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Concern Troll

Without the least hint of irony, Avik Roy (a senior fellow at the Manhattan Institute and health-care advisor to Mitt Romney) has written an article for National Review called How Obamacare Harms the Poor (via subscription). The main thrust of his argument is that Obamacare (that is, the Affordable Care Act) will expand Medicaid, which isnt as good as commercial insurance, since many physicians dont accept it. Therefore, Roy suggests, because the poor would be better off with private insurance than with Medicaid, they are better off with no insurance than with substandard public insurance Obamacare would provide. Roy spices up his discussion with some supply-side economics: Obamacare will increase insurance costs for some businesses, which will cause them to cut back on hiring, which is bad for poor people. (This, not incidentally, is the same discredited argument the National Review crowd uses against the minimum wage.) And he throws in a few miscellaneous potshots, complaining, for example, that Obamacare includes an individual mandate while also complaining that its mandate isnt strong enough to work. But, overall, Roy seems to believe that the poor, and probably everyone else, is better off with the status quo.

Roy begins his diatribe with the story of a boy who died of a toothache. The toothache was from an untreated abscess that eventually infected the boys brain. Roy claims that the abscess was not treated in a timely manner because the boy couldnt find a dentist who would accept Medicaid. Now, it is a scandal that Medicaid does not reimburse providers for the full cost of treatment. (Roy says that the reimbursement is fifty percent of cost; its more like sixty, but never mind: its definitely less than one hundred.) Medicaid is subsidized by private insurance and (to some extent) Medicare. But since Medicaid patients tend to be money losers, many doctors and dentists wont take them. Roy points us to some statistics showing that people on Medicaid have poorer health outcomes than those who have private insurance. What he does not quite explain is how the dead boy would have fared better with no insurance at all, and surely that is the relevant question.As it happens, there was an article on the front page of yesterdays New York Times that addresses that question. Pam Belluck reports on a study published in the New England Journal of Medicine that found that the number of deaths for people age twenty to sixty-four decreased in three states that expanded Medicaid eligibility. During the same period three neighboring states that did not expand their Medicaid programs saw the number of deaths for the same age group go up. (The numbers were adjusted for population growth.) Obamacare would have the federal government pay for every state to expand its Medicaid program the same way the first three states did. In its recent decision on the law, the Supreme Court ruled that states were free to refuse this expansion without losing the federal money they already receive for Medicaid, but this study strongly suggests they would be foolish to do so.Roys explicit comparison of Medicaid to private insurance might lead one to suppose he thinks Medicaid should pay doctors as much as private insurance does. Or that he is advocating something even more obvious: a national single-payer insurance program. But no. According to Roy, Obamacare will not only hurt the poor by forcing them onto Medicaid; it will also ruin the middle class. His argument for this claim is odd, but lets let him speak for himself. Not all health coverage is created equal, he writes.

A plastic card in your wallet with the word insurance on it doesnt guarantee that youll have access to the medical care that you need when you need it. And that is the fundamental problem with Obamacare: It expands coverage without any regard to the value, or the quality, of that coverage.

And how does Obamacare ignore value and quality?

[I]t requires regulated health-care plans to provide insurance with a generous minimum actuarial valuethe percentage of total average health-care costs that the plan coversforcing plans to reduce their co-pays and deductibles, in exchange for higher premium.

Far from providing one-size-fit- all insurance plans, as Roy claims, Obamacare will require that there be several different levels of minimum coverage at different prices. But its minimum-coverage and minimum-actuarial-value requirements will insure that the plastic card in your pocket does guarantee the care you needand the care most people expect their insurance providers to cover.Roy also claims that Obamacare will negatively affect flexibility, by which he means not the policy-holders flexibility but his or her employers.

If you have a chronic disease such as diabetes, or if your daughter has multiple sclerosis, a prospective small employer will be especially reluctant to offer you a job, because Obamacare will leave that company with no flexibility in the kind of health care it can offer, thereby increasing its financial risk (italics mine).

In other words, under Obamacare the business will have to offer you benefits that will cover you or your daughters chronic disease and will not have the flexibility not to. Roy is looking at this exclusively from the employers point of view. And thats the real problem with Obamacare for people like Roy and Romney: it may give the consumer more, but it puts more obligations on businesses, obligations whose expense will have to be passed on to the consumer. So why rock the boat? Better a few more poor people without insurance than a reform law that makes it harder for business owners to stop insuring their employees.



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'Obamacare would have the federal government pay for every state to expand its Medicaid program the same way the first three states did."But those federal government funds are for only a few years, correct? And after that, the expectation/assumption is that states will need to pony up the additional funds to cover the expanded Medicaid rosters?

Jim Pauwels:The Federal Government pays 100% of the cost of the expansion for the first few years, after which their contribution reduces to 90%, which is the permanent Federal contribution level. This permanent level is significantly higher than the Federal contribution percentage for the current level of benefits, although I do not know that precise percentage.

Please Kate That 90% will drop with time; anyone can see that.The solution is to repeal Obamacare (ACA) in its entirety and start over.Back to the drawing board - 2013

This mornings NPR Morning Edition had a segment on a strategy change in the Republican proposed repeal and replacement of Obamacare.

For decades, the primary goal of those who would fix the U.S. health system has been to help people without insurance get coverage. Now, it seems, all that may be changing. At least some top Republicans are trying to steer the health debate away from the problem of the uninsured.The shift in emphasis is a subtle one, but it's noticeable.Take this exchange between Fox News Sunday host Chris Wallace and Senate Minority Leader Mitch McConnell (R-Ky.) earlier this month, just after the Supreme Court upheld most of President Obama's health law.Wallace: "What specifically are you going to do to provide universal coverage to the 30 million people who are uninsured?"McConnell: "That is not the issue. ... The question is how can you go step by step to improve the American health care system? It is already the finest health care system in the world."Wallace: "But you don't think that 30 million people who are uninsured is an issue?"McConnell: "Let me tell you what we're not going to do. We're not going to turn the American health care system into a Western European system. That is exactly what is at the heart of Obamacare. They want to have the federal government take over all of American health care....Clancy is only one of many policy types who are trying to convince more Republicans to put expanding coverage on the back burner. Another is Michael Cannon, head of health policy at the libertarian Cato Institute.Cannon has long questioned the idea that expanding insurance coverage should be the holy grail of health reform."The idea that the government should guarantee health insurance to everybody passes as really gospel in health policy circles, without any serious consideration, without any sort of examination of why is it that we want people to have health insurance, is health insurance the best way to serve those goals, could there be lower-cost ways of achieving those goals," he said.People need to have the freedom not to have insurance if the marketplace is to function properly, he says. "Because if they don't have freedom, if the government is requiring them to purchase health insurance either from a private company or the government, then the government gets to define what health insurance is, and that stifles a lot of innovation in the health insurance and health care delivery markets, and we're suffering under that sort of regulation right now," he says.

That's quite a nice drawing board you have there Mr. McConnell...

Ken, i live in a state that has had Obamacare for six years (here, it's Romneycare). Works fine.

I don't think Mr Roy's assumptions fit the facts on the ground here in NYC. (Even if he is a senior fellow with the Manhattan Institute). The budget health plans that I have offered as an employer and participated in as an employee do not seem demonstrably less attractive than Medicaid; Medicaid might actually provide better coverage. And dental insurance here in NYC has been, for my family, a huge joke. Not all employers offer dental , and when they do, even with the most generous dental plans there are still substantial out of pockets once you need anything beyond cleanings and fillings. I go to a dental school clinic which is cheaper for me as a self-pay than what I was paying private dentists under an insurance plan. That same clinic most certainly accepts Medicaid which, I understand, also fully covers orthodontia.I just don't think Mr Roy's negative comparisons of Medicaid work here in NYC.

The HHS contraception mandate goes into effect next Wednesday for Taco Bell stands and other for-profit businesses. The Thomas More law center is trying to get a federal judge to issue a Temporary Restraining Order. filing says "If a TRO does not issue, Plaintiffs will be forced to violate their religious beliefs or potentially forfeit health insurance."Although individual Bishops have said they would close church-owned hospitals if they have to provide insurance coverage for contraceptives, has the USCCB provided guidance to private Catholic employers as to whether providing that cover is gravely sinful or allowable remote cooperation?. How would their pastor know how to advise them if they ask the question?

1. It's already illegal to deny or diminish health coverage based on an employee's health status or that of their dependents.2. It's illegal to ask them about their health status prior to offering them employment.3. Most small employers don't have the "flexibility" to offer anything other than state approved benefit plans through insurers, and those benefit plans NEVER carve out coverage for chronic diseases like diabetes. 4. One very good feature of the ACA is to mandate states to make reimbursement for Medicaid PCPs comensurate with Medicare reimbursement (maybe that's why Roy is so focused on dental care, so he doesn't have to admit how much stronger Medicaid might be with that provision). 5. Has it occurred to Roy that sometimes it's the employer who is the sick one? Or that "would be" job creators don't create jobs because they are terrified of losing their health coverage for themselves or a dependent?It doesn't sound like he knows much about existing health care markets, preferring, apparently, to analyze by anecdote.

"That same clinic most certainly accepts Medicaid which, I understand, also fully covers orthodontia."I have private dental insurance, and am now facing the prospect of orthodontia for a couple of my children at once. I expect that the out-of-pocket portion will be such that they will qualify me for Medicaid. :-)

The new Republican position reminds me of the Vatican monsignor who insisted the Church was stronger in Italy than in the United States. He admitted no one goes to church in Italy, but the doctrine, he insisted, was much purer. Likewise, as we ger nearer to the point when no one gets health care in the Unites States, Cato thinkers can glory in the purity of our markets.By the way, can anyone who believes his stuff translate the last paragraph of the quote from Michael Cannon that John Hayes provided (starting with "People need to have the freedom... ") into language I can understand?

One compny has obtained a Temporary Restraining Order:

A federal court said Friday that a Colorado-based company does not have to comply with the Obama administrations birth-control mandate because of the employers religious beliefs.Several businesses and religious groups have sued over the policy, which requires most employers to provide contraception coverage in their healthcare plans. Fridays temporary injunction is the first time a court has ruled against the policy.Judge John Kane emphasized that his ruling only applies to the specific company whose lawsuit he considered Colorado-based Hercules Industries.The company, like many others, said the contraception order violates the religious beliefs of its owner. Most of the lawsuits have been filed by Catholic groups who say they should not have to provide coverage that violates their religious opposition to contraception.

I see the Brits are proud enough of their national health care system that they are celebrating it in the opening ceremonies for the Olympics!

Washington Post:"This spring, Republicans were on a mission: repeal the Obama administrations rule to require employers to cover birth control.House Speaker John Boehner even stood on the floor of the House in February and promised that Congress would act. This attack by the federal government on religious freedom in our country must not stand and will not stand, Boehner said.But now, with the rule set to take effect Wednesday part of the Obamacare law the GOP hates so much the fiery repeal rhetoric has fizzled. In fact, few on Capitol Hill are saying anything about it at all.And that House vote to block the rule? Never happened and isnt in the works either. A group of die-hards on the issue asked for it again in a closed-door meeting Wednesday with House leadership but said no promises were made.Even Rep. Jeff Fortenberry (R-Neb.), one of the most vocal critics of the rule and co-sponsor of a bill to eliminate it, has gone quiet now that the rule is about to kick in.Its a reminder of how fast things changed for Republicans this spring.What looked like a great attack line against the president on religious liberty and a chance to rally evangelical and Catholic voters against President Barack Obama quickly morphed into another example of what the left dubbed the Republicans war on women.And it seems like House Republican leadership took the attacks to heart. A small group of House Republicans and religious liberty groups are trying to get the issue going again including attempts to get the courts to halt it but theyre not getting any traction with top Republicans....But the issue faded away on Capitol Hill quickly after the debate led to P.R. disasters like the all-male House hearing on the contraception rule and Rush Limbaughs attacks on Sandra Fluke, the Georgetown law student who later testified at a Democratic hearing on the issue.And by March 1, when the Senate narrowly defeated an amendment by Sen. Roy Blunt (R-Mo.) to overturn the rule, the GOP fight was already losing steam. That day, Boehner promised only that the House will decide on how we will proceed...."Even the rules most vocal outside opponents, the United States Conference of Catholic Bishops, say theyre not doing anything to mark the day. Theyre still mad about the rule, but they may not do much more than say theyre mad about it."Read more: more:

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