The Associated Press has been an important voice in the health care debate. So it was disappointing to see its latest story: “HealthCare 101: A consumer primer on Obama’s bill.” There was nothing wrong with the premise of the piece, which tried to show how different stakeholders would fare under reform. In fact, for months we have been urging news outlets to do just that. But the story seriously skimped on the details. This was one time where brief was not better.
The AP tackled the immediate changes the new law would bring—for one thing, sick uninsured people could join state high risk pools, which the feds are pumping up with a $5 billion cash infusion. It called that solution a “workable alternative,” and asserted—without attribution—that premiums “should be much lower than what’s charged by private insurers willing to take those in poor health.” Where did it ever get that idea? We’ve been told ad nauseum that insurers didn’t take sick people. What’s more, risk pool coverage is no bargain. What’s the evidence that the pool policies (which are among the highest priced in the universe) will be cheaper? The whole discussion left me scratching my head.
A workable alternative? Don’t AP editors check their own clip files? Last fall, it moved a story that claimed the stopgap solution was practically unworkable. It talked about a six-month waiting period before benefits begin. That obviously doesn’t help those who need coverage now. And that same story raised the issue of whether the $5 billion was sufficient for all those needing help now. It noted that “people eligible for government benefits often fail to sign up. And if only one-third were to enroll, the budget could work.” In other words, as Campaign Desk pointed out, the government may be hoping that the other two-thirds would engage in some self-rationing to make its puny allocation stretch further.
In an early January report, Richard Foster, Medicare’s chief actuary, predicted that some 15 million people would gain coverage this year, costing around $4 billion—but that the fund would be exhausted in 2011. How’s that for a definition of “workable”?
Nor did the AP totally level with readers about how much coverage will cost them, even when the tax credits kick in to help them pay for premiums—the sine qua non of the bill. That gets to the crux of whether those with middling incomes will be able to afford the policies the government will require them to buy. The AP correctly reported that the subsidies “would be generous for lower-income families, less so for those solidly in the middle class.” And it showed by example that a family making $66,000 would have to spend $6,257 for premiums—nearly ten percent of its income. Subsidies would cover the rest.
But the AP story didn’t talk about other out-of-pocket costs. A look at the numbers put out by the White House a few weeks ago shows that this family would be on the hook for 30 percent of their health care expenses, since insurance would cover only 70 percent. An official at one of the state insurance departments told me that his state’s largest carrier, Blue Cross, was designing policies with deductibles around $3200. That means this family would have to pay about $9500 before the policy pays a dime—a wad of money, even with the government’s help.
Then there was the AP’s assertion that once the exchanges, or shopping services, were operative in 2014, “insurers will not be able to turn away people with medical problems or charge them more.” We need much more explanation, please! True enough, insurance companies could no longer turn down people with health conditions, costly or otherwise, and they can’t explicitly charge them more because they are sick. But they can certainly charge them more money. The bill allows something called age rating—that’s wonk talk for making older people pay more money. Age, in other words, becomes a proxy for health. Older people generally have more health problems.
- 1
- 2
Obama and Democrats knew full well that the Massachusetts plan on which Obamacare is modeled was a failure not long after it rolled nearly four years ago. Health care costs and premiums have continued to rise by double digits, and currently MA residents are looking at up to 30 percent more for premiums which, like in Obamacare, are mandated, and failure to comply with the law can cost a pretty penny that some can't afford to pay. Obamacare will not decrease health care costs or stop premiums from increasing either. The insurance is compulsory so there's no incentive for insurers or pharma to do any of the above. Forget what they promise.
Lately, MA Gov. Deval Patrick is in meetings with his commission trying to get the costs down, but when you have a commission mostly made up of politicians and insurers, how does that work?
Oh, wait - that works sort of like Obamacare which was put together in the backroom by insurers and pharma writing the national plan (bills).
The incessant talking points used to sell this monster to the American people: everyone will have affordable care, all Americans will have choice, you can keep your doctor if you want, no more donut hole in Medicare Part D, insurers will cover pre-existing, etcetera, is but smoke and mirrors. Read the bills, and you will find that this is not quite it. The loopholes and details will take your breathe away when you realize we are about to be duped bigtime if this plan doesn't hit the cutting room floor.
My favorite phrase in the table of contents and section heads is "shared responsiblity," a euphemism that allows the IRS to steal your money that you need to pay the bills if you can't afford the "affordable" insurance. For those who don't understand how this affordability thing works: the gov't tells you how much you can afford to pay based on PRIOR year income. When you shop at the "Exchange," you will not be eligible for a subsidy until you have spent a specified percentage of your gross income on a premium. This doesn't include copays, annual deductibles or coinsurance. At one point last summer, it was 11 percent for incomes at 400 percent FPL; then it was increased to 12 percent (needed a better CBO score) - in the final bill that is about to go through Demon Pass (deem and pass), it could be around those amounts; maybe it is slightly less, but Obama didn't tell people about this during his speeches, and neither has Congress.
They also didn't let on that Americans found eligible for the expanded Medicaid would have no other option and may be auto-enrolled if they don't sign up. So much for all Americans will have choice.
They also haven't mentioned that Medicaid contains the federally-required estate recovery program for people 55 and up and applies to all states that receive federal Medicaid funding. This program is as the name implies - there go your assets when you die to pay for the benefits you used while in Medicaid - RX and hospital must be recovered under the federal statute, but a state is allowed to recover for any and all medical care. Some states take the minimum, some the maximum and some a mix. This is not only for people going into long-term care institutions, so don't be fooled. MA residents know all about the excuses that were given. Obama said mandated health insurance, not a mandated loan!
The MA plan and Obamacare are both bully laws that target segments of the population that don't have the resources to defend themselves.
Disenrollment (termination) in the MA "affordable" subsidized plans outpaces enrollment on a near-monthly basis. That tells you something. People are bouncing in and out of the plans which affects continuum of care but actually saves the state money AND brings in needed revenue b/c now these residents are facing penalties enforced by the MA Dept. of Revenue as income tax evasion complete with interest and late fees when applicable. A win-win for the state
#1 Posted by dianne, CJR on Fri 19 Mar 2010 at 10:29 PM
Don't GATS regulations prohibit many or the protections in the HCR bill?
I think that its not unlikely that the mandate to buy insurance would remain but many of the protections would be nullified by GATS regulations that explicitly prohibit them. Also, GATS - once triggered for health insurance very clearly would prohibit single payer because it is a imitation on number of providers (one) and also it competes with potential multinational providers.
This is from the introduction to "Presidential Candidates’ Key Proposals on Health Care and Climate Will Require WTO Modifications":
.......
"How could U.S. WTO commitment limit the policy space for domestic health care policy reforms?
The WTO labelled the GATS the world’s first “multilateral investment agreement”13 because GATS rules cover every conceivable way that a service might be delivered, not only traditional cross-border trade in services. The GATS delineates “modes” of services delivery, with “Mode 3” granting foreign corporations the rights to buy, establish, invest in or otherwise operate service-sector companies within the territories of other countries.
Such foreign service-providers operating within the United States may be regulated only under policies that do not extend beyond the constraints set by the GATS.
The GATS scope of coverage is extremely broad.
When a service sector is bound to the agreement, the GATS requires that all policies “affecting trade in services”14 “taken by central, regional or local governments and authorities” and “non-governmental bodies in the exercise of powers delegated by central, regional or local governments or authorities”15 conform to GATS rules.
GATS rules extend beyond requiring that domestic and foreign firms be treated the same.:
Some GATS rules simply forbid certain policies, such as those that limit the number or size of service suppliers “in the form of numerical quotas, monopolies, exclusive service suppliers” or policies that limit the “value of a service transaction or asset.”16
The GATS also forbids the use of economic needs tests, which are frequently used in health care policy. Also, the GATS forbids “measures which restrict or require specific types of legal entity or joint venture through which a service supplier may supply a service,”17 which would forbid requirements that certain health services be provided only on a not-for-profit basis.
Additionally, the GATS national treatment or “nondiscrimination” rules require that public subsidies and grants given to service providers be shared with foreign service suppliers on the same footing as U.S. service suppliers, unless those funds were specifically exempted from the terms of the agreement within the U.S. schedule of commitments.
The GATS non-discrimination rules are extremely broad, allowing challenge of domestic policies that are facially identical for domestic and foreign firms, but that may have a different effect on them.18
Current WTO Doha Round talks include proposals to further limits signatory countries’ domestic service sector policy space, including talks to establish new “disciplines on domestic regulation” in the service sector to ensure that domestic licensing, qualification and technical standards are not “more burdensome” or more trade restrictive than necessary.19
The draft text that has been generated in these talks, if adopted, would impose another layer of WTO constraints on U.S. health care services. "
#2 Posted by Luke, CJR on Mon 22 Mar 2010 at 08:21 PM