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PPACA Links: 2013-07-24

Readers, this should have been Monday, but with painting and other things to do, my schedule has gotten a little out of control. --lambert

Immigrants Contributed An Estimated $115.2 Billion More To The Medicare Trust Fund Than They Took Out In 2002–09 Health Affairs, July 2013

In 2009 immigrants made 14.7 percent of Trust Fund contributions but accounted for only 7.9 percent of its expenditures—a net surplus of $13.8 billion. In contrast, US-born people generated a $30.9 billion deficit. Immigrants generated surpluses of $11.1–$17.2 billion per year between 2002 and 2009, resulting in a cumulative surplus of $115.2 billion. Most of the surplus from immigrants was contributed by noncitizens and was a result of the high proportion of working-age taxpayers in this group. Policies that restrict immigration may deplete Medicare’s financial resources.

Countdown To The Health Insurance Marketplaces: Four Actions Essential To Success Health Affairs, 2013-07-08. Note that the administration has adopted a diametrically opposed campaign strategy.

We recommend four actions that policy makers should take to promote the success of the marketplaces, the structured exchanges where consumers will shop for health coverage under the ACA. Some of these actions can be implemented before the October 1 launch date, while others will need to be initiated now to bring about changes needed by 2015 and 2016.

  1. The marketplaces must disallow unreasonable prices from insurers.
  2. A unified national campaign should be launched to attract a broad pool of marketplace enrollees.
  3. Consumers receiving advanced premium tax credits to purchase insurance should be protected from unanticipated tax liability for the first two years of operation, so that the marketplaces attract as many people as possible.
  4. New non-profit consumer-run insurance plans (CO-OPs) sponsored by the ACA should have funding restored. This would enable more CO-OPs to enter the market in 2015 and 2016 to help hold down prices in the 26 states where they do not yet exist. In addition, the Office of Personnel Management (OPM), responsible for contracting with at least two “national plans” to enter each state to spur competition, should focus on developing networks of smaller plans to serve as national plans in 2015; this would avoid giving greater market share to dominant insurers.

43% Believe that US Health Care is Corrupt, 64% that Government is Run by a Few Big Interests, Media Shrug Health Care Renewal, 2013-07-10

More than one-third (43%) of [Transparency International] respondents thought that US health care is corrupt. …

For comparison, the proportions of people who thought the health care sector is corrupt were 24% in Canada, 28% in France, 48% in Germany, 47% in Japan, and 19% in the United Kingdom.

Friends with Benefits, Insureblog 2013-07-15. Walking around money.

[Among others:] The advertising firm Porter Novelli was founded by William D. Novelli, who was the CEO of  AARP from 2001-2009. Catherine “Kiki” McLean is a senior partner and managing director of Porter Novelli.  She is a Democratic Party operative who worked for the campaigns of Al Gore, John Kerry, and Hillary Clinton, as well as the 2008 presidential campaign of Barack Obama.  McLean was hired by Porter Novelli in June of 2009. Since 2010, Porter Novelli has been awarded $49 million in HHS contracts.

Health Insurance Marketplace by State Commonwealth Fund

[Handy interactive map.]

Health Insurance Exchanges and State Decisions Health Affairs, 2013-07-18. Neutral evaluation of the state of play.

Although GAO and others have questioned exchanges' ability to be fully operational in time for open enrollment, particularly given the compressed time frame in which exchanges and supporting infrastructure are being developed, HHS maintains that exchanges will be ready on time. Key milestones to be completed in the months before open enrollment include testing state and federal information technology systems, certifying plans, and training and certifying navigators and in-person assisters.

Are the Wheels Coming off the ACA Wagon? History Suggests Not Center on Health Insurance Reforms 2013-07-18

These early decisions by the Bush Administration to delay, modify, or phase in policies required by the law were by no means indicators that the Medicare Part D program would fail. On the contrary, they demonstrated that when problems arose – as they inevitably did – federal officials were willing to use their authority to implement the law with flexibility and to delay enforcement of certain requirements to ease the transition for beneficiaries and health plans alike. That early flexibility paid off. Eight years after its launch, the Medicare Part D program is widely popular among the public and, more importantly, it is helping seniors obtain access to life-saving drugs. …. These early decisions by the Bush Administration to delay, modify, or phase in policies required by the law were by no means indicators that the Medicare Part D program would fail. On the contrary, they demonstrated that when problems arose – as they inevitably did – federal officials were willing to use their authority to implement the law with flexibility and to delay enforcement of certain requirements to ease the transition for beneficiaries and health plans alike. That early flexibility paid off. Eight years after its launch, the Medicare Part D program is widely popular among the public and, more importantly, it is helping seniors obtain access to life-saving drugs.

Consumers In Most States Unlikely To See N.Y.’s 50 Percent Reduction In Premiums In Individual Market  Kaiser Health News, 2013-07-19

New York’s announcement this week that insurance premiums would drop 50 percent next year for individuals buying their own coverage in new online marketplaces made good talking points for proponents of the health law, but consumers in most states are unlikely to see similar savings.

That’s because only a handful have New York’s rules, which like the federal law bar insurers from rejecting people with health problems. Unlike the federal law, however, New York does not require consumers to purchase coverage, so over time, mainly older, sicker people, have purchased coverage. That drove up prices and discouraged younger, healthier people from buying policies, as did a requirement that insurers charge the same rates regardless of age or health status.

"ObamaCare" Small Ball––The Republicans Are Winning the Battle Over the Big Idea Health Care Policy and Marketplace Review  2013-07-21

It shouldn't be a surprise that this administration, now buried in the minutia of injecting an extraordinary amount of micro management into a sixth of our economy, would think a $100 rebate for someone already paying thousands of dollars in health insurance premiums would be a major accomplishment.

GOP support grows to force shutdown over funding ObamaCare The Hill, 2013-07-22

Sen. Mike Lee (R-Utah) said he’s recruited more than a dozen Senate Republicans willing to shut down the government to prevent President Obama’s healthcare law from going into effect.

Lee said the Republicans would block a continuing resolution to fund the government beyond Sept. 30 if it includes funding for ObamaCare.

Lee acknowledged that certain parts of the law were popular, such as coverage for pre-existing conditions and children being able to stay on their parent’s coverage until they’re 26 but said that since these parts had already been implemented, Republicans weren’t looking to do away with them.

Majority of employers already in compliance with ACA mandate Health Reform Talk, 2013-07-22.

The majority of employers (56 percent) said that they are already in compliance with the employer mandate under the Patient Protection and Affordable Care Act (ACA), according to recent research from PricewaterhouseCoopers (PwC). … Overall, 72 percent of private companies said that they were prepared for the ACA's next wave of requirements, but only 35 percent said that they were well prepared.

Phillip Caper, The end of Obamacare? Think again Bangor Daily News, 2013-07-22

Despite its serious flaws, Obamacare has benefits, some intended and others not. One major barrier to reform of our health care system has been apathy on the part of people who already have good health care coverage (“I’ve got mine”) or who have been lucky enough not to need health care (the young and healthy), and are therefore unaware of our system’s many problems. That’s about to change. Due to its requirement that as many people as possible have health insurance (the individual and employer mandates) the apathetic population is about to become dramatically reduced. Like it or not, many more people in the U.S. are about to become engaged in the health care system.

Q & A – Early Implementation of MAGI 2013-07-23

The Affordable Care Act (ACA) requires all states to implement the new income counting methodology, Modified Adjusted Gross Income (MAGI) , for applicable Medicaid eligibility categories beginning January 1, 2014. To help facilitate the transition to MAGI, CMS issued guidance allowing states to implement MAGI on October 1, 2013, coinciding with the beginning of open enrollment in the new health insurance marketplaces (exchanges). The following addresses questions and concerns regarding the early implementation of MAGI.

Q 1 . Why should a state implement MAGI early?

A. Early implementation of MAGI will simplify and streamline state Medicaid eligibility processes. During the open enrollment period from October 1 to December 31, 2013 , states must screen applicants for eligibility for insurance affordability programs using two different sets of rules - the state’s existing Medicaid rules to determine who is immediately eligible , and the new MAGI rules to identify those eligible January 1, 2014. By implementing MAGI early, states can use just one income counting methodology for all new applicants . Early implementation will also ease the transition by allowing states to operationalize new systems before the influx of new applicants expected when new coverage options become available in January 2014.

OFA embraces tea party blueprint for August push Politico 2013-07-23

OFA’s preparing a range of under-the-national-radar tactics in conjunction with heading for town halls. Rallies, distribution of fliers and district office demonstrations will be aimed at drawing the same sort of local attention that tea party groups managed four years ago, hoping to spook members of Congress worried about the 2014 midterms.

[T]he group has grown more quickly than even its leaders anticipated, raised millions of dollars and hired 26 state directors, but they’re still building support staff and volunteers out in the states. Even at the meeting on Monday night, a call from Planned Parenthood Action Fund President Cecile Richards to get involved in Arkansas revealed that none of the prospective action leaders in the room actually lived in the state (though one woman in the crowd shouted that she used to live there).

They’ll begin Aug. 4, marking the president’s birthday with a day of events organized to promote the benefits of Obamacare.

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Rainbow Girl's picture
Submitted by Rainbow Girl on

HHS (presumably an agency that exists to promote health care) awards $49 million in 3 years to Porter Novelli -- an advertising agency.

Only in a rentier-captured health care system does the federal health agency have a budget for advertising (!) that exceeds Zero dollars.

Walking around money indeed. And it's OPM (our tax money), so it's easy for the givers to slosh it around to friends and cronies who add zero value to the purported "core mission" of HHS.

Rainbow Girl's picture
Submitted by Rainbow Girl on

The young, healthy and uninsured are now negatively tagged as the "apathetic" class. Funny how under "Free Markitz" theory their refusal to purchase private insurance is the optimal and most rational decision (and one to be praised).

But in the perverse monopoly-market logic of ObamaCare, these same rational actors, are now "apathetic" ... in the sense that they did not feel a moral duty to buy overpriced crap products just because it would help insurance companies' bottom lines.

Also, "apathetic" -- strikes me as kind of an insulting nickname to tag the very demographic that Obama most desperately wants to reel in as consumers of O'Care. I'm a zero in marketing and advertising, but this seems like a bad idea (from Enroll America's perspective).

Submitted by lambert on

So he's definitely not doing market segmentation work for ObamaCare. Also, here's what Caper writes:

apathy on the part of people who already have good health care coverag

("I've got mine," which is funny, because I've been saying it for years).

The "national conversation" will definitely change; I agree with Caper.

Rainbow Girl's picture
Submitted by Rainbow Girl on

... he labels as "apathetic" those who are currently with good insurance and those who are healthy enough not to need it.

"has been apathy on the part of people who already have good health care coverage (“I’ve got mine”) or who have been lucky enough not to need health care (the young and healthy), ..."

Caper has bought into the PPACA is progress "but we have a long way to go." He does not question the mandate, he does not question the private insurance framework for ObamaCare, etc. If Maine AllCare is an insurance company (I don't live in Maine) then everything he says falls neatly into place, and Caper's moralizing and patronizing tone about those who have been "apathetic" (i.e., insufficiently "civic minded" to realize "everyone has to buy insurance to make it work" -- barf) makes perfect sense.

I did wonder if he grabbed "I've got mine" from you. Except for him it denotes the selfishness of people who don't "participate" in the insurance market as opposed to the selfishness of the Career Progressives and Creative Classes (which I think is how you use the expression).


Rainbow Girl's picture
Submitted by Rainbow Girl on

... then the "apathetic" meme (as used in the posted article) is even more surprising. I assumed that given its single-minded focus on Universal Public HealthCare (Medicare for All) PNHP (or its chapters) would categorically avoid involvement in Obama's fraudulent campaign to coerce people into buying insurance (as opposed to health care). Calling out young and uninsureds as "apathetic" because they're not rushing to shell out earned income on the ACA crap seems to me perilously close to helping out Enroll America in targeting the actuarially necessary consumer base ....

Submitted by lambert on

I didn't have insurance until I was well over 35 -- never gave it a thought, never mind I couldn't have afforded it. I suppose I could call myself apathetic. I know there are polls saying young people who don't have insurance feel it's very important and would buy it if they could, but, ya know, pollls.....

Rainbow Girl's picture
Submitted by Rainbow Girl on

I just think there isn't/wasn't a darn thing wrong with people into their 30s or 40s if they were super healthy to forego insurance which -- in this 4-decade period of stagnating/declining wages -- became more and more of an unaffordable luxury to may in this demographic who weren't getting insurance from their employer(s).

That's what irks me about Caper's pretty out-there judgmentalism against that very demographic, as if they had been violating a civic duty so far by not buying insurance and now -- by Gum -- they're gonna hafta deal with it and "grow up."

So that's the extent of my peeve, really. I don't think I'm over-reading; just reacting to what Caper is clearly saying. Hey, maybe the guy had a deadline and he didn't mean what he seems to have said/meant. Seems possible, given that he's involved with a PNHP affiliate.

We can put this one to bed now! :) :)

Alexa's picture
Submitted by Alexa on

article is "conservative" or "Third Way" in its lingo.

I take it that the following is Caper's description of himself:

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all.

This is another example of why we need to define "the left."

Is "the left" best described as actual "liberals" (along the lines of a Howard Zinn, etc.)?

Or, are we talking about conservative/corporative, so-called "progressives"--that make up most of the blogosphere.

One of my main objections to the PPACA, is the mandate.

Remember, Medicare has NOT been "mandated."

You make a program decent enough (which we should), and there's no need to do so.

So, I pretty much know where you're coming from, and don't much care for that characterization.

I've had insurance all my life (except a little over a year), and did without as a very young person to afford at least SOME health insurance coverage. Before I went up in the ranks (federal service), we actually carried a policy that didn't include major medical at all--only hospital costs.

IOW, we did the best that we could,at that time. Would Caper have called us "irresponsible" or "apathetic" when we were just starting out because we didn't carry better coverage?

Caper's self-description is almost identical to the language that was in the DLC "Middle Class" Plan that Hillary and Carper wrote in about 2006. Check it out (I linked to it) in my comments from this past week. ;-)

Submitted by lambert on

Here is PNHP's mission:

Our Mission: Single-Payer National Health Insurance

Maine AllCare Report to PNHP:

In early September, we have scheduled a strategic planning retreat to assess our progress to date, and to chart a course forward to 2017, when we hope to position Maine to be one of the states to put a universal, not-for-profit health care system in place as part of the waiver authority of the Affordable Care Act.

Caper in the Bangor Daily News, Dec 2012:

A single, publicly financed and managed health care system will permit us to create a fair, unified, simplified and enforceable budget for all health care in Maine, while at the same time reducing our intrusive management of individuals’ health care decisions. It would give everybody in Maine a stake in seeing to it that the system that includes everyone works well for everyone.

As I’ve written before, Obamacare is in some ways a step in the right direction, but it’s far more complicated than need be and will not be as effective in constraining health care costs as it must be. But it does contain provisions that would permit Maine to set up a program that would provide the tools to manage the competing claims and objectives of different stakeholders. We could simultaneously improve access to care, the quality of care, and restrain the rise in costs for everyone in Maine.

Legislative testimony:

I am Dr. Philip Caper. I am here today to testify in favor of LD 1397 - An Act To Establish a Single-payer Health Care System. I am on the board of Maine AllCare, a non-partisan, non-profit group committed to educating policymakers and the Maine public about how to improve upon the Patient Protection and Affordable Care Act (PPACA). Our goal is to make health care in Maine universal, accessible and affordable for all.

If advocating for single payer be Third Way-ism, then have at it, say I.

Alexa's picture
Submitted by Alexa on

I've even seen or heard of.

I realize that a lot of progressives like ObamaCare. I don't.

I am convinced that it was enacted to make certain that we NEVER arrive at a system like MFA. That's all that I was saying. And I've never made a secret of it that I don't agree with the "individual mandate."

There are several reasons. One of the main ones is that it serves as "Camel's nose under the tent," to enact federal mandates for a whole host of programs.

I've already posted video here regarding the discussion on "mandating" long-term health care.

Months ago I provided a link regarding making working Americans carry "unemployment insurance."

And Senator Tom Harkin produced a bill last year that would make mandatory "opt-in" for federal pension programs (for those not covered already).

And, of course, "health insurance" is already mandated in America.

Where does this end?

I'm wondering with a minimum wage of $7.25 an hour (still), and already 1 out of 2 people "poor or low income," what on earth "standard of living" will the bulk of Americans enjoy if Democrats continue their crusade to impose their "Opportunity Society" (DLC lingo) on folks who can barely get by. (BTW, IMO, this is just another way of saying "Ownership Society" (Bush), with a little more progressive tone.)

Why not actually tax the wealthy in a substantial way, and pay for these programs through redistribution?

Hey, I have no personal objection to Caper.

But someone whose mission is what is stated at the conclusion of his piece, does not sound like (to me) someone who is trying to enact MFA. No more than the Third Way/DLC/No Labels crowd advocates for MFA.

But, that's just my opinion. I could be wrong. It wouldn't be the first time. ;-)

Submitted by lambert on

... == Medicare for All. And if either PNHP or MaineCare for All get Third Way funding, I would be very surprised.

Which is why I think the sole focus on verbiage is a false positive, IMNSHO, especially give that I quote Caper's Op-Ed and his legislative testimony in favor of single payer (to which you do not respond).

One could also argue that Medicare for All is, by definition, a Federal program, and therefore there should be no efforts made to pass single payer programs at the state level. But I don't hear that argument being made, if it is.

Or one could argue that in seeking a waiver under ObamaCare for a single payer experiment in ME, Capet et al are taking the same road that VT is, and there's a case to be made that's the wrong road. (Though I would imagine the strategists have Alberta in mind). But I don't hear that argument being made either, if it is.

Alexa's picture
Submitted by Alexa on

the State Exchange (if they have one--thought they didn't, but truthfully, don't know), etc. That's why I limited my comments to his article.

My point being that his description

"Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all,"

sounds very similar to the quote from Hillary's Plan, "Saving The American Dream," that I recently posted here.

- Every family should have the opportunity to afford health insurance for their children, and the responsibility to obtain it.

During the so-called health care debate, many conservative Dems spouted off about marginally progressive health care solutions (Kent Conrad talking about "coops," etc., come to mind). In the end, it didn't amount to a pile of beans. And I no longer follow the topic closely.

But I am glad that you and a few other hardy individuals here have taken up the topic of the implementation of the ACA.

Submitted by lambert on

PNHP is a single payer advocate group. Maine All Care is a PNHP affiliate. Caper personally advocated for single payer in an Op-Ed (trust me, the Bangor Daily News is big here) and before the state legislature.

The verbal congruence is a false positive. That's why, as a question of method, you can't work from the words alone. You have to consider the words, the funding, the history, the policies.

Rainbow Girl's picture
Submitted by Rainbow Girl on

... According to those, he appears to be working towards a MFA (though he doesn't use the words?). I'm all the more puzzled as to why he expresses Actuarial Contempt for the young healthies in the non-employer/non-group coverage markets. Why would he be engaging on that theme at all -- as an MFA advocate, it seems illogical that he would be scolding people for improper actuarial behavior under the private (looting/scam) health "care" insurance system and its government-enacted extension PPACA (ObamaCare).

Submitted by lambert on

I've said what I have to say; interpret as you will.

Rainbow Girl's picture
Submitted by Rainbow Girl on

It's almost as though someone writing it has been closely reading Lambert's posts and our merry threads here at Corrente and pulled it together for AP.

Highlighting the reality that there's gonna be lots of "mail, faxes and emails" (as opposed to an Expedia experience), and then functionalities that aren't going to be there for various state systems or the federally managed ones -- e.g., no calculator giving you the real bottom line on cost (i.e., not just the premium, but all the other liabilities, e.g. deductibles, copays, "cost sharing", not covered ...) and also, e.g., one state won't let people plug in their doctors' names to immediately find out which insurance they accept (something that would be of enormous and determinative value to a purchaser).

The passive aggressive statement at the end -- by one of the people in charge of one of the "marketplace" rollouts -- is a classic. The only thing missing was: "Even though all these things will not be online by October 1, which is too bad, it still won't be a third world experience." (Which, frankly, is debatable.)