Tag: ACA

What is the conservative plan on health care?

With the Iowa caucuses 48 hours away, poor Ted Cruz just can’t catch a break. His debate performance was lame, his campaign got caught playing Big Brother with voters, and now he - rather than any of his competitors - had to field the killer question on Obamacare.

An Iowa voter confronted him at a town hall and told  the story of the voter’s wife’s brother,  a hard-working self-employed barber who couldn’t afford health insurance until the ACA came along. Then he felt sick, went in for a check-up, and was diagnosed with inoperable late-stage cancer. The voter’s question was straightforward: if you repeal Obamacare, what replaces it for people like my wife’s brother? (Left unspoken: if ACA had passed earlier, the brother-in-law might have lived.)

Cruz expressed ritual sympathy and immediately pivoted to his health-care talking points. The voter pressed for a real answer, but Cruz didn’t have one for him, just as none of his competitors would have had one. No Republican has proposed any actual substitute for the ACA formula of affordable health insurance for everyone who wants it.

Now, there’s an honest conservative/libertarian answer to that voter’s question; I’ve heard it from friends on that side of  the aisle. It goes more or less like this: Continue reading “What is the conservative plan on health care?”

“Pre-existing condition” gets personal: the case of Kevin Drum

Go ahead, libertarians and conservatives: tell me why what ACA repeal would do to Kevin Drum is OK with you.

Kevin Drum explains what would happen to him if ACA were repealed: due to his cancer, he’d be uninsurable. If his current employer folded - not a remote eventuality, in the world of magazine and online journalism - he’d be s.o.l.

Kevin, let us recall, is neither poor nor reckless. He didn’t choose to get cancer. He did choose to have health insurance. Nothing he could have done - short of working for a government or TBTF private outfit - could have protected him from the risk he will face if a Republican is elected President in 2016 and does what he will have promised to do in order to become the Republican nominee.

So, here’s a challenge to my conservative and libertarian readers:  Tell me, if you can, why that would be OK with you.

I promise to publish any literate and coherent reply verbatim, or link to any post elsewhere that answers the challenge.

Update A reader points me to this Megan McArdle post from 2012, which explains in detail how a little-known provision of HIPPA (a law that long pre-existed ACA) would protect someone in the position Kevin would be in should Mother Jones fold. Anyone who has continuously maintained health insurance is, apparently, eligible to buy new insurance without underwriting. That’s not much help to people who, when they lose their jobs, don’t have enough in the bank to keep paying for unsubsidized health insurance. But that’s not Kevin’s situation. Unless some health care wonk tells me otherwise, I’ll count my challenge as having been fully met, and will have to fall back on the other 69,000 reasons Friends Don’t Let Friends Vote Republican.

Second update Harold Pollack says there are more twists and turns. Yes, HIPPA protects someone who has been continuously insured, and who can afford to pay for health insurance without an employer subsidy after he’s lost his job. That would include Kevin. But what that person is protected against is only explicit discrimination in premium or coverage based on his pre-existing condition.  He’s still at the mercy of the individual-insurance market, whose products are often designed with “adverse selection” in mind: since some  healthy people who are unemployed or self-employed or employed without health benefits will decide to go uncovered rather than pay the full cost of health insurance, the individual-insurance market will have a higher share of sick people, and insurers tend to tailor their individual plans accordingly.

In the absence of ACA, insurers could and did exercise many non-underwriting strategies to avoid high-cost individuals or to impose high out-of-pocket costs on these individuals. Some of the most obvious issues included stringent annual and lifetime caps on dollar coverage now abolished under ACA. There were also limitations on benefits now included in ACA’s essential health benefit structure. HIPAA left untouched many aspects of coverage important to cancer patients and others with costly conditions. 

As I noted here, groups such as the American Cancer Society’s Cancer Action Network and the National Multiple Sclerosis Society had good reason to rank among the leading supporters of universal coverage.
So while HIPPA did protect a rather narrow group of relatively well-off people against the specific suckage of “underwriting” based on pre-existing conditions, they were still fully exposed to the general suckage of the individual health insurance market.
So, with that amendment to the question, this column is still open to any ACA opponent who wants to explain why we should be willing to subject ourselves to that sort of risk.

 

 

 

My interview with the Kaiser Family Foundation’s Larry Levitt on the progress of health reform

If you want to catch up on health reform-how it’s going, how the 2014 election might affect things, what Republicans might try to change in ACA, and how the Supreme Court might cause further problems-this three-part interview with the Kaiser Family Foundation’s Larry Levitt has you covered. Larry is one of the most widely-respected experts on ACA. I really enjoyed our conversation. And I really enjoyed the illustrations produced by the healthinsurance.org team. Part 1 is here. Part 2 is here. Part 3 is here. I hope you enjoy it.

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A human being lives there: Grubergate

Jon made some really misguided and condescending comments that fueled the #Grubergate frenzy. So I am both angry with and sad for him today. In the apocalyptic politics of Obamacare, it’s easy to forget that he’s also a good person and a distinguished scholar who is getting the full internet-frenzy gang tackle right now.

Ezra Klein captures well my own sadness:

I’ll offer a slightly smaller final thought here: Gruber increasingly looks like a casualty of Obamacare. He’s become a liability to the law’s supporters — “I don’t know who he is,” said Nancy Pelosi, who had cited Gruber’s analyses during the health-care debate — and a villain to its opponents. He has been made into the worst comments he ever uttered on tape.

That’s a shame. Gruber tried to make it a better bill than it is. He tried to make what was in it clearer and more known than it was. And then — and this is where all the tapes come from — he traveled the country trying to explain it to people. And Gruber, as is perfectly clear now, was not an experienced political operator who knew how to talk carefully in front of a camera. The lesson other academics will take from his humiliation is that they best stay out of big policy debates, and they had really better make sure they never say anything interesting on tape.

Washington has always done this to people, but it’s happening more frequently, and more viciously, in the age of Twitter and YouTube. And while it makes sense in every individual case, it is, on the whole, bad for American politics. “It’s a healthy world where academics can speak their minds at conferences and the like without their words becoming political weapons in a bigger fight,” writes Tyler Cowen.

Cowen goes on to suggest that “perhaps we should subsidize people who end up looking foolish, rather than taxing them.” We’re not going to do that, of course. But we can at least try to be a bit more generous. We can remember people are more than the most controversial thing we’ve ever heard them say.

I am reminded of Philip Roth’s comments about a much more megawatt and sordid scandal. Roth also advised President Clinton to hang a banner outside the White House: “A human being lives here.” On all sides, we easily forget our humanity and compassion these days. The ecstasy of sanctimony is an ugly thing to see.

“Almost awesome in its evilness.” Jon Gruber on states’ rejection of Medicaid expansion

Over at healthinsurance.org, I interviewed MIT economist Jon Gruber on the state of ACA.  We discussed a huge range of things, ranging from the case for the “Cadillac tax” to lessons of the botched rollout. It was a pretty upbeat conversation. But Jon was characteristically blunt regarding states that have declined ACA’s Medicaid expansion:

Jon: I think, Harold, the single thing we probably need to keep the most focus on is the tragedy of the lack of Medicaid expansions. I know you’ve written about this. You know about this, but I think we cannot talk enough about the absolute tragedy that’s taken place. Really, a life-costing tragedy has taken place in America as a result of that Supreme Court decision. You know, half the states in America are denying their poorest citizens health insurance paid for by the federal government.

So to my mind, I’m offended on two levels here. I’m offended because I believe we can help poor people get health insurance, but I’m almost more offended there’s a principle of political economy that basically, if you’d told me, when the Supreme Court decision came down, I said, “It’s not a big deal. What state would turn down free money from the federal government to cover their poorest citizens?” The fact that half the states are is such a massive rejection of any sensible model of political economy, it’s sort of offensive to me as an academic. And I think it’s nothing short of political malpractice that we are seeing in these states and we’ve got to emphasize that.

Harold: One of the things that’s really striking to me is there’s a politics of impunity towards poor people, particularly non-white poor people that is almost a feature rather than a bug in the internal politics in some of these states, not to cover people under Medicaid, even if it’s financially very advantageous to do so. I think there’s a really important principle to defeat this politically, not just because Medicaid is important for people, but because it’s such a toxic political perspective that has to be … It has to be shown that that approach to politics doesn’t work because otherwise, we will really be stuck with some very unjust policies that will be pursued with complete impunity in some of these places.

Jon: That’s a great way to put it. There are larger principles at stake here. When these states are turning – not just turning down covering the poor people – but turning down the federal stimulus that would come with that.

[…]

They are not just not interested in covering poor people, they are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.

More here.