What’s wrong with a ‘skimpy’ healthcare plan?

Opinion This article first appeared on the Hoover Institution site. Individual health plans under the Affordable Care Act (ACA) are in a state of serious disrepair. The deep structural problems with these plans cannot easily be fixed. Keep up with this story and more by subscribing now The main issue is that the benefits packages are too generous—and there is not enough revenue coming in to fund them, as young and healthy individuals and families desert the plans in increasing numbers. The danger of implosion is everywhere. In Idaho, the rate increases in individual ACA-compliant plans for the last three years—12 percent in 2016, 24 percent in 2017, and 27 percent in 2018—explain why middle-class families have quit the exchanges, even though their income is too high to qualify for either Medicaid or ACA subsidies, leaving them with no coverage at all. Faced by this breakdown, Idaho Governor Butch Otter issued an Executive Order directing the Idaho Insurance Department to devise “creative options” to expand market access. As a legal advisor to Blue Cross of Idaho (BCI), let me explain what was done and why. The key challenge is to promote access, but without some of the ACA’s most onerous features, such as premium compression by age and no restrictions on coverage for preexisting conditions when there have been coverage breaks. It would be folly in a system of federal dominance for states to allow local insurers like BCI to junk all ACA-compliant plans.   But the same conclusion does not apply to a program in which all these plans are left untouched. Subsequent to BCI and other companies would like to offer, alongside ACA-compliant plans, a more basic state-compliant plan that may well prove attractive to those people who today have no coverage at all.   These other plans are to remain in the same risk pool as the ACA plans. Anyone who wants to enroll in the ACA-compliant plans may do so. The new Idaho program Continue Reading

Healthcare We Can Believe In

Katha Pollitt’s new book of poems, The Mind-Body Problem, has just been published by Random House. I am not a wonk. Usually this is not a problem. But when it comes to healthcare reform, it matters. You see, I long to dash forward, flaming sword in hand, to champion President Obama’s healthcare plan. Every day I get e-mails from Health Care for America Now, Organizing for America, MoveOn.org and similar groups urging me to write my Congressman, attend a town-hall meeting, host a gathering. But how can I speak knowledgeably about a plan that does not yet exist and in which the parameters keep shifting? I’d like to tell people, Obama’s plan is great–for example, it has a public option that will insure those who can’t afford private coverage, help rein in the insurance companies by competing with them for members and drive down drug prices through forceful negotiation. But maybe the final bill won’t allow the government to negotiate drug prices, because that’s the price of Big Pharma’s support, which apparently the Obama administration negotiated for in secrecy. Maybe it won’t even have a public plan; it will have insurance co-ops instead. And then, maybe, I should say those will be just as good, as Rahm Emanuel’s brother, Ezekiel Emanuel, the MD/PhD bioethicist, says. OK, but what are insurance co-ops? I poked around online for fifteen minutes and discovered that they’re untested, small, unregulated, that they exist in twenty states and that Senator Kent Conrad of North Dakota really likes them–but I didn’t discover what they actually are. I understand “public option,” and “public” has a good, strong ring to it–it says, Healthcare is a right, part of the common good, something everyone should have, and if you can’t afford it in the marketplace, the government will provide it. “Insurance co-op” speaks a whole other language, of Continue Reading

Wrong Prescription: McCain’s Healthcare Plan

Deregulation has worked so well for Wall Street, John McCain wrote recently, that we should use the same approach to fix our healthcare system. In the September/October issue of Contingencies, the magazine of the American Academy of Actuaries, the Republican presidential candidate asserts, “Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.” McCain was writing just before Wall Street collapsed, and he obviously did not think Americans needed to be insured against the failure of a deregulated financial sector. Likewise, he was not concerned that the 53 percent of Americans who get insurance from their employers need protection from the risk of losing it. In fact, he’s hoping they will lose their employer coverage, betting they’ll be better off on their own in a deregulated market. McCain’s healthcare plan replaces the tax incentives for employers to offer health insurance with a tax credit for people to buy insurance on their own. This proposal embraces a “consumer directed” approach to healthcare, a model that has become popular among free-market conservatives. The more directly people bear the costs of their care, the thinking goes, the more they will drive down costs by becoming better shoppers. Under this model, employees, not employers, should pay for their care. Al Hubbard, a former White House economic adviser who devised a similar proposal unsuccessfully advanced by George W. Bush in 2007, explains this approach by suggesting we imagine a world in which employers offer “food insurance” instead of health insurance. If an insurance company paid for your groceries as it does your healthcare bills, he argues, “pretty soon you would start buying caviar, the most expensive steak, and you would start buying more Continue Reading

It Would Cost Just 5 Cents More Per Plane Ticket to Get Airport Catering Workers Some Decent Healthcare

On top of all the obscure extra fees that get heaped onto your already overpriced plane ticket, you might be getting an unexpected discount—a single nickel saved on every airfare. That’s how much extra it would theoretically cost to provide a decent healthcare plan to thousands of airline catering workers. An extra five cents a ticket, according to their union, could ensure that the person who prepares your reheated pasta tray doesn’t sneeze on your butter pats because she can’t afford to see a doctor. Hundreds of catering workers represented by UNITE HERE marched in Washington, DC yesterday to demand access to decent health insurance that will help them stay healthy, do their job safely, and avoid falling further into poverty. Representing some 12,000 airline catering workers with major contractors like Gate Gourmet and Sky Chefs, the union is calling on the big airlines to build into their supply chain the cost of decent healthcare, which they calculate as roughly five cents per ticket, to be passed down to workers to offset insurance costs. According to a national survey of airline catering workers, over 40 percent of catering service workers—who handle meal preparation, processing and logistics at airports across the country—earn less than $10.10 per hour. That’s well below a living wage in many of the cities where major airports are located (and less than the minimum wage repeatedly proposed by the Obama administration to bring the base wage closer to 1960s levels). According to UNITE HERE, extremely low wages leave workers “unable to pay the premiums of so-called ‘minimum value plans,’ [those complying with federal mandates] but ineligible to purchase more affordable options from health care exchanges.” Despite the introduction of Obamacare, precarious airline catering workers have fallen into an insurance black hole. Though they are unionized, many earn just above the threshold to qualify for Continue Reading

PX: Can FC Cincinnati just be honest with the public about its stadium plans?

City Council decided to approve spending $36 million on a soccer stadium after a 4½-hour marathon meeting on Monday.Great, FC Cincinnati's new stadium is going to Oakley.Maybe.Or maybe not.Well, where's it going then? Seriously, can someone just be straight up with the public? We have a done deal that apparently isn't done. "I acknowledge that there's a level of uncertainty," FC Cincinnati President Jeff Berding told City Council. That's the understatement of the day. It sums up why Politics Extra has been questioning this whole deal.We left City Hall late Monday afternoon confused about where the hell the stadium is going and who's going to cover more than $20 million of an infrastructure funding gap. Oh, but just trust us.That was Berding's underlying message throughout his testimony. He sidestepped P.G. Sittenfeld's and Chris Seelbach's questions about who is going to cover the deficit after the city puts in its $36 million for new streets and sewers and Hamilton County pays $15 million for a parking garage. Remember, the soccer team says it needs between $70 million and $75 million in public money for infrastructure to support building a $200 million stadium.Basically, the meeting was a dog and pony show for FC Cincinnati to get something – anything – down on paper to ship off to Major League Soccer next month as part of its expansion bid package.That's great for the soccer team. But not so much for citizens, especially considering Berding opened the door to the possibility that Oakley might not even be where the stadium ends up."The mayor and council may work with us to say it might be in a different neighborhood," he said.Said Councilman Kevin Flynn: "It may not be in Oakley. It may be somewhere else."So this meeting was all smoke and mirrors then? The belief is FC Cincinnati really wants to build the stadium in the West End, where Taft High's football stadium is located, a block or so off Central Parkway. It could be Continue Reading

New Senate Republicans healthcare bill already in trouble

By Susan Cornwell and Yasmeen Abutaleb WASHINGTON (Reuters) - Senate Republican leaders released on Thursday a revised plan to dismantle the Obamacare law, but it drew criticism from senators on both sides of the political divide within the Republican party, indicating a treacherous path for the bill. The bill played to the party's disparate factions by letting insurers sell cheap, bare-bones policies while retaining taxes on the wealthy. But the immediate outcry illustrated the difficult political terrain that U.S. Senate Majority Leader Mitch McConnell must navigate. He is under pressure by President Donald Trump to pass a healthcare bill and make good on Republicans' seven-year mission to gut Democratic former President Barack Obama's signature legislative achievement. "The American people deserve better than the pain of Obamacare. They deserve better care. And the time to deliver that to them is next week," McConnell said. In addition to the criticism from some senators, a major hospital association and one large insurer said the measure falls short in critical areas. With Democrats united against it, McConnell cannot afford to lose more than two Republican senators to win passage. But moderate Susan Collins and conservative Rand Paul voiced opposition to even bringing the new plan up for debate. Several senators said they had concerns about the legislation, particularly its Medicaid cuts, including Shelley Moore Capito, Rob Portman and John McCain. And two other Republican senators, Lindsey Graham and Bill Cassidy, complicated matters by announcing an alternative plan. McConnell, a skillful tactician who was forced two weeks ago to scrub a planned vote on an earlier version opposed by both moderates and hard-line conservatives in his party, has planned for a vote on the retooled bill next week. The continuing lack of consensus among Republicans on what to do with Obamacare after calling for its demise since 2010 shows that it is no sure Continue Reading

House Republicans introduce plan to repeal Obamacare

WASHINGTON — House Republicans released their long-awaited plan to repeal and replace Obamacare on Monday, the first major step in an arduous and uncertain journey to overhauling the law. The legislation would replace the federal subsidies that help low-income people buy healthcare plans with tax credits, give out grants to help states design their own systems, and gradually eliminate the Medicaid expansion that has helped 11 million people get insurance for the first time. It would also cut funding to Planned Parenthood. Only less wealthy Americans would get the tax credits under the new plan, a change from previous GOP drafts, while older Americans would get slightly larger tax breaks. Individuals who make $75,000 or more would get smaller credits, and those who make more than $215,000 wouldn't get any help under the new plan. The tax breaks range from $2,000-$4,000 depending on income and age. "The American Health Care Act is a plan to drive down costs, encourage competition, and give every American access to quality, affordable health insurance," House Speaker Paul Ryan (R-Wis.) said in a statement shortly after the bill was released. "Working together, this unified Republican government will deliver relief and peace of mind to the millions of Americans suffering under Obamacare." White House Press Secretary Sean Spicer said, “Today marks an important step toward restoring healthcare choices and affordability back to the American people. President Trump looks forward to working with both Chambers of Congress to repeal and replace Obamacare." But passing the Obamacare repeal may prove even more problematic for the GOP than passing the original law was for Democrats eight years ago, however, as both moderate and conservative Republicans have raised concerns about earlier drafts. The bill could lead to a vicious internal fight in the party, especially once the nonpartisan Congressional Budget Office Continue Reading

GOP 2016 hopeful Scott Walker offers healthcare plan focused around tax credits

Republican presidential candidate Scott Walker's plan for replacing President Barack Obama's health care law would extend refundable tax credits to help pay for private health insurance based on age instead of income, restructure Medicaid and allow people to shop for insurance across state lines. The Wisconsin governor provided details of his proposal to The Associated Press in advance of a Tuesday speech in suburban Minneapolis where he was to outline his first major policy initiative of the presidential campaign. Walker's plan does not include cost figures or an estimate of the number of people who would be covered, making it nearly impossible to compare with current law. For the period from April to June of this year, 11.4 percent of U.S. adults were uninsured, which translates to about 16 million people gaining coverage since the rollout of Obama's health care law in 2013. Walker's campaign said the plan would be paid for by eliminating $1 trillion in taxes that are levied under the current law and by making other changes to Medicaid and how health insurance is taxed. The Supreme Court in June upheld a key portion of the Affordable Care Act allowing for federal subsidies to defray the cost of coverage, a major defeat for opponents of the law. Walker and other Republican candidates have insisted they would repeal the law, starting on the first day of a GOP presidency. The biggest hurdle Walker, and any opponent of the law, faces is getting it repealed. That would take 60 votes in the Senate, and Walker's plan does not address how he would undo the law in any other way. Walker, in excerpts of his speech released by his campaign, blamed fellow Republicans with not doing enough to repeal the law. ``Republican leaders in Washington told us during the campaign last year that we needed a Republican Senate to repeal Obamacare,'' Walker said in the prepared remarks. ``Well, Republicans have been in charge of both houses of Congress since Continue Reading

Your guide to Obamacare: How to size up health plans with the online exchange

Now, it's time for a little comparison shopping. New York State's new health insurance exchange, New York State of Health, aims to simplify your hunt for affordable healthcare coverage. When it opens on Oct. 1, you'll be able to size up healthcare plans side-by-side by their costs and benefits, and then sign up. "Access to quality health insurance means access to good health, and enrolling has never been easier," said Donna Frescatore, New York State of Health's executive director. "New York State of Health gives people the peace of mind that comes from knowing they are prepared for life's events." Still, with the exchange offering dozens of plans from 16 different insurance companies, plus dental plans from ten insurers, there are some important things you'll want to know to make the right choice for you and your family. The plans all cover a basic set of benefits, such as doctor visits, hospital stays, maternity care, prescription drugs and lab services. And you can't be rejected or charged extra just because you're already sick. But they do come in four different tiers of coverage — bronze, silver, gold and platinum — that vary based on how you will share the cost of healthcare with the insurance company. Bronze plans will have the lowest monthly premiums, but your out-of-pocket costs will be the highest when you get care. Platinum plans, at the other end of the spectrum, will tend to have the highest premiums, but the plan will cover the biggest portion of your medical costs when you're sick. That means you'll want to think about how much of your budget you can and want to dedicate to paying your premiums each month. But that shouldn't be your only consideration, and the lowest-tier plan isn't always your best option. "One of the main things people need to think about is: What care do they anticipate needing?" said Nora Chaves, director of the community health advocates at the Community Service Society of New Continue Reading

Obama asks supporters to help with rollout of troubled healthcare plan

President Barack Obama, defiant against mounting criticism of his troubled healthcare plan, vowed on Monday to press ahead with the rollout and asked supporters to help as the White House struggled to gain control of the debate over his signature achievement. Obama went before 200 of the core activists who helped turn out the vote for him in his re-election a year ago, seeking their assistance to enroll people into the Affordable Care Act amid signs that early enrollment numbers will fall far short of expectations. “I need your help to implement this law,” he told leaders of the Organizing for Action group that grew out of his 2012 campaign. “I need your help to educate folks about this law.” Obama has come under fire for a website that has not worked properly since the system came online Oct. 1 and for the fact that thousands of Americans are seeing their private insurance plans canceled despite his 2010 promise that under Obamacare, “if you like your healthcare plan, you’ll be able to keep your healthcare plan.” The problems have contributed to a drop in his job approval rating to about 40 percent and given his Republican critics ammunition to use against a healthcare law they have fought bitterly since it was proposed during his first presidential campaign in 2008. Obama promised that the problems with the website will be fixed and vowed the healthcare law would not be stopped. “When the unanticipated happens, we’re just going to work on it, we’re going to fix things that aren’t working the way they should be and we’re just going to keep on going,” he said. His administration has set a target of the end of November for HealthCare.gov to be operating smoothly. Aides on a conference call with reporters promised it would be much improved, a possible sign that all problems will not be worked out in time. Obama called the website problems “inexcusable” Continue Reading