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Tuesday, November 19, 2013

The Affordable Care Act: In Proper Perspective

I’m sorry, did I miss something?  Tell me again why ObamaCare should be repealed?

1)  Because the website wasn’t ready?  That doesn’t wash, as the website has nothing to do with the healthcare provisions of the Act.  It does, however reflect on everyone involved in terms of management and executive coordination and oversight.  In my opinion, the people surrounding the President did not do their best in terms of keeping him informed.   The head of CMS did not alert the president, and Secretary Sibelius evidently didn’t get word to him either, about the glitches in the first test run of the website. What are these people doing sitting on such crucial information?

This makes me wonder:  what is the Chief of Staff up to?  I asked a group of active Democrats the other day if they could even name the COS.  No one knew who he is!  That is a problem. (His name, by the way, is Denis McDonough).  Just how well is the President being served by his department secretaries, office heads and others responsible for overseeing this administration, like his Chief of Staff and White House advisors?  
Whatever the situation, my reading is that there may be a culture of keeping information in one’s own agency; an understanding perhaps that the President expects agencies to handle things on their own.  Or maybe, it’s an environment of protecting a President even though such protection has led to vulnerability.  And what about that Chief of Staff?  Is he following up with department heads and other bureaucratic leaders, or does he concentrate on legislative liaison duties?  What is his part in building this culture; this environment?  How does he see his responsibility for getting information of a sensitive nature to the ears of the President?  Why did he not say to the President about 8 months before the roll out, you need to look into this?

According to Wikipedia, “A White House official, speaking on condition of anonymity, said McDonough has played a key role in all of Obama’s major national security decisions in recent years, including the end of the war in Iraq, winding down the war in Afghanistan, responses to natural disasters in Haiti and Japan and repeal of the military’s ban on openly gay service members.  Earlier, McDonough worked as a foreign policy specialist in Congress, including as a senior foreign policy adviser to former Senate Majority Leader Tom Daschle, D-S.D., before moving to Obama’s Senate office.”  Perhaps this is part of the problem: domestic affairs may not be getting the attention they deserve.

There is something telling about the fact that in a crisis, the President seems to be advised constantly to go out to the people and to engage in campaign-like rallies.  It is telling that there is much use of social media to propel forward what looks like campaign rhetoric.  Has anyone told the White House staff, and the President for that matter, that the campaign is over?  We are now in a management phase and that demands personas quite different from campaigners.  It demands attention to detail; attention to nuance, an attention to how things work, and an attention to consequences of actions taken.  This is part of the problem with the roll-out, it seems to me: not enough attention to management detail  and possible consequences.  More attention was paid to the need to get the product - the website - up and running.  Where’s David Axelrod when you need him most?

I want to put one other sobering thought forward for consideration.  The holdover of appointed and career bureaucrats from the Bush administration has not been helpful.  Congress is in large part responsible for that fact because they have delayed or refused to confirm many of President Obama’s appointees in a timely fashion.  That one factor can lead to chaos in departments and offices of the federal government.  I know, because I’ve seen and experienced it up close and personal in a federal agency that oversaw a large federal grant for the State of New York.  You cannot expect a new administration to act in accord with its own principles and policies when holdovers are reluctantly administering such policies and directives, and thus more prone to withhold vital information and actions specifically because of their divided loyalty.  A President cannot be fully responsible for the operation of government when loyalties are divided in persons who hold key positions, or in career civil servants who don’t make easy transitions from one administration to another. 

In other words, some of what we are seeing in terms of government “fumbling” or “bumbling” or “dropping the ball” may be because Congress has refused, and still refuses, to approve hundreds of nominees to give the President the people he needs to oversee the policies he has set forth for his administration.  It’s another method of sabotage that has been practiced by this radical Republican Congress.  It is not an excuse; it is a reality.

2)  Because private insurance companies decided to send cancellation letters to consumers?
In most of the letters, it was clearly stated that the cancellation or termination was made necessary by the Affordable Care Act, the implication being that “ObamaCare” was responsible for the termination of each individual’s plan.   Neither the ACA nor the President are the culprits here.  They didn’t tell the insurance companies to do what they did; the companies made their own decisions to terminate plans, and offer new ones, some at higher prices.  The insurance companies thereby managed to blame Obama for cancellation instead of being truthful with consumers about the need to add certain essential benefits to all policies as required by the new law.  They made it sound like their old policies were simply being terminated, instead of being clear that they had to be ended because they simply did not comply with the improvements and benefits now being offered under ObamaCare.  Nor did they indicate that replacement plans would contain the newly mandated upgrades.  Nor did they indicate the full range of alternatives for the consumer, including the ability to buy affordable care through a state or the national exchange.  The letters were a sham.

Thus, the insurance companies blindsided the President, blaming his signature piece of legislation for the need to get rid of the very policies many consumers thought they could keep because “the President promised they could keep their old policies.“  Unmentioned was the fact that the “junk policies” that these companies had been offering were now illegal because they do not meet the vastly improved standards of benefits that are now required!  The insurance companies willingly misled their policy-holders into thinking that ObamaCare (and the President himself) was responsible for cancelling their policies.  And therein lies a conundrum.

The insurance companies are the ones responsible for the systemic mess that had to be addressed.  They blamed the President for the termination of the very inadequate policies that created the need for reform.  In my estimation, they meant to exact some  revenge for his ACA that put them in a bind, and made them conform to beneficial practices for consumers.  Now they have gotten back at the President for changing the status quo that previously enabled them to make enormous profits off junk policies that were not adequate in the first place.  This was not insurance companies simply complying with the ACA.  If it had been, they would have singled out the Act as the reason for having to meet new REQUIREMENTS for coverage with an explanation of what new coverages were required and what items the old policies did not cover. 

Recent events have mollified the companies to some extent because it may just be that they stand to make some considerable profit in the year that has now been given to extend the old inadequate policies.  In the rush to hang on to their old policies, uninformed consumers may have made a bad choice.  Keeping those old junk plans may cost them, not only in terms of raised premiums, but in terms of their health care not being adequately covered in this next year.  In other words, the choice made to keep those old inadequate plans, absent the newly required benefits, rather than exploring the possibility of obtaining new and better plans offered in the marketplace exchanges (along with subsidies that make most of those better plans affordable), may be a boon to the insurers and a disaster for many consumers.

Kaiser Health News reports that some consumer advocates are saying that cancellations raise concerns that insurance companies may be targeting their most costly enrollees with these cancellation notices.  This may be the opportunity they have been looking for to push the most expensive of their enrollees into the marketplaces, thus purging their rolls of policyholders they no longer want to cover because of the cost to them.  For instance, two companies in Pennsylvania are reported to be cancelling so-called “guaranteed issue” policies which had been sold to customers who had pre-existing conditions when they signed up.  Insurers, of course, deny this, saying they are encouraging existing customers to enroll in their new plans.  But will they be at lower rates? 

Consumers who choose to stay with their old plans are indicating by their action that they trust the health insurance companies more than they trust the federal government.  That is the key to what radical Republicans want to see happen.  They want to erode confidence in government generally so they can continue to convince the ordinary citizen that nothing that is administered by government (especially national government) is worthy of consideration.  On that premise, they will lead uninformed voters to the debacle of no more government-run social security, Medicare, Medicaid, food programs, housing help or jobs programs. 

The private health insurance conglomerates are the same ones who were doing the following to screw-over as many consumers as possible:

--denying coverage on basis of a pre-existing condition
--stopping coverage when an acute illness or disease made its appearance
--setting lifetime caps on coverage and denying insurance after one reached the cap
--selling junk policies to people at high risk (and to some who weren’t) under cover of being ‘economical plans’ (just wait until an expensive procedure or catastrophic illness hits ---not covered!)
--denying women basic coverage for contraception; treated them as pre-existing conditions; made them pay more for same coverage given a man
--staying away from offering free preventive care
--producing the “donut hole” concept which made millions for drug companies, especially because the law prevents groups from bargaining for lower prices
--raising premium prices without offering increases in benefits

This is what some people want to go back to -- a system where private insurance companies can rip you off on a whim and you can’t do a thing about it.  “What fools these mortals be”.

3)  Because the Act itself is harmful to all American consumers?
When we as a people lose sight of what we are doing, there is usually a catastrophe in the making.  That’s where we stand right now, thanks to the Republican party.  They have so misled the citizenry on the supposed malevolence  of the Affordable Care Act, that most of the population think it is about to affect them, and is taking something good from them.  It does not!

--Take Seniors for example: they are, as a group, the most unaffected by the ACA, yet some of them are the first to complain about the horrors of ObamaCare.  They are mostly covered by Medicare and Medicaid, and the marketplace policies are not needed or available in their situations.

--Take employees of large companies for another example.  They are not affected by most of the Act because they are already covered by employee or union policies that are not being terminated, but improved as needed.

--Take all those on Medicaid and those who can be added to it now that the ACA has raised the maximum eligibility limits.  They will not be concerned with plans in the marketplace exchanges.

--For the 85% of those who already have health care insurance, in one form or the other, almost all of ObamaCare’s changes are already in place and operating smoothly.

--Even those 21 new Taxes are not going to affect most of us because most of them are applicable to high-income earners, large businesses, and the healthcare industry itself.  Only 0.2% of businesses have over 50 FTE employees and don’t already offer insurance to their full-time employees.  Only the top 3% of small businesses will have to pay the additional ObamaCare Medicare tax increase.  Besides, ObamaCare provides for $20 billion in tax credits for as many as 4 million small businesses to offset the cost of purchasing insurance on the Exchanges!   That individual fee you have to pay if you don’t have coverage by Jan. 1, 2014?  Exemptions are available, as is assistance, for those who can’t afford health insurance.

So, once again, let us say to those who have missed it somehow:   the individual mandate and use of the insurance marketplace only affect uninsured Americans, not the 85% already insured!!  Thus, anything said about “Obamacare” by the radical Republicans is pure baloney if applied to (all) “the American people!”  It applies only to a small percentage of the American people in terms of its most important function which is to provide coverage for the uninsured!

So, who are we primarily talking about?  We are talking about the 15% of uninsured citizens who have to find health care where they can, and who often end up in hospital emergency rooms where they must be treated at government expense, which means ultimately at taxpayer expense since we all foot the bill for this over-use of the emergency healthcare system.  Uninsured Americans cost our healthcare system an additional $49 billion each year.   What’s more, only 12% of uninsured families can afford to pay their hospital bills in full, and this includes some families making over $88 thousand a year!  These costs affect the rising costs of insurance premiums, but ObamaCare helps to reduce this dramatically (according to

So every time that a politician says that everyone will have to pay a fine, or higher taxes, or get caught in a government-run system, you are being bamboozled --made a fool of; treated like a baboon!!  It’s all a bunch of distortions and lies; just like those non-existent “death panels” that never materialized and never existed.  The fact is that the ACA was primarily aimed at the 40-50 million people in this country who have no healthcare coverage at all. 

The mandate that everyone be covered by adequate health insurance is not a question of government takeover, but of the procuring of a right for all, rather than a perpetuation of a privilege for those who can pay.  The fact is that ObamaCare does not replace private insurance, Medicare or Medicaid.  The ACA actually expands the affordability, quality and availability of private and public health insurance through consumer protections, industry regulations, subsidies, taxes, insurance exchanges and other reforms.  ObamaCare doesn’t regulate your health care; it regulates for-profit health insurance companies and gets rid of some of the worst practices of the for-profit health care insurance industry.  The individual mandate affects only those who have no insurance and the employer mandate in 2015 means that few larger employers who don’t, must now cover their full-time employees or pay a fee per employee (see Facts below). 

Let’s look at some revealing statistics just to gain a better perspective on this Act (see

--the current population of the United States is around 317 million people based on the 2010 census and other factors used by the Bureau of the Census to calculate this figure
--about 15% of Americans are uninsured, which is a little less than 50 million men, women and children
--the 101.5 million people already enrolled in government health programs like Medicaid, Medicare, and CHIP won’t need to use the marketplace
--the 170.9 million already covered by employer insurance won’t need to use the marketplace

--poor working families are the most likely to be uninsured
--in 2010, 16% of the uninsured were full-time workers or their dependents; that’s about 8 million people
--the primary reasons for Americans being uninsured are cost and job loss; about 60% of all personal bankruptcies in the U.S. are related to medical bills.

--in 2010, only 53.8% of private sector firms offered health insurance
--the “employer mandate” means by 2015 larger employers will have to insure their full-time employees and their families or pay a fee per employee.
--over half of uninsured Americans are small business owners, employees or their families.
--in 2013, American employers with 25 or fewer employees may receive tax breaks of up to 35%; in 2014, it increases to 50%.
--the number of uninsured has dropped every year since the ACA was signed into law; the rate of the uninsured decreased from 16.3% in 2010 to 15.7% in 2011 -- the biggest percentage drop since 1999 due to the ACA

--over 100 million Americans have already benefited from the new health care law because many of the provisions of the ACA have already been enacted; the rest start in 2013 and 2014 and will continue to roll out through 2022.
--More than 105 million people have accessed preventive services for free that had previously been subject to out-of-pocket costs, including yearly check-ups, immunizations, counseling and screenings, including two most widely used forms of preventive care: colonoscopies and mammograms.  In 2011 alone, ObamaCare helped around 86 million Americans use free preventive services that had previously been subject to co-pays or deductibles
--billions of dollars have been saved on prescription drugs by seniors who fell into the “donut hole” of Part D but who received discounts on the brand name and generic drugs they still needed and had to pay out-of-pocket
--47 million women not only have access to preventive services, but now they can’t be charged different rates than men pay.
--Over 15 million more men, women and children will be eligible for Medicaid in States that participate in Medicaid Expansion.  States that do implement ObamaCare’s Medicaid Expansion will receive billions in additional federal dollars.  States who opt-out not only lose that federal cash, but also deny health coverage to a significant portion of their poorest citizens.  Texas is a prime example:  in 2010, 25% of Texans didn’t have health insurance, which included 1,247,300 children.

--of the 23 million estimated to use the exchanges, the Congressional Budget Office (CBO) estimates that 19  million will receive Tax Credits
--Due to tax credits and up-front assistance, Americans making less than 400% of the Federal Poverty Level (roughly $90 thousand for family of four) could see up to a 60% reduction in the cost of health insurance premiums
--6 in 10 Americans without health insurance can get a plan for under $100 per month through their State’s Health Insurance Marketplace
--there are three ways to save money on insurance plans through your State’s marketplace: advance premium tax credits which lower monthly premium costs, cost sharing subsidies which lower out-of-pocket expenses like co-pays and deductibles, and Medicaid which does both.

The largest health care crisis in this country right now is not the inexcusable botched roll-out of the national website for enrolling in ObamaCare.  It is not even the matter of the promise by President Obama that if you like your current healthcare plan, you can keep it, and the “fix” that followed.  It is not the recent policy termination letters from insurers.  Nor is it that  Republican legislation in the House (Upton bill) that passed with the support of 39 Democrats,  or even the President’s “fix” that allows insurers to extend certain existing plans until the start of 2015 when all plans will have to comply with the ACA.

Those are simply “bumps in the road” that all new major programs experience in both the public and private sectors!  NO, the crisis is what uninsured, or under-insured, people have to endure in their lives when they are not adequately covered.

The healthcare crises are the catastrophes faced by people like the 47 year-old truck driver in Oregon whose problem is a tumor in his bowel that went untreated because he couldn’t afford private insurance after his employer no longer offered that as a benefit.  This is the second patient his doctor has seen this year who put off getting medical attention because of lack of health insurance and as a result now has advanced colon cancer.  “It was heartbreaking to see the pain on his face,” his doctor said.  “It got me very angry with people who insist that Obamacare is a train wreck, when the real train wreck is what people are experiencing every day because they can’t afford care.  “Website problems are a nuisance,” he said.  “Life and death is when you need care and can’t afford to get it.”  These stories of catastrophe under the old system are widespread and voluminous, but we hear too little about them.

An article in the Nov. 17th edition of the NY Times tells us about an international survey released last week by the research organization, the Commonwealth Fund.  It reminds us of the inadequacies of our current health care system and why the changes put forth by ObamaCare are so necessary.  The report found that by virtually all measures of cost, access to care, and ease of dealing with insurance problems, Americans fared poorly compared with people in other advanced nations.   The survey covered 20,000 adults in the U.S. and 10 other industrial nations (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and Britain) that have what we don’t: universal or near universal health care coverage.  Yet the U.S. spends far more than any of these countries on a per capita basis and as a percent of the national economy.

Put it all in perspective -- don’t be bamboozled by the side shows. As the NY Times concludes:  “The Affordable Care Act is needed to bring the dysfunctional American Health Care system up to levels achieved in other advanced nations.”   What’s more -- it’s already doing much of the job it was meant to do, and a turn-around in citizen support is on its way!