decline — while the uninsured rate fell by only 9 percent among states that haven’t expanded.  A survey from the Commonwealth Fund found a similar trend. Read More
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With the growing success and momentum of the Affordable Care Act, it’s increasingly evident that opponents have lost the national debate. The national media are now overflowing with stories about how the right is desperately searching for a new issue to focus on during the upcoming fall elections.

Here in North Carolina, where conservative obstruction continues to hold sway for the time being — at least with respect to a federally-funded Medicaid expansion for 500,000 low-income people — we’re also seeing growing signs that the blockade is starting to crack and crumble.

The newest evidence of the occurred this week at the General Assembly where ACA opponents ran headlong into advocates for people with autism. As Adam Linker explained here the other day and Raleigh’s News & Observer explained this morning, the advocates are fighting for health insurance coverage of Autism Spectrum Disorders are running into opposition from the corporate lobbying community, which as usual, is doing everything in its power to save itself money and limit coverage.

The interesting twist is that the debate over autism coverage has served to help bottle up a conservative anti-ACA bill that would also ban new insurance mandates.

In other words, the efforts of lawmakers to pass another anti-ACA law has been revealed yet again to have an Achilles’ heel — namely, that people want health insurance. Try as they might to undermine the new law, ACA opponents cannot overcome the simple on-the-ground reality that Americans of all stripes want coverage for themselves and their families and will not — in the long run — allow politicians to deny it to them. The debate over autism coverage at the General Assembly is just the latest example of this powerful reality.

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Politicians and members of the press are keenly interested in premium rates for Affordable Care Act Marketplace plans next year. Lawmakers want to use insurance prices as a cudgel on the campaign trail and the media knows that talk of premium spikes will attract attention.

That’s why reporters were interested in the announced enrollment statistics for Blue Cross and Blue Shield of North Carolina on Friday. The resulting coverage noted that BCBSNC enrollees were older and sicker than the company expected. In the race to make political hay out of these numbers there are a few points to keep in mind.

First, approximately 91 percent of ACA plan enrollees in the state receive a subsidy to purchase coverage. For this population premiums are capped as a percent of income. If, for example, you earn 150 percent of the federal poverty level then you will need to pay 4 percent of your household income for an ACA plan regardless of how premiums behave. Unless your income changes, you will pay the same rate next year.

Second, an older risk pool is not a major driver of premiums. Insurance companies certainly need younger and healthier enrollees to balance out payments for customers who use a lot of medical services. Still, as Kaiser Family Foundation has pointed out, even if insurers miss the mark substantially, this less healthy risk pool will only have a 1 or 2 percent impact on premiums. The primary drivers of premiums continue to be underlying medical costs and negotiated payment rates to providers.

Third, insurance companies have an interest in talking up their bad risk and steep medical costs. Insurance companies are, after all, companies. They want to set rates as high as the market will allow yet they also have to justify premium hikes to regulators. So, if they begin preparing the public for large premium increases the companies can then blame older and sicker enrollees for the requested boost in rates. Insurers also use the poor risk pool when negotiating with hospitals to explain cuts in payments for certain services. This is not to impute ill will to the insurance companies. It’s just how the game is played.

The risk pool mix, premium increases, and changing medical costs are all critical policy issues. We must restrain the rise in health care costs because, in the end, we all pay for our unnecessarily overpriced system. But when you hear that ACA Marketplace premiums will increase next year keep this context in mind.

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While millions of dollars have been spent to tie incumbent U.S. Senator Kay Hagan to her support of the Affordable Care Act, there are now signs that Republican strategists may be moving away from making the health care law the singular issue of the 2014 campaign.

Think Progress reports it’s becoming increasingly difficult for some critics to keep up the drumbeat against the ACA:

‘Republicans called a House hearing on Wednesday with health insurance companies in an effort to embarrass the White House with revelations about double digit premium increases and claims that one-third of federal exchange enrollees still haven’t paid their health insurance premiums. Instead, the insurance leaders calmly explained that premiums for next year were still being calculated and that more than 80 percent of enrollees have in fact sent in their first-month checks.

One insurance company CEO even observed that while President Obama’s claim that if you like your health insurance plan you can keep it did not apply to everyone, the promise held true for “99 percent of our customers.” As The Hill observed, “Republicans were visibly exasperated as insurers failed to confirm certain assumptions about ObamaCare” and many simply exited the hearing.’

During Thursday’s confirmation hearing for Sylvia Mathews Burwell to head the U.S. Department of Health and Human Services, Senator Richard Burr avoided further attacks of the health care law, instead offering glowing remarks for President Obama’s HHS nominee. The New York Times reports:

‘Senator Richard M. Burr, Republican of North Carolina, said he intended to vote for Ms. Burwell because she had “a portfolio of experience that would make her a tremendous asset” to the Department of Health and Human Services.’

Political science professor David McLennan of William Peace University also sees the continued ACA attack losing some of its luster as the public becomes more comfortable with the law and the impact on their own lives.

“The question is: Will the Republicans continue that line of attack against Kay Hagan or try to find some other issues?  I think if they continue the Obamacare attack, it’s not going to be particularly effective.”

For a preview of McLennan’s weekend radio interview with NC Policy Watch’s Chris Fitzsimon, click below:

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Americans now appear to be evenly split in their opinion of the Affordable Care Act. A recent Christian Science Monitor/TIPP poll finds 47 percent of American adults support the law and 47 percent oppose it. But it’s worth noting public support has jumped seven percent from late March to late April, according to that poll.