By Lambert Strether of Corrente.
ObamaCare needs no introduction, and so without further ado:
Counting ObamaCare Enrollees
I’m not going to play the numbers game, at least not for long. But here are the numbers anyhow! From the New England Journal of Medicine:
[N]umerous factors, including the economy, survey sampling error, and preexisting trends, can affect estimated rates of Americans without insurance. More generally, the systemic changes brought by the ACA pose a particular challenge for identifying the effect of the law, owing to the lack of a control group
As I kept saying, the numbers are soft. More:
We used three approaches to test for associations between the ACA open-enrollment period and coverage changes, using the largest national daily poll on health issues, the Gallup–Healthways Well-Being Index (WBI). ….
Combined with 2014 Census estimates of 198 million adults 18 to 64 years of age,19 this corresponds to 10.3 million adults gaining coverage, although depending on the model and confidence intervals, .
Wowsers, that’s quite a range! Anyhow, the all-important headline reads “Study Estimates 10 Million Americans Gained Health Coverage” so, whatever. Now, if you step back a minute, you’ll see the Alice in Wonderland quality of so much of the Obama discourse. Think about it: Would we be determining the number of Social Security recipients on the basis of a Gallup Poll with a ginormous margin of error? (Not ’til it’s privatized, anyhow.) Would we be making policy decisions on that basis? How about the number of troops in the Army? No? And yet this seems perfectly normal for ObamaCare.
For my part, I think playing the numbers game was just as silly as betting on the collapse of the ObamaCare website. I believe there should be equal access to health care for all, and so the fact that ObamaCare helps some people is just proof that it doesn’t help all, equally. Why is the random delivery of government services considered praiseworthy? So, to me, the entire “debate” presents the not especially edifying spectacle of the Republicans painting themselves into a corner by depicting RomneyCare as a socialist plot (I wish!), while the Democrats throw thousands of people under the bus while piously proclaiming their policy bona fides and good faith. And the health insurance companies laugh all the way to the bank.
Halbig v. Burwell and King v. Burwell
And I’m not going to talk about Halbig v. Burwell or King v. Burwell (which say that ObamaCare policies purchased through state exchanges either cannot, or can, be subsidized, respectively, depending on whether the actual text or putative Congressional intent determines the interpretation of the law). If the Roberts Court wants to scratch out “cat” and write in “dog,” because they feel Congress intended “dog,” they have the prerogative, bless their hearts, so there’s no point fussing. Which won’t prevent people from doing just that! And fortunately I’m not the judge who has to figure out the impact of Pelosi’s famous statement that “[W]e have to pass the [health care] bill so that you can find out what’s in it.” First, with Halbig and King winding their way up to the Court, Pelosi’s words have come true in ways that we never dreamed of. More importantly, if we take Pelosi at her word, is it even possible to determine Congressional intent? And although I like Sarah Kliff’s work, determining Congressional intent by reading columns in WaPo seems like a very odd suggestion indeed. For starters, why WaPo? So where do we look to determine intent?)
Flexian and Corporate Corruption
And I don’t want to talk about corruption. I don’t want to talk about the kind of corruption where neo-liberal Flexians infest public policy and private enterprise, shaping both to their ends. But Donna Smith does:
Remember Liz Fowler? She was the WellPoint executive who took a brief sabbatical from her direct paychecks from the private health insurance industry to write the Affordable Care Act while working for Senator Max Baucus. Once that project was wrapped up, Liz went to work briefly for the U.S. Department of Health and Human Services as she transitioned her way back to work as a lobbyist for health industry giant Johnson & Johnson. [Actually, Fowler visited the White House, too, to meet with at least one stock picker.]
I met with Fowler once in Washington, D.C. I was part of a delegation of people hoping to be heard on single-payer, improved and expanded Medicare for all for life health care reform, and she had the most sincere, concern-filled gaze I had ever seen in D.C.
But Fowler’s not the only one. Smith continues:
Now, in Colorado, we’re seeing Patty Fontneau, the CEO of the health insurance exchange, making her departure to return to private industry. Fontneau will take a position as president of health insurance giant CIGNA’s private exchange business. Prior to heading up the exchange, she worked for a law firm and in finance. No doubt her new role at CIGNA will provide her an income that supports the lifestyle to which she became accustomed while earning nearly $200,000 annually (plus bonuses) as the head of the Colorado exchange. It’s a safe bet she never had to apply for or worry about any tax credits or subsidies to cover her own health insurance premiums.
No doubt Fontneau’s gaze was sincere too. If you can fake sincerity, you’ve got it made. Smith concludes:
It is an affront to the basic common sense of most Americans and Coloradans to ask us to think that executives like Fowler and Fontneau have not been rewarded for their loyalty and success in protecting the big business interests that drive our health system.
It’s the genius of our Federal system that every state exchange provides a niche for Flexian infestation. And I want to talk about institutional corruption even less than personal, though Bob Laszewski’s come up with a doozy. We’ll go to the Obots at Kos for the spin — “Good Obamacare news: UnitedHealthcare jumps into market” — but Laszewski actually knows what he’s talking about:
United’s strategy of laying back a year letting the other guys pick-up the first year sick people and then making sure in 2015 to be able to keep and compete for the more healthy pre-Obamacare legacy business looks like a very savvy underwriting move to me.
The new health law does contain a risk adjustment system that is supposed to discourage any risk selection strategies by insurers. But if the experience with risk adjustment in Medicare Advantage is any indication, there is plenty of room for improvement.
I am sure UnitedHealth will now get plenty of plaudits from the administration and Obamacare supporters for expanding their public exchange presence arguing this announcement is proof of the new law’s sustainability. So, on top of being a savvy underwriting move it will also turn out to be a shrewd political move for UnitedHealthcare––a division of United is also the Obama administration’s lead federal health insurance exchange contractor. [And what a job they did!]
Think about it. They implement an old-style underwriting/risk selection strategy and the Obamacare supporters applaud them for it!
Savvy and shrewd.
Sounds like something out of Netflix’s House of Cards.
Indeed. Face it, ObamaCare isn’t really care at all. Like all insurance, it’s a financial product. And it’s part of Obama’s genius — he really is the more effective evil — that he’s managed to turn an entire political party into a sales tool for the FIRE sector. And guaranteed them a market, too!
Nancy Pippenger and Marcia Perez live 2,000 miles apart but have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers.Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions start to use the coverage they signed up for this year through the new federal and state marketplaces.
Note that there’s really no easy way to get an overview of ObamaCare problems even when they’re on the scale of (potentially) “millions.” The reporting system is fragmented across all the exchanges and two levels of government. Complaints will be routed to the individual insurance company, or possibly navigators, or state insurance regulators. And “No results found for PPACA +ombudsman” (Readers?) If we want to track complaints that people have with ObamaCare’s products and services — and if you’re a Democrat in an election year, why would you want to do that? — we’re orders of magnitude worse off than we are with taking a simple headcount of ObamaCare enrollees. ObamaCare, as a system, isn’t even architected to do the job. So who do we outsource job over to? Gallup again? J.D. Power? Obama For America?
The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect.
“It’s totally different,” said Pippenger, 57, whose new Anthem Blue Cross plan doesn’t pay for any care outside its network, although the job-based Anthem plan she had last year did cover some of those costs. “To try to find a doctor, I’m very limited. There aren’t a lot of names that pop up.”
Consumer groups argue many enrollees were misled. In California, consumers filed class-action lawsuits against some insurers, alleging they were given inaccurate information about their plans’ limitations and about which doctors and hospitals participate in them.
And, as we warned, the narrow networks put citizens at the financial risk that ObamaCare was supposedly designed to avoid. Patients can either go out of network by accident (or through being gamed by hospitals) or because their network doesn’t offer care they need or because of emergency:
Going out of a managed care plan’s network often means patients foot the entire bill, which can be financially devastating in cases of serious illness. In other types of insurance plans, a portion of the out-of-network bill might be covered, but consumers still face sharply higher costs than if they see a network provider.
The Democrats and the Filibuster
Finally, I’m going to skip over cherry picking by health care “sharing ministries,” an obvious way that insurance companies can game refunds to “consumers” under ObamaCare’s 80/20 rule, the reaction of New York “consumers” to rate increases, automatic renewal screwups, and how those pesky back-end 834s (here) are still FUBAR, at least in Connecticut. (For tech dudes and dudettes, this is unconscionable.) But I’m saving the best for last! Brett LoGiurato in Business Insider has an amazing catch that, alas, he does not see the implications of:
How Harry Reid Might End Up Saving Obamacare
Democratic Senate Majority Leader Harry Reid might have saved Obamacare by going “nuclear.”
Last November, Reid pushed the button on the so-called “nuclear option,” dramatically changing Senate filibuster rules to get more of President Barack Obama’s judicial and executive nominees approved. Reid’s rule change allowed Obama’s nominees to be approved by a simple majority vote rather than with the support of 60% of senators, which prevented the Republican minority from blocking the president’s picks.
And it turns out, Reid’s maneuvering might become the White House’s most effective weapon as it faces the most serious legal challenge to the Affordable Care Act in more than two years.
“It’s the first big case where the effects of the nuclear option could be felt,” one Senate Democratic aide told Business Insider last week.
Here’s how Reid’s senatorial nuke could theoretically save Obamacare. Last week, a three-judge panel on the D.C. Circuit Court ruled that a 2012 IRS regulation that implements key subsidies under the law is invalid, in the case of Halbig v. Burwell. The decision has the potential to affect more than five million people who have been given tax credits when purchasing health insurance through the federal exchange.
But the Department of Justice is appealing the panel’s decision, requesting an “en banc” review by the full D.C. Circuit Court. The math for the Obama administration is better in this situation — the court splits 7-4 in favor of Democratically appointed judges, because of Reid’s rule change.
(I’m going to pause for a moment to give the mealy-mouthed yet somehow reptilian Reid a moment to savor the hagiography he must so rarely receive. [pause]. All done!) If Reid — and here we’re entering the Alice in Wonderland world once again — could invoke the nuclear option in 2013 to get a few judges on the bench to save the mountainous labor and mouse-like results of
RomneyCare ObamaCare, then why couldn’t he have invoked the nuclear option in 2009 for single payer, when the Democrats had a mandate for “hope and change,” controlled both houses of Congress, were led by a charismatic President universally hailed as the greatest orator of the age, and could have saved thousands of lives and hundreds of billions of dollars? A question that answers itself, once you ask it.