Let’s be honest, Americans don’t often “look to Kentucky” as an exemplar for a lot of things. But Kentucky is turning out to be a bright and shiny star for President Obama’s health care reform law. And here’s why…
Kentucky governor Steve Beshear is one of the only Southern governors to apply the Affordable Care Act as it was written – persuading the Legislature to expand Medicaid eligibility as well as create a state-based health insurance exchange. The effect? In a state where 15% of the population is uninsured (about 640k people), over 56k have already signed up for new health care coverage. The majority have signed up for Medicaid, but about eleven thousand people have signed up for private health plans.
Creating a state run exchange instead of relying on the federal website has proven to be a godsend for many states, not just Kentucky, as the federal website has continued to flounder. For those who are salivating at all of the chatter about cancelled insurance plans and skyrocketing premiums, this article from the Washington Post describes the Kentucky experience in Breathitt County. These are the very people the law was designed to help – those with low incomes that are too high for traditional Medicaid but too low for insurance. Those with part-time jobs that don’t offer insurance. Those who never knew they were eligible for health insurance and those who could never afford the care they needed.
To the generation that preceeded mine, the assassination of President John F. Kennedy is one of those seminal moments in history, a moment burned into the collective memory of our nation. Like those of us who witnessed the terror of September 11th, the generation that witnessed the death of President Kennedy will forever remember that moment 50 years ago, where they were and what they were doing when the President was killed. Fifty years ago today in Dallas, one of America’s most admired Presidents was assassinated.
It’s no secret that I’m a fan of the Affordable Care Act. One need only scroll down the posts on here to see many on the topic. So as a supporter, one can imagine my disappointment with the lackluster debut of the health insurance exchange website healthcare.gov (yes, I’m being kind here…). And also why this post will be so surprising to many.
For those of you living in states that decided to run their own insurance exchanges, chances are that you are experiencing far less issues. Reports from Washington, California, New York, and Kentucky have been largely positive while Oregon’s rollout has been a little bit of a disaster.
But Oregon’s problems pale in comparison to the failure of the federally-run website, which is responsible for running the exchanges for the majority of the states. I don’t think I need to detail them out for anyone, especially if you pay attention to the news. To say that the website failure is disheartening is an understatement. The President, rightfully so, is mad as hell – as he should be. And Secretary Sebelius is taking the heat.
Here’s what is so upsetting. The Affordable Care Act is the President’s signature legislative achievement (you can all argue out there whether it’s the fault of the GOP or the President that no other major legislation has been passed – I’ll reserve my comments). The insurance exchanges, and tied with them the individual mandate, are the MOST visible portion of the law to the general public. The general public isn’t going to notice Medicaid expansion, nor will they notice the Prevention and Public Health Fund. The American people aren’t going to notice the efforts to boost primary care. And they’re only going to notice the benefits of free preventative services AFTER they already have health insurance. Those of us who support the law know that it’s “more than a website”, but the website is the public face of the law to many.
The fact that the government had months to design the website only adds salt to the wounds. But they obviously missed the mark, especially when U.S. Chief Technology Officer Todd Park has said that the government expected HealthCare.gov to draw 50,000 to 60,000 simultaneous users – which was clearly a gross miscalculation. When Massachusetts launched its own website years ago, early problems hardly mattered because very few people used the website early on, and most people in the state was already insured. The country as a whole is a completely different picture, and the federal government should have been prepared for an onslaught of users, especially given the amount of press and attention the law has garnered over the last 5 years. The people finally had a tangible component of the law. Hell, I was tempted to check it out even though I have insurance AND live in Massachusetts.
No, the government couldn’t sit back and wait and see – a point that should have been hammered home to every individual working on the website. Because the expectation that 50 or 60 thousand people would use the website on day 1 was blown out of the water, and the government should have expected far more. As Steven Stromberg notes, “The government’s health-care mavens shouldn’t just have expected high Web traffic, they should have expected that high interest would mean that people’s impressions about the site would be formed early-on, impressions that would be hard to dispel later.”
The final truly upsetting part is that the government shutdown, which highlighted congressional dysfunction in Washington DC, provided the perfect opportunity for the White House and the Department of Health and Human Services to prove just how much good the Affordable Care Act could actually do. A perfect opening to the exchange was unlikely (as with any new major technological undertaking), but a good opening with less glitches would have provided the President ample fuel to blast the health law opponents. Instead, the website’s failure has done the exact opposite.
The good news, if there is any to be had, is that supposedly the feds know what needs to be fixed and are working hard along with insurers to fix the website. The bad news is no one really knows how long that will take.
Are they for real?
Stuart Altman speaks for the Boston University School of Public Health’s October Health Policy Forum. Dr Altman is an economist by trade and is currently the Chairman of the Massachusetts Health Policy Commission. He is an active faculty member at the Brandeis University Heller School for Social Policy and Management. He formerly served as Chairman of ProPAC, the congressionally legislated Prospective Payment Assessment Commission, responsible for advising the U.S. Congress and the Administration on the functioning of the Medicare Diagnostic Related Group (DRG) Hospital Payment System and other system reforms.
His official job title should be genius.
Yesterday, New Jersey became the 14th state in the nation to endorse same sex marriages. Chris Christie, the moderate Republican governor thought by many to be a 2016 hopeful, has long stated his disagreement with marriage equality. When the New Jersey Legislature approved same-sex marriage in 2012, Christie was quick to veto the bill, stating that the 8.8 million people of New Jersey should decide on the issue – not the 121 politicians in the state capital. Christie reaffirmed his position in September after New Jersey Superior Court Judge Mary Jacobson ruled that New Jersey’s civil unions were not equal to marriage and therefore violated the recent US Supreme Court decision on DOMA. At the time, the administration was quick to appeal that decision, but thankfully, Governor Christie yesterday announced that the administration would drop its appeal – paving the way for marriage equality in New Jersey.
Governor Christie is certainly entitled to his opinion on same-sex marriage, though I find it narrow minded and misguided. However, his assertion that the people of New Jersey should vote on the rights of a persecuted minority group is, quite frankly, completely wrong. It begs the question – in recent history, when have we ever allowed “the people” to decide on the rights of a minority group and thought it was a good idea?
Women’s suffrage? No. Desegregation? Wrong again. And in any other context, it seems absolutely silly. Would we allow people to vote for whether or not Asians or Latinos could get married, share health insurance, or file joint tax returns? Even interracial marriage was approved not at the polling station but by the Supreme Court. In fact, the most recent time that the general public was allowed to vote on the rights of a specific minority group was in 2012, when Maryland, Maine, and Washington voted in favor of marriage equality, and the good people of Minnesota voted not to approve a same-sex marriage ban. Voters, in fact, have been responsible for denying minority rights, starting in 1998, when voters in Hawaii approved a constitutional amendment to ban marriage equality.
As C.J. Prince points out, allowing the majority to vote on the rights of a relative few rarely turns out in favor of the minority.
Putting minority rights to majority vote doesn’t work all that well for minority groups. Just ask the LGBT families living in any one of the 35 states that currently have constitutional or statutory bans on same-sex marriage. If repeal of anti-miscegenation laws had been left to popular vote rather than to a Supreme Court decision, we’d probably still have states outlawing interracial marriage.
And while it’s true that recent polls show growing support for marriage equality in a number of states, polls don’t predict who actually shows up to election day. Nor do polls predict if propositions and ballot initiatives will ever make it to ballot. The Founding Fathers knew that certain rights could not be left up to the people to decide, with the First Amendment serving as the ultimate example. So then why are we so quick to suggest that the general public should be allowed to abrogate the rights of a relative few?
(I have a feeling someone well versed in history is going to school me. And that’s totally fine, by all means please do.)
Proof that good things can come on Mondays as well, New Jersey joins 13 other states to affirm marriage equality today.
Despite Chris Christie’s best efforts to defy the New Jersey Legislature, earlier today the governor of New Jersey announced that the administration would drop it’s appeal of lower court judge’s ruling that current law in New Jersey violated federal law following the repeal of DOMA.
But let’s be honest – this was inevitable. Just look at the Great Seal of New Jersey… there are two women practically holding hands.
I cannot take credit for this list of things that millenials need to know about the ACA, but a big thanks to Kaiser Health News for this list.
- Even superheroes need health care.
- The time has come – a lot of big ACA changes already happened… on October 1st.
- Obamacare marketplaces are like shopping online – something millenials are good at.
- Your coverage options are affected by a lot of factors, especially where you live.
- What’s covered under your plan also depends on where you live.
- Employers with greater than 50 workers will have to give employees coverage, but the options vary.
- Navigators, available both online and in person, are like the GPS of health care.
- Insurers can no longer charge you more or drop coverage because of certain health conditions.
- One of the most important things you can do is understand your plan!
The government shutdown has left several federal agencies running with skeleton crews. The problem? Many of those agencies are directly responsible for monitoring the nation’s health. If there was ever a time to highlight the important role that public health plays in keeping America healthy, it is now. Here’s a few specific examples:
-the Centers for Disease Control and Prevention is one of the agencies affected by the shutdown. The CDC monitors for disease outbreaks, in particular for foodborne in particular for foodborne illnesses. If you hadn’t heard, there’s currently a salmonella outbreak that has sickened over 270 people. This is only one of some 30 other outbreaks that the CDC is monitoring, but with reduced staff, investigating outbreaks has slowed significantly.
-The CDC has also stopped its surveillance for influenza, although thankfully it’s early in the flu season.
-OSHA or the Occupational Safety and Health Administration has stopped workplace checks for safety and health violations
-probably the scariest public health related casualty of the government shutdown is the Food and Drug Administration (FDA), which has stopped routine inspections of food facilities. The FDA is responsible for inspecting approximately 80% of the nation’s food supply (the other 20% falls mostly under the authoridy of the USDA – which is still mostly staffed).
Ever since the term “Obamacare” made it into popular vernacular, I have hated it. I initially hated it because the GOP was using the term pejoratively to poke fun at the President’s health reform law. I mean, after all – it’s not like we called Medicare “Johnsoncare” or Social Security “Rooseveltcare”. I hated the term even more once the President started to embrace it; with all due respect Mr President, accepting the use of the pejorative term for your signature legislative achievement muddied the message to the American people. Embracing the term “Obamacare” instead of the Affordable Care Act was possibly the worst public relations move the White House could have made with regard to the law, aside from the general lack of publicity about the law prior to the 2012 election.
If you don’t believe that statement, last week’s media coverage of the government shutdown provides ample proof. Polls have consistenly shown that people don’t like the law when it’s referred to as “Obamacare” but love the individual components of the law – things like coverage for pre-existing conditions, allowing young people to stay on parents’ insurance until age 26, etc. As Jimmy Kimmel quipped “It’s like the opposite of a (McDonalds chicken) McNugget.”
But Jimmy Kimmel also learned that plenty of people have no idea that Obamacare and the Affordable Care Act are the same thing. The exact same law. A recent CNBC poll found more Americans oppose Obamacare than oppose the Affordable Care Act. But more Americans support Obamacare than the Affordable Care Act. It doesn’t seem to make sense until you know that CNBC polled two different groups, using “Obamacare” for one group and the Affordable Care Act for the other. Forty-six percent of the group asked about “ObamaCare” opposed it. But only 37% of those asked about the health law opposed it. Conversely, 29% of those polled support Obamacare compared with 22% who support ACA. (the remainder didn’t have enough information or were neutral).
Rationally speaking, this makes no sense. But that requires that Americans be rational, informed human beings, and that’s where it all falls apart – and why the term “Obamacare” is such a tragedy. Because that same CNBC poll determined that 30% of the public didnt know that the Affordable Care Act was, and even with all the press, 12% of those polled didnt know what Obamacare was either. You read that correctly – nearly a third of those polled didn’t now about the biggest health reform law since Medicare and Medicaid were enacted.
The ignorant American is an enormous problem, and one of the biggest problems in our democracy. Because politicians will never blame the public for being ignorant of the issues, and far worse, they play on our ignorance to pass their agendas. The Republican Party knew that labeling the Affordable Care Act as “Obamacare” would instantly make a specific subset of the American public hate the idea – merely because the President’s name was associated with the law. The President similarly bet that attaching his name to the legislation would rally the Democractic Party behind the law. As Jonah Goldberg notes, since “politics is so often driven by our attitudes toward specific personalities, for many Americans, their attitudes toward a monumentally significant piece of legislation are driven by something as petty as whether ‘Obama’ is in the title.” If you believe the CNBC poll numbers, it would seem both parties’ logic was somewhat successful.
“Worse, virtually all the conventional wisdom, not to mention academic and media gasbaggery, is that the biggest problem with our political system is that not enough Americans are participating.” In order to vote, we must be informed enough to form opinioins on pieces of legislation. It’s fairly safe to say that if you don’t know that Affordable Care Act is, you probably aren’t voting. And the ill-informed voter is problematic for both political parties… depending on which party is able to whip up enough emotion right before an election. Holding the public’s attention after election season is over, however, is an entirely different matter. After all, the Affordable Care Act was passed in 2010…
As of 7pm tonight, a shutdown of the federal government tomorrow appears to be all but imminent. There is undoubtedly last minute shenanigans going on behind the scenes in Washington to avert such a disaster, but it doesn’t look good. The latest news is that a group of moderate Republicans in the House of Representatives is working to gather enough votes to pass a continuing resolution, but I’m not holding my breath.
Regardless of whether the federal government shuts down tomorrow, the next major step in the Affordable Care Act is set to occur tomorrow. On October 1st, the state based health insurance exchanges will open. For the first time, consumers who don’t currently have health insurance will be able to effectively be able to “shop around” for health insurance. They’ll be able to select from several different tiers of products – platinum, gold, silver, and bronze. They’ll find out if they are eligible for government subsidies to help with the cost of their monthly insurance premium. The options will vary from state to state depending on where an individual lives.
But wait… if the government shuts down tomorrow or if “Obamacare” is defunded, won’t that stop the insurance exchanges from opening?
Nope. The insurance exchanges aren’t funded by the Congressional budget. In other words, dedicated money has already been set aside for this portion of the Affordable Care Act. Unless somehow the entire law is shut down before tomorrow, the exchanges will open for business as scheduled.
According to the Obama administration, the opening of the exchanges is the one of the key steps to getting as many uninsured individuals as possible onto private health insurance plans. The other major component of the Affordable Care Act designed to close the uninsurance gap is the expansion of Medicaid. Oddly enough, these two components are tied together. Let me explain…
Last year the Supreme Court upheld the Affordable Care Act, but the justices also ruled that each state could decide whether or not to accept the ACA’s Medicaid expansion. Many states have chosen not to – primarily those controlled by Republican governors or legislatures who remain vehemently opposed to the Affordable Care Act – claiming that Medicaid expansion would destroy state budgets. Accepting the Medicaid expansion will allow thousands of poor residents to quality for health insurance via Medicaid. Not accepting the expansion means that these residents either have to go on the state-based health exchanges or forgo health insurance and pay a penalty to the federal government when filing income taxes (although in truth, many of these people don’t make enough money to have to file income taxes).
Ironically, there will be previously uninsured individuals who intend to purchase health insurance on the exchanges, only to find that they qualify for Medicaid. And they always did, even before the Affordable Care Act. Even in states that aren’t expanding Medicaid. They just didn’t know it. In fact, tens of thousands of people required by the Affordable Care Act to get into the insurance market in 2014 will discover they are eligible for Medicaid benefits for which they’ve never applied.
I posted this Forbes article to Twitter yesterday, but this infographic about SNAP (Supplemental Nutrition Assistance Program – aka food stamps) is really great and dispels a lot of the myths about food stamps. Given the recent decision by lawmakers to cut money from SNAP while enrollment has increased, perhaps these same lawmakers should be looking at some of this data as well…
At the end of August, the US Census released a series of maps of the United States that are incredibly important for the future of health reform. Two are particularly noteworthy
The first map details by county level the % of uninsured adults living at or below 138% of the federal poverty level (FPL). The second map details by county the % of uninsured adults living at or below 400% FPL.
Why are these maps so important? The first map is significant because it highlights the areas that could most benefit from Medicaid expansion under the Affordable Care Act, which loosened eligibility criteria for Medicaid to those living at or under 138% of the FPL. The second map illustrates the areas that could most benefit from insurance premium subsidies on the state-based insurance exchanges.
You’ll notice a pattern with both of these maps, in that areas in the Northeast and the Midwest have lower uninsurance rates than the South and West. There are several reasons for this: 1) the stronger role of unions in the Northeast and Midwest that traditionally came with better health benefits, 2) higher per capita incomes, particularly in the Northeast which makes insurance more affordable and 3) many of the states in the Northeast already had looser Medicaid eligibility criteria to cover more of their residents.
But the maps also highlight where the Affordable Care Act has the potential for the greatest impact, and where the refusal of some states to expand Medicaid is problematic – with Texas and Florida as the prime examples. The maps clearly show where the White House has to concentrate its efforts to advertise and implement the Affordable Care Act. Unfortunately, many of those same areas are controlled by governors and legislatures that are hostile to the health reform law.