The CLASS Act
Short for the Community Living Assistance Services and Support Act, the CLASS Act was supposed to be a down payment on a national program to pay for long-term care, a big shortcoming in the US health system. It was a voluntary effort in which people could join a government plan and pre-fund their long-term care needs. When they needed care, they would get a daily cash benefit to pay for services. The program was none too popular with many politicians. In the end the government found it unsustainable. Because it was voluntary (meaning there was no mandate to buy here), lots of people had to sign up to make it viable. If they didn’t, premiums would rise, and very few people could afford them. There was no way, the government decided, to make the program actuarially sound over 75 years.
Co-op insurance companies.
These are gone, too. About $6 billion in federal start-up money for co-ops was supposed to spur their development as a lower-priced alternative to big insurance carriers; it was sort of a sop to the public option advocates. Twenty-four co-ops were funded even though the government had begun to reduce funding. Then came the New Year’s surprise. In final negotiations over the fiscal cliff deal, Congress killed the remaining funding for 40 more co-ops whose applications were in the pipeline. Insurers, it seems, were not keen on the new competition.
WHAT’S BEEN DELAYED?
The employer mandate.
This is in the big one in this bucket. In early July the Obama administration announced a one-year postponement until 2015 of the employer mandate, the requirement that businesses with more than 50 full-time employees had to provide health insurance or pay a penalty. The idea was to prod employers that did not provide coverage to do so. Again business complained about the record keeping and reporting requirements.
The law said they had to provide coverage to full-time employees working 30 hours a week. That was tough for firms whose workers’ hours fluctuated. Who was a full-time worker? Who was part-time? Many firms were threatening to cut worker hours to avoid the requirements. The delay means that workers in firms that don’t provide coverage might be offered so-called “skinny plans.” Such plans might cover some drugs and preventive services, but not hospital care or surgeries, for example. There’s little protection for catastrophic illness, but the premiums are cheap for employers and workers. The employee’s share may be as little as $40 or $50 a month.
SHOP exchanges.
These marketplaces for small businesses to buy insurance for employees, will offer only one plan in 2014 instead of an array of choices the law envisioned. The administration said there were “operational challenges,” and the choice option would be available in 2015. Most small businesses offer only one choice now, so the exchange won’t be of much value unless more carriers can sell their products.
Rules requiring smokers to pay more for their coverage. During debate there was little doubt that insurers would be able to charge smokers more money, because they present greater health risks and more potential costs for insurance companies. But now smoking penalties applied to policies sold through the exchanges are delayed a year because of what the administration described as a “system limitation.” The law says insurers cannot charge older people more than three times it charges a younger person, and it allows carriers to charge smokers 50 percent more. The problem, discovered a few months ago: the system cannot process a premium for a 65-year-old smoker that is more than three times the premium for a 21-year old smoker.
Setting aside the fact that this article has nothing to do with journalism, it's amusing that Lieberman simply passes along the administration's press-release terminology about "system limitations" and "operational barriers" without even attempting to explain what's really happening. This just emphasizes that the goal here is to publicize the administration's spin on events, and not to look behind it.
#1 Posted by Tom T., CJR on Tue 30 Jul 2013 at 07:12 AM
All of the confusion could be avoided with a Medicare-for-All plan, 100% funded by the federal government.
And for all those who believe our Monetarily Sovereign government "can't afford" to fund Medicare for every man, woman and child in American, look up the meaning of Monetary Sovereignty at http://mythfighter.com/2013/07/27/i-just-thought-you-should-know-lunch-really-can-be-free/
#2 Posted by Rodger Malcolm Mitchell, CJR on Tue 30 Jul 2013 at 09:38 AM
The Republican v. Democrat angle is a diversion. Both parties and the entire corporate elite support the austerity Obamacare will usher in (not to mention more corporate welfare).
One concrete example of the sleight of hand: how many media sources reported spouses can now be dropped by employers under Obamacare? Very few. This change in the law will be of huge importance to families, especially during the next downturn when employers use the "exchanges," er "marketplace" (or whatever PR tested word they go with), as an excuse to drop spouses.
Dropping spouses will have a much larger effect on households than allowing a 21 year old to stay on his parents' policy, which is one of the "good" changes in Obamacare (i.e. 21 year olds will not use or need health care coverage like a 55 year old spouse will).
And of course the media plays up the R v. D angle re spousal coverage by pushing the lie that the Democrats overlooked the change when they passed Obamacare and now they really, really, (really!) want to change the law but the meany Republicans won't allow them to.
The media gets an F for complicity in my book. This austerity and corporate welfare is being foisted upon us by a corrupt political process and media.
#3 Posted by Walter W., CJR on Tue 30 Jul 2013 at 02:42 PM
As to subsidies for out-of-pocket costs, be sure to read the fine print. It is my understanding that the subsidy will be available to holders of silver plans--not the cheaper bronze plans.
Oh--for single payer Medicare for all. Everybody In--nobody out--no meed to read the fine print.
Today 7/30 in DC, Physicians for a National Health Program (pnhp.org), Public Citizen, Rep. John Conyers and Sen Bernie Sanders will discuss single-payer and how it could be funded.
#4 Posted by Harriette Seiler, CJR on Tue 30 Jul 2013 at 03:01 PM
"For starters, after all those changes, what is Obamacare, exactly?"
Unfortunately, I don't think this article answers the question.
Here's my attempt (sorry for the length but I'm trying to be concise while describing the change in law and it is a complicated subject):
Obamacare is a bipartisan neoliberal approach that putatively provides near-universal health insurance coverage to citizens. The individual mandate requires citizens to purchase a bare minimum insurance policy from an industry that still enjoys exemption from anti-trust laws and is largely exempt from other consumer protection laws (like bad faith torts per ERISA). Citizens that do not purchase insurance will be fined by the government and millions will still go without insurance under this near "universal" system. Employers will have to pay a small fine for not providing benefits for full time employees but will still enjoy huge tax breaks on the insurance they do provide.
The insurance companies get substantial subsidies based on a citizen's ability to pay. But the citizen is responsible for predicting his income, and therefore his subsidy, under pain of penalty, as well as theoretically choosing the best product in a confusing "marketplace" that is sponsored by the government (but run mostly by private contractors). In exchange for this captured market share insurance companies will be forced to provide basic policies (how basic is in flux but it looks pretty meager--if you get seriously sick you still go bankrupt). Insurance companies will be forced to provide wellness visits, cover children of insureds under 25 years of age, and not be allowed to deny coverage based on pre-existing conditions (but the ability to rescind policies based on "fraud" remains). Health insurance companies, drug companies, and hospital stocks are all rising in anticipation of the huge profits to be gained. The U.S. health care system will most likely continue to be the most expensive in the world while offering middling results to its citizens in terms of health care (despite the misnomer, "Affordable" in the title of the legislation).
Also, Medicaid will be expanded under Obamacare, but on a practical level it looks like many states will cut back on Medicaid benefits and coverage--so more citizens may qualify for Medicare but those already on it may be worse off than before (not to mention the other services states are cutting because of increased Medicaid expenses). Another practical effect of Obamacare is that employers are cutting employee hours to under 30 hours to avoid health care coverage requirements. Also, employers will now have an incentive to hire undocumented immigrants as they will not be required to provide the same medical coverage benefits as for citizen employees.
All in all, austerity will increase health care costs, raise profits for insurance companies, drug companies, and hospitals, while still not covering all citizens. Most other citizens will have to pay more for a shoddy product and will still go bankrupt if they ever get seriously sick on their basic coverage.
#5 Posted by Walter W., CJR on Tue 30 Jul 2013 at 03:24 PM