Rubio has been boasting on the campaign trail and on Hate Talk Radio that he killed Obamacare. Since it isn't dead, he must be lying. Although he is trying. What he's trying to do is to lead an effort to deny requests to reimburse big insurers some $2.5 billion for unexpected losses suffered in 2014, which falls under a key Affordable Care Act provision known as risk corridors, included to help insurance companies that suffer higher-than-expected losses. Rubio with a cynical ploy persuaded Republicans to insist on "budget neutrality" and has engineered a $2.5 billion loss to insurers (like Blue Cross, Humana and Coventry. His objective is to drive up insurance rates so as to deny coverage to low income workers and their families. Half the state health cooperatives have closed as a result, which will also drive up costs, this time for consumers and diminish competition. And this snide little asshole is running for president, bragging to neanderthal audiences that he killed Obamacare.Oddly enough, when ideologues suddenly become executives responsible for real people's lives-- Christie, Bush and Kasich love pointing out how Rubio has never actually done anything in his life except suck up to rich donors and pontificate-- things change. Kentucky's new far right governor, Matt Bevin campaigned on killing Obamacare in his state. Yeah, Tea Party avatar Matt Bevin understands that poor families need health care too. Kentucky will continue with Medicaid expansion (just like Kasich's neighboring Ohio and Christie's New Jersey).After taking a beating from the far right before Christmas for not shutting down the government, Paul Ryan is trying to save face with another Death To Obamacare bill which he knows the president will veto. If the president wasn't a Democrat, however, we're back in the Republican land of no more coverage for preexisting conditions with a big donut hole sucking up money and at least 16 million currently insured people with no insurance. Paul Ryan can hand out as many Ayn Rand books as he wants, he's not going to get around those facts.Today Ryan had his zombie Rules Committee teeing up a bill to make-believe defund Planned Parenthood and make-believe kill Obamacare, which he plans to have the House do another show vote tomorrow or the next day. Trumpf was making fun of Ryan in his standup routine in Massachusetts last night. All the little GOP robots will vote for it but it will be interesting to see, which Republicans do a different kind of calculus and decide not to. And it will also be interesting to see which Blue Dogs and New Dems go along with the Republicans. How many Hillary endorsers in Congress will cross the aisle and vote with the GOP to end health insurance for millions of families and to deny healthcare to women? Maybe none... maybe she's had a good influence on them. We'll soon see, won't we?It's a shame that the childish Tea Party politics of the GOP prevent a mature look at the Affordable Care Act to actually fix some of the flaws. A study by Professors Tim Jost and Harold Pollack for the Century Foundation points out 6 ways to improve Obamacare. They start off by pointing out that "the ACA has largely succeeded in its principal task-- enrolling tens of millions of people in health insurance coverage. Indeed the period from 2010 to 2015 may be the most successful five years in the modern history of health policy" while achieving a great deal in the way of significant accomplishments. Three of many examples:
• Even with 20 Republican states refusing Medicaid expansion, the ACA has reduced the ranks of the uninsured by 17.6 million since 2010.• Hospital expenditures for uncompensated care have plummeted by $7.4 billion, with the decline particularly great in states that embrace the ACA’s Medicaid expansion.• Public health care expenditure growth has markedly slowed, which suggests the change extends beyond transient economic patterns associated with the Great Recession. The ACA is now projected to reduce budget deficits far more than was projected at the bill’s passage.
Then they get into what Republicans and Democrats should be working on together to improve for the people who pithier handsome salaries, at least their legal handsome salaries. But playing partisan games that lead nowhere is much easier and more satisfying for them. They propose 19 steps to strengthen the ACA and make it more effective on every level, improving the access and affordability, creating more robust provider networks, enhancing competition among insurers, improving the consumer experience, and strengthening Medicaid, none of which, alas, interests Ryan or most of his conference.
Despite these accomplishments, our health care system continues to face serious challenges, some traceable to flaws and weaknesses in the ACA. The ACA undertook from the beginning an ambitious reform agenda, but some of its approaches have turned out to be ineffective, poorly targeted, or not ambitious enough to address deeply rooted problems.Many of the remaining challenges in health care reform reflect the inherent complexities and path-dependency of the American system and were beyond the reach of any politically feasible reform. Perhaps the most serious problem-- which this report will address repeatedly-- is the inadequacy of the ACA’s subsidies and regulatory structures to address the problems of low-income Americans, for whom merely meeting the costs of day-to-day essentials is a continuing challenge, and for whom even modest monthly insurance premiums and cost-sharing are often serious barriers to health coverage and care.
Last night, the L.A. Times explained 5 of the most important of the 19 suggestions:
1- Fix the Family Glitch. Jost and Pollack properly call this "the most glaring defect" in the ACA's subsidy structure. Under the ACA, a worker is ineligible for ACA subsidies if he or she is offered affordable health coverage by an employer. Whether because of a drafting error or inattentive rulemaking by the IRS, that ineligibility extends to all members of the worker's family even if affordable family coverage isn't obtainable from the employer.The Rand Corp. has estimated that the change would add as many as 4.7 million Americans to the rolls of the subsidized insured at a cost of up to $8.9 billion, or about two-tenths of one percent of the federal budget.2- Improve subsidies and otherwise reduce the burden of cost-sharing. Sticker shock in the individual health insurance market has shifted from premiums to deductibles, co-pays and out-of-pocket limit. These still leave too many working-class families with heavy medical bills, and discourage some from signing up for insurance at all, even given the existing subsidies. That's especially true of families earning over the eligibility ceiling for tax subsidies, which is 400% of the federal poverty line ($97,000 for a family of four).Jost and Pollack endorse increasing subsidies for families below 400% of the FPL, and providing those over that line with subsidies that would bring down coverage costs to a given percentage of household income -- say 8.5%. One option is to give those families the option of fixed-dollar tax credits that would improve insurance affordability while still leaving them responsible for most of the costs.3- On Medicaid, give states an option they can't refuse. The Supreme Court in 2012 saved Obamacare generally but threw a monkey wrench into a key provision mandating that states expand Medicaid to cover the poorest households. The court made Medicaid expansion voluntary, and 20 states, all with GOP control of the legislature or governorship or both, are still holding out.One common rationale of the holdouts is that the federal share of the expansion, which is 100% through this year, will gradually ratchet down to a permanent 90% through 2020. Jost and Pollack call this "one of the most generous federal-state financing arrangements in the history of health policy," and observe that expansion has been a boon to state governments and economies that have accepted the change.But in some states it remains at least an ostensible argument against expansion, which has left more than 3 million Americans uncovered in the holdout states. So they propose making permanent a federal share at 100%. This will cost about $5.2 billion in 2020, when 11.9 million adults would be covered.4- Eliminate estate recoveries from the new Medicaid patients. The ACA drafters overlooked that traditional Medicaid rules allow states to recover the cost of care from the estates of patients who received expensive care on the public's dime despite owning homes or other assets that could be sold to repay the program.That provision remained in place for patients gaining coverage from Medicaid expansion, even though they're a discrete population and uniquely charged for coverage among ACA beneficiaries. (The tax subsidies enjoyed by wealthier insurance enrollees don't have to be paid back.) Several states say they may try to recover Medicaid expenditures from enrollees over 55; others such as California say they won't do so, but have the right to change their minds.The provision is unfair at best and counterproductive at worst, since it may discourage some households eligible for Medicaid from signing up, fearing that their meager assets eventually will be seized. The rule is a recordkeeping nightmare and the return is insignificant. Jost and Pollack rightly say that Congress should kill it.5- Restore the "public option" by offering Medicare to the 60+ population. The original public option, which resembled Medicare for all, was killed during the ACA's legislative phase by opposition from the drug industry, hospitals and physician groups, and medical device makers who feared having to negotiate prices with Medicare.Jost and Pollack propose a demonstration program offering Medicare to Americans in the near-retirement cohort-- say ages 60 to 65, after which they're eligible for Medicare anyway. This group tends to have high medical needs, pay the highest insurance rates under the ACA's limited age-based cost ratings and often earn too much to be eligible for subsidies. But they might benefit the most from early admission to Medicare.
