Economics, Health Care

What we learned about Obamacare April 29-May 5, 2014

Image Credit: National Journal

Image Credit: National Journal

1,) “Obamacare youth sign-ups at or below 25% in 15 states,” notes Philip Klein:

In 15 states, 25 percent or fewer of those signing up for coverage through President Obama’s health care law are from the crucial young adult demographic, according to an analysis of data from the Department of Health and Human Services. This is far below the 40 percent threshold White House officials initially said was required to ensure healthy insurance exchanges. On Thursday, I reported that nationally, about 28 percent of those signing up through the exchanges were aged 18 to 34. But national numbers are only a rough indicator of the state of play on the exchanges, because in reality, the insurance market is made up of 51 different risk pools – one for each state, plus the District of Columbia….

A further breakdown of the numbers reveals that a number of states did especially poorly in signing up younger participants. West Virginia was the worst performing state, with just 19 percent of sign-ups coming from the younger age group. In Hawaii, 20 percent were from the younger demographic. The percentage was 21 in Arizona and 22 in Oregon, Vermont, and Maine. On the flip side, Washington, D.C., was the only exchange to exceed the original target of the Obama administration with 45 percent of sign-ups coming from the younger demographic, as it got a boost from a flood of Capitol Hill staffers who were required to get their insurance through the exchange…. All in all, 13 states were at 30 percent or higher.

2.) Scott Atlas in WSJ says “ObamaCare is already creating one class of care for the poor and middle class and another for the affluent”:

The health-care law was generated by an administration promoting government as the solution to inequality, yet the greatest irony of ObamaCare is what will undoubtedly follow as a long-term, unintended consequence of the law: a decidedly unequal, two-tiered health system. One will be for the poor and middle class, and a separate system will be for those with the money or power to circumvent ObamaCare….

The hidden truth is just around the corner—those more dependent on public insurance, mostly the poor and middle class, will have limited access to medical care. About one-third of primary-care physicians and one-fourth of specialists have already completely closed their practices to Medicaid patients…. More doctors than ever already refuse Medicaid and Medicare due to inadequate payments for care, and that trend will only accelerate as government lowers reimbursements. At the same time, ObamaCare is squeezing out the middle class from affordable private insurance that correlates with far better disease outcomes than government insurance. By bloating coverage requirements and minimizing the consideration of risks fundamental to pricing insurance, the law has already increased premiums by 20%-200% in more than 40 states, according to a 2013 analysis by the Manhattan Institute’s Avik Roy and others…. ObamaCare is also eliminating access to many of the best specialists and the hospitals for middle-income Americans…. Meanwhile, concierge practices are increasing rapidly, as patients who can afford it, along with many top doctors, rush to avoid the problems of an increasingly restrictive health system.

3.) Here are the latest findings from Pew Research on Obamacare. Below is the first of several graphs scattered throughout this post:

4.) “GOP: Only 67 percent have paid first monthly ObamaCare premium,” reports the Hill:

House Republicans on Wednesday said they have data from insurance companies that shows only 67 percent of people who selected a health plan under ObamaCare have paid their first month’s premium. That total contradicts expert estimates that about 80 to 90 percent of enrollees have paid their first month’s premium. In March, Health and Human Services Secretary Kathleen Sebelius said as many as 90 percent had paid, based on insurance company estimates.

The House Energy and Commerce Committee’s subpanel on Oversight and Investigations said it contacted every insurance company involved in the federal marketplace, and based its data on people who had paid by April 15. The committee said it found only 2.45 million had paid for coverage through the federal marketplace at that time. Many enrollees still have time to make their first month’s payment after the enrollment surge earlier this month, so the committee said it would ask insurance companies to update its numbers again by May 20…. House Majority Leader Eric Cantor (R-Va.) challenged President Obama to have HHS release its own data if the numbers are in dispute.

5.) “Challenges face US as Obamacare sign-ups move to Year 2,” says Alex Wayne at Bloomberg:

The push to sign up people for Obamacare won’t get any easier in Year 2. The Obama administration needs to improve everything from customer service to Spanish-language outreach if it’s to parlay a functioning website and recent enrollment momentum into even more Americans with health coverage, supporters said.

“Adding new people — the marginal enrollment — only gets harder and harder,” George Brandes, director of health-care programs at tax preparer Jackson Hewitt, said in a telephone interview. “For whatever reason these people sat on the fence. This is no longer the low-hanging fruit.”

The administration faces challenges to reach those potential customers, supporters of the health-care law said. The enrollment period for 2015 begins Nov. 15 and is just three months, half as long as this year. The federal government may not have as much money to spend on advertising or on groups that help people sign up. Negative ads and speeches about the law from Republicans leading up to Nov. 4 congressional elections may confuse uninsured Americans, deterring enrollment. The law’s supporters say the Obama administration can take steps unilaterally, without the help of Congress, to boost participation. The Spanish-language health-exchange websites still lag behind English versions.

6.) On Friday CMS released a document, referenced in the tweet above, on “Special Enrollment Periods and Hardship Exemptions for Persons Meeting Certain Criteria”: “This guidance provides information related to three types of special enrollment periods (SEPs) for persons seeking to enroll in qualified health plans (QHPs) through the Federally-facilitated Marketplace (FFM). State-based Marketplaces (SBMs) are encouraged to adopt similar special enrollment periods. The document also contains information about two hardship exemptions available for eligible consumers in FFM and SBM states.” Read the whole thing here.

7.) “Housing and Urban Development Department will be investigated for involvement in Obamacare promotion,” reports the Washington Examiner. The government accountability group Cause of Action “requested the investigation in April, the Hill reported. HUD’s inspector general notified the group of its decision to investigate on Friday.”

8.) For a look at some of the people affected by Obamacare, check out these pieces: “Faces of the Affordable Care Act,” “Even with Obamacare, many Latinos still seek treatment in Mexico,” and “Some Obamacare enrollees emboldened to leave jobs, start businesses.”

9.) George Will looks at “Obamacare’s Doom”:

 [On Thursday at the DC Circuit Court of Appeals, Obama] can hear an argument involving yet another constitutional provision that evidently has escaped his notice. It is the origination clause, which says: “All bills for raising revenue shall originate in the House of Representatives; but the Senate may propose or concur with amendments as on other bills.” The ACA passed the Senate on a party-line vote, and without a Democratic vote to spare… What will be argued on Thursday is that what was voted on — the ACA — was indisputably a revenue measure and unquestionably did not originate in the House, which later passed the ACA on another party-line vote. This case comes from Matt Sissel, an Iowa artist and small-business owner who is represented by the Pacific Legal Foundation, which litigates for limited government….

In June 2012, a Supreme Court majority accepted a, shall we say, creative reading of the ACA by Chief Justice John Roberts. The court held that the penalty, which the ACA repeatedly calls a penalty, is really just a tax on the activity — actually, the nonactivity — of not purchasing insurance…. The “exaction” — Roberts’s word — “looks,” he laconically said, “like a tax in many respects.” It is collected by the IRS, and the proceeds go to the Treasury for the general operations of the federal government, not to fund a particular program. This surely makes the ACA a revenue measure. Did it, however, originate in the House? Of course not. In October 2009, the House passed a bill that would have modified a tax credit for members of the armed forces and some other federal employees who were first-time home buyers — a bill that had nothing to do with health care. Two months later the Senate “amended” this bill by obliterating it. The Senate renamed it and completely erased its contents, replacing them with the ACA’s contents.

Case law establishes that for a Senate action to qualify as a genuine “amendment” to a House-passed revenue bill, it must be “germane to the subject matter of the [House] bill.” The Senate’s shell game — gutting and replacing the House bill — created the ACA from scratch. The ACA obviously flunks the germaneness test, without which the House’s constitutional power of originating revenue bills would be nullified. Case law establishes that the origination clause does not apply to two kinds of bills…. The ACA’s tax, which the Supreme Court repeatedly said is not an enforcement penalty, and hence is not analogous to a fine, fits neither exception to the origination clause…. Two years ago, the Supreme Court saved the ACA by declaring its penalty to be a tax. It thereby doomed the ACA as an unconstitutional violation of the origination clause.

10.) “Michael Hash, a top Department Health and Human Services official overseeing the rollout of the Affordable Care Act, will be retiring, agency staff confirmed on Friday,” reports Louise Radnofsky. “Mr. Hash, 70 years old, joins a long list of health-care officials leaving the administration in the aftermath of the rollout of the law. Health and Human Services Secretary Kathleen Sebelius heads that list, of course, but it also includes Gary Cohen, who headed the Center for Consumer Information and Insurance Oversight and was the top insurance regulator in the country, Jonathan Blum, the deputy administrator at the Centers for Medicare and Medicaid Services who oversaw the Medicare program, and White House health adviser Chris Jennings, who went back to the private sector in January.”

11.) “Comedian in Chief’s new punch line: Obamacare,” comments The New York Times: “Mr. Obama started his annual remarks at the White House Correspondents’ Association dinner Saturday night with the recognition that the rollout of his health care website could have gone better, admitting that ‘in 2008, my slogan was ‘Yes, we can!’ In 2013, my slogan was ‘Control-Alt-Delete.’’”

12.) Finally, check out the latest from the Kaiser Health Tracking Poll here. Below is one of the charts:

Featured graphic from National Journal.

Follow AEIdeas on Twitter at @AEIdeas.

3 thoughts on “What we learned about Obamacare April 29-May 5, 2014

  1. The AEI never critiques a huge federal and nearly pure form of communistic health care in America—the VA. Are there PC forms of communism?

  2. Lack of health coverage does not correlate to lack of access to medical care.

    In fact, govt health insurance(ie: Medicaid and Medicare) guarantees lack of access to medical care.

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