a link.
The Republican case for repealing the Affordable Care Act and moving swiftly to enact a “replacement” plan largely rests on oft-repeated arguments that the law is floundering so badly, urgent action is needed.
President Donald Trump uses terms like “disastrous” and “failing.” House Speaker Paul Ryan (R-Wis.) calls repeal-and-replace a “rescue mission,” because the law has a “fatal conceit” ― a design flaw that means insurers aren’t attracting enough young and healthy people to cover the costs of customers with big medical bills.
The health insurance markets regulated by the Affordable Care Act are actually in better shape than Republicans admit. Just this week, the Congressional Budget Office said the marketplaces were on their way to stability.
But the struggles that Trump and fellow Republicans describe in their speeches are real enough. Particularly in states like Arizona and Tennessee, premiums have shot up and insurers have fled, leaving few choices for consumers.
What Republicans fail to mention is that many of these problems are the handiwork of state and federal Republican officials who spent years undermining the law, contributing to the conditions they now say oblige them to dismantle it.
These efforts are not by any means the only reason so many insurers have struggled. But they have played a significant role.
Defunding Risk Corridors
When Democrats wrote the Affordable Care Act, they understood that insurers might initially have a hard time figuring out where to set prices. Because insurers hadn’t sold these kinds of policies (with comprehensive benefits) under these conditions (without exclusions for pre-existing conditions), they didn’t have actuarial data on which to base pricing decisions.
In order to reassure insurers that might hesitate to enter the markets amid such unknowns, and in order to protect them against crippling losses, the law’s architects created a “risk corridor” program, in which the government promised to reimburse insurers, mostly, for excessive losses. (Insurers that misjudged in the other direction, and had unexpected windfalls, would pay part of that money into the program.)
The idea was not novel. Medicare Part D, the program that provides seniors with prescription drug coverage, also has a risk corridor program. And it has never been controversial ― even though it’s a permanent part of the program, unlike the temporary one in the Affordable Care Act.
But conservative groups targeted the program, calling it a “bailout” for health insurance companies, despite the fact that it was included in the law from the beginning. Sen. Marco Rubio (R-Fla.) picked up the mantle and led a crusade to undercut the program’s funding.
In 2014, Rubio got his proposal into the year-end spending agreement and President Barack Obama, feeling the rest of the legislation was necessary to keep the government functioning, signed it. Later, during a presidential debate, Rubio even bragged about it.
Congress not funding the risk corridor program was the most consistent issueKevin Counihan, former HHS official, on what he heard from insurance executives
Insurers ended up filing $8.3 billion in claims for 2014 and 2015, but the program ended up paying out just $362 million. Several insurers have since sued to get the money they claim to be owed, and one has already won its case. But it’s not clear they will ever get the money.
Kevin Counihan, who ran HealthCare.gov for the Obama administration after overseeing Connecticut’s health insurance exchange, said he heard about risk corridors all the time last year, while he was meeting with insurers about participation for 2017.
“Congress not funding the risk-corridor program was the most consistent issue,” Counihan said. “Many carriers established their 2014 and 2015 rates with the assumption that the government would make good on this part of the law. Not doing so hurt both their financials, our credibility, and their board’s commitment to remain in the program.”
And this is about more than just health insurance companies losing money. The true purpose of these payments is to reduce premiums by allowing insurers to charge lower rates, knowing they’re protected if they get hit with higher-than-expected costs. Premiums were 10 percent to 14 percent lower in 2014, and 6 percent to 11 percent lower in 2015, because of this program,according to the American Academy of Actuaries.
Insurance companies got no payments from this fund for 2015 because the government had no money left. The realization that this money wouldn’t be available again for 2016 and 2017 contributed to insurers’ decisions to institute large premium increases this year and, likely, more rate hikes next year.
Blocking the Medicaid Expansion
The theory of the Affordable Care Act’s coverage expansion was pretty simple. People with incomes above 133 percent of the poverty line, or about $32,000 for a family of four, would buy coverage through the exchanges, where low- and middle-income people can apply for tax credits to reduce their premiums. People with incomes below that threshold would get coverage throughMedicaid, once states took advantage of new federal funding to expand eligibility.
The theory didn’t count on the Supreme Court, which in 2012 affirmed that states have the right to reject the money to expand Medicaid and keep the limited eligibility they had before. Initially, more than half the states did precisely that. All had Republican governors or majority-Republican legislatures, although a number of GOP-led states, like Arizona and North Dakota, did adopt the expansion.
The immediate consequence of refusing to expand Medicaid was to deprive millions of Americans living in those states of insurance. But those decisions also had a spillover effect.
Exchanges in these states are picking up more of the lowest-income customers ― the ones with incomes between 100 percent and 133 percent of the poverty line, or between $24,600 and $32,718 for a family of four. (Under the law, people with incomes below the poverty line are not eligible for the subsidies.) It might not sound like a big deal, but it had a direct impact on premiums for everyone.
Those extra enrollees tended to be in worse health than the rest of the population. In states that did not expand Medicaid, these people ended up signing up for exchange plans ― where their relatively high medical bills drove up costs for the insurers, eventually contributing to losses and higher premiums for all customers.
On the whole, rates in expansion states were about 7 percent lower than in non-expansion states, according to a Department of Health and Human Services study that controlled for demographics and other factors.
Undermining Outreach
Enrolling a sufficiently large population in the new insurance plans was always going to be a challenge, because many of the uninsured had little experience shopping for and buying coverage ― and because, particularly among middle-class consumers, the prices were in many cases going to seem high.
And while the federal government took on some of that responsibility, state officials had a special role to play, because they retain a lot of regulatory authority over insurance and, crucially, they better understood the idiosyncrasies of their insurance markets and their states’ residents.
Some states, typically the ones that had decided to create their own exchanges, promoted enrollment enthusiastically. But other states didn’t offer support. A few ― again, all with Republicans in power ― actually did their best to make enrollment difficult.
Georgia’s insurance commissioner, Ralph Hudgens, put it unusually bluntly. “Let me tell you what we’re doing,” he said in August 2013, just two months before the first open enrollment period. “Everything in our power to be an obstructionist.” Hudgens also said, “I’m not going to do anything in my power to make this law successful.” In other words, rather than assist Georgians who elected him with getting health coverage, Hudgens prioritized resisting Obama.
The impact of these efforts isn’t clear. But enrollment in states that ran their own exchanges, which is a pretty good proxy for enrollment enthusiasm, was moderately higher overall than in states that relied on HealthCare.gov, according to a 2016 paper by economists Molly Frean, Jonathan Gruber, and Benjamin Sommers.
One constant for the early years of the Affordable Care Act was enthusiastic support from Washington. That obviously changed in January, when Trump became president ― and open enrollment for this year was entering its final days.
The very day Trump was inaugurated, he issued an executive order instructing agencies to relax Affordable Care Act rules. The IRS responded a short while later by announcing it wouldn’t fully enforce the law’s individual mandate, which has the potential to suppress enrollment among healthy people who need the coverage less.
The end of open enrollment period has historically seen a surge of signups, as people rush to meet the deadline, and the late signups tend to be healthier on average, helping the risk pool. But the Trump administration canceled some planned digital and television advertising and, this year, only about 400,000 people signed up in the final two weeks. In the same period last year, 700,000 did.
That drop may help explain why, this year, overall signups forHealthCare.gov policies fell slightly this year. It’s also a reminder that the kind of people who have been trying to undermine Obamacare are now in charge of it. They may yet do more damage, unless they manage to repeal it altogether.
SINGLE PAYER UNIVERSAL HEALTH CARE FOR ALL AMERICANS just like every other Industrialized Nation.
Repeal the Bush/Cheney tax cuts, slash the Military-Industrial-Congressional Complex, STOP American Empire Building and we can afford health care and FREE COLLEGE!
STOP THE GOP RIGGED ELECTIONS AND VOTE THEM OUT!
Let's work together and get rid of these clowns.
[Does Rubio even go to Washington? Worst attendance record!]
[Does Rubio even go to Washington? Worst attendance record!]
The Problem here is that Donald Trump ran an 18 Month Campaign saying he was "Anti-Establishment", then when he got elected to the Presidency with a Senate that had 52 members out of a 100 from his own Party he began confirming Establishment and more importantly WALL STREET appointees to his Administration, so the 25% of the US electorate that elected him and his Party to Congress have been royally duped, much like when Obama got the Nomination in 2008 instead of Dennis Kucinich or Mike Gravel or this time where Bernie Sanders could have had the Democratic nomination.,
Additional information available on LINKS.
Dead Beat Don's woeful ignorance should embarrass any informed American/
After Trump tweets embarrassingly inaccurate info, former NATO ambassador publicly educates Trump
Saturday Mar 18, 2017
Could he get any more embarrassing? Let's hope not.
This morning Donald Trump once again took to Twitter to show his utter ignorance and misunderstanding of how the world operates. On the heels of his widely mocked, embarrassing, petulant, child-like behavior with German Chancellor Angela Merkel, he simply couldn’t help himself this morning:
Needless to say, people who know better immediately began correcting the President of the United States about how NATO is funded. The most notable of Twitter teachers who gave Trump a lesson in how NATO works was Ivo Daalder, the former United States Ambassador to NATO:
Doesn’t Donald Trump have anyone close to him who can explain how the world works? He’s embarrassing the nation:
http://www.dailykos.com/stories/2017/3/18/1644889/-After-Trump-tweets-embarrassingly-inaccurate-info-former-NATO-ambassador-publicly-educates-Trump?detail=facebook
Trump repeated a delusion about Germany that's been floating around the White House
During Friday's press conference with German Chancellor Angela Merkel, President Donald Trump repeated the big idea about trade that has been floating around his White House lately.
Trump told Merkel and the press that Germany had gotten the better end of the stick in trade deals with the US in the past and that he was looking to rectify that situation.
"The negotiators for Germany have done a far better job than the negotiators for the United States," he said. "But hopefully we can even it out."
We know what "even it out" means, and it is an absurd notion. It means negotiating a bilateral trade deal with Germany and somehow ignoring the rest of the rest of the European Union.
Of course, that can't happen. The US has to negotiate with the EU as a whole.
Merkel made sure to remind Trump of that fact — literally saying, "The European Union is negotiating those agreements for all of the member states" — after having told reporters she was "deeply convinced" that the EU is integral to the success of Germany's economy.
"The success of Germany ... has always been one in where the German success is one side of the coin, and the other side of the coin is European unity," she said.
Of course, what Merkel says about it doesn't matter in a White House that is gripped by the delusion that Germany can just tell the EU to take a hike — at least, it will be gripped by this for as long as that policy is directed by Trump's trade head, Peter Navarro.
Navarro, in a much-derided speech this month, said Germany "uses the argument" of being in the eurozone to avoid trade deals with the US, and that because of this Germany would be "one of the most difficult trade deficits we're going to have to deal with."
Navarro has gone as far as to accuse Germany of being a currency manipulator for using the euro. He thinks that because countries with weaker economies than Germany's are factored into the euro's value, Germany can sell its manufactured goods more cheaply than it could if it had its own currency.
Obviously, that's not currency manipulation. That's just the reality of the euro's makeup.
But it means Merkel faces a scenario in which the president of the United States and his top trade adviser think one of their closest and most important allies is lying to them about its need to respect the EU. Trump and Navarro think this is a choice Germany is making about the US, not an obligation that is part of the fabric of its political and economic systems.
To be fair — and this is where we see fragmenting in the White House — some members of Trump's economic team, like Commerce Secretary Wilbur Ross, have said they understand Germany isn't a currency manipulator.
But that isn't enough. The last thing we need is a White House that is irrationally angry at Germany, an important ally, because it's pushing for a trade deal that cannot realistically happen.
It's bad enough when presidents unnecessarily anger the US's enemies. We don't need one who unnecessarily aggravates its friends, too.
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