Perhaps I should say the building myth and the reality.
What is the building myth? That the worst is behind it. Megan McArdle fills you in:
Many of the commentators I’ve read seem to think that the worst is over, as far as unpopular surprises.
But she then takes a chain saw to that particular notion:
In fact, the worst is yet to come.
· 2014: Small-business policy cancellations. This year, the small-business market is going to get hit with the policy cancellations that roiled the individual market last year. Some firms will get better deals, but others will find that their coverage is being canceled in favor of more expensive policies that don’t cover as many of the doctors or procedures that they want. This is going to be a rolling problem throughout the year.
· Summer 2014: Insurers get a sizable chunk of money from the government to cover any excess losses. When the costs are published, this is going to be wildly unpopular: The administration has spent three years saying that Obamacare was the antidote to abuses by Big, Bad Insurance Companies, and suddenly it’s a mechanism to funnel taxpayer money to them?
· Fall 2014: New premiums are announced.
· 2014 and onward: Medicare reimbursement cuts eat into hospital margins, triggering a lot of lobbying and sad ads about how Beloved Local Hospital may have to close.
· Spring 2015: The Internal Revenue Service starts collecting individual mandate penalties: 1 percent of income in the first year. That’s going to be a nasty shock to folks who thought the penalty was just $95. I, like many other analysts, expect the administration to announce a temporary delay sometime after April 1, 2014.
· Spring 2015: The IRS demands that people whose income was higher than they projected pay back their excess subsidies. This could be thousands of dollars.
· Spring 2015: Cuts to Medicare Advantage, which the administration punted on in 2013, are scheduled to go into effect. This will reduce benefits currently enjoyed by millions of seniors, which is why they didn’t let them go into effect this year.
· Fall 2015: This is when expert Bob Laszewski says insurers will begin exiting the market if the exchange policies aren’t profitable.
· Fall 2017: Companies and unions start learning whether their plans will get hit by the “Cadillac tax,” a stiff excise tax on expensive policies that will hit plans with generous benefits or an older and sicker employee base. Expect a lot of companies and unions to radically decrease benefits and increase cost-sharing as a result.
· January 2018: The temporary risk-adjustment plans, which the administration is relying on to keep insurers in the marketplaces even if their customer pool is older and sicker than projected, run out. Now if insurers take losses, they just lose the money.
· Fall 2018: Buyers find out that subsidy growth is capped for next year’s premiums; instead of simply being pegged to the price of the second-cheapest silver plan, whatever that cost is, their growth is fixed. This will show up in higher premiums for families — and, potentially, in an adverse-selection death spiral.
In fact, she is exactly right. Note how many of these surprises happen before 2016. And, as they come true, perhaps … just perhaps … when voters are told that the rest of this nonsense is likely to come true too (it is the law, you see), they might believe it.
Perhaps. The “Cadillac tax” was inartfully delayed until after the election. However, the snowball will already be rolling down hill by then and you’d think the public would be open to believing that the rest of this abomination, that which was delayed, will indeed happen. And you’d also believe they’d want to do something about that (that, of course assumes Obama doesn’t wave the magic executive pen and waive all of this until after the election).
But then, doing something would depend on what? Well, getting elected officials that want to actually get rid of most of this monstrosity and are willing to say that and then do it. Uh, that won’t be Democrats (well except perhaps blue dog Democrats, if they’re not extinct by then).
What it all boils down too is that voters will have to depend on Republicans to do the heavy lifting. The question is will they do that if elected? In other words, will Republicans be up to the job?
If I had to base it on the current crop – yeah, not so much.
You remember the post a couple of days ago when I broadly hinted that you shouldn’t believe a single statistic (or most of anything else) this administration proffers?
More proof. You might recall a number of administration spokespersons and Democrat mouthpieces telling us that millions have enrolled and paid?
An official from the Centers for Medicare & Medicaid Services admitted at a House hearing today that no one knows how many people have actually paid for Obamacare coverage.
“So we don’t know at this point how many people have actually paid for coverage?” asked a member of Congress.
“That’s right,” the CMS official conceded.
Inept, incompetent and unfortunately, in charge.
Of course “ICYMI” is internet shorthand for “In Case You Missed It“. And in case you missed a couple of things I found interesting I thought I’d throw them up here.
According to the White House, 79% of those enrolled in Obamacare need subsidies because they cannot otherwise afford the premiums that have, in some cases, nearly doubled. Only 21% did not need subsidies.
As Businessweek noted, people “earning up to four times the poverty rate—as much as $96,000 a year for a family of four”—can get Obamacare subsidies from the federal government.
79%. That’s right, 79%. And why do they need subsidies? Because they can’t afford their insurance premiums anymore. And why can’t they afford their insurance premiums anymore?
Oh, and here’s a great chart on something else you might have missed:
Yes, that’s right … when all is said, done and figured, the real unemployment rate is around 11%, not 6.7%. No wonder those 79% need subsidies.
I threw that in because this is the state of the job market and that has an effect on who is going to enroll in this boondoggle of a government program. But right now, it appears young people – you know, the one’s Obama et al are counting on paying for this – aren’t enrolling.
But hey, is the White House worried? Nah, they – as usual – have it all figured out:
About 30 percent of new enrollees are under 35. White House officials say that’s an acceptable mix, and they expect more young people to come on board closer to the March 31 deadline. “We think that more and more young people are going to sign up as time goes by, based on the experience in Massachusetts,” Gary Cohen, deputy administrator at the Centers for Medicare and Medicaid, said on a conference call with reporters. “We’re actually very pleased with the percentage that we have right now, and we expect that percentage to increase.”
This is the usual whistling past the graveyard this administration is so prone too. They have no idea what will happen. They “think” more will sign up.
Uh huh …
ObamaCare says it needs an enrollment of 38% of youth to pay for this monstrosity. 24% are enrolled. And, apparently knowing youth better than I do (“Insurance? I”m not sick. Beside, I want that new 60″ TV.”) they’re sure they’ll make the time and effort to enroll and throw their money into the pit before March.
Not going to happen. I’d suggest those who are going to enroll have, for the most part, enrolled.
Of course that doesn’t mean the administration won’t claim to have 38%. But I’ll remind you they also claim unemployment is at 6.7%
The Affordable Care Act, the monstrosity of Democratic legislation with the Orwellian name, continues to lose supporters. And, as an added special feature, people in employer based programs are now paying more out-of-pocket for their medical expenses than before ObamaCare. Very “affordable”, no?
Support for the Affordable Care Act has plummeted since late last summer, and people with employer-based health insurance say they increasingly are paying more for out-of-pocket medical expenses, a new Bankrate.com survey released Wednesday revealed.
When Bankrate.com first polled people in September—right before the launch of Obamacare insurance exchanges, there was an even split between those who said they would repeal the Affordable Care Act if given the power to do so and those who would keep it: 46 percent each. (The rest either had no opinion or didn’t know how they felt.)
But three months later, after the botched launch of those government-run exchanges, the number of people who said they would gut Obamacare had risen to 48 percent, while the number of respondents who said they would keep it as law had plunged to 38 percent.
While the “botched launch” may have had some effect on that “plunge”, my guess is that hitting people’s wallet has pushed it down even more. Health care insurance isn’t some esoteric policy argument. It’s something that is important to everyone. It is about their family and trying to afford the best for their family’s health. When policy negatively effects real people, they react just as negatively (and I do hope that Democrats double down on their support of the law, since it is all theirs anyway) :
The survey also found that people, by a 2-to-1 margin, felt Obamacare had had a more negative than positive impact on their own, individual health care. The poll questioned 1,005 adults, and had a margin of error of 3.6 percentage points.
His company’s survey also found that a total of 44 percent of people with employer-provided insurance said they are shelling out more dollars in deductibles and copayments than they were a year ago. And 47 percent of that group of people reported having more money deducted from their paycheck to pay the cost of those insurance plans than in 2012.
People earning between $50,000 and $75,000 annually were the most affected group: with 64 percent of them reporting a bigger hit on their paychecks from health insurance. Just 38 percent of the people earning less than $30,000 reported paying more for insurance in payroll deductions as of 2013.
The great leveling. Apparently you’re “rich” if you earn between $50 and $75k, so it’s okay that you’re paying more – and besides, those “Cadillac plans” just aren’t fair (well, except for the exempt unions, of course … and Congress, and ….). Don’t forget the tsunami of cancellations that will hit employer based programs hasn’t yet happened.
Obviously it doesn’t take great powers of perception to realize that this is just going to get worse and worse as the months pass. And as those months pass, those supporting the legislation will become fewer and fewer. It will be a grand issue on which Congressional Republicans can run (if they actually can figure out how to do that successfully without the usual idiocy). Unfortunately, politics aside, it is going to be a building disaster for the American people.
Repeal is the best remedy.
Not that anyone should be surprised:
Even without the full number of enrollments, Obamacare’s current net effect is clearly in favor of cancellations. Millions are already seeing Obamacare’s adverse effects — largely due to more mandates for more services.
The mandates? Well they’re one of the major reasons for most of the cancellation notices – their plan just doesn’t have all the benefits your wise and caring public servants think you should have:
The health-care law requires that all insurance plans cover 10 “essential benefits,” eliminating millions of plans that don’t fit the bill and boosting costs for consumers that have to purchase coverage for services they may not want or need.
All plans must include maternity coverage, for example — including plans for men and post-menopausal women. Even customers without children must purchase plans that cover pediatric services. Other newly established essential benefits include hospitalization, mental-health services and preventive and wellness services.
While a grandfather clause allowed plans purchased before Obamacare passed in 2010 to continue, HHS estimated that 40-67 percent of plans would eventually lose their status and cost millions of Americans their insurance plans.
So you see little horror shows like this family’s acted out all over the nation.
And those cheap affordable plans? How are they working out so far (if you can even get one). Well with high deductibles, not so hot (but all the men have maternity coverage, that’s a plus):
Experts are worrying that some new enrollees will be discouraged from seeing doctors if they have to pay the full charge, rather than simply a copayment. In Miami, for example, 40 percent of bronze plans require consumers to pay the full deductible before coverage kicks in, according to an analysis by online broker eHealthinsurance.com, a private online marketplace, for Kaiser Health News. The average deductible among the examined bronze plans in Miami is $5,735.
Patients in those plans who haven’t yet met their annual deductibles would have to pay the full cost of the visits, unless they were for preventive services mandated by the law. A typical office visit can run $65 to $85, while more complex visits may cost more.
So, as Ed Morrissey puts it:
Put it this way: If the average deductible is $5,735 and a doctor visit is $85, it would take sixty-eight doctor visits before the insurance kicked in — more than one visit per week. And it would start all over again every year.
So how’s ObamaCare going?
About how you’d expect a politically driven piece of law from an incompetent administration to go.
However the apologists have a different reason in mind:
“[S]outhern White radicals vowed to stop implementation of the Obama-care law leading one to wonder if Tea Party members would oppose affordable healthcare if it came from a nonBlack [sic] President,” writes Browne-Marshall.
Yeah, that’s the reason.
First let me thank all the great QandO readers who sent their condolences upon my brother’s passing. They are greatly appreciated.
Now on to the nasty business of government and politics – in particular, the abominable law called ObamaCare:
An estimated seven out of every 10 physicians in deep-blue California are rebelling against the state’s Obamacare health insurance exchange and won’t participate, the head of the state’s largest medical association said.
“It doesn’t surprise me that there’s a high rate of nonparticipation,” said Dr. Richard Thorp, president of the California Medical Association.
Why? Because doctors refuse to work for a pittance. They provide something of value and believe they should be compensated accordingly. But with price fixing by the government, they’re just not going to get their just compensation. So they’re not going to play the game and join in.
California offers one of the lowest government reimbursement rates in the country — 30 percent lower than federalMedicare payments. And reimbursement rates for some procedures are even lower.
In other states, Medicare pays doctors $76 for return-office visits. But in California, Medi-Cal’s reimbursement is $24, according to Dr. Theodore M. Mazer, a San Diego ear, nose and throat doctor.
In other states, doctors receive between $500 to $700 to perform a tonsillectomy. In California, they get $160, Mazer added.
Only in September did insurance companies disclose that their rates would be pegged to California’s Medicaid plan, called Medi-Cal. That’s driven many doctors to just say no.
In fact, as pointed out above, only 30% of the state’s doctors have opted in.
Gee, let’s see the left take the doctor’s side here, okay? Aren’t they the ones always wanting the raise the “minimum wage”. Well, as is obvious here, the “wage” offered is below the “minimum” doctors believe they should be payed. The left ought to be out in the street in protest of this travesty.
Higher pay for doctors! After all, most of them are small business owners and … oh, wait, that makes them the bad guys. I forgot. The left isn’t going to protest this because these guys are privileged or something. Nevermind the fact they provide jobs for others and can’t pay them more than they receive.
I’m sure trying to think this through and come to an equitable solution will shred a few brains on the left.
There’s been much discussion amongst the punditry about the precipitous decline in Pres. Obama’s poll numbers. The fact that his RCP average has dropped below 40% for the first time, or that Hispanics and white women have seemingly soured on Obama and the Democrats, is causing much buzz. Most alarming, are the numbers on millenials:
Young Americans are turning against Barack Obama and Obamacare, according to a new survey of millennials, people between the ages of 18 and 29 who are vital to the fortunes of the president and his signature health care law.
The most startling finding of Harvard University’s Institute of Politics: A majority of Americans under age 25–the youngest millennials–would favor throwing Obama out of office.
Obama’s approval rating among young Americans is just 41 percent, down 11 points from a year ago, and now tracking with all adults. While 55 percent said they voted for Obama in 2012, only 46 percent said they would do so again.
When asked if they would want to recall various elected officials, 45 percent of millennials said they would oust their member of Congress; 52 percent replied “all members of Congress” should go; and 47 percent said they would recall Obama. The recall-Obama figure was even higher among the youngest millennials, ages 18 to 24, at 52 percent.
To be sure, these numbers don’t bode well for the survival of Obamacare, or for the Democrats chances in 2014. But I don’t think they necessarily mean that the GOP will reap the benefits.
For example, with respect to younger voters, Kristen Soltis Anderson makes some interesting points over at The Daily Beast:
The way young voters feel about Obama doesn’t just matter in 2014 or even 2016. Despite the conventional wisdom that young voters don’t matter in politics, the way a voter first looks at politics when they come of age resonates throughout their voting behavior through their lifetimes. Just last month, Pew Research Center released a study showing that if you came of age under Nixon, you’re more likely to vote Democratic, even to this day. Came of age during the Reagan years? You’re still more likely to lean Republican.
Harvard rolled out a chart of party identification by age, which showed that in November 2009, some 43 percent of those aged 18-24 called themselves Democrats. Four years later, that has fallen to 31 percent. A huge drop to be sure, but that doesn’t mean people were necessarily changing their minds; it mostly means last election cycle’s bright-eyed kiddo has had a few birthdays. Our gender and race don’t change much year to year, but each of us is constantly moving up in our age bracket. And sure enough, when you look at the Harvard survey’s 25-29 year olds, they’re as Democratic as ever.
That doesn’t mean that this block of voters won’t ever change their minds and views, but it does suggest that, however low their opinion of the Democrats and their leader is now, they are more likely to remain loyal to that party and change it from within.
Another way to look at this is, those who voted for Obama because they wanted to see the ACA enacted and implemented, among other changes he promised, are going to suddenly change their minds about state vs. market solutions just because of a failed implementation. If anything, they are likely to seek out more capable technocrats as their political leaders, and to express greater interest in single-payer health care.
Even so, Anderson makes another great point, i.e. that not all millenials are the same:
To better understand what’s happening with today’s “youth vote,” first consider this fact: someone who turned eighteen on election day last year would have been just six years old on September 11, 2001. They would have been eighth graders during Obama’s first election.
I’ll violate some rules of decorum here by revealing my age: I am 29 years old. I’m a few short months away from aging out of “the youth vote” entirely. And I have about as much in common with today’s high school seniors as I do with my own parents. We researchers and pundits lump 18-year-olds and 29-year-olds into the same bucket when we talk about the “youth vote,” but the truth is that the back end of the “Millennial” generation has little memory of “hope and change” at all.
In short, provided that the GOP can deliver a compelling alternative to the Democrats, it’s possible that they can pick up some of those young voters. Of course, they aren’t called the stupid party for nothing, so don’t expect much on this front.
I hope everyone had a great Thanksgiving and I know you’ll rest much better knowing the ObamaCare website is now “fixed”. No. Really. They say so:
The White House announced on Sunday that it had met its goal for improving HealthCare.gov so the website “will work smoothly for the vast majority of users.”
In effect, the administration gave itself a passing grade. Because of hundreds of software fixes and hardware upgrades in the last month, it said, the website — the main channel for people to buy insurance under the 2010 health care law — is now working more than 90 percent of the time, up from 40 percent during some weeks in October.
So there. We’re at 90% and have been declared to be “working smoothly”.
Well, except for the part that actually gets you enrolled in an insurance program:
The problem is that so-called back end systems, which are supposed to deliver consumer information to insurers, still have not been fixed. And with coverage for many people scheduled to begin in just 30 days, insurers are worried the repairs may not be completed in time.
“Until the enrollment process is working from end to end, many consumers will not be able to enroll in coverage,” said Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group.
The issues are vexing and complex. Some insurers say they have been deluged with phone calls from people who believe they have signed up for a particular health plan, only to find that the company has no record of the enrollment. Others say information they received about new enrollees was inaccurate or incomplete, so they had to track down additional data — a laborious task that would not be feasible if data is missing for tens of thousands of consumers.
In still other cases, insurers said, they have not been told how much of a customer’s premium will be subsidized by the government, so they do not know how much to charge the policyholder.
Details, details. What’s wrong with you people. It’s fixed! We say so. This other stuff is, well, something that is the insurance companies problem. Or maybe Bush is at fault. Certainly the Republicans.
But now that the White House has declared all its problems addressed — and on time too — well they don’t want to hear anything more about it.
“Health plans can’t process enrollments they don’t receive,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans.
It’s fixed. End of story.
Time to move on. Change the subject.
Oh, and don’t call it ObamaCare anymore.
They’re finally “coming home to roost” as Mr. Obama’s favorite preacher might say:
According to a new CNN/ORC International survey, only four out of 10 Americans believe Mr. Obama can manage the federal government effectively. Fifty-three percent don’t view him as a strong and decisive leader. And 56 percent say he does not agree with them on important issues and he does not inspire confidence.
But the numbers on the president’s personal characteristics should alarm the White House most of all. More than half (53 percent) believe he’s not honest and trustworthy, while 56 percent say he’s not a person they admire.
Each of these figures are all-time records for Mr. Obama in CNN polling.
In their fascinating behind-the-scenes book on the 2012 election, Double Down, Mark Halperin and John Heilemann write that the campaign’s research showed “that there was a deep well of sympathy for Obama among voters.” In focus groups after the first debate, they write, “people offered excuse after excuse for his horrific presentation. In Florida, one woman said, almost protectively, ‘I just bet you he wasn’t feeling well.’”
That deep well of sympathy–that willingness to give the president the benefit of the doubt and the attachment and connection voters felt for Mr. Obama–has been crucial to his success for his entire political life. He has always been viewed as a likeable and decent man, even when his campaign employed fairly ruthless tactics. But the days of broad public faith and trust in this president appear to be over. And no wonder.
The fact that the president knowingly misled the public on such a crucial element of his health-care program so many times, over such a long period of time, with such apparent ease, has penetrated the public consciousness in a way nothing else ever has. Incompetence has now been twinned to mendacity. And not surprisingly, that deep well of sympathy is drying up.
The characteristics which have taken such a beating are the one’s that kill a reputation – honesty, trustworthiness and admiration. You can forgive a goof. You can even forgive a certain level of incompetence if you have a deep reservoir of admiration for someone based on your belief that they’re an honest and trustworthy person.
Obama’s killed that with this monstrosity he claims as his legacy. The Democrats too suffer from that albatross.
The usual excuse makers are having trouble ginning up the enthusiasm for attempting to support this president. Why? Because their honesty and trustworthiness are at stake if they do. Oh, sure, there are those that are so much a party hack that they’re going to sputter and spout the usual reality defying nonsense. Debbie Wasserman Shultz, Nancy Pelosi and Harry Reid are the poster children of this breed.
But as mentioned many times before, reality is a bitch and she has shown up after 5 years of this nonsense with a vengeance. She is taking no prisoners. I can think of a million cliches that fit this situation and none of them are complementary to the President or Democrats.
By the very way they went about putting this law through the legislative process, they deserve each and every negative thing that happens to them. It is so bad, that Obama and company are left with trying to hijack Thanksgiving in order to save this awful law.
Barack Obama is the lamest of lame ducks (and that pretty much includes internationally as well, for mostly the same reasons). Because what he messed with went so badly and the fact that what he messed with was so important and personal to all Americans, you better believe any “well of sympathy” has dried up. And according to some reports, the worst is yet to come (the possibility that up to 80 million Americans will be dropped from their employer plans).
It is difficult to survey the wreckage of his reputation and not realize that this was all brought on by his own incompetence, arrogance and narcism. What’s interesting is he is a product of his ideology. He is its crowning achievement. And he demonstrates better than any tome, op-ed or television piece how bankrupt that ideology is.
Whether anyone will really pick up on that is probably arguable. But there it is – he is indeed the prefect product of liberalism. And, as anyone who has eyes and a will to actually see, the emperor has no clothes.
That’s a dangerous combination but that pretty aptly describes the ObamaCare roll out (ObamaCare is a name that the administration and Democrats would now like to distance themselves from).
It seems now that “no one knew” that the roll out was going to be a disaster because, well, no one knew. Gee, maybe they should have asked the IT guy:
A key player in the development of the Obamacare website said Tuesday that up to 40 percent of IT systems supporting the exchange still need to be built.
The revelation from Centers for Medicare and Medicaid Services Deputy Chief Information Officer Henry Chao occurs as the administration works to meet its Nov. 30 deadline to shore up the website.
40% of the supporting systems … still need to be built?!
And no one knew? That’s freaking mindboggling. You have a system that is 40% incomplete, you’re the head of a department charged with rolling out the system and you don’t know it’s not even close to being ready?
“It’s not that it’s not working,” Chao told lawmakers at an Energy and Commerce oversight subcommittee hearing. “It’s still being developed and tested.”
Phenomenal. If incompetence could be bottled, this administration could corner the market.
Financial management tools remain unfinished, he said, particularly the process that will deliver payments to insurers.
The update hits hardest at Democrats, hopeful that the system would function smoothly by the end of the month.
Chao said that the consumer portion of the website, including account registration, plan shopping and enrollment functions, won’t be affected by the ongoing development effort, but that “back office” functions including accounting and payment systems were not yet complete.
Did this boob tell anyone? And if he did, didn’t they listen? How do the insurance companies get paid? And until they are, how can any insurance plan go into effect?
My goodness … why wasn’t Chao sounding the alarms?
Oh, wait, see, he really didn’t know either:
He also told lawmakers he didn’t see a spring report that warned of potential stumbles and foreshadowed many of the problems that thwarted the website’s launch.
“I was aware some document was being prepared,” he said, but had no knowledge of a report until it was leaked to The Washington Post and obtained by POLITICO.
Chao told the House Energy & Commerce oversight subcommittee that he may have answered questions for the study but was not involved in any briefings on it.
The report, which independent consulting firm McKinsey conducted for CMS, described a process that relied too heavily on outsider contractors, didn’t provide enough time for complete testing and failed to hand authority to one decision maker. Chao’s limited knowledge of the report feeds lawmakers’ frustrations with the site’s fractured management and unclear controls.
These are the people who would run your healthcare (and everything else in you life if you’d let them) and make it both cheaper and better (and a good number of Americans swallowed that snake oil and ordered another bottle).
Oh, by the way, speaking of trust in government, did you know the jobs numbers were faked by the Census Bureau on the eve of the 2012 election?