Charles Gaba's blog

Back in 2003, when the second round of the utterly unnecessary Bush Tax Cuts were doled out (jacking up the federal deficit for decades to come), I received my very own check from the IRS for something like $300 or so. I distinctly remember that it had, typed in the lower left-hand corner, "TAX RELIEF FOR AMERICA'S WORKING MEN & WOMEN".

As it happens, I donated the entire $300 to charity, since I had never asked for it and didn't want it. However, I always remembered the shamelessly partisan promotional nature of how it was done. A physical check with the actual dollar amount and a big, bold slogan referring to "relief" (the implication being, of course, that taxes are by their very nature a negative, awful thing which one needs relief from).

Little-Known Benefits of the ACA, Exhibit A:

When you think of the flu, the cost of getting sick probably isn’t the first thing that jumps to mind. But coming down with the virus can prove pricey.

A visit to the doctor’s office can run $80 to $100—or more. If you need to head to the ER on a night or weekend for care, the tab can easily total $500.

...The good news is that you probably don’t have to pay a penny for the best defense against the flu. Under Obamacare, a flu shot is free as long as you have health insurance (though plans that were in place before the law passed in 2010, known as grandfathered policies, are exempt). It’s one of the preventive services that insurers must fully cover without charging you a co-pay or co-insurance—even if you haven’t met your annual deductible yet. Under Medicare, you also pay nothing.

Little-Known Benefit of the ACA, Exhibit B:

Thanks to Margot Sanger-Katz for bringing this KFF study to my attention; Tricia Neuman has done an interesting study to try and predict how many of the appx. 7.3 million current ACA exchange policyholders are likely to make the move from their current policy to a different one (either through the same company or a different one).

She goes pretty deep in the weeds on some of it, but her takeaway is that, based on 3 other government healthcare programs (Federal Employee Health Benefits, Medicare Part D and the Commonwealth Care program in MA), it's likely that only about 7 - 14% of enrollees are likley to switch:

This is a rather awkward post for me, because it cuts to the heart of the main thing I don't like about the Affordable Care Act. As a single-payer advocate, and one who knows all too well the abuses by the health insurance industry in the past, I'm not exactly thrilled about this development. On the other hand, this news also shoots down Yet Another Talking Point® that FOX News/etc. have had about the law: That it would "ruin" the private insurance industry. The ACA has always been a strange hybrid of left-wing/progressive provisions (Medicaid expansion, tax credits to enrollees) and right-wing free market capitalism (the individual mandates and private, for-profit marketplaces). As such...

Even after the disastrous rollout of the web site a year ago, health insurance companies and providers of medical care are reporting more promising profits as third quarter earnings emerge.

The Halbig/King federal suit cases have been off the radar for awhile now, but they're still swirling around in the ether, and will pop up again sooner or later. While a final ruling (by the SCOTUS either taking up one of the cases or refusing to do so) likely won't happen until next summer or so, the insurance companies and the HHS/CMS Dept. are understandably concerned about the ramifications of the possibile outcome, so they've taken some steps accordingly:

The agreements to participate in the federally-facilitated marketplace (FFM) that CMS sent to issuers last week include a new clause assuring issuers that they may pull out of the contracts, subject to state laws, should federal subsidies cease to flow. CMS did not say if the clause is meant as a safeguard against the potential impact of various high-profile lawsuits -- including Halbig v. Burwell -- that could end up in the Supreme Court next year, but stakeholders assume that is the point.

Add Utah to the list of GOP-run states changing their tune on Obamacare:

Gov. Gary Herbert announced Thursday that after months of negotiations, he has reached a final agreement with the Obama administration on his novel alternative to expanding Medicaid.

"They are giving us more flexibility than has been given to any other state in America. We are breaking some new ground," Herbert announced in his monthly press conference on KUED.

Herbert said he soon will send to the Obama administration a letter outlining the agreement they’ve reached on Utah’s alternative, his Healthy Utah plan.

The deal would help low-income Utahns earning up to 138 percent of the federal poverty level who are not covered by Medicaid buy private health insurance plans.

From the sounds of it, it looks like this will be set up along the lines of the Arkansas "private option" program, which basically amounts to using Medicaid funding to cover practically 100% of the cost of private QHPs.

As we head into the final few weeks before the 2nd Open Enrollment period, it looks like MNsure is the only state which is left posting regular off-season enrollment updates. Things are definitely tapering off (only 113 new QHPs over the past 6 days & 3,294 added to Medicaid/MinnesotaCare), but that's still over 3,400 more people with coverage.

latest enrollment numbers 

October 22, 2014

Health Coverage Type Cumulative Enrollments
Medical Assistance 227,476
MinnesotaCare 78,321
Qualified Health Plan (QHP) 55,564
TOTAL 361,361

I wouldn't normally give much thought to the Daily Signal, seeing how a) it's an offshoot of the right-wing Heritage Foundation and b) the last time I analyzed one of their pieces it was this idiotic piece by Sharyl Attkisson. However, supporter Adam Goldstein asked me to check out their latest, so I did...and while it's heavily biased against the Affordable Care Act, I find it noteworthy that even these wingnuts are willing to concede that a) their own colleague, Ms. Attkisson, was pathetically wrong and b) the net reduction in the uninsured rate nationally thanks to Obamacare is actually off to a pretty good start:

Our analysis of the data is reported in more detail in our latest paper, but our key findings are that in the first half of 2014:

Well isn't this a breath of fresh air!!

WASHINGTON -- Democratic Sen. Jeanne Shaheen refused to shy away from Obamacare on Tuesday in the first televised debate of the New Hampshire Senate race.

Shaheen, one of several vulnerable Democrats up for re-election in November, forcefully defended the health care law moments after Scott Brown, her Republican opponent, said he would fight to repeal it. When specifically asked if Obamacare was a proud achievement, Shaheen responded, "Absolutely."

"I think making sure that almost 100,000 people in New Hampshire have access to health care is real progress for people in this state," Shaheen said.

Good for her!

Many Republicans are caught in a quandary when it comes to the Affordable Care Act. They hate the fact that a black Democrat implemented their own law nationally, they hate poor people getting healthcare coverage at little cost to them and they hate middle-class people getting healthcare coverage at a price they can afford. However, they love getting elected/re-elected. So, what's a good Republican candidate to do?

Well, for Mitch McConnell, many GOP Governors and other Republican candidates, the answer seems obvious: Repeal the Affordable Care Act nationally while at the same time changing the laws at the state level to increase eligibility to the same 138% FPL (Federal Poverty Level) threshold included in the ACA.

Ohio Republican Governor John Kasich, folks:

Gov. John Kasich of Ohio said his comments about a Republican-led Congress being unlikely to repeal the Affordable Care Act — which commentators on the right and left pounced upon Monday — were taken out of context.

...Mr. Kasich, referring to repealing the Affordable Care Act, was quoted as saying “that’s not gonna happen.”

...“I’ve always thought if we got a majority we would repeal Obamacare,’’ he said. “My only point was they’d probably make an accommodation for Medicaid expansion.’’

...It is an open question how expanding Medicaid benefits as generously as the Affordable Care Act allows, to adults earning up to 138 percent of the poverty level, could be paid for without increased taxes and Medicare cost reductions also created by the health care law.

...“I’m in favor of repealing Obamacare,” he repeated. “That’s all I can tell you.’’

Well, let's see here.

Last week the "Healthy Michigan" program (our name for Obamacare Medicaid expansion) had reached around 415,000 enrollees. Today it was announced that this number is around 10,000 higher:

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 424,852
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of October 20, 2014 
*Updated every Monday at 3 p.m.

Obviously this is fantastic news; the state is up to 88% of the 477,000 Michiganders estimated to be eligible for the program.

However, when you add in the 213,000 residents of Michigan who are receiving tax credits via private healthcare policies through the Affordable Care Act...aka "Obamacare"...that's around 638,000 people who would lose their coverage if the Republican Party were to successfully repeal the law, which they've been dead-set on doing for 4 years now.

Last week I announced that I've started writing occasional pieces for Today they've published my 2nd entry, which is all about Kentucky, Mitch McConnell and the real-world impact on hundreds of thousands of people that repealing the ACA would have.

UPDATE: In my story, I noted that the Federal Government is picking up 100% of the tab for the expanded Medicaid enrollees for the first 3 years, and then thought that it dropped down to 90% for another 6 years, and then to the normal fed/state split after that (70/30 in the case of Kentucky).

Thanks to David M. for bringing to my attention this correction: The expansion program is an even better deal for the states than I thought, because apparently the Federal share only drops to 90% permanently (well, unless a future Congress messes around with that provision of the ACA, of course).