Transcript Obamacare” is Doomed to Fail (or, so said its opponents)

January 1, 2015...
The Affordable Care Act
(Obamacare)...Measuring its
Successes and Failures...
So Far
Jeanne Scott Matthews
talking-head-in-chief
health-politics.com
Health Care for More …
… But Still Not All Americans
The United States of America stands
alone among ALL industrialized nations in
NOT assuring all its citizens access to
efficient, effective and timely health care
… as one-by-one these other nations
moved to provide health care services to
their citizens, treating health care as a
“societal cost” to be covered, not
exclusively by the individual, but as a cost
to all citizens in furthering a more
egalitarian and democratic state.
America’s Failed Health Care System
In Coverage – the Uninsured and the
“Underinsured”:
Increasingly, Americans on the margin, working
in jobs that do not offer employer-assisted
group health coverage at affordable prices; or
suffering from what the industry described as
“pre-existing conditions” were being effectively
“priced-out-of-the-market” for health care
insurance.
America’s Failed Health Care System
In Productivity, Employment and Economic
Competition:
Under the American “Employer-Run, Employment-Based,
Primarily Employer-Funded” Health Care Financing System,
American corporations were at a distinct pricing disadvantage
in world markets: E.g., American cars cost $3-5,000 more,
per car, just to cover the employer’s cost of employee health
insurance compared to competitors in other countries where
health care costs were born by society and not individuals or
employers.
Poor Competition Models and Payment Mechanisms:
In the U.S. , payment systems based on services rather
than outcomes, results in volume increases without
relationship to actual patient wellness and quality
effectiveness: E.g., why do just two tests when doing 10
tests will generate more revenue. Americans pay upwards of
80-100% MORE on average for care and in many instances
receive less quality than in other nations.
American Exceptionalism … ???
We in the United States have grown up celebrating ourselves as
the world’s most powerful nation, the world’s richest nation, the
world’s freest and most blessed nation.
Norwegians may be wealthier per capita, and the Japanese may
live longer, but the world watches the N.B.A., melts at Katy
Perry, uses iPhones (albeit, Chinese assembled) to post on
Facebook, trembles at our aircraft carriers, and blames the
C.I.A. for everything. We’re No. 1!
In some ways we indisputably are, but a major new ranking of
livability in 132 countries puts the United States in a sobering
16th place. We underperform because our economic and military
strengths don’t translate into well-being for the average citizen.
In the Social Progress Index, the United States excels in access
to advanced education but ranks 70th in health, 69th in ecosystem
sustainability, 39th in basic education, 34th in access to water and
sanitation and 31st in personal safety. Even in access to cell
phones and the Internet, the United States ranks a disappointing
23rd, partly because one American in five lacks Internet access.
The United States is the world’s
16th most socially advanced
country according to a major new
global index published today by
US-based nonprofit, the Social
Progress Imperative, and
released at the 2014 Skoll World
Forum on Social Entrepreneurship.
Despite the United States’ very
high GDP per capita, it finishes
behind top performing New
Zealand and other countries with
lower GDP per capita including
Canada, Australia, Germany, and
the UK–according to the Social
Progress Index 2014 which ranks
132 countries based on their
social and environmental
performance.
16th
United States and Canada
Both the United States and
Canada place within the top
20 on the Social Progress
Index, with strength in Basic
Human Needs and
Opportunity tempered by
some weakness in Foundations
of Wellbeing. However,
Canada outranks the United
States by a considerable
margin (7th vs. 16th), with a
more than 3 point advantage
in all three dimensions. The
U.S. registers similar social
progress versus peers despite
higher GDP per capita.
Why is This Important in the
Obamacare Debate?
Many who back proposed Republican cuts in
Medicare, Medicaid, food stamps and other
public services believe that such trims would
boost America’s competitiveness. Looking at the
Social Progress Imperative report, it seems that
the opposite is true.
Among the nations with which the United States
openly competes and weighs itself against, we are
near the bottom … How are they succeeding in
providing their people wide ranges of benefits and
services and we are not?
How Can Canada Have BOTH A Universal Health
Care Plan For All Of Its Citizens... And Lower
Corporate Taxes Tax?
Canada can have BOTH a universal health care plan for all of
its citizens with higher quality and more availability than the
USA ... AND a lower corporate tax rate. HOW? -- BECAUSE
it spends per capita on its military for every man, woman and
child in Canada less than 10% of what the USA spends per
capita on its military for every man, woman and child.
The USA is the world's cop, and the individual US taxpayer is
now funding all this “police” work, as US corporations, many of
which profit enormously from servicing the US military, are
seeking new ways to avoid and/or evade US taxes. Of course
we need to spend on our nation’s defense, but currently the US
spends more on its military than the next eleven largest
defense-spending countries do combined. More than all the
other NATO nations, China and Russia combined. These other
nations, like Canada and many western European democracies,
spend virtually nothing on their military comparatively speaking
and are freer to provide their citizens with the perks of “Pax
Americana,” perks like universal health care, better education,
new highways and much needed infrastructure, while the
American tax-payer is picking up the tab for their protection.
Tuesday, March 23, 2010
Bush Signing Medicare Modernization Act,
Obama Signing:
December 8, 2003
“Patient Protection & Affordable
Care for America Act,”
LBJ Signing
March 23, 2010
Original
Medicare
Act,
July 30,
1965
PPACA: It Really is a “Big [Bleeping] Deal“
This a really big [bleeping] deal!
Who Coined the Term “Obamacare?”
http://www.cnn.com/2012/06/25/politics/obamacare-worddebate/index.html?on.cnn=
http://www.theatlanticwire.com/politics/2011/10/who-coined-obamacare/44183/
http://www.nytimes.com/interactive/2012/03/25/us/politics/fighting-to-control-themeaning-of-obamacare.html
“House Democrats are blocking their Republican colleagues from using Obamacare in letters
mailed on the taxpayer's dime to voters, but who made up the term in the first
place? Lots of people are asking this question, getting answers like "Certainly a Republican,
potentially Glenn Beck" and "I am about 80% sure it was Rush Limbaugh" and "Hillary
Clinton's campaign coined Obamacare." Iowa Rep. Steve King claimed President Obama
himself made it up. Free Republic posters want to claim credit. Lots of liberals suspect an
insidious plot by Fox News. But the answer appears to be: …
Jeanne Scott Matthews argued for the trade journal Healthcare Financial Management in March
2007 that then-President Bush had "put all his eggs into his 'privatization' basket" in his 2007
State of the Union address; nevertheless, he made health care the "issue du jour" for the 2008
presidential race. "Health care is hot!" she wrote, and then made a prediction that seems so
quaint given all that's passed in the last four-and-a-half years:”
“The many would-be candidates for president in 2008 are falling over
themselves offering their own proposals. We will soon see a ‘Giulianicare’
and "Obamacare" to go along with ‘McCaincare, ‘Edwardscare,’ and a
totally revamped and remodeled ‘Hillarycare’ from the 1990s.”
People “Hate” Obamacare … Only
if Obama’s Name Is Attached
What is this “Obamacare” and Why is
the Public So Confused About it?
KEY ELEMENTS IN OBAMACARE
In case you have been hiding under a rock these past three years
… the key elements in the Patient Protection and Affordable Care
Act of 2010 include:
Requiring most U.S. citizens and legal residents to have health
insurance… the “Individual Mandate”
Creating state-based American Health Benefit “Exchanges“
through which individuals can purchase coverage
Requiring larger employers to provide employee health coverage or to
pay penalties for employees receiving tax credits for health
insurance through an exchange
Imposing new regulations on health plans in the exchanges and in the
individual and small group markets … “private health insurance
reforms”
Expanding Medicaid to 133% of the federal poverty level with
incentives to private physicians to continue participation. The federal
government picks up 90% of the tab until 2020
Why Haven’t Republicans Figured Out an
Alternative to the Patient Protection and
Affordable Care Act?
The Patient Protection and Affordable Care Act
was their alternative. They’ve needed an
alternative to their alternative.
House Republicans Have Voted 50 Times To Repeal
Obamacare; Not Once Have They Considered An
Alternative Or Replacement
“Obamacare” is Doomed to Fail
(or, so say its opponents)
1. It’s unconstitutional …
2. Enrollment will fall far short of the
numbers and even if people sign up, they
won’t pay their premiums …
3. More people will lose coverage because of
Obamacare than will gain it …
4. There will be “rate shock” … as younger,
healthier people won’t sign up …
5. Obamacare rates will skyrocket …
6. The American people won’t tolerate a
government takeover of health care …
“Obamacare” is Unconstitutional
Is the “Individual Mandate” a Constitutional Exercise of
the Interstate Commerce provision in Article 3 of the
Constitution? The
Supremes said NO!
Is the expansion of the Medicaid program a valid
exercise of Congressional authority under the 10th and
14th Amendments to the Constitution?
said NO!
Is the “Individual Mandate” a
Constitutional Exercise of the
Congressional power to impose
a “tax?”
The
Supremes said YES!
The Supremes
Obamacare Enrollment Will Fall Far
Short of the Numbers and Even if
They Do Enroll, They Won’t Pay
the Premiums
As of June 30, 2014: 8.48 million Americans
had enrolled in Obamacare through one of the
exchanges (original estimate was for 7 million)
7.63 million had paid the premiums, 89.997% …
a rate HIGHER than the average “paid”
experienced in the private non-group health
insurance market
Enrollment In Idaho’s Exchange
Has Exceeded Estimates
•8 million have selected a plan through an Exchange
•28% are young adults between 18 and 34
•54% are female and 46% are male
•65% selected a Silver plan
•85% selected a plan with financial assistance
But Idaho’s Obamacare Bashing
Hasn’t Been Cheap
“Idaho Gov. Butch Otter has on his desk … a couple of reports that
scream ‘take the Medicaid expansion!’ … Other Republican governors
do, too, and they’re starting to cave in to the reality that it’s not
worth punishing uninsured citizens, hospitals and taxpayers to aid
and abet Obama Derangement Syndrome. This is the malady that
causes them to scurry to the opposite side of whatever position the
president has taken.”
Editorial: Idaho Spokesman-Review, August 31, 2014
FACT: Those states who have expanded Medicaid have seen just in
the first few months of this calendar year, 2014, a reduction in
uncompensated care. That means people who show up at the
hospital, show up at the emergency department, are uninsured and
can’t pay anything. “Charity” care that’s provided by the hospital:
has gone down by 30% just in the first few months. Hospitals and
physicians are getting paid for care previously written off.
Obamacare Bashing Is Costing
Idaho Taxpayers Millions
Last year Idaho rolled up its sleeves and built its own health insurance
exchange rather than defer to the federal exchange. The state-run
marketplace has forced insurance companies to compete in a fair way
and given 76,000 Idahoans access to affordable coverage. Many
received tax credits to help pay for their premiums.
But approximately 70,000 Idahoans fall into the “coverage gap.” They
earn too little to qualify for discounted coverage, but earn too much to
qualify for traditional Medicaid.
In Idaho, two consultants have shown that Idaho could stanch the
budgetary bleeding in its county-financed medical indigency program
and the state catastrophic health care program. One report says these
plans need an extra $284 million over the next 10 years. But if the
state expanded Medicaid, it could save $6.5 million instead.
The Idaho Hospital Association projected $407.4 million in savings.
STUPID IS AS STUPID DOES
(apologies to Forrest, he is actually smarter than this)
Sunday, Sept. 14 2014:
Obamacare Helps Slash Hospital Charity Care Costs In State
Washington hospitals provided nearly $154 million less in charity care in the
first half of this year than in the first half of 2013, in many cases boosting the
hospitals’ bottom lines. Hospitals attributed the plunge in charity care -about 30 percent -- to the Affordable Care Act’s focus on reducing the
number of uninsured patients. …
Wednesday, September 3, 2014
North Carolina taxpayers could spend more than $10 billion by 2022 to
provide medical care for low-income residents of other states while getting
nothing in return ... The Affordable Care Act tried to expand Medicaid to
millions of low-income, uninsured adults. But many Republican-led states opted
out of the Obamacare plan in order to spite President Obama. The 23 states
still rejecting Medicaid expansion will contribute $152 billion over 10 years
to states that take the federal money. … The only “spiting” being done is to
their own citizens.
Other States Have Tempered
Their Obamacare Bashing
Last Month, the feds approved a proposal from Pennsylvania’s GOP
governor to accept the expanded Medicaid dollars under Obamacare. As a
result, an estimated 500,000 Pennsylvanians will gain health coverage, and
the state will save $125 million on indigent-care programs.
In a report that predated the Pennsylvania conversion, the Robert
Wood Foundation estimated that the 24 Medicaid expansion holdout
states would lose $600 billion in lost federal funding and
uncompensated care through 2020. Meanwhile, complying states are
receiving $13.41 for every dollar they spend. Dollars that come in part
from Idaho tax-payers
Other red states have also surrendered … for the benefit of their
citizens, Arkansas and Kentucky lead the nation in declines in their
uninsured and dollars for their state health systems, hospitals and
physicians. And yet seven other “red states” are expected to act,
neighboring Wyoming among them.
(VA,WV,UT,KS,LA,IN)
Expanding Medicaid Helps Providers
A Colorado Hospital Association study looked at 30 states, 15 with
Medicaid expansion and 15 without. In expansion states, hospitals saw
uncompensated care decrease from an average of $2.8 million per
hospital in the first quarter of 2013 to $1.9 million in the first quarter
of 2014, a 32% drop. And out-of-pocket charges decreased from 4.7%
of all charges to 3.1% of all charges -- a 34% drop. Meanwhile,
Medicaid charges surged from 15.3% to 18.8%, a 19% jump.
The study found that unpaid care decreased by 30% in expansion states
and remained essentially unchanged in non-expansion states. The
report links an enrollment surge in expansion states to not only the
reduction in uncompensated care but also the 25% decrease in people
paying out of pocket.
Uncompensated care cost the country about $46 billion in 2012, according
to the American Hospital Association. It's been increasing the past several
decades and risen at an even faster rate the last ten years.
More People Will Lose Coverage Under
Obamacare Than Will Gain It
Obviously Obamacare got off to a pretty rocky
start, first with the glitches in the federal
health exchange and secondly with the admission
that Pres. Obama was wrong in saying, “If you
like your current insurance, you can keep it.” *
• PolitiFact.com’s “Lie of the Year for 2013”
(even though Obama said it in 2010)
The Federal Exchange glitches were quickly fixed
and even a couple of “Blue” states have dropped
their state exchanges and signed on to it, i.e.,
Oregon and Maryland
Obama “Lied” About Keeping Your
Previous Insurance
There’s no doubt about it, the 7 million Americans who
previously bought insurance under non-group individual policies
faced a dilemma when the Obamacare mandate kicked in this
past January 1. Notices about “cancelled policies” went out
and ruined more than a few Christmases for some, as the
“ACA-compliant plan” offered in its place was priced in many
instances at 2-3 times more than the their “old” plan.
What had happened was that for-profit insurers took the
opportunity under the cloud of consumer ignorance to jack up
rates for these individual plans and blame the increases on
Obamacare, mainly on Obamacare’s standard benefit
package, which for some included services which were
excluded under plans, i.e., “maternity benefits.”
Almost All Cancelled Policies Were
Replaced Through the Exchanges
But for nearly all of these cancelled policies, an
alternative plan was available in the Exchanges, most
often at a lower cost than the old with better
coverage. And for many, the actual cost of these new
plans plummeted because of the subsidies they were
now eligible for.
You didn’t hear that on Fox News …
Even for those whose cancelled plans were better (for
them) and cheaper, the ACA-compliant requirement was
later waived and they were able to get their old
policies renewed, albeit in most cases at a higher cost
EXCHANGE SUBSIDIES TO UNINSURED
The Subsidy Issue:
Too Much, Too Expensive ???
Low Income Subsidies: People who earn up to 400 percent
of poverty -- currently about $92,000 for a family of
four -- are eligible to get financial help in purchasing
coverage.
Democrats AND Republicans tend to
agree that these subsidies might
need to be scaled back, but
Congressional efforts to do so have
been stymied by having this
“modest” adjustment tied to more
extensive cuts in the program.
The “my way or the highway” keeps
getting in the way of Congressional
compromise …
More Americans Are Covered … But
Obamacare Will Never Cover All
Before January 1,
2014, the number
of uninsured in
America hovered
around 17.1% …
48 Million of us
The uninsured rate for U.S. adults as of July 1, 2014
leveled off at 13.4% … leaving 31 million still uninsured
More Americans Are Covered … But
Obamacare Will Never Cover All
The uninsured rate, currently 13.4% has decreased
sharply since the Obamacare’s requirement for most
Americans to have health insurance went into effect at
the beginning of 2014. In fact, the uninsured rate has
dropped by 3.7 points since the fourth quarter of
2013, when it averaged 17.1%.
And is expected to drop even more as additional states
expand Medicaid and as the 2015 enrollment starting in
October proceeds more smoothly than in 2014, perhaps
going below 10% … but at even the best estimates, the
Affordable Care Act would leave 22-25 million
Americans still uninsured …
Will the Exchanges Work?
To succeed, health exchanges have to
attract a mix of healthy and sick
people so that the costs balance out.
There’s a risk that some won’t attract
enough healthy people, meaning the
people who do join will be those with
health problems … leading to high
premiums and “rate shock.”
Massachusetts, where the exchange model for Obamacare has
been running for 7 years … the one created by Mitt Romney’s
health care law … however, has a good balance.
The second Open Enrollment in the Exchanges is set for November 2014.
Predictions: Kaiser’s Stuart Altman expects a mixed verdict:
“There will be great success stories and there will be failures, and a lot
of state exchanges that will fall somewhere in the middle … It’s hard to
imagine that the exchanges won’t be a vast improvement over the
individual [insurance] market and the small group market that we have
now. Both of those markets are completely broken.”
Young-uns are Enrolling, Although
Not All the Healthy Ones
HHS reported that of all the people who enrolled in a
marketplace plan during 2014's open enrollment 28
percent were between the ages of 18 and 34.
According to a July study by the Commonwealth
Fund the uninsured rate for 19-to-34-year-olds
declined from 28 percent to 18 percent, with an
estimated 5.7 million fewer young adults uninsured.
In a Blue Cross survey, 8% of new exchange members
ages 18-34 consider themselves in “Fair” or “Poor”
health, compared with 4% for Commercial group. About
7% of the young people ages 18-34 enrolling in
exchange plans have diabetes, compared with 4% for
commercial plans
Obamacare Price Increases: More Insurers Means
Lower Prices, But Barriers Put in Place in Several
States Limited Competition
Obamacare Easing Pressure on
Medicare
In 2006, the Congressional Budget Office’s 10-year projection
was that Medicare costs would reach $15,000 annually per eligible
beneficiary by 2016 …
In major part due to changes in health care delivery models
supported by Obamacare, the recently released 2014 CBO
projection, the per capita costs for 2016 were projected at
“only” $11,000 and ten years out at 2024, “only” $11,900.
WOW!
Extend these numbers out for the 69 million projected
beneficiaries in 2024, and it’s an enormous amount of money BUT
far less than thought just a couple of years ago AND delaying the
projected point at which the Medicare Trust Fund would be
exhausted to 2048, 30 years LATER than predicted in 2006.
Don’t get me wrong, Medicare still needs to be bolstered … but
we are on track to make the needed corrections.
So Far on the “Cost” Front Obamacare
is Looking Good … But Only So Far
-- Nearly 60% of enrollees in ACA-compliant exchange health plans
this year were previously uninsured–most of them for two years or
more. (Source: Kaiser Family Foundation.)
-- Obamacare cut costs for buyers eligible for subsidies by an
average of 76% compared with non-subsidized premiums. More than
80% of buyers are eligible for government subsidies, and for them
the average premium is $82 a month. (Source: Department of
Health and Human Services.)
-- Most people can save money by choosing plans offering narrower
provider networks, and there’s “no meaningful” difference in health
outcomes between plans with narrow hospital networks and those
offering broader networks. (Source: McKinsey & Co.)
-- Projected rate increases for 2015 are coming in well below
expectations. Anthem Blue Cross rates will rise by less than 10%
next year, about in line with health plan rate increases in the
individual market in the pre-ACA era. (Source: Anthem Blue Cross.)
“Obamacare Will Cause
Insurance Rates to Skyrocket
Obamacare will cause rates to skyrocket … and
younger, healthier people won’t sign up … but:
A CMS report shows premium affordability,
competition and choice in the Marketplace in
2013-2014
“Shoppers paid an average of $69 per month
after tax subsidies for silver plans and had, on
average, a choice of five health insurers and
47 plans.”
Health Insurance Rates Will Go Through the
Roof Under Obamacare, NOT!
Yes, health insurance rates are still going up, but at a
rate FAR SLOWER than they have virtually EVERY
year for nearly three decades.
20
18
16
14
12
Impact of
Hillarycare
10
8
6
4
2
0
Source: Kaiser Family Foundation
Impact of
Recession and
Obamacare
Premiums
Inflation
Earnings
What Else Will Opponents do to Fight
Obamacare?
More Legal Challenges:
There’s a pending legal challenge against
the rule that makes most companies with
more than 50 workers provide coverage or
pay a fine. Opponents have vowed to fight
this all the way to the Supreme Court.
Obama has delayed this rule until 2015.
Additionally there is a challenge that centers on whether people
will be able to get subsidies in health exchanges that are run by
the feds, or only when the states themselves run them. So far
two federal circuits have ruled that subsidies can be paid through
the federal Exchange. One 3-judge panel ruled the other way BUT
the full DC Circuit vacated that decision and will re-hear it.
Lawsuits against the Obama administration’s contraception coverage
requirement, issued under the health law, were mostly settled by
Obama cutting back on the requirement after the Supremes in the
Hobby-Lobby case rejected the rule.
Will Obamacare Do Anything to Actually
Begin to Control Health Costs?
Remember the days when Obama was
saying the health care law would save
$2,500 per family? That hasn’t happened.
Premiums are still going up, and they’re
going to keep going up.
But Obamacare does fund experiments
aimed at slowing the growth of spending
by restructuring payment mechanisms and
encouraging health care providers to
coordinate better.
The law also tests ways of paying to
encourage higher quality care. And the
early indications are that these changes
are beginning to work … and one thing is
becoming absolutely clear, these changes
are here to stay, no matter if the ACA is
repealed or not.
Will Employers Drop Coverage?
Some employers will surely decide it’s
cheaper to stop covering their workers and
let them get coverage through the
exchanges instead. The only question is how
many … and whether it’s something that
affects enough Americans to sink the law in
the eyes of the public. Private studies on
this have been all over the place.
The CBO says between 4 million and 6 million fewer people could have
coverage through the workplace because of the law.
And every time a business floats the idea of dropping coverage … like
when Darden Restaurants announced it’s testing the use of more
part-timers so it doesn’t have to give them health benefits … it
generates damaging headlines.
As a result, the large “employer-mandate” has been delayed until at
least 2015, and there are pressures to eliminate it altogether.
Compromise between the GOP and Democrats could resolve this, but
“compromise” is NOT a word in the Congressional dictionary.
Obamacare is a Government
Takeover of Health Care
If Obama’s statement that
you can “keep your
insurance” was the “Lie of
the Year” for 2013 (even
though he said it in 2010),
the cry that Obamacare is
a “government takeover of
health care” actually was
www.politifact.com’s
“Lie of the Year” for 2010