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Short Takes on Obamacare

The Affordable Care Act is more popular among Republicans than Obamacare, by a 22% to 14% margin, and among the general population, 39% to 34%, according to a Fox News poll.

According to Pew, of the 53% of Americans surveyed who disapprove of the ACA, 27% want Congress to make it work as well as possible, while 23% want Congress to “do what they can to make it fail.” Among the Tea Party, 64% want their representatives to work actively at making it fail. “The Tea Party wing of the GOP is dead set on sabotaging Obamacare above all else,” writes Kevin Drum at Mother Jones.

Jonathan Chait looks at that effort, and gives details on the status of reforms:

Health-care inflation since 2011 has fallen to its lowest level in half a century. The Congressional Budget Office estimates of Obamacare’s costs, widely derided at the time of its passage as too optimistic, have thus far proven too pessimistic. The agency has already cut $600 billion off the expected ten-year spending total for Medicare and Medicaid. If the reforms continue to bear fruit, costs will come in even lower.

And health experts increasingly expect the reforms will bear fruit. “The ongoing slowdown in the health-care growth rate defies historical post-recession patterns and is likely to be sustained,” concluded Price­Waterhouse-Coopers in June. “It appears that the reforms will stick and health-care exchanges and other policies will bring competitive pressure to markets,” says Randall Ellis, a professor of health-care economics. “Although the proof for this point of view is not yet definitive,” reports the Health Affairs blog, “the depth and breadth of change suggest that significant transformation in the nation’s delivery system is under way.” Among health-care wonks, this is no longer a controversial assertion: The evidence thus far suggests Obamacare’s cost reforms are a staggering success.

The Wall St. Journal says the defunding drive is a political loser:

Mr. Obama is never, ever going to unwind his signature legacy project of national health care. Ideology aside, it would end his Presidency politically. And if Republicans insist that any spending bill must defund ObamaCare, then a showdown is inevitable that shuts down much of the government. Republicans will claim that Democrats are the ones shutting it down to preserve ObamaCare. Voters may see it differently given the media's liberal sympathies and because the repeal-or-bust crowd provoked the confrontation. …

We've often supported backbenchers who want to push GOP leaders in a better policy direction, most recently on the farm bill. But it's something else entirely to sabotage any plan with a chance of succeeding and pretend to have "leverage" that exists only in the world of townhall applause lines and fundraising letters.

The Congressional Budget Office warns of unsustainable debt levels by 2023, due mainly to the rising costs of Medicaid, Medicare, and Social Security. In response to the report, Paul Ryan, leader of the House Budget Committee, suggests eliminating Obamacare.

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NPR/Morning Edition has been been running a series on the ACA this summer (including the fact that people like the Affordable Care Act better than Obamacare ...). Those who want to understand it better might want to start with Julie Rovner's report here: http://www.npr.org/blogs/health/2013/07/01/196335133/you-ask-we-answer-demystifying-the-affordable-care-act

I wish the bishops who threw so much energy into the "Fortnight for Freedom" would devote the same energy to telling Paul Ryan--loudly, publicly, and often--that he cannot be a devotee of Ayn Rand and a Catholic at the same time.  It's not What Jesus Would Do.

What do you mean by unsustainable debt levels? The projected levels of debt in 2023 look to be similar to our current levels as a percentage of GDP, and even in 2038 the levels are high but within levels that have been sustained by large nations with their own currency.

Since the "Affordable Care Act" gets substantially more support from the public than "Obamacare" does, I guess the law would be really popular if pollsters used its full name, the Patient Protection and Affordable Care Act.

If opponents truly believed that the ACA was going to prove a miserable failure, they might not be in such a sweat to stop it. They could let it fail, take credit for having been against it, and then propose their alternative, if any. The take-no-prisoners opposition now suggests that they know there willl be no later for them once the law takes effect. If it saves money while increasing access to health care, people will not look kindly on those who tried so hard to deny them its benefits.

According to NCR, the leaders of the USCCB have reiteerated their opposition to what they call the HHR mandate that is connected with this law. They continue to fret about the fact that the mandate makes no exception for owners of businesses who oppose the mandate on conscience grounds to be exempted from the mandate's requirements. What a nutty position for the USCCB to take! Imagine what would happen if their "principle" were applied to all civil legislation.

It would be nice if the bishops (and other religious leaders) also fretted publicly about the fact that employers who increase profits by hiring part-timers are cutting part-time hours so that they won't be liable for providing insurance to employees under ACA. This is happening largely in retail, service, higher ed sectors where adjuncts are used to keep costs down, and, ironically, many areas of the health care biz itself (nursing homes, home care, etc.). 

Reducing hours reduces income, and that means that those workers whose hours are cut below the ACA requirement may have to rely on expanded Medicaid or subsidized policies that they might otherwise have been able to pay for on their own. This could raise the cost of the ACA for taxpayers, which, in my opinion, constitutes business welfare.

Jean, I agree with your concern.  But let me play devil's advocate for a moment.

I expect that underlying your concern is an assumption that employers have certain responsibilities for the well-being of their workers: e.g. to pay a living wage and, in the US until the advent of the ACA, to provide health care coverage.  But the ACA seems to rewrite that part of the social contract.  The ACA tells employers and employees that the employer isn't really responsible for the health care of employees.  Employer group health care plans, under the ACA, now are nice-to-provides but no longer are expected-to-provides.  Employees, starting in a couple of weeks, will have these hi-tech insurance exchanges whose mechanism is designed to push down the price of individual health insurance to levels that are affordable for consumers; and the government (not the employer) will subsidize individuals and families who can't afford to pay the premiums on their own.  

Old social contract: employer subsidizes health insurance.  New social contract: individuals and the government pay for health insurance, with employers participating if they wish.

This is as much to tell employers: Go ahead and schedule your employees for 29 hours per week.  We, the government, will pick up the tab.  Perhaps that was not the intent of the authors and supporters of the ACA.  But surely it is the "intent" of the legislation itself, as this is the way it is written and is playing out.  The authors and supporters of the ACA also have a responsibility: to pass legislation that accords with their view of how the worlds of employment and health care should work.  If employers merely follow the law that the authors and supporters of the ACA have passed, it's hard to blame the employers.  They're just rats finding their way through the maze that the ACA has constructed for them.  

If the ACA is causing serious unintended consequences, it's on the supporters of the ACA to fix the legislation.

 

Jim, I think ACA proponents could (and should) have anticipated the adverse effects of the bill on part-time employees. Certainly, the emails I sent to my elected representatives alerted them frequently to this eventuality. 

However, is the problem with the ACA? Or is the problem with the employers? In my view, it's a bit of both. The employers do have choices about whether to cut hours and avoid benefits. 

 

Jim,

Breaking the connection between employment and health insurance was one of the intentions of the act. Part of the reason for this is that it was already broken for a lot of people. Millions were unable to get insurance either through their employer or on the individual market. Dealing with this intrinsically requires making employer-provided insurance less necessary and therefore less desirable. The other part is that tying insurance to one's employer causes people to make decisions based on access to health insurance such as staying at a job at a large employer because the difference in prices and tax subsidy offset the increased earning at another job or because one doesn't want to risk the financial implications of a family member developing a chronic condition when one doesn't have access to a large risk pool.

There are some problems with the way the law was written that I would like to fix, but given that the majority of the House will only accept the current law or full repeal, I choose the law as it is. It's not perfect, but it is much better than what we had before.

Ryan - those are all good arguments to have 'Medicare for all' rather than the half-measure that the ACA represents.

Regarding this:

There are some problems with the way the law was written that I would like to fix, but given that the majority of the House will only accept the current law or full repeal, I choose the law as it is.

... those two items - the existence of ACA, and the subsequent realignment of the House - are not independent of one another.  The one was the cause, the other the effect.  A law which is neither repealable nor revisable is yet another unintended consequence of the ACA and the process by which it was enacted into law.

 

 

 

 

However, is the problem with the ACA? Or is the problem with the employers? In my view, it's a bit of both. The employers do have choices about whether to cut hours and avoid benefits.

 

Yes, I agree.  However, as hard as it seems to revise the ACA, it's more realistic than pursuading tens of thousands of employers to voluntarily do what it is not in their financial interest to do, just as raising the minimum wage - also a difficult thing to push through - is easier than convincing all of the minimum wage employers to voluntarily double their workers' wages.

 

 

Jim,

While I would prefer Medicare for everyone, guaranteed issue + individual mandate + subsidies is also capable of achieving the goal of universal healh insurance coverage.

Check the employment facts from the Labor Department. More full time jobs are being created than part time. Only a small minority are going to part time. And could, just could the labor picture be caused by the recession and not the ACA which really doesn't go into full efeect till January?

Regarding the bloc in the GOP that wants Congress to do what it can to make Obamacare fail, this article may be of interest:

http://www.usnews.com/opinion/blogs/peter-roff/2013/09/17/forget-default-obamacare-will-collapse-of-its-own-weight

Some [Republican lawmakers], believing the party's commitment to "repeal and replace" was written in blood, advocate using the upcoming continuing resolution necessary to keep the government open to "defund" it. Others, sensing that President Obama would regard such a move as leaving him no choice but to allow the government to shut down – and it's  doubtful anyway that such a measure would be approved by the Senate so that it could get to the president's desk – are taking the position that repeal cannot be accomplished in one bold stroke but must instead be done piecemeal.

Even though there is plenty of polling data showing the American people do not support Obamacare in its current form and would like to see it repealed or fundamentally altered, it is the proponents of the gradualist approach that seem to slowly be winning the argument. The reason for this is simple: They have the president on their side.

Not intentionally of course. The president still stands squarely behind his singular – perhaps even his only – legislative accomplishment of any substance. The sad fact is however that his team has made such a hash of the implementation phase of Obamacare that "delay" is already a reality.

[...]

Nevertheless, with the administration already in the "delay" phase it seems only natural that Congress should follow along, the difference being the Democrats want to "delay" until they get it right while the Republicans want the "delay" in order to get something else.

 

 

 

Here is an innovative way for employers to dump their employees: private health care insurance exchanges.  Apparently not quite traditional employer group plans, and not quite ACA insurance exchanges.  Note that the employers highlighted in these stories - Sears, Walgreen's, Darden - employ retail and food service workers, traditionally a couple of low-paid cohorts.

A Reuters story: http://www.chicagotribune.com/business/sns-rt-us-healthcare-exchanges-private-20130917,0,6691639.story

An AP story: http://www.dailyherald.com/article/20130918/business/709189907/

Here is one more article on private health care exchanges.  Note the subhead: "As More Companies Drop Insurance, Consumers Get Stuck with the Bills".  It looks like the ACA avoidance scheme that businesses have been longing for.

http://www.thefiscaltimes.com/Columns/2013/09/19/Business-Boondoggle-Shedding-Cost-Health-Care