“Conservative criticism of the Affordable Care Act has created the impression that liberal, “big government” ideas are driving the health-care system. But plenty of ideas that conservatives like are taking hold in health care as well. To wit:
*The number of Medicare beneficiaries in private Medicare Advantage plans reached nearly 16 million this year, a record, and the Congressional Budget Office projects that it will hit 22 million by 2020. This partial privatization of Medicare is happening despite concerns that reductions in payments to private plans (what some call over-payments) would curtail enrollment.
*More than half of people on Medicaid are enrolled in managed-care plans, which are typically run by private insurers that contract with states on a capitated, or risk, basis. More than 30 million low-income Medicaid beneficiaries are in private plans. The number is growing as states move sicker and disabled populations covered by both Medicaid and Medicare to managed care and as many states expand their Medicaid programs under the ACA, putting newly covered beneficiaries into managed care.
About 50 million Americans covered by Medicare and Medicaid at some point in the year are in private insurance arrangements. Now, this is not the block grant of Medicaid or voucherization of Medicare that some conservatives ultimately seek–just as the ACA is not the single-payer system that some liberals want–but it’s a substantial privatization, and one that has occurred largely incrementally and under the radar.”
“While enrollment in private health insurance through online marketplaces may be closed until Nov. 15, Medicaid and the Children’s Health Insurance Program added almost a million new patients in May, according to the Centers for Medicare and Medicaid Services.
Between April and May 928,628 people signed up for Medicaid or CHIP across the 48 states that reported data, up from 805,038 who joined in April but down from the 1.4 million who joined in March. The May figures, released Friday, bring total enrollment to nearly 66 million.
Medicaid is jointly funded by states and the federal government to serve low-income children, parents, the elderly and disabled people. The program was expanded through the Affordable Care Act to childless adults earning up to about $15,856 for a single household, though states can choose whether to expand. Twenty-six states and the District of Columbia have done so. CHIP, which is also jointly funded, serves children in families with incomes that are too high to qualify for Medicaid.”
“One of the oft-repeated arguments in favor of the Affordable Care Act is that it will reduce people’s need for more intensive care by increasing their access to preventive care. For example, people will use the emergency room less often because they will be able to see primary care physicians. Or, they will not develop as many chronic illnesses because they will be properly screened and treated early on. And they will not require significant and invasive care down the line because they will be better managed ahead of time.
Moreover, it is often asserted that these developments will lead to reductions in health care spending. Unfortunately, a growing body of evidence makes the case that this may not be true.
One of the most important facts about health care overhaul, and one that is often overlooked, is that all changes to the health care system involve trade-offs among access, quality and cost. You can improve one of these – maybe two – but it will almost always result in some other aspect getting worse.”
“There’s been quite a bit of bad news about Obamacare in recent weeks:
•a SCOTUS smackdown on the contraception mandate overreach,
•the possibility of an even more momentous court decision being handed down next week,
•worrying signs of more rate shock to face Exchange plan buyers next fall, with many states seeing double-digit premium increases, and
•a bleak picture of Obamacare’s unfolding fiscal disaster.
In that context, it should be no surprise that progressives are cheering the purported good news that the number of uninsured appears to be declining since last summer:
•A Commonwealth Fund survey released in June shows 9.5 million fewer uninsured adults age 18 and older;
•A RAND survey released in April found a decline of 9.3 million uninsured non-elderly adults;
•An Urban Institute survey released in June shows a decline of 8 million uninsured non-elderly adults, and
•Gallup shows a decline in the percentage of adults (18 and older) who are uninsured of 3.7 percentage points since the fourth quarter of 2013 (equivalent to 8.8 million adults).
As Jonathan Cohen snarkily concludes: “Obamacare Haters, Your Case Just Got Weaker.” I don’t view myself as an Obamacare hater, but I freely concede I am a great Obamacare skeptic. Let’s unpack the available evidence to see what we really know (and don’t) about Obamacare’s impact on the number of uninsured.
My conclusion is that anyone who says they are certain we have hit the CBO target of a 12 million reduction in the average daily number of uninsured in 2014 has cherry-picked the evidence.”
“After being without health insurance for two years, Miranda Childe of Hallandale Beach found a plan she could afford with financial aid from the government using the Affordable Care Act’s exchange.
Childe, 60, bought an HMO plan from Humana, one of the nation’s largest health insurance companies, and received a membership card in time for her coverage to kick in on May 1st.
But instead of being able to pick a primary care physician to coordinate her healthcare, Childe says she repeatedly ran into closed doors from South Florida doctors who are listed in her plan’s provider network but refused to see patients who bought their coverage on the ACA exchange.
“I just felt that I wasn’t being treated like a first-class citizen,’’ said Childe, who eventually found a doctor with the help of a Humana counselor. “Nobody, I don’t care what kind of degrees they have, should ever be treated that way.’’
Nearly one million Floridians enrolled in a private health plan through the ACA exchange but some, like Childe, are finding that some physicians refuse to honor their coverage — even when the doctors are included in the plan’s provider network.”
“The evidence is piling up now: Obamacare really does seem to be helping the uninsured.
Survey after survey is showing that the number of uninsured people has been going down since the start of enrollment last fall. The numbers don’t all match, and health care experts say they’re not precise enough to give more than a general idea of the trend.
But by now, the trend is unmistakable: Millions of people who didn’t have health insurance before the Affordable Care Act have gained it since last fall. The law is not just covering people who already had health coverage, but adding new people to the ranks of the insured — which was the point of the law all along.
There’s still a lot of variation in the numbers, too much for health care experts to pin down an exact number with any confidence. But even health care analysts who think the law is a bad idea acknowledge that the evidence suggests the uninsured are being helped. Given the predictions of doom that accompanied the law’s passage and launch, that’s a sweet bit of vindication for the president and ACA supporters.”
“The Commonwealth Fund has a new study out on Obamacare enrollment, estimating that about 9.5 million people gained coverage through Medicaid and the exchanges; this is roughly in line with some previous estimates but perhaps slightly more encouraging for the law’s supporters. Jonathan Cohn uses the estimate to declare that the law is meeting expectations in covering the uninsured:
… The Congressional Budget Office predicted that, one year into full implementation, Obamacare would reduce the the number of Americans without insurance by 12 million. That included the young adults who got insurance before 2014, by signing onto their parents’ plans. There’s been some controversy over exactly how many more young people are insured because of that new option, but the best estimates I’ve seen place the number somewhere between 1 and 2.5 million. Add that number to the 9.5 million from the Commonwealth survey, and you’re close or equal to the CBO projections.
Of course, the Commonwealth survey has a hefty margin of error and the CBO projections, revised to take account of the early technological problems on Obamacare websites, were never that scientific. But the figures seem to be in the same ballpark. That’s what matters.
In broad strokes, this is plausible: Obamacare has stabilized, it’s insuring substantial numbers of people, the disaster scenarios have been averted and most people getting coverage seem reasonably happy with it. I would only offer the caveat that when Cohn says “in the same ballpark,” he means “in the same ballpark, but probably lower than what was hoped for, which in turn was lower than what was originally projected.””
“Alabama, buckle up. You’ll soon learn how much your health insurance premiums will go up for next year. The percentage increase will probably be in the double digits.
But that’s nothing compared to what you’ll face in 2017. In May, I released a comprehensive study showing how the Affordable Care Act — otherwise known as Obamacare — will likely play out. The diagnosis isn’t good.
In two years, the ACA will cause substantial premium increases. This will likely cause Alabamians to leave the insurance market in droves — they won’t be able to afford health insurance, even with federal subsidies. Within a decade, this could swell the ranks of the uninsured by nearly 11 percent.
I reached this conclusion by using a peer-reviewed economic model published in several health journals. It was funded by both private and government sources, including the Department of Health and Human Services.
“Tired of waiting for states to reduce their backlogs of Medicaid applications, the Obama administration has given six states until Monday to submit plans to resolve issues that have prevented more than 1 million low-income or disabled people from getting health coverage.
The targeted states are Alaska, California, Kansas, Michigan, Missouri and Tennessee.
“CMS is asking several state Medicaid agencies to provide updated mitigation plans to address gaps that exist in their eligibility and enrollment systems to ensure timely processing of applications and access to coverage for eligible people,” said Aaron Albright, a spokesman for the Centers for Medicare & Medicaid Services. He said the agency will monitor states’ progress in solving the problems getting people enrolled in the state-federal insurance program for the poor.”
“The Supreme Court’s ruling this week that “closely-held” companies like Hobby Lobby aren’t obligated to comply with the health law’s contraception mandate because it conflicts with their religious beliefs has put a renewed focus on the employer-sponsored healthcare.
Consumers getting their healthcare through their employers is a deeply ingrained practice in the United States (although that trend has been diminishing in recent years), and the court ruling has sparked all kinds of arguments pertaining to that the arrangement. Some have concluded that it will lead workers to seek alternatives outside the workplace, which they can find on the federal health exchanges created under Obamacare.
However, a new poll from Morning Consult found that the public isn’t there yet.
In fact, a strong majority of workers are worried that their employers will stop offering health insurance altogether and move them into the Obamacare exchanges. Workers with employer-sponsored health plans largely have a negative view of what such a move would mean for their coverage, and would even consider looking for a new job under that scenario, the poll found.”