Wednesday, March 14, 2012

When ObamaCare Becomes NanoCare

I bet you didn't see this one coming: the Affordable Care Act is not going to be covering nearly as many people as originally thought. Since it was passed on the assumption that employers would be purchasing much of the mandated private insurance for workers, and millions of jobs have been and continue to be lost, the Congressional Budget Office now estimates that two million fewer people will be covered by 2016. More than 27 million Americans will still be uninsured four years from now. That is, if the Supreme Court rules favorably on the constitutionality of forcing people to purchase products from private vendors. 

In theory, this revised government estimate should make the deficit hawk critics happy -- since so many people will be getting thrown under the bus, it will also cost about $50 billion less than originally thought, too. People not getting the medical care they need will actually help balance the federal budget. Hooray for austerity!

But not to worry, says the CBO -- more people than ever will be eligible for the state-administered Medicaid programs because poverty is going up, up, up. So if you live in a state like Texas, which hopes to opt out of Medicaid entirely, you might want to think about emigrating.

Still, the CBO report goes on, the number of employers expected to pay penalties for noncompliance with the law is expected to increase, as are the individuals having to pay fines because they lack insurance. (That part is confusing. I am guessing that after the uninsured pay their fines, they can then qualify for Medicaid. Eligibility requirements for Medicaid are supposed to be looser once the law kicks in. And meanwhile, the Obama Administration is gifting Scrooge employers like WalMart and McDonalds with waiver after waiver after waiver. What an unholy mess). 

The CBO, to its nonpartisan credit, also takes note that American wages continue to stagnate. Therefore more children of struggling parents than expected will be eligible for the government-subsidized CHIP program. The CBO simply hadn't dreamed that one in four American children would be thrust below the poverty level when they started crunching their numbers two years ago in Obama's misguided effort to make his delayed health care plan deficit-neutral.

Julian Pecquet of The Hill offers a summary: 
The combined effects of the revised estimates over the 2012–2021 period add up to:
■ An increase of $168 billion in projected outlays for Medicaid and CHIP;
■ A decrease of $97 billion in projected costs for exchange subsidies and related spending;
■ A decrease of $20 billion in the cost of tax credits for small employers; and
■ An additional $99 billion in net deficit reductions from penalty payments, the excise tax on high-premium insurance plans, and other effects on tax revenues and outlay, with most of those effects reflecting changes in revenues.
As I laid out in a previous post, the Supreme Court will hear arguments on the individual mandate in less than two weeks. The libertarian Koch Brothers are transporting busloads of "Keep Your Hands Off My Healthcare" astroturfers to demonstrate against the ACA, and the Obama administration is "facilitating" counter-demonstrations, even prayer vigils, to keep its behemoth of a signature accomplishment alive. Now that the CBO has estimated that the law is becoming ever more unwieldy because of the reality of the crappy economy, will the Court be that much more inclined to strike down the individual mandate? Without the provision that we all be forced to buy policies from insurance leeches, the whole law is kaput.

Obama blew it when he abandoned the single payer option. If he had really wanted to, he could have forced it through Congress via the reconciliation tactic.  So, while a declaration of unconstitutionality may be a blow to those lucky few people now benefiting from the measure, it will be a blessing in disguise to most of us. Almost two-thirds of those polled have expressed a preference for a Medicare for All program.

As former Labor Sec. Robert Reich puts it when making the case for Single Payer, nobody from either left or right would object to a payroll tax deduction, which is how it would be paid for. No court has ever struck down a payroll tax as being unconstitutional. Reich says:
Other federal judges in district courts - one in Virginia and another in Florida - have struck down the (ACA) law on similar grounds. They said the federal government has no more constitutional authority requiring citizens to buy insurance than requiring them to buy broccoli or asparagus. (The Florida judge referred to broccoli, the Virginia judge to asparagus.) Social Security and Medicare aren't broccoli or asparagus. They're as American as hot dogs and apple pie.


Will said...

"What an unholy mess."

So true, Karen. It's about an hour later, and my brain still hurts a little after slogging through just your excellent synopsis of the revised CBO report.

Quick note: The thoughtful and measured responses to DW's comments in the last post ("Fear, Loathing....") did NOT hurt my brain. In fact, they were exactly the kind of stuff that keeps me coming back for more here "in the salon of Sardonicky." God I love this place.

One more thing. I'm sure many of you already visit the Vast Left-Wing conspiracy blog, but the comics have been so hilarious lately I have to post the link for those who haven't experienced them yet:

Denis Neville said...

Now that’s change we can believe in!

We continue to lead the developed world in health care injustice and our health care system is the most expensive in the world.


The Affordable Care Act was written by and for the private health insurance industry.

The HHS rule on the state insurance exchanges to be established under the Affordable Care Act hands control to private insurers! The HHS rule on the governing board composition states that “representatives of health insurance issuers, agents, brokers, or other individuals licensed to sell health insurance may not constitute a majority of the governing board.” The private health insurance industry can occupy up to one-half of the seats on the governing board. Conflict of interest? HHS’s response, “We believe that further definition of conflict of interest may create inconsistencies with State law and other existing State standards.”

In Kansas, Republican Gov. Sam Brownback is planning to let for-profit managed health care companies run the Kansas Medicaid program. Kansas Medicaid beneficiaries, long-term care for the elderly, disabled and mentally ill, will go into risk-based managed care plans run by three out-of-state, large, for-profit companies. Trust them not to cut services and to put to put patient’s health care needs ahead of profits?

Hooray for profits for them! Hooray for austerity for the rest of us!

Jay - Ottawa said...

Single Payer or Medicare for All would cost less, improve health for all and run so much more smoothly than the Rube Goldberg ACA -- or the hodgepodge payment system that now exists for the diminishing class of more-or-less lucky people adequately insured by profit-making interests.

That Single Payer is vastly superior to ACA is provable with eyeshades and computers that can count, as well as through the experience of other countries. Want to check the math and the detail for yourself? Give this site a good look:

Why didn't such calculations and experience nail down Single Payer as a no-brainer for the US decades ago? What stood in the way?

The Private Health Insurance Industry. Duh.

Guaranteeing the continued malfeasance (on an expanded scale) of the Private Health Insurance Industry through Obamacare is about as stupid as was bailing out Wall Street. When will the middle class tire of handing its money over to the rich? What's in it for us, if it's not too impolite to ask? What's the point of rewarding criminals and incompetents, unless of course you're on the take yourself?

What should the US do with the Fifth Wheel of the Private Health Insurance Industry, if ever Single Payer becomes fact? (Ha! That'll be the day.)

a) Throw it under the bus where it belongs?

b) Develop a training program to qualify its over-bonused executives in more productive and socially useful lines of work?

c) Retrain thousands of its benefit-denying desk workers into bedside clinicians? (For example, we are short tens of thousands of RNs and the shortage is getting worse.)

d) Just give the whole lot of them six months of unemployment insurance and a CD of Bob Dylan singing "Like a Rolling Stone" over and over?

How does it feel
How does it feel ....

The Black Swan said...

I thought I would share a recent experience I have had with our HealthCare System. I am in my 20's and was on my parents insurance policy until I turned 26. I was in school and unemployed and did not sign up for my own health insurance. The cheapest plans for catastrophic care start at around $89/month and have deductibles around $5000. This is a lot of money when you are a poor student. Unlucky for me, I broke my leg over the winter. My total medical bills are around $80,000. This includes surgery and 3 nights in the hospital, plus an ER visit, physical therapy and medications. I could have gone and had this surgery done in Spain for $12,000 plus airfare! Trust me on this, I priced it out and contacted surgeons over there. Now I am lucky, or not, that my financial destitution qualifies me for all sorts of charity care and with a little luck I will get almost all of my medical bills written off.

Take what you want from this story. I just thought I would put it out there to let people know just how outrageously expensive medical care is. They may have put my leg back together, but the financial cost could ruin me for life.

There is no option but single-payer Medicare for all. Anything else is pillaging the ill for the benefit of billion dollar corporations.

Karen Garcia said...

@Black Swan,
I hope your leg is better. It's fine to be a medical tourist if it's a non-emergency, but what can you do with a broken leg? I imagine getting through TSA security would be the pits. They would probably saw your cast off before letting you on the plane.
What a country.

Kat said...

I'm going to have to say that I think it would have been the right time to pass single payer. The right would have had a field day with that. I'm of the mind that things are going to have to get worse before they get better. I am sorry that Obama wasted political capital with health care "reform". We did end up with an unholy mess. ACA made things worse than doing nothing. We need all sorts of reform to our health care system and single payer is just one part of that.

James F Traynor said...

@Black Swan

Geez! Sorry about your leg. This country is a mess.

Valerie said...

Yes @Black Swan - things are far more expensive than they have to be in our medical system – a good portion of it being administrative costs and the hospitals trying to capture as much insurance money as possible. I relayed, in a distant past comment, taking my daughter on a Sunday to the emergency room for a bladder infection. Seriously, the test for this - in case you are a man and don't know this - is to pee in a cup. The nurse then puts a stick in the cup and can tell whether or not there are bacteria present. We spent four hours in the hospital seeing three people who took our insurance or other details, three or four nurses who took blood pressure, temp, etc., and finally a doctor – who, fairly enough, checked for abuse. My insurance was charged $1500.

My point is why couldn't a nurse have handled this? If (s)he found anything wonky the nurse could have THEN called in a doctor. It was the same when I cut my hand with a butcher knife while cooking and anther time when I was bitten by our dog. Huge waits, nothing complicated that required a doctor - stitches and a tetanus shot - and each visit costing between $1000 and $2000 dollars.

There are so many ways our medical system could work more efficiently and charge far less.

Kat and Anne are both nurses, I believe. You both must be totally frustrated having to work within such an inefficient system.

And this doesn't even address the reality that so many people won't go to a hospital at all because they don't have insurance and therefore won't go to the hospital for fear of the cost. If a broken leg costs $80,000 what do uninsured people do when they feel pains in their chest? or find lumps in their breasts? I will tell you what I would do, stay at home and hope for the best rather than burden the family I love with hundreds of thousands of dollars of hospital debt. You can bet plenty of uninsured people in their fifties and older do exactly that in America.

But I guess the uninsured and working poor or unemployed are non-persons so they don’t count.

And we think of ourselves as a First World Country. This alone is a shocking testament to how unfettered capitalism is an inhumane system.