Archive for the ‘Healthcare’ Category
Interesting interview in Pacific Standard by Charles Ornstein of Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, a nonprofit think tank (and not related to Kaiser Permanente, an HMO).
Few groups have tracked the Affordable Care Act as closely as the Kaiser Family Foundation, a non-profit, non-partisan think tank (not affiliated with Kaiser Permanente). Integral to those efforts has been Larry Levitt, senior vice president for special initiatives at the foundation.
Back in February, Levitt wrote a commentary for the Journal of the American Medical Association about what he expected to happen in the early going of the health insurance exchanges. He predicted: “It is very likely that it will be less than perfect.”
That’s certainly been the case. He continued:
“There also will undoubtedly be technical glitches in the eligibility and enrollment systems that are being created from scratch on a tight schedule. Some people will see their premiums increase, and anecdotes about those cases will undoubtedly be highlighted in the media. The fact that others will see their costs decrease or will have insurance that offers better benefits and more secure coverage may be overlooked. Although personal out-of-pocket costs for health care should decrease for most people, some may nonetheless perceive their deductibles and co-pays as unaffordable.”
With the impending Dec. 23 deadline to sign up for Obamacare coverage that begins on January 1, I checked in with Levitt to see if his thoughts had changed. The email interview has been edited for length and clarity.
As we approach the December 23 enrollment deadline, how do you feel?
I’d say we’re pretty much where I anticipated we’d be with implementation—two months ago. I always expected, as did many others, that things wouldn’t be perfect at the start. In fact, I wrote about that back in February in JAMA. My expectation was that there would be some glitches in the systems, things wouldn’t necessarily work smoothly for people with more complex family and financial circumstances, there would some mix-ups on the back end transmitting enrollment information to plans (as in the Medicare Part D program at first), and things would be working better in some states than others. That’s essentially where we are now. That’s not ideal, but there is still time to get things back on track. January 1 is important, but March 31—the end of open enrollment—is even more important.
It looks like there’s going to be a last-minute crush of applications (online and on paper). Are they going to be processed on time?
Well, my crystal ball is a bit blurry today, so there’s no way to say for sure whether all the last-minute applications will be processed on time. The good news is that data from the states, which have generally been reporting enrollment information faster than the federal marketplace, are showing a December surge. That suggests people have not necessarily been discouraged by the early problems.
I’d say the highest priority is avoiding coverage gaps for people who were buying their own insurance before. That’s folks who had their policies cancelled because they didn’t meet the new requirements of the ACA, as well as some people with serious health conditions in high-risk pools. There are also still a lot of people in the system who have been determined eligible but have not yet picked a plan. I know the federal marketplace has been reaching out to those people, and hopefully they can be converted into actual enrollees.
There have been a number of reports about well-known hospitals not being included in many health plans. Are you concerned that consumers will discover this after it’s too late? . . .
Reporters seem unable to learn from experience, not a good sign. Yet again they ran with a story leaked by Darrell Issa—big problem found in Healthcare.gov security!!!—only to learn that the bug was trivial and fixed before the system went live. Michael Hiltzik reports in the LA Times:
Bingo! We have not one but two “investigative” news reports, from CBS and ABC, based on the same partial transcript. And both, consequently, have the same level of credibility: none. CBS News even offers a dividend — a thoroughly dishonest and discreditable interview with Issa himself. We’ll get to that in a moment.
The topic of the latest leak is the purported security flaws in healthcare.gov, the federal health enrollment website. The raw meat is a partial transcript of an interview conducted by the staff of Issa’s House Committee on Oversight and Government Reform with Teresa Fryer, chief information security officer at the Centers for Medicare and Medicaid Services, which is handling the healthcare.gov rollout.
Cue Sharyl Attkisson of CBS: “A top HealthCare.gov security officer told Congress there have been two, serious high-risk findings since the website’s launch, including one on Monday of this week.”
Well, yes. But not exactly. Fryer said more, which you’d know if you read the parts of the transcript left out of the Issa leak but distributed by the committee’s Democratic minority. There you discover that Fryer also said that the system’s security measures exceed industry standards, that there haven’t been any security breaches of the website, and the parts of the system affected by the high-risk findings were promptly shut down and quarantined.
That brings us to Issa, who went before the CBS cameras to charge that Fryer’s recommendation that the website launch be delayed was overruled by mysterious “individuals” who, he said, “were looking at a broader array of risk.” His tone of voice put air quotes around that “broader.” He continued, “I took that to mean the risks such as risk to the president of embarrassment, the risk to people who were counting on being able to sign up for these plans.”
See what he did there? He suggested that CMS was pressured by the White House to launch a website with security holes.
But there’s absolutely no basis in Fryer’s transcript — zero — to support that. What she said was that it’s standard operating procedure to place security assessments like hers in a broader context. In fact, the process is set forth by NIST, the National Institute of Standards and Technology, which is the government’s technology assessment agency. And of course that makes sense: You weigh the security aspects of a technical system against numerous other factors, including the importance of the program, and decide from the totality whether to launch.
There’s nothing in Fryer’s words even remotely hinting at an effort to spare the president “embarrassment.” Issa appears to have made that up out of whole cloth.
But he didn’t stop there. He suggested to CBS that the healthcare.gov website exposed virtually the entire government to hacking. “Remember, Sharyl, this is not about your application being compromised. This is a system, exchange and portal, that lets me go into the Department of Homeland Security, lets me go into the IRS … Social Security. Think about what’s at Social Security, what’s at IRS, what’s at Department of Homeland Security. That’s the vulnerability.”
Is that so? A flaw in a healthcare enrollment website that could let hackers in on our most precious government secrets? Let’s agree that if this were true, it would be huge. But once again, Issa has absolutely no evidence that it’s remotely true. If he had it, he would shout it from the rooftops, and he’d be right to do so. He wouldn’t slink around in the dark to a news show and slip it into the conversation with a credulous reporter.
CBS plainly knows Issa was blowing smoke. . .
Aha! So reporters are not fooled! They just don’t give a shit.
Very interesting report in the Washington Post by Ezra Klein.
Junk often costs less than quality. Tony Pugh has an interesting piece for McClatchy:
April Capil has mixed feelings about the national outcry over canceled health insurance policies.
Five years free of the stage III breast cancer that nearly claimed her life, the Boulder, Colo., resident is once again healthy, but she’s still struggling to put her life back together.
Like millions of Americans, Capil thought she had solid individual health insurance. Then she got sick and found that her coverage was woefully inadequate.
The financial problems that followed would aggravate Capil’s health struggles, force her into bankruptcy and trigger a fraud lawsuit over $230,000 in unpaid medical bills against HealthMarkets Inc., the parent company of her former insurer.
The litigation is nothing new for HealthMarkets. The North Richland Hills, Texas, insurer, formerly known as UICI, has a long history of battles with state regulators trying to root out “junk insurance” in the individual market. But numerous sanctions and a host of consumer protections in the Affordable Care Act have put a financial squeeze on the company and forced it to change its business model.
Beginning in January 2014, the health care law prohibits the kind of limitations, exclusions and benefit spending caps that made Capil’s coverage so problematic.
But after falsely promising that Americans could keep their health insurance if they liked it, President Barack Obama bowed to political pressure in November and OK’d a one-year extension on 2013 individual policies – even those facing cancellation next year because they don’t meet the health law’s new minimum standards.
Now Capil, a software project manager, wonders how many Americans will use the president’s canceled-policy “fix” to unwittingly renew another year of “junk insurance” like she used to have.
“It’s sad that there are people who have this insurance who don’t know that they’re going to end up like me if they ever get sick,” she said. “I feel like people are upset that they’re losing these plans and they’re upset because they think their plans are comprehensive. But they aren’t. These insurance companies have been selling Americans coverage that will bankrupt them if they ever have a serious illness.”
It’s a concern others share as well.
“As those policies are grandfathered in, people have to be aware they may be exposed,” said Mark Rukavina, a health care consultant in Massachusetts and an expert on medical debt. “It’s something to think about as these people stay with these plans that seem like a good deal.”
Capil thought her plan was a good deal. She said her insurance agent told her it was full, comprehensive coverage and if she ever got cancer, Capil would never pay more than a deductible or co-insurance.
What she got instead was a “limited benefit plan,” which is “commonly seen as inadequate because it tends to pay for routine care and leave you without coverage fairly soon if something major costing tens of thousands of dollars kicks in,” said Ed Haislmaier, a senior research fellow for health policy at the Heritage Foundation, a conservative Washington think tank.
Donna Ledbetter, HealthMarkets’ director of external communications, declined an interview request for this story, citing Capil’s pending lawsuit. She also declined to answer questions not involving that litigation. . .
Now that Healthcare.gov is (more or less) working, and the various exchanges in those states that decided to implement them are running, we’re starting to find out the effects of Obamacare. The National Journal has an interesting article by Lucia Graves about the “unlikely winners” in finding new healthcare, a puzzling title: the whole purpose of the Affordable Care Act was to help people with health insurance, so calling it “unlikely” that people would find good healthcare insurance via the ACA is very strange: that “unlikely” thing is the whole point of the ACA.
At any rate, the article begins:
Sue Spanke of Missoula, Mont., was highly displeased this fall when she learned her health insurance had been canceled.
“I got so mad that I went to my phone and started calling all the political people and giving them what for,” Spanke told The Billings Gazette. That was before she learned she was eligible for a policy at a much lower cost.
After angrily calling her state auditor’s office, Spanke, a self-employed artist in her 50s, found she was eligible for a federal subsidy. Her new insurance will cover her for a mere $30 to $40 a month with a deductible of only $500. She had been paying $350 a month for a Blue Cross policy with a $5,000 deductible. “I went from a horrible policy that didn’t cover anything, that was breaking me, to the best policy at the best price I’ve had since I was in my 20s,” she said.
With the website largely fixed, one of the last lines of attack against Obamacare is that the president lied when he said if people like their insurance plans, they can keep them. The White House is hoping stories like Spanke’s will inoculate them against those arguments. And the positive stories abound.
Another man interviewed by The Billings Gazette, Gary Mermel, said he received cancellation notices for his family’s Blue Cross policies only to find later that he and his family were eligible for much more affordable insurance. Mermel, a retired physician with apreexisting health condition, had been paying almost $1,700 a month to cover his family, and last month Blue Cross informed him his rates would go up to nearly $2,100 a month for the remainder of the year. Under the Affordable Care Act he was able to find insurance covering his entire family for just $1,200 a month with comparable benefits and a lower deductible than he’d had previously.
He also won’t have to worry about being denied coverage or getting charged more for preexisting conditions. “Before, the insurance companies had full control,” he said. “They were allowed to place people at risk [of financial ruin] and they no longer can do that.”
Other local outlets have documented the success post-insurance cancellation stories as well.
In Lancaster, Pa., Lori Lapman, 58, learned her health plan was being canceled in September—by October things were looking up. Per The Sunday News: “Sitting at a laptop with a certified health law helper, Lapman went to HealthCare.gov, found it running smoothly, and bought a subsidized Highmark plan that allows her to keep her doctors while saving her money. Her canceled plan cost her $520 a month. Her new coverage? Only $111.73.”
In Harrisburg, Pa., The Patriot News documented the case of Lynn Keltz, one of the hundreds of thousands nationwide who received a cancellation notice. Keitz, who happens to be one of the federally funded navigators helping state residents find new coverage under the Affordable Care Act, said her new policy provides her better coverage and costs $80 per month less.
In a letter to the editor in The Santa Maria Times, Allan Pacela told the story of how after his wife lost her insurance this fall, she found much better coverage under Obamacare. The couple is now saving $8,000 per year for a “much better plan.”
These stories can be found in national media outlets as well. The Huffington Post relayed the story of an HIV patient from . . .
Ezra Klein is puzzled (or at least says he is; I suspect he understands it perfectly) by Republican hypocrisy on health care. For many years the GOP has advocated things that are supposed to bring the magic of the marketplace and individual incentives to health care: higher deductibles to give people “skin in the game”, competition among private insurers via exchanges — competition that would include reducing costs by limiting networks — and, of course, for cuts in Medicare. Now the GOP complains bitterly that some Obamacare policies have high deductibles, that it relies on the horror of exchanges, that some networks are limited, and that there are cuts in Medicare.
Klein suggests that Republicans are really upset by other aspects of Obamacare, but are going after the easy targets even though they’re attacking their own ideas. In a sense he’s right, but as I said, I suspect that he knows that the issue is both bigger and simpler than he says.
What underlies what Jonathan Chait calls the Heritage uncertainty principle? He describes it thus:
Conservative health-care-policy ideas reside in an uncertain state of quasi-existence. You can describe the policies in the abstract, sometimes even in detail, but any attempt to reproduce them in physical form will cause such proposals to disappear instantly. It’s not so much an issue of “hypocrisy,” as Klein frames it, as a deeper metaphysical question of whether conservative health-care policies actually exist.
The question should be posed to better-trained philosophical minds than my own. I would posit that conservative health-care policies do not exist in any real form. Call it the “Heritage Uncertainty Principle.”
Well, actually it’s pretty simple. The purpose of most health care reform is to help the unfortunate — people with pre-existing conditions, people who don’t get insurance through their jobs, people who just don’t earn enough to afford insurance. Cost control is also part of the picture, but not the dominant part. And what we’re seeing right now, in any case, seems to confirm a point some of us have been making for a long time: controlling costs and expanding access are complementary targets, because you can’t sell things like cost-saving measures for Medicaid and limits on deductibility of premiums unless they’re part of a larger scheme to make the system fairer and more comprehensive.
And here’s the thing: Republicans don’t want to help the unfortunate. They’ll propound health-care ideas that will, they claim, help those with preexisting conditions and so on — but those aren’t really proposals, they’re diversionary tactics designed to stall real health reform. Chait finds Newt Gingrich more or less explicitly admitting this.
Hence the rage of the right. Here they were, with a whole raft of ideas they could throw out, like chaff thrown out to confuse enemy radar, to divert and confuse any attempt to actually provide insurance to the uninsured. And those dastardly Democrats have gone ahead and actually incorporated those ideas into real reform.
Once you realize this, you also realize that people who warn that by opposing Obamacare Republicans are undermining their own proposals are missing the point. Yes, the Ryan plan to privatize Medicare looks a lot like Obamacare — but Ryan comes to Medicare not to save it, but to bury it, so the question of whether his plan could work is irrelevant.
There’s no mystery here; it’s just top-down class warfare as usual.
The GOP is in sort of a bind on healthcare. First, Obamacare is based on their own ideas. Second, though they are eager to repeal the program, they have yet to come up with (another) alternative. (Their first idea was Obamacare, but since that’s been implemented, they need now to come up with something else.) Ezra Klein points out some aspects of the bind they’re in:
Now that HealthCare.Gov is on a clear path to functionality, Republicans are having to come to terms with the fact that Obamacare will not conveniently collapse before anyone can purchase insurance. If the law is going to fulfill its promise of destroying Barack Obama’s presidency and giving Republicans their long-awaited chance to repeal-and-replace, it will have to be because people actually hate the insurance they get through Obamacare.
Republicans have zeroed in on two things that people really will hate about insurance under Obamacare: The high deductibles and the limited networks. Brendan Buck, press secretary for House Speaker John Boehner, tweets:
“As consumers dig into the details,” Robert Pear reports in the linked article, “they are finding that the deductibles and other out-of-pocket costs are often much higher than what is typical in employer-sponsored health plans.”
What’s confusing about this line of attack is that high-deductible health-care plans — more commonly known as “health savings accounts” — were, before Obamacare, a core tenet of Republican health-care policy thinking. In fact, one of the major criticisms of Obamacare was that it would somehow kill those plans off. “Obamacare may be fatal for your HSA,” warned the Heritage Foundation on 2010. “Health Savings Accounts Under Attack” blared Red State.
When Republicans were forced to come up with alternatives for Obamacare, high-deductible plans were core to those proposals. “Conservatives have suggested deregulating Obamacare’s exchanges to make it easier to provide policies with high deductibles,” wrote Ramesh Ponnuru. One of those conservatives was right-wing darling Dr. Ben Carson. “In order to right the ship, we need to return the responsibility for good health care to the patient and the health care provider,” he said. “One of the best ways to do this is through health savings accounts, which patients can control.”
This always baffled Obamacare’s supporters. “The minimal, or bronze, insurance option allows out-of-pocket spending of up to $12,500 for a family of four,” wrote Jonathan Cohn. “Those are some pretty high deductibles!”
Now that those high deductibles are here, Republicans have decided that they are, if anything, too high. Just one more broken promise.
Obama’s pledge that “if you like your doctor, you can keep your doctor” is also under fire. The issue here is that insurers entering the competitive health marketplaces are tightening their networks in order to cut costs and improve quality. It’s worked: Premiums in the marketplaces are far lower than was expected when Obamacare passed.
This, too, is a success for a longtime conservative health-policy idea. Insurance exchanges have been in every major Republican health-care bill since the early 1990s. They were in Paul Ryan’s 2009 health-care proposal. They’re the basis of the GOP’s plan for Medicare reform.
Conservatives believe that a huge problem with the health-care status quo is that most people get insurance through their employer or the government. In both cases, they don’t directly pay the full cost of the plan, and so they have every reason to demand more generous care rather than more cost-effective care. If they were paying and shopping for plans themselves, they would care about price, and insurers would have an incentive to cut costs by carefully choosing the doctors and hospitals that can do the best job for the least money.
“Narrow networks are not some cruel attempt to limit patient choice foisted upon us by the insurance industry,” write economists David Dranove and Craig Garthwaite. “Instead, these plans may provide our best opportunity for harnessing market forces to lower prices.”
But Republicans don’t seem pleased to see their ideas in action. “As I travel across Kentucky, I hear from many constituents who are seeing premiums increase along with higher co-pays and higher deductibles as a result of Obamacare,” wrote Mitch McConnell in an op-ed for the New Democrat Leader. “Adding insult to injury, these constituents are discovering that despite these higher costs, they have no guarantee that they will be able to continue using the hospital of their choice.”
The Republican turnaround on high-deductible plans and tighter networks has puzzled many longtime health-care observers. “Conservatives are winning at least as much as they are losing in health care, even if they don’t know it or won’t say it,” wrote Drew Altman, president of the Kaiser Family Foundation.
I asked some of the GOP’s most influential health-care voices about the tension between the criticisms Republicans are launching against Obamacare and their longstanding commitment to these ideas. . .
Continue reading. The whole column is interesting and mordantly entertaining.
Good news, which should be cheer to Congress, which was complaining mightily when the exchange wasn’t working. I expect to see some guarded praise from the Right… well, no, not really. Lizette Alvarez and Jennifer Preston report in the NY Times:
After two months of false starts, error messages and pleas for patience from the once-hobbled federal online health care exchange, Karen Egozi, the chief executive of the Epilepsy Foundation of Florida, watched on Monday as counselors navigated the website’s pages with relative ease.
Click. Next page. Click. Next page. The website, HealthCare.gov, was working so well that Ms. Egozi, who oversees the 45 navigators in eight locations who help consumers enroll in health plans, said her team gave the system an 8 on a scale of 1 to 10, meaning that most people got as far as selecting a plan or taking home information to select a plan. It felt like a champagne moment.
“I’m 80 percent satisfied,” Ms. Egozi said. “I think it will be great when it’s 100 percent.”
A little over a week after the deadline that President Obama gave for fixing the federal health care exchange, the system is definitely working better, according to consumers and navigators interviewed in several states. The technical errors that had bedeviled visitors to the site for weeks seemed to have been tamed by the patchwork of hardware and software fixes ordered by the administration, and applicants were finally selecting health care plans under the president’s new law, the Affordable Care Act. By last week, the number of applicants who dropped a plan into their virtual grocery carts was climbing at a rapid clip.
Still, the interviews indicated, some technical obstacles persist. After shoppers clicked all the way to the plans, for example, the system was not letting some people actually choose one. In other cases, people were asked to try again later.
Improved entry into the online marketplace has also exposed a new layer of problems and confusion for applicants who are suddenly finding their efforts to buy insurance delayed by requirements that they provide proof of identity or citizenship or that they wait for determinations on Medicaid eligibility.
For the most part, though, the news for the beleaguered online exchange, which serves 36 states, is improving. Since early December, the federal exchange website has run without crashing, officials said. In the first week of December, about 112,000 people selected plans — compared with about 100,000 in all of November and only 27,000 in October. Last week, more than half a million people created accounts on the federal website, according to people familiar with the health care project.
Technical experts involved with the exchange said they are now preparing for a surge of applications before Dec. 23, the enrollment deadline to receive coverage by the first of the year. Although those preparations will require some significant changes to the system, the work will be easier now that the site seems stable during heavy use, the experts said.
In offices spread across the country, from Florida and Pennsylvania to Wyoming and Wisconsin, all of them states that rely on the federal government’s insurance exchange, navigators and applicants reported far fewer problems.
“I was hearing so much about the glitches in the system that I was worried that it wouldn’t work,” said Caroline Moseley, 54, who lost her job as a housing program analyst for the City of Philadelphia. After asking a navigator from the nonprofit Resources for Human Development for help in finding a plan, Ms. Moseley chose one that costs $27 a month with a $6,000 deductible. “It was a great experience,” she said. “The site was running very smoothly. It took about 30 minutes tops.”
Stephanie Lincoln, 60, of Lansdowne, Pa., also had quick success with the exchange — after a frustrating experience trying to submit an application online in October and November. With the help of a navigator, Caroline Picher, working at the local library, Ms. Lincoln signed up in just one hour on Friday for a policy that will cost $113 a month, with no deductible.
“I am one of the people whose plans were canceled,” Ms. Lincoln said. “It was just the easiest thing in the world.” . . .
Brian Beutler discusses the improved performance and links to other reports of progress; from his article:
. . . Here’s one from the State in South Carolina:
An elbow-injuring fall in March proved nearly as painful financially as physically for Carolyn Gates, who was uninsured and ended up with an $8,000 bill for her emergency room visit.
She felt much better Wednesday after a visit to the S.C. Progressive Network’s Columbia office, where she worked with Navigator Tim Liszewski to sign up on the Health Insurance Marketplace under the Affordable Care Act. While Gates and her husband slowly pay off that emergency room debt, she’ll also be paying a $107-per-month health insurance premium next year.
“As far as I’m concerned, it was the best thing ever,” Gates said. “I told my Bible study about it, and three said they’re going to sign up.”
And here are several more from the St. Louis Post Dispatch:
At the Columbia location of Primaris Healthcare Business Solutions, an enrollment event Monday proved successful for all of its visitors. Jeremy Milarsky, navigator program manager, said he didn’t experience any website glitches and all of his appointments with consumers ended in successful plan selections.
“Today was, I would say, an enrollment event with a capital ‘E,’” he said.
The St. Louis Area Agency on Aging, another nonprofit group assisting consumers with health insurance enrollment, held several outreach events this week. Mark Smith, case management coordinator, said navigators are still seeing some website problems, but also significant improvement. The new feature that allows users to delete their applications and begin again has helped, he said, and the majority of people at the events have been able to select a plan. . . .
Progress is good, right? Things are looking up (except for those in states that refused to expand Medicare for their citizens).
Becky Bach reports in Pacific Standard:
Thousands of veterans suffering from post-traumatic stress disorder rely on the Department of Veterans Affairs for relief. They might be better served, however, if they tapped the hard-won wisdom of incarcerated Vietnam veteran Michael “Doc” Piper.
Piper knows, though the VA has yet to acknowledge, that community service could be the most effective treatment available for PTSD, a debilitating condition marked by nightmares, anxiety, flashbacks, pain, anger, self-blame, alienation, and depression.
Despite his confinement in Soledad Correctional Training Facility, a California state prison, 67-year-old Piper is a professional volunteer. From a 106-square-foot former broom closet with no Internet access, Piper helps fellow incarcerated veterans access VA benefits. By helping others, Piper says he’s been able to cope with his anger, nightmares, and flashbacks. But he’s not the only one who understands the power of community service.
Mission Continues, a St. Louis-based organization, is generating national attention, including a June 2013 Time cover story, for its success helping veterans who served in Iraq and Afghanistan integrate into society. It’s a dire need: The VA has treated nearly 300,000 veterans from those conflicts for PTSD symptoms, according to a November report. Mission Continues, which was founded in 2007 by a group of veterans, places veterans in six-month service fellowships in community organizations across the country.
Fellows paint hospital walls, collect food donations, and plant gardens, developing career and life skills in the process. And although in-depth studies are lacking, an investigation (PDF) by Washington University in St. Louis social scientist Monica Matthieu, found that Mission Continues helps.
Matthieu and her team surveyed 27 Mission Continues fellows, many of whom have been diagnosed with PTSD. Following their fellowship, 71 percent continued their education and 86 percent were able to find employment.
The VA currently assaults PTSD with a grab bag of treatments. It recommends (PDF) a combination of drugs, most commonly anti-depressants, and therapies including individual and group psychotherapy, hypnosis, and meditation. The department’s 2010 guidelines also recommend social and family skills training, job training, education, and spiritual support. VA therapists even teach stress-tolerance techniques.
For example, . . .
Now this is good legislation, whatever the motive: in 2009 the GOP votes to require that Congress be covered under Obamacare. While the intent was political theater and punitive, the effects are likely to be salutary and good for the country. One has to recognize positive legislative action when it occurs, whatever brings it about. Ryan Cooper writes in the Washington Post:
Right now, one of the primary ways Congressional Republicans are attacking Obamacare is to cite the sob stories of Congressional staffers — and lawmakers themselves — who are having a bad experience with the law. Thanks to a bit of Republican legislative trolling that forced Members and their staffs onto the exchanges to make a political point, some are discovering that premiums are higher than they would have expected, having previously enjoyed the protection of government benefits that essentially shielded them from reality.
But if anything, the fact that Members of Congress are now having an unpleasant brush with the American health care system is a good thing. These Members are experiencing the same American health care system that the uninsured and people with preexisting conditions have been experiencing for many years. They are being forced to face the fact that American health care costs a lot, which, of course, is one of the reasons reform is so hard.
The health care system is already deeply unjust. A good article in the New York Times sheds light on this, and on how Obamacare is changing things for the better:
More than 243,000 have signed up for private coverage through the exchanges…and more than 567,000 have been determined eligible for Medicaid…For many, particularly people with existing medical conditions… the coverage is proving less expensive than what they had. Many others are getting health insurance for the first time in years, giving them alternatives to seeking care through free clinics or emergency rooms — or putting it off indefinitely.
Kevin Drum adds a related note about how hospitals routinely gouge uninsured people for everything they’ve got:
A heart attack that gets billed—profitably!—to Blue Cross at $50,000, can end up costing you $200,000 if you’re unlucky enough to suffer that heart attack while you’re uninsured. Think about that: for decades, the health care industry has deliberately taken ruthless advantage of the very people who are the weakest and most vulnerable—those who are poor or unemployed… It’s shameless and obscene. It’s like kicking a beggar and stealing his coat just because you know the cops will never do anything about it.
Obamacare, by slowing bringing everyone into the insurance system, will eventually stop this. Compare that to Rep. Michael McCaul (who with at least $114 million is the second-richest member of congress) complaining that the new plans on the DC health exchange are expensive.
This sort of experience is unvarnished good news. Finally, wealthy members of congress are getting a tiny, tiny taste of how the healthcare sector actually works. Five decades of skyrocketing health price inflation didn’t inspire so much as a peep when Republicans held all three branches of government. But now that Republicans have derped themselves onto the exchanges, they’re shocked, shocked at how expensive things have gotten. . .
The NY Times has an excellent editorial:
Beyond new state efforts to restrict women’s access to proper reproductive health care, another, if quieter, threat is posed by mergers between secular hospitals and Catholic hospitals operating under religious directives from the nation’s Roman Catholic bishops. These directives, which oppose abortions, inevitably collide with a hospital’s duty to provide care to pregnant women in medical distress. This tension lies at the heart of a federal lawsuit filed last week by the American Civil Liberties Union.
The suit was brought on behalf of a Michigan woman, Tamesha Means, who says she was subjected to substandard care at a Catholic hospital — the only hospital in her county — after her water broke at 18 weeks of pregnancy. Doctors in such circumstances typically induce labor or surgically remove the fetus to reduce the woman’s chances of infection. But according to the complaint, doctors acting in accordance with the bishops’ directives did not inform Ms. Means that her fetus had virtually no chance of surviving or that terminating her pregnancy was the safest treatment option.
Despite acute pain and bleeding, Ms. Means was sent home twice, and when she returned a third time with a fever from her untreated infection, she miscarried even as the paperwork was being prepared to discharge her again. The fetus died soon after.
The case has gained attention because Ms. Means is not suing the hospital for medical negligence but the United States Conference of Catholic Bishops. The A.C.L.U. is arguing, on her behalf, that having issued the mandates and made them conditions of hospital affiliation, the conference is responsible for “the unnecessary trauma and harm” that Ms. Means and “other pregnant women in similar situations have experienced at Catholic-sponsored hospitals.”
How the suit will play out is unclear, but it showcases an important issue. Catholic hospitals account for about 15 percent of the nation’s hospital beds and, in many communities, are the only hospital facilities available. Allowing religious doctrine to prevail over the need for competent emergency care and a woman’s right to complete and accurate information about her condition and treatment choices violates medical ethics and existing law.
The problem Ms. Means encountered is not unique or limited to her particular medical needs. In 2010, the Diocese of Phoenix punished a nun and stripped a hospital of its affiliation after doctors there performed an abortion to save a mother’s life.
In a statement last Friday, the president of the bishops’ group, Archbishop Joseph Kurtz, said that the religious directives did not encourage or require substandard medical treatment. He also portrayed the case as an attack on religious freedom — the same unpersuasive argument the bishops are making against the new federal health care law’s requirement that all plans include contraception coverage.
The bishops are free to worship as they choose and advocate for their beliefs. But those beliefs should not shield the bishops from legal accountability when church-affiliated hospitals following their rules cause patients harm.
Harold Pollack has an interesting column in the Washington Post:
Healthcare.gov’s troubled rollout brings new attention to competing proposals to alter health coverage for low-income Americans. One group of Republican analysts would largely replace Medicaid with some combination of primary care supports and catastrophic coverage. Others wouldn’t go that far but would make greater use of patient cost-sharing to provide incentives for disciplined use of medical services.
Ross Douthat has put the argument well in some thoughtful columns.
[C]omprehensive health insurance is, at its heart, a deeply wasteful use of resources: Modern people, and especially modern Americans, are much more likely to overconsume health care than to underconsume it… This doesn’t mean that social insurance shouldn’t protect people against adverse medical outcomes and unaffordable medical bills, but it suggests that there are better ways to allocate our resources than comprehensive coverage, and that most people would be better off if public policy didn’t push so much money into that direction.
Economic intuition suggests that Harold Pollack and Ross Douthat alike would use care more efficiently if we had more skin in the game, if we were less comprehensively insured. Sure enough, non-poor participants in the RAND Health Insurance Experimentused roughly one-third less care when they were enrolled in something akin to a catastrophic plan than did their counterparts who were enrolled in more generous plans. Despite their reduced service use, participants in the catastrophic plan also appeared, on average, to be just as healthy. Such findings provide a powerful argument for catastrophic plans. (Recent results from the Oregon Medicaid experiment are another matter.)
The cracks in this argument become more noticeable when one shifts attention from the typical insured person to the typical insurance dollar spent for patient care, particularly when one considers the vulnerable populations overrepresented among public insurance recipients.
Most people are light users of medical care. As Aaron Carroll regularly emphasizes, expenditures are concentrated within a group of costly patients with complex conditions, many of whom would hit any reasonable catastrophic coverage cap and who are poorly placed to manage the practicalities and financial risks associated with their medical care.
Although I’m curious to see how healthy, affluent professionals would purchase (say) knee and hip replacements if they faced the full costs, this won’t save much money. Most people in a position to make such choices don’t consume much health care. The real money is spent on patients like my relative who is recovering from a nasty stroke. For all sorts of reasons, giving him something other than comprehensive coverage seems unwise.
These distributional realities hold especially true among poor people. Figure 1 shows 2012 data for Illinois’s 3.2 million Medicaid recipients, ranked by percentile from lowest to highest expenditure. The top line shows cumulative Medicaid spending. The bottom bars show average annual expenditures in dollars. (If you look closely, you’ll notice straight lines where I interpolated between available data points.)
The bottom 72 percent of Illinois Medicaid recipients account for 10 percent of total program spending. Average annual expenditures in this group were about $564, virtually invisible on the chart. We can’t save much money through any incentive system aimed at the typical Medicaid recipient. We spend too little on the bottom 80 percent to get much back from that. We probably spend too little on most of these people, anyway. For the bulk of Medicaid beneficiaries, cost control is less important than improved prevention, health maintenance and access to basic medical and dental services.
The real financial action unfolds on the right side of the graph, where expenditures are concentrated within a small and incredibly complicated patient group. The top 3.2 percent of recipients account for half of total Medicaid spending, with average expenditures exceeding $30,000 annually.
Many of these men and women face life-ending or life-threatening illnesses, as well as cognitive or psychiatric limitations. These patients cannot cover co-payments or assume financial risk. In theory, one might impose patient cost-sharing with some complicated risk-adjustment system. In practice, that is far beyond current technologies and administrative capabilities. Even if such a system were available, we couldn’t push the burden of medical case management onto these patients or their families.
The Affordable Care Act’s Medicaid-expansion population won’t include traditional dual-eligible and nursing home patients who make up much of that 3.2 percent. The new group will still include a mix of basically healthy adults alongside more costly recipients with complicated problems who will account for the bulk of actual spending.
In my view, the best way to improve Medicaid is to tackle three inter-related challenges.
First, . . .
Kevin Drum calls it like it is. Some Republican states seem desperate to prevent the poor from getting any help whatsoever. A friend in a red state who is a rabid Republican (and former Methodist minister) explained that they don’t want the poor to get such help because it will foster “dependency”. By preventing the poor from getting (for example) healthcare, they are actually helping the poor. Jesus wept.
And do read the article linked in Drum’s post:
Under Obamacare, if your income is less than 100 percent of the poverty line, you don’t qualify to buy subsidized insurance on the exchanges but you do qualify for Medicaid. Unless, that is, your state has refused to participate in Obamacare’s Medicaid expansion. In that case you don’t qualify for anything.
Dylan Scott has a piece at TPM about health care navigators who have to break this news to people. Here’s the saddest passage:
In some cases, those being left out seem to understand, having been left out of the health insurance complex for a while, said Cynthia Rahming, who is heading the Houston, Texas, navigator program. She did agree, though, that her team is “often” coming across people who are part of the Medicaid gap in that state.
“They were excited. They were trying to see what’s available to them,” she said. “But they’re still okay. They know it’s just a chance.”
These are poor people. They mostly represent families making less than $20,000 per year. And yet in many cases, they greet the news that they’re completely excluded from access to health care with weary acceptance. They probably never really believed that anything good might come their way in the first place. In the meantime, multi-millionaires can virtually bring the government of the United States to a screeching halt over the prospect of a 2 percent increase in the marginal rate they pay in income taxes.
The refusal of Republican states to accept Obamacare’s Medicaid expansion surely ranks as one of the most sordid acts in recent American history. The cost to the states is tiny, and the help it would bring to the poor is immense. It’s paid for by taxes that residents of these states are going to pay regardless of whether they receive any of the benefits. And yet, merely because it has Obama’s name attached to it, they’ve decided that immiserating millions of poor people is worth it. It’s hard to imagine a decision more depraved.
Conservatives hate it when you accuse them of simply not caring about the poor. Sometimes they have point. This is not one of those times.
And, unfortunately for her, Missouri is one of the 24 states that refused to expand Medicare (though it would have cost them nothing), so that many in those states are out of luck:
I think it’s worth noting that the legislators who refused to accept the expansion of Medicare do not fall into that gap, and they couldn’t care less about those who do. Obviously.
Here’s the story, by Charles Ornstein in Pacific Standard:
For Missouri public radio reporter Harum Helmy, the Affordable Care Act is more than just a story she covers. It is also a story she’s living.
“I know — an uninsured health reporter,” she wrote to me last month. “The joke’s not lost on me.”
Helmy, 23, a part-time reporter/producer for KBIA in Columbia, Missouri, recently completed her coursework at the University of Missouri. She’s on her first professional job. At the station, she covers Obamacare, among other things. But she doesn’t make much money, and if the law worked as it was intended, she would be covered by Missouri’s Medicaid program beginning January 1.
That wasn’t meant to be.
As signed by President Obama, the Affordable Care Act (ACA) would have required every state to expand its Medicaid program for the poor to include adults earning less than 138 percent of the federal poverty level. Those earning more than that, up to four times the poverty level, would qualify for subsidies to purchase health insurance in marketplaces.
But the Supreme Court ruled last year that states could opt out of the Medicaid expansion without consequence, and Missouri along with 24 other states have done just that. The problem is that the law didn’t include subsidies for people in those states who earn less than the federal poverty level to buy coverage through the exchanges—they were supposed to be covered under Medicaid.
That’s the gap in which Helmy sits.
She earns less than the poverty level ($10 an hour for 20 hours per week) and qualifies neither for Medicaid nor a subsidy. Helmy was born in Texas and is a U.S. citizen, though her parents live in Indonesia. While she attended classes at the university, her parents paid for her health coverage.
According to the Kaiser Family Foundation, a non-partisan think tank, “In states that do not expand Medicaid, nearly 5 million poor uninsured adults have incomes above Medicaid eligibility levels but below poverty and may fall into a ‘coverage gap’ of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits.” In Missouri, 193,000 people, including Helmy, fall into the gap, Kaiser estimates.
On paper, the Medicaid expansion seems like a great deal. The federal government has agreed to pick up 100 percent of the cost of the expansion for the first three years, phasing down to 90 percent in 2020. But officials in states that have declined to take part view Medicaid as a broken program. They don’t trust the federal government to keep its funding pledge and do not believe they have adequate state funds to cover their portion.
Missouri Governor Jay Nixon, a Democrat, wants to expand Medicaid in his state, but the Republican-controlled Legislature won’t go along with it.
Helmy discussed her situation in a podcast in October (around the 12-minute mark). “I would just get a little bit personal here and say I’m one of those people,” she said. “I’m in this weird gap where I need insurance, my employer doesn’t give me insurance, but I don’t make enough to get a subsidy.”
I asked her what it felt like to be affected by the act. . . .
I think as people in the 24 states become aware that their legislators turned down free money that would have enabled them to have healthcare insurance, and they see that people making less than they get coverage, and people getting more than they are covered, the people left out in the cold are going to get amazingly angry. We may seem some interesting surprises in the November 2014 elections in those states.
Ezra Klein makes a very good point: in the old days, people were terrified of losing their healthcare insurance (employer provided or not). If they left the company, they would lose their medical benefits. If they were covered on an individual plan that was cancelled for any reason, there was no guarantee that they could get another. If they had a chronic illness, they were unable to get any individual healthcare insurance at all. Klein writes:
The furor over “if you like your plan, you can keep it” touches on a deep fear in American life: That your health-care insurance can be taken from you. That fear is so powerful because it happens so often: Almost everyone in the country can lose their health insurance at any time, for all kinds of reasons — and every year, millions do.
If you’re one of the 149 million people who get health insurance through your employer, you can lose your plan if you get fired, or if the H.R. department decides to change plans, or if you have to move to a branch in another state.If you’re one of the 51 million people who get Medicaid, you could lose your plan because your income rises and you’re no longer eligible or because your state cut its Medicaid budget and made you ineligible. You could lose it because you moved from Minnesota, where childless adults making less than 75 percent of the poverty line are eligible, to Texas, where there’s no coverage for childless adults.
If you’re one of the 15 million Americans who buys insurance on the individual market, you could lose your plan because your insurer decides to stop offering it or decides to jack up the price by 35 percent. And that’s assuming you’re one of the lucky people who weren’t denied coverage based on preexisting conditions in the first place.
Then, of course, there are the 50 million people who don’t have a plan in the first place. The vast majority of them desperately want health-care coverage. But it turns out that just because you want a plan doesn’t mean you can get one.
Virtually the only people whose health coverage is reasonably safe are those on fee-for-service Medicare and some forms of veterans insurance. And even there, enrollees are only safe until the day policymakers decide to change premiums or benefit packages.
President Obama’s critics are right: Obamacare doesn’t guarantee that everyone who likes their health insurance can keep it. In some cases, Obamacare is the reason people will lose health insurance they liked.
What Obamacare comes pretty close to guaranteeing, though, is that everyone who needs health insurance, or who wants health insurance, can get it.
It guarantees that if you lose the plan you liked — perhaps because you were fired from your job, or because you left your job to start a new business, or because your income made you ineligible for Medicaid — you’ll have a choice of new plans you can purchase, you’ll know that no insurer can turn you away, and you’ll be able to get financial help if you need it. In states that accept the Medicaid expansion, it guarantees that anyone who makes less than 133 percent of poverty can get fully subsidized insurance.
Health insurance isn’t such a fraught topic in countries such as Canada and France because people don’t live in constant fear of losing their ability to get routine medical care. . .
A series of charts that compares various aspects of healthcare:
Total expenditures, with proportion covered by government and not
Out-of-pocket expenses by country
Proportion of people with public insurance that buy private insurance
Total healthcare expenditures by country
Proportion of people who do not seek medical aid because of costs
Costs for routine doctor visits by country
Prescription drug and screening costs
And yet I believe that many still hold to the idea that the US offers “the best healthcare system in the world.”
Quite a few conservative voices are raised in an outcry about contraception coverage under the Affordable Care Act, which requires companies with more than 50 employees to provide health insurance coverage that includes, among other things, contraceptive services. NOTE: There is no requirement that any individual actually use such services: that is left up to the personal religious convictions of the individual. Businesses, however, hate to pay money, so some are saying that they should not be required to pay for insurance that includes contraceptive coverage because they (the business owners) don’t believe in it. In other words, the business owners want to impose their own religious views on their employees, which I think is wrong.
So a question to ask those espousing such a view: “Do you believe that a large business owned by Christian Scientists should be allowed not to offer healthcare insurance at all, since the owners do not believe in medical services in general?”
UPDATE: Emily Baxter has an interesting post at ThinkProgress on the general topic of healthcare insurance and religious liberty: Despite The Fights Over Religious Liberty, Obamacare Doesn’t Have To Be ‘Girl Versus God’
Though some GOP arguments certainly seem like wrecks of one sort or another. Kevin Drum tries to set the record straight at Mother Jones:
Here’s the astonishing statement that started this kerfuffle:
Kevin Drum responds:
One of the most maddening aspects of the debate over Obamacare isn’t simply the fact that conservatives dislike it, but the fact that they seem unable even to understand what the point is. Via Ed Kilgore, here is Georgia state insurance commissioner Ralph Hudgens—surely a guy who should understand what insurance is and how it works—comparing pre-existing condition requirements to having a car wreck:
A pre-existing condition would be then you calling up your insurance agent and saying, “I’d like to get collision insurance coverage on my car.” And your insurance agent says, “You’ve never had that before, why would you want it now?” And you say, “Well I just had a wreck, it was my fault, and I want the insurance company to pay for the repairs to my car.” And that’s the exact same thing on pre-existing insurance.
Well, sure, it’s the exact same thing except for the fact that it has nothing in common whatsoever. In fact, this is basically a defense of the individual mandate, though Hudgens doesn’t seem to understand that either.
People with pre-existing conditions aren’t folks trying to scam the system. They’re just people who got sick. And Republicans simply have no realistic plan for allowing them access to affordable health care. This is a problem for the GOP, because unlike the $100-a-plate crowd that tittered at Hudgens’ story, most people understand that pre-existing conditions can happen to anyone. That’s why Obamacare’s requirement for community rating—i.e., for insurance companies to cover people with pre-existing conditions at the same price as anyone else—is so popular. What most people don’t quite understand is that this is what produces the rest of Obamacare too. If insurance companies have to cover people with pre-existing conditions, they’ll go out of business unless they cover everyone else too. That way the entire insurance pool covers the small number who get seriously sick in any given year. So you have to have an individual mandate. But lots of people can’t afford insurance. So if you have an individual mandate, you have to have subsidies for low-income workers. And with that, you have community rating, the individual mandate, and subsidies. And that’s about 90 percent of what Obamacare is.
It’s one thing to oppose Obamacare. But Republicans have no realistic alternative. They can blather away about tort reform and HSAs forever, but even low-information voters dimly understand that it’s just blather. Either you’re going to cover sick people or you aren’t. And if you do, you’re going to end up with something that has most of the same features of Obamacare. Smarter Republicans understand this perfectly well, which is why they dance around the issue so manically. They know that their plans don’t actually provide health coverage for much of anyone at all. Dimmer Republicans like Hudgens don’t have a clue, so they just tell dumb stories to well-heeled crowds. I’m not really sure which is worse.
This amounts to fraud. Read and think about what this reveals about the GOP. And let’s wait for the news stories that will be coming out just about this time next year, when every heart-tugging talk show segment in the land will feature stories of 20-somethings whose lives have been ruined because they were convinced not to get health insurance, that going uninsured would be a good idea. “And now, here I am…” <breaks down in sobs>
Talk shows won’t be able to resist because those stories will resonate with the audience, particularly with those able to pat themselves on the back for being smart enough to have healthcare insurance.
But read at the link. Unfortunately, believable.
Interesting article by R.J. Eskow in Salon:
You don’t have to be an unqualified fan of the Affordable Care Act to recognize the lunacy of most Republican objections to it. From “death panels” to “a loss of liberty,” there’s only one consistent through-line to most of their objections: They come from Republicans, they’re directed at a Democratic president, and they’re irrational.
The president’s self-imposed deadline for fixing the website has arrived and, while it’s still far from perfect, the complaints are likely to become broader once again. The Republicans may not realize it, but that way lies danger.
More than once, Democrats have made the mistake of taking victory laps for a plan with very real problems. But the Republicans are setting traps for themselves – traps they may find it difficult to escape, especially if Democrats are shrewd enough to take advantage of them.
This shortsightedness already wounded them once, in the 2012 election, when candidate Mitt Romney was forced to attack a program that was nearly identical to the one thatGov. Mitt Romney implemented in Massachusetts. It looked absurd – because it was. Romney’s campaign was probably always a lost cause, but that didn’t help.
For the Republicans, there’s more where that came from.
The trouble starts with their gleeful rubbing of hands over the Healthcare.gov rollout. Gloating about the website is unwise for a couple of reasons. First, the website’s design and implementation was conducted by a private government contractor, CGI Global, not by government employees. There are many lessons to be learned from the website’s problems, but one of them clearly seems to be this: The privatization of government services, a key goal for the Republican Party, can work very poorly.
Accounts of the Obamacare implementation read like a how-to manual in inept contracting with outside corporations, and the administration deserves to take a hit for that. But the problem isn’t that government created the website. A larger part of the problem lies in the fact that it used a private contractor to do the job.
Worse, the administration chose to use a company whose specialty was not healthcare administration but “government contracting.” The fact that this is now an industry of its own, and one with enormous growth, shows just how far the privatization trend has come on the federal level.
That’s a problem. Professional government contractors know how to game the government procurement system for maximum profits, and those profit margins are added to the cost for taxpayers.
CGI Global, the all-purpose government contractor that handled the website, is a case in point. Even though the Obama administration has made a point of saying government should end no-bid contracts, this project – the most important of Obama’s presidency – was offered on a no-bid contract.
As someone who once led a company that contracted with government agencies, I can tell you that somebody “worked the system” extremely well on this one. Unfortunately, the “system” works much better for the contractors than it does for the public. Every time Republicans crow about the website’s problems, another thought should be implanting itself in the public’s mind: privatizing government services is a very bad idea.
The challenge for Republicans runs even deeper than that. They’ve been mocking the very concept behind the Obamacare exchanges. It’s a concept that made the rollout extremely difficult. The idea was that government would create an electronic “marketplace” where people could comparison-shop for health insurance. This, we were told, would keep costs down by employing market forces and competition.
This also happens to be an excellent way to describe the Republicans’ plan for Medicare. The description is still up at Rep. Paul Ryan’s website:
Beginning in 2024, for those workers born in 1959 or later, Medicare would offer them a choice of private plans competing alongside traditional fee-for-service option(sic) on a newly created Medicare Exchange (emphasis ours) … The Medicare Exchange would provide all seniors with a competitive marketplace where they could chose a plan the same way members of Congress do.
Every time the Republicans tell horror stories or make fun of the ACA’s exchange, they’re telling people that their own plan for Medicare is going to turn the most popular, cost-effective and successful health plan in the country into a tragedy – or a joke.
They’re also sabotaging their own arguments for privatizing Social Security. The plan that George W. Bush proposed in 2005 called upon the government to administer a portfolio of private investment plans on behalf of retirees. There’s still talk of reviving this GOP proposal. Rep. Paul Ryan, leading House Republican and 2012 vice-presidential candidate, continues to push a privatization scheme that even the Bush administration described as “irresponsible.”
As Obamacare goes, so goes the Social Security privatization plan.
There’s a reason why their negative characterizations of Obamacare match their own proposals so closely. As many people know, the Affordable Care Act began its life as a right-wing proposal meant to blunt the drive toward healthcare reform during the Clinton administration. Republicans loved the idea back then. They loved it when Gov. Arnold Schwarzenegger proposed something similar in California. And they loved it when future presidential candidate Mitt Romney implemented it in Massachusetts.
That’s why they’re in such a trap now. Their attacks have already trashed the credibility of the Heritage Foundation, which was a principal architect of the plan back in the Clinton years. The Heritage Foundation’s Robert Moffit brought ridicule on himself and his organization when he wrote that the ACA’s individual mandate was “an Unconstitutional Violation of Personal Liberty” that “Strikes at the Heart of American Federalism,” adding that “It is an assertion of federal power that is inherently at odds with the original vision of the Framers.”
In fact, most experts agree that the idea of the individual mandate originated with the Heritage Foundation itself in a 1989 paper that proposed that the government “mandate all households to obtain adequate insurance.” The paper by Stuart M. Butler argues that:
Many states now require passengers to wear seatbelts for their own protection. Many others require anybody driving a car to have liability insurance. But neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious injury or illness.
The paper continues, “Under the Heritage plan, there would be such a requirement.” And in case there is still any doubt about whose plan contains this individual mandate proposal, the section of the document containing these words is titled “The Heritage Plan.”
Then there’s the issue on which Republicans have scored most heavily . . .