I haven't posted too much on the health care bill, because I don't feel qualified. It's an extremely complex bill, and I have neither the policy expertise nor the time to research it all. I am personally very, very reassured because my son has one hell of a pre-existing condition, and we will need to switch insurance in 2-3 years. That was a serious worry, and I'm relieved I can check that off the list of Things That Might Go Horribly Wrong in My Middle Term Future. Whether it is in the country's best interest to give me such reassurance, I don't pretend to be sure.
That said, I'm going to make like the TV guys and cover up my lack of policy knowledge by making a gut-level political prediction. The health care bill won't matter much to the November elections. This prediction is based on the following beliefs, for which I have little to no actual evidence:
1) If a voter is apt to swing (mee-ow!), then she is less apt to respond to policy concerns than she is to respond to the candidates' personal strengths/weaknesses, and the current economic conditions.
2) Faits accomplis have a way of becoming part of the scenery, and certainly much less terrifying. I think there are very few people who are going to get worked up over it, who are not already worked up over it. And there are many people who are concerned about it who will become less so, just because the fact that the bill even got passed is an odd sort of psychological imprimateur. It will be interesting to see if this bounce holds.
3) Most people will experience no change in health coverage between now and November. If they experience any change (as I will), it will be a positive one.
4) Eight months is a political eternity. At this point in 2008, all the talk was about white working class voters, big states, and delegate math. There was a general perception that Obama had a glass jaw and was too effete yet unknowledgable to get anything done (no matter what you think of him, that was not the public perception of him right before November 2008, and even less so now). Think what happened to change political perceptions between then and November: Lehman Bros, Sarah Palin. The health care bill is unlikely to be foremost in most voters' minds.
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Elizabeth, sorry to be the bearer of bad news, but children can still be denied coverage due to pre-existing conditions until 2014.
ReplyDeleteObama made better coverage for children a centerpiece of his health care remake, but it turns out the letter of the law provided a less-than-complete guarantee that kids with health problems would not be shut out of coverage.
Under the new law, insurance companies still would be able to refuse new coverage to children because of a pre-existing medical problem, said Karen Lightfoot, spokeswoman for the House Energy and Commerce Committee, one of the main congressional panels that wrote the bill Obama signed into law Tuesday.
These kinds of screwups are but one of the reasons these complex, comphrehensive reform bills are inferior to smaller, understandable real reforms. Even someone with super-genius levels of brainpower can't figure out what the bill really says:
And Saturday, addressing House Democrats as they approached a make-or-break vote on the bill, Obama said, "This year ... parents who are worried about getting coverage for their children with pre-existing conditions now are assured that insurance companies have to give them coverage — this year."
Imagine what new Easter Eggs we are going to find in the bill in the coming months! Speaker Pelosi spoke the truth when she said we'd need to pass the bill to find out what was in it.
I'm pretty sure that if Republicans won't block a fix, this one will be the one they don't bloack. ANd it looks like they do plan a fix.
ReplyDeleteFromt he same article:
Late Tuesday, the administration said Health and Human Services Secretary Kathleen Sebelius would try to resolve the situation by issuing new regulations. The Obama administration interprets the law to mean that kids can't be denied coverage, as the president has said repeatedly.
"To ensure that there is no ambiguity on this point, the secretary of HHS is preparing to issue regulations next month making it clear that the term 'pre-existing exclusion' applies to both a child's access to a plan and his or her benefits once he or she is in the plan for all plans newly sold in this country six months from today," HHS spokesman Nick Papas said.
Block the fix? It is bundled in with lots of other fixes for lots of other problems and may get lost in the noise. Worse, fixing it will cost money. Congress will need to cut something else to pay for this particular fix under the reconciliation rules. Whose ox will they gore to save yours?
ReplyDeleteDon't count on HHS's regulatory approach. The Administration can't issue regulations willy-nilly. The regulations must be backed up by Congressional laws, or they are vulnerable to a Court challenge. Do you think those evil, cold-hearted Big Insurance execs who drop cancer patients in a heartbeat (or so we are told) would avoid taking this to court? Maybe, maybe not.
Oh, and lookee, the promise that young adults would be able to stay on their parents' plan until 26? It didn't make the bill either. I wonder what other icebergs are lurking ahead, captain.
I have no pleasure in saying "I told you so", but I told you so. And this isn't the end, but just the beginning of problems for Obamacare.
Well, you didn't say I told you so to me, because I have not been posting much about the health care bill.
ReplyDeleteGJ, I'm pleased to reassure you about that promise to young adults. From the same article you linked to above:
ReplyDeleteThe bill Obama signed leaves a giant loophole, one that will be fixed if the reconciliation bill now being debated in the Senate passes.
Whew! Thank heaven the reconciliation bill passed the Senate. I'm sure it's a load off your mind.
Elizabeth, that was the second person plural 'you', referring to the Gentle Readers of Bleakonomy.
ReplyDeleteDr. Dan, I am pleased to see the problem might be resolved, assuming the same legislative geniuses who wrote the defective language can get it right the 2nd time around. I'm sure the 3rd time will be the charm if not. What is the saying? There's never time to do it right, but always time to do it over.
And I am curious what got cut to pay for this new spending. Not that anyone is likely to ever find out.
yes, because we all know things would have been better if nothing had been done at all. Oh wait, incremental reform, except you can't do incremental, it would be like building half a boat. You want to stop rescission and offer guaranteed issue? Wonderful, except that insurance companies would never go for that for fear that people will try to game the system, so you make a mandate, except you can't mandate people buy insurance unless they can afford it, so you offer subsidies. And what was incremental is now a full on bill. Let me add offering insurance exchanges is, by far, the greatest element of this bill since we can begin to move away from the abomination that is employer health care. Does any say "Yes, I am happy my employer chooses my health care policy and they are happy to waste hundreds of man hours negotiating with different health insurance companies each year." And starting soon there will be high risk pools for people who are denied coverage now.
ReplyDeleteAs to imperfections, well we all know Social Security, Medicare, or other non health care items such as Military spending, the Space program, all of these emerged fully formed and absolutely perfect and never once needed any revisions. I have never in my life ever heard anyone ever say "I told you so" with regards to military contracts.
charo
Elizabeth, isn't it interesting though how quickly the Republicans in the Senate folded? Last week Sen. Hatch was saying the passage won't mean it is over, they will fight on and on...well, they got 2 very minor revisions and the House will pass the amended version.
ReplyDeleteIf the economy picks up, the Republicans are in for a long night in November, picking up maybe 23 24 seats in the House and 5 in the Senate. They will try to portray this as a great victory, but it will truly be a crushing defeat. Due to the two Democratic victories in a row in Congressional races, there are Democrats in Red districts who really don't belong there and so it will return to its natural mean. And it looks like Republicans learned their lesson in NY, you don't have many tea bag whack jobs running. When it comes down to it, Republicans do tend to nominate people who can win (like political moderates like Chris Christie, you should have seen the Club for Greed guy, total nutjob who got creamed in the primary)
Of course, if the economy double dips, Democrats are toast, but I don't see that happening (much to the Republicans certain chagrin) a lot of the Stimulus actually kicks in this year.
Incremental is like building half a boat? Maybe for people with room temperature IQs. Once a system is up and running, incremental reform is almost the only way to make successful changes. I'm sure everyone here knows a horror story or three starring some company that tried the Big Bang method of replacing an existing system.
ReplyDeleteRescission is easy; after a policy has been in force for 90 days, it cannot be cancelled for any reason other than non-payment.
Guaranteed issue is incompatible with insurance. One fix is to have the government cap OOP medical expenses for everyone.
There is a reasonable solution to every problem I've heard to date. The reasonable solution to Obamacare is to defund it and repeal it.
"Rescission is easy; after a policy has been in force for 90 days, it cannot be cancelled for any reason other than non-payment."
ReplyDeleteExcept, of course, when people lose their jobs, I suppose they should pay the $1,000 a month out of their unemployment insurance. And, of course, no one ever moves, so that is real easy to have a health insurance policy HMO in NJ when I choose to move to Oregon. That will work real easy, just pop on a plane everytime I get sick. And, of course, insurance companies can jack up rates for people with illnesses as much as they wanted to, or did gj miss that whole 40% rate increase in California?
So yeah, rescission is easy if people never lose their jobs, never relocate, and are willing to pay whatever rate the insurance company sees fit to charge. Yes, so easy.
And Guaranteed issue is not incompatible with insurance. That is a meaningless assertion. Guaranteed issue is absolutely compatible with insurance. (now I can leave it at that, which would be as idiotic as making an assertion without backing it up, but I am not an idiot)
Again, covering people with pre-existing conditions does not mean that insurance companies have to pay pre-existing bills.
Obviously, some people here have never bought an insurance policy. I have never heard any that have been forced to pre-date their policies, you do have to wait for it all to take effect. Under the system post passage the pre-existing bills would have already been paid for when people switch insurance for work. Before, people with illness would be forced to stick with an insurance company no matter what, regardless of other opportunities, and this would allow said companies to jack up the rates as much as they want.
And, of course again, the Hospitals charge off uninsured care to the insurance companies, who charge it off to the policy holders. In America people without coverage get charity care, the tooth fairy doesn't pay for it, either the policy holders do or the taxpayers (through medicaid)
So if by reasonable solution you mean utterly unworkable in the real world, well then we are in agreement.
And considering how quickly the Republicans in the Senate caved, they aren't going to defund or repeal anything, ever. Republicans are not going to kick off millions of people off of insurance exchanges, or tell Junior who has cancer: Die. Even the insurance companies will love the millions of new policy holders so they will fight repeal.
So keep on deluding.
Oh why does it have to be so easy?
charo
One more flog of the deceased mare...
ReplyDeleteExcept, of course, when people lose their jobs [blah, blah, blah]...and that isn't rescission. Words have meanings, and it would be nice if you paid attention to the meaning of words.
And Guaranteed issue is not incompatible with insurance. Riiight. Can you name one other form of insurance that issues policies to people who have already incurred events that will be paid by the policy? Just asking.
And, of course again, the Hospitals charge off uninsured care to the insurance companies Total bullshit. Cite, please.
Even the insurance companies will love the millions of new policy holders so they will fight repeal. The first thing you have gotten right. Yes, these large corporations love them some Democrats for tossing them in the briar patch of mandated coverage, and taxing all of us top pay (part of) people's premiums. Way to stand up to the Big Corporations, liberals.
Again, they don't not pay for events that have already occurred. There is nothing that obligates insurance companies from paying pre-existing bills. Show me where that is? You are just making things up now. If you have a heart attack you can't then buy a policy and expect them to pay because they don't have to.
ReplyDeleteNow, people who have pre-existing conditions can pick up on the health care that they will already have been receiving, the only thing that will change is the payer, either a different insurance company or charity care. You seem to think that people who don't have insurance get no health care.
Rescission means cutting peoples insurance off for any reason the insurance company feels it can legally justify. I know what rescission is. But you want to deprive people who have any family member with a health condition from ever changing insurance policies, because they won't be able to without guaranteed issue. Essentially, these people are married to death to their insurance company. Go ahead and justify that if you can.
Yes. CMS makes payments - significant payments - to hospitals that treat a large number of uninsured and low income patients.
For example, the Medicare and Medicaid
disproportionate share provisions paid $22 billion to hospitals last year. Medicare pays over $1 billion per year to hospitals for the bad debts of medicare patients.
Now this is coming out of your taxes. As to insurance companies:
Cost of uninsured adds $1,100/year to premiums of insured families.
When the uninsured cannot pay for the care they receive, health care providers shift costs to Americans with insurance in the form of higher premiums. A new report from The Wonk Room’s Ben Furnas and Peter Harbage concludes that a failure to continuously cover all Americans accounts “for roughly 8 percent of the average health insurance premium“:
This cost-shift amounts to $1,100 per average family premium in 2009 and $410 per average individual premium. By 2013, assuming the cost shift remains the same percentage of premium costs, the cost shift will be approximately $480 for an individual policy and $1,300 for a family policy.
Read the full report here: http://wonkroom.thinkprogress.org/wp-content/uploads/2009/03/cost_shift.pdf
Yes, I am sure my citing evidence will elicit any kind of "my bad" from you. You will simply ignore it. Well, I cited it. Disprove it.
As I said, it is way too easy.
charo
"Way to stand up to the Big Corporations, liberals." By the way, I am not a Liberal. I am pro-life, I think education is a local matter, I supported the Iraq war, etc. And I had no idea supporting something very similar to Romneycare made anyone a Liberal. And the Heritage Foundation (the commie pinko think tank) was the people who came up with the idea of the individual mandate. (Heritage foundation is not Liberal, it is very conservative). Might I suggest you read their reasons for the mandate, something to do with responsibility (but do it quick, you will have to check the google cache because they are trying to hide it)
ReplyDeleteHonest to God, do you or Republicans have any consistency? I know you think what Glenn Beck tells you to, but try to think on your own for once.
charo
correction bad english: The Heritage Foundation was the think tank that came up with the idea of the individual mandate, which Romney incorporated (and lauded)
ReplyDeletecharo
"Can you name one other form of insurance that issues policies to people who have already incurred events that will be paid by the policy? Just asking." Just so you are clear, this is utter bullshit. They do not have to pay pre-existing bills.
ReplyDeleteNow, of course, you can buy car insurance for a car that is likely to incur insurance charges by getting into an accident, say it has bald tires, etc. They are taking the car as is. They are not paying for old accidents. Neither will health insurance companies. And just because people have pre-existing conditions you assume they will incur expenses, you simply don't know that. They could drop dead, or move, or their disease can go into remission, hell they can even have a miracle (you believe in miracles, don't you?)
So you are wrong, wrong, wrong.
charo.
charo, if insurance despite pre-existing conditions means anything at all, it means the policy will pay for treatment after the policy is issued for a pre-existing condition. I've helpfully bolded the parts that you seem to be missing.
ReplyDeleteOK, since you seem to be missing the main point. There is an industry where there are pre-existing conditions, that has a mandate, and has guaranteed issue. It is called the Car insurance industry. Have you ever heard of points on a license? That qualifies as a pre-existing condition, correct? Are you forced to keep your car insurance company if you have points and they jack up your rates? No, of course not, you can shop elsewhere. Now I don't know in every state but in NJ if you have a valid license you have the right to buy insurance, points and all.
ReplyDeleteThey have to cover you after the policy is issued even though you have that pre-existing condition (of being a dangerous driver). There are also mandates, if you drive you have to have insurance.
So lets repeat: Pre-existing conditions (points), mandate, and guaranteed issue is part of the Car insurance industry.
Now as far as pre-existing conditions go for people in health insurance, some one will pay, whether it be the state or private industry, or do you propose we let people who have diseases die?
And no one, no one on the left or even the right is against guaranteed issue. I am talking about politicians or policy experts. Even Paul Ryan, the Ayn Randian states insurance exchanges would be regulated at the state level, as would any high risk pools. Each state would act as a laboratory of innovation in cost control and adverse risk redistribution amongst private carriers.
Individuals would be guaranteed access to any plan in their state’s exchange. Any plan licensed in their state is eligible to join their state’s exchange as long as it meets minimum federal standards.
Now if guaranteed access doesn't mean guaranteed issue it would be frankly insane. What would guaranteed access mean? You can walk in anytime and look at all the pretty policies?
Here is another thing bound to make you happy:
Sen. John Cornyn, chair of the National Republican Senatorial Committee, is trying to pull the rug out from under the repeal Obamacare movement before it even gains traction.
He tells the Huffington Post:
"There is non-controversial stuff here like the preexisting conditions exclusion and those sorts of things," the Texas Republican said. "Now we are not interested in repealing that. And that is frankly a distraction."
What the GOP will work to repeal, Cornyn explained, are provisions that result in "tax increases on middle class families," language that forced "an increase in the premium costs for people who have insurance now" and the "cuts to Medicare" included in the legislation.
So, when one of the leaders of the Republican party states that pre-existing conditions is not controversial, and no one anywhere jumped on him about that, you should begin to understand you are alone on this issue.
By the way, here is testimony from the Heritage Foundation to Congress: Testimony before Subcommittee on Health of the Energy and Commerce Committee
ReplyDeleteUnited States House of Representatives
Delivered on March 17, 2009
My name is Edmund F. Haislmaier. I am Senior Research Fellow in the Center for Health Policy Studies at The Heritage Foundation. The views I express in this testimony are my own, and should not be construed as representing any official position of The Heritage Foundation.
Mr. Chairman, Representative Deal, and members of the committee, thank you for inviting me to testify before you today on some of the key issues involved in health insurance market reform.
There is currently considerable interest in both Congress and a number of states in health insurance market reforms as part of broader designs for health system reform. In that regard, I will focus my testimony today on four key issues:
Reforms to create greater choice and portability in the employer-sponsored coverage market.
The application of guaranteed issue rules to the individual health insurance market.
Risk adjustment mechanisms to accompany these first two reforms.
The role of "automatic enrollment" and "personal responsibility" provisions.
1) Creating choice and portability in employer-sponsored coverage.
Now, gj, have you testified before Congress? Have they called you up with your brilliance in ability to highlight in html? You do know the Heritage Foundation, don't you? Not exactly Liberal. Give it up, you are utterly beaten, no one with brains agrees with you.
By the way, you are welcome for the cited link, I noticed how it completely skipped your mind to acknowledge that yes you were indeed wrong.
charo
By the way, here is testimony from the Heritage Foundation to Congress: Testimony before Subcommittee on Health of the Energy and Commerce Committee
ReplyDeleteUnited States House of Representatives
Delivered on March 17, 2009
My name is Edmund F. Haislmaier. I am Senior Research Fellow in the Center for Health Policy Studies at The Heritage Foundation. The views I express in this testimony are my own, and should not be construed as representing any official position of The Heritage Foundation.
Mr. Chairman, Representative Deal, and members of the committee, thank you for inviting me to testify before you today on some of the key issues involved in health insurance market reform.
There is currently considerable interest in both Congress and a number of states in health insurance market reforms as part of broader designs for health system reform. In that regard, I will focus my testimony today on four key issues:
Reforms to create greater choice and portability in the employer-sponsored coverage market.
The application of guaranteed issue rules to the individual health insurance market.
Risk adjustment mechanisms to accompany these first two reforms.
The role of "automatic enrollment" and "personal responsibility" provisions.
1) Creating choice and portability in employer-sponsored coverage.
Now, gj, have you testified before Congress? Have they called you up with your brilliance in ability to highlight in html? You do know the Heritage Foundation, don't you? Not exactly Liberal. Give it up, you are utterly beaten, no one with brains agrees with you.
By the way, you are welcome for the cited link, I noticed how it completely skipped your mind to acknowledge that yes you were indeed wrong.
charo
Leaders of the Republican Party? You mean the Party that effed up so badly it lost the House, the Senate, and the Presidency? That Republican Party? I should pay attention to a leader with that kind of legacy? Erm, no.
ReplyDeleteYou can appeal to authority all you want; it isn't an effective rebuttal against actual facts and logical argument.
what actual facts (as opposed to what, unactual facts?) and what logic? you have no rebuttal because your logic is your own and not of this planet. But yes, pretend you are right while the whole world ignores you. Fat lot of good it will do.
ReplyDeletecharo
Actual facts, as opposed to Democratic facts (i.e., you can keep your insurance if you like it, you'll get a big premium reduction, we'll cover more people and reduce the deficit).
ReplyDeleteI noticed that the guaranteed issue for children wasn't fixed, despite what Ms. Sebelius and Pres. Obama claimed. Now the lastest eff-up is over public companies recognizing the increased costs of retirees, as required by GAAP and the SEC, thanks to the all-seeing, all-wise Congress charging tax on a subsidy. I swear, I would need to undergo two strokes and about 12 minutes of oxygen deprivation to reach the IQ level of a bog-standard Congressional Committee Chair.