Josh Marshall: How the GOP Bet on Failure And Lost

[babylonsister]

http://talkingpointsmemo.com/edblog/how-the-gop-bet-on-failure-and-lost


How the GOP Bet on Failure And Lost

Josh Marshall – April 18, 2014, 2:20 PM EDT


On Obamacare, the Republican party has bet big on failure for four years. Now the results are in. And they lost. Big time.

snip//

As I noted recently, GOP policy analysts are pretty clear now that Obamacare isn't collapsing, hopes of the politicals notwithstanding. And strategists have started to hint that flat opposition - repeal with no alternative that provides something like the same range of benefits - may no longer be viable from a political standpoint.

Of course, in the Obamacare gotterdammerung bubble, Obamacare is on its last legs and President Obama will soon resign and ask the country for mercy as he's hustled off by federal marshals to stand trial for Obamacare and socialism. Back on planet earth though reality-based opponents see the writing on the wall.

Indeed, the new data goes beyond simply saying that Obamacare is stable or is not headed toward a death spiral. It's better than that. It's working as expected. The rate of uninsured Americans is going down substantially - especially in states that didn't try to sabotage the rollout.

They bet on failure. And they lost the bet.

[central scrutinizer]

1. GOP strategist, "Be sure to always call it Obamacare, not Affordable Care Act...

... so we can brand it in the public discussion and piggyback off the racist dog whistle approach."

Oops! How's that branding working out for you now? Bwah hah hah

[malaise]

3. Bwaaaaaaaaaaaah hahahha indeed

Epic Failure!!

[sheshe2]

11. Touche!

[elias49]

10. No kidding. Think of the legacy!5

50 years from now, President Obama's name will still be ringing in the ears of the right wing! LOVE IT!

[lolly]

47. Yeah, but by then

They will be claiming him as one of their own and using his image in their campaign ads.

[rhett o rick]

2. Thanks for the post. I do have a question about the ACA.

I have asked before but havent gotten an answer. It might be straight forward for someone smarter than myself.

The ACA is directed at giving the poorer among us decent, affordable health insurance. Some people I know are worried that the insurance premiums for the 85% of Americans not directly affected by the ACA will go up dramatically. Is the only way the ACA controls premium cost for the 85% is via the 80% rule (80% of premiums must be used for benefits)? If so then wont the loses from taking on high cost individuals (e.g., with aids) be passed on to the 85% via premium increases?

I hope my question makes sense.

[babylonsister]

5. Since I fall into the poorer among us,

I don't know. Hopefully someone with more insight or a higher income will weigh in.

[rhett o rick]

6. Well I am retired and completely relying on the integrity of my company retirement

insurance. Every year there is a move to "fix it".

If I may indulge, I have another question. While recently in Calif I spoke to a lady I slightly know that is an insurance broker. She told me that the ACA has cost her a very large percent of her income. I dont know her well enough to trust her completely but she did close her office and move her business to her home. It doesnt make any sense to me because the ACA is geared for those that didnt have insurance and wouldnt have been giving her business. I realize there isnt much here to go on but I dont have a clue. I am asking a mutual friend to find out what the real story is.

THe reason I am asking these questions, is that I occasionally, as the local liberal, get questioned about these things from people that have heard the Fox talking points.

thanks again

[Wounded Bear]

9. Well, if I may speculate...

You said she is an insurance broker. If so, I could see how she, personally, is in trouble. The exchanges probably mean that health insurance brokers working on individual plans are going the way of travel agents.

But again, anecdotal evidence is seldom indicative of major trends.

[rhett o rick]

17. I considered that but those that were giving her business before the ACA arent the ones

using the exchange. At least I wouldnt think so. I might be wrong on that. Prior to the ACA if you bought COBRA for example, did you have to go thru a broker? I know someone to ask that has first hand experience.

[Wounded Bear]

20. I don't think so...

COBRA involves a continuation of the coverage one had from employment, just that the individual would pick up the un-subsidized cost of it. I think it is the same ins. company, so a broker would be unnecessary, except to replace it. But there are many un- or self-employed people out there that would have used brokers, but could possibly get better deals on the exchanges. In any event, they wouldn't have to trust that the broker finds the 'best' deal, or would get their cut.

[rhett o rick]

25. I agree with your second point but thought one could get COBRA even if you worked

for someone not offering insurance. But dont know that for a fact.

[Curmudgeoness]

42. No, that is not what COBRA is.

You had to be covered by an employer plan prior to losing your job. So your employer had to have a plan and you had to be enrolled in it. The point was to provide the group plan rates to people who were suddenly in a position to have to go to individual plans, which usually cost more. COBRA will cover you for up to 18 months, provided you pay the premiums the whole time.

[rhett o rick]

43. Thank you. nm

[LiberalFighter]

40. Cobra requires the ex-employer to provide the same insurance coverage they had

but 105% or maybe it is 107% of the cost. The ex-employee or spouse is in the same group as they were before they left.

ACA in my opinion should eliminate anyone wanting to go the Cobra route as ACA exchange should be less expensive. Many ex-employees likely did not bother continuing coverage due to expense. Only doing so if medical expenses necessitated the need.

[Rozlee]

39. There might be some losers in the new law, I guess.

Especially if they worked in areas of healthcare that were wasteful and redundant and that the ACA is trimming down and making more efficient. But, look at some of the statistics in new employment figures. Healthcare hiring is among the highest and the ACA is credited for most of it. My sister is a disabled RN who has long wanted to work from home, but found little opportunity to do so living in a rural area. She got lucky and found a job filing and reporting conclusions on medicine and treatment errors for a new data bank that's required by the ACA that she can do from home. The sweet irony is that she's a major league teabagger.

The need for healthcare workers due to the ACA and a growing elderly population of baby boomers is going to be huge. But, I was reading that there's a lot of competition already in some metropolitan areas that are experiencing a glut of such health professionals as RN's. They're desperate for them in more rural and underserved areas. I'm a retired RN myself and my inbox is filled with requests for nursing contracts in areas where there's greater need. The critical jobs will be as nurse's aides, personal attendants, and other allied health workers. Hopefully, it will mean that they'll be more appreciated and get better pay than they're getting now.

[rhett o rick]

53. I suspect that the case I was talking about is a good thing for the overall health of the program.

Using online exchanges may be more efficient.

[rhett o rick]

8. Well the cost will be spread over 85%, but it will be a high cost for now including

patients with expensive illnesses. Of course it should cost the 85% less overall because they were covering these costs all along but thru less efficient methods (e.g., emergency room treatments). Hopefully the savings but covering the ill with insurance in lieu of emergency treatments will reflect in lower health care costs.

[SunSeeker]

12. You save by not having to pay for the uninsureds' use of emergency rooms for all their care

Before the ACA, the uninsured poor could only get help in emergency rooms, where they by law had to be treated if it was an emergency. So they would let whatever malady they had get bad enough to be treated in the ER, at tremendously higher cost than a doctor's visit would have cost. For example, instead of dealing with the flu via a simple doctor's office visit ($150), they waited until they were at death's door and went to the ER ($1500+). The poor are judgment proof, so the hospitals jacked up their costs ($50 for an aspirin) to cover all those bad debts, and you paid all those higher costs through higher insurance premiums. Now, with more poor people being insured, you won't have to pay for their very expensive and inefficient ER use, since they'll be able to get care through much cheaper regular doctor visits for most of their care, including free preventive care.

[rhett o rick]

14. Yes and I agree. Hopefully those savings will be reflected in keeping premiums costs

down because that's what the ACA will be judged on.

[SunSeeker]

23. It won't be judged by the thousands of lives it will save? nt

[rhett o rick]

24. No. I wish it would but that information wont be publicized to the masses.

If premiums for the 85% skyrocket, people wont like it.

[SunSeeker]

33. It will be heard if we all talk about it.

Dems should do PSAs about the ACA and the lives it has saved.

[rhett o rick]

34. I so agree with you. nm

[BlueStreak]

13. Premiums go up EVERY YEAR. Has nothing to to with the ACA.

What you are talking about is Medicare and corporate group policies. There is very little in the ACA that affect them directly. The one provision that improves every single group plan out there is the provision that group plans must spend at least 85% of the premiums on actual care or else rebate the policy-holders. Note that the percent is 80% for individual plans, so group policies should be 5% cheaper than individual policies in general.

There are many, many things in the ACA that indirectly benefit group policy holders. The biggest is that we are greatly reducing the number of people that go to the ER for their "health care" and never pay those bills. Who paid for that before? Group plans and anybody else that had coverage because providers had to jack up their rates to cover the unpaid care. Getting those people insured and treating most of their conditions in the doctor's office will reduce the cost of health care for EVERYBODY.

But this is vitally important. before the ACA, HC costs were going up at about 4-5 times the rate of inflation year after year after year. They are still going up, but for the last 4 years, the increases are very close to the rate of inflation. So what we are talking about is holding the line, not reducing premiums. It is important that every discussion make that perfectly clear. We won't get reductions until we can deal with Big Pharma, the specialties that charge absurdly high fees, and the other parts of the HC system that are still mostly out of control.

And finally, the competition n the exchanges gives small businesses some leverage against predatory insurance companies. If a group plan isn't as good as what is available on the exchange, employees will push back hard. And the company has the option to drop the group policy and help the employees buy their own policies on the exchange.

Some people think that is a bad thing. Actually I think it is a very good thing. Insurance never should have been tied in with employment. That was an historical accident because of the tight labor force after WWII. Over the next 15 years, if lots of businesses stop offering group plans and those employees end up buying from the exchanges, that puts is much closer to a single payer system Why go to all the trouble of requiring a person to buy the insurance and taxing them if they don't, when you could simply take care of everything with a payroll deduction

[rhett o rick]

27. I understand what you are saying and dont disagree. Thanks. nm

[IronLionZion]

32. Risk pools are expanding tremendously

in both ways. So depending on how your specific insurance firm's risk pool has changed, you may have gotten new young healthy people because of the mandate, which would lower your premiums. Or you may have gotten patients with expensive chronic conditions, which would increase your premiums. A big part of this may depend on if your state has expanded Medicaid and built their own exchange. People in states that did not, will be seeing higher premiums.

There's also the national trend of employers wanting to pay less and have their employees pay more.

There's also the supposedly reduced use of the ER by uninsured, which is very expensive and should lower everyone's hospital bills and premiums. Again, this depends on which state and people's attitudes. My blue state (MD) has lots of new urgent care centers and walk in clinics to take on new patients because of PPACA.

Premiums are only one part of the story. There's also deductible, copays, provider network size, etc. Remember no more caps on annual or lifetime, and more stuff is covered including free preventive screenings each year with no copay. Personally, my total expenses for health have gone down and I actually go for my annual physical each year when I didn't before.

Look at the options your employer has. Mine, offered a cheaper high deductible plan with HSA, so I pounced on it. They deposit money each year into the HSA as an incentive for things like annual checkups, not smoking, participating in wellness programs, logging my exercise each week, etc. This is one overlooked part of the employer plans in the PPACA that no one ever mentions for some reason. Its a lot of money, like close to $1000 a year for very reasonable amount of effort. It makes a big difference to me.

Good luck!

[rhett o rick]

35. Thanks for the reply and info.

[brett_jv]

44. This is a great ? and I'm wondering about the same thing ...

We just got my wife on a seemingly 'too good to be true' deal/plan offered thru the exchange (though we actually bought it through my company's insurance broker), and of course she has pre-existing conditions so has immediately began taking advantage of her benefits. I have to wonder if there isn't LOTS of others doing the exact same thing, and wonder if there's any guarantee whatsoever that the cost of her plan might not double or triple next year. So I'm also very interested re: the answer to this question ... what's to stop them from doing that? Anything in the ACA?

Cause if there's nothing to stop it from happening other than the 80% rule, I can easily foresee a PR DISASTER next year when 8M people's premiums shoot through the roof, and the GOP dances around going 'We Told You So!!!'

[jazzimov]

45. Oh no! That's only ONE of the reforms

and the one that addresses Insurance Companies directly. There are also direct cost-cutting measures to Health Care costs themselves. Such as:

Cutting down on Emergency care, which is often unpaid and often spread around to other HC costs.
An emphasis on preventative care, when the ailments are much cheaper to treat.
An emphasis to cut repeat visits, which raise the total costs.

There are many more, these are just off the top of my head.

[Bandit]

52. The key to the ACA's success is to get younger healthy people to sign

Before ACA was launched the estimate was at least a third of the enrollees needed to be 35 or younger for it to be successful. According to Obama 35% of all new enrollees are 35 or younger. Because of this large number of Healthy enrollees the insurance companies should still make a Profit. Also because of the 80-20 split in Admin costs and actual health care costs premium costs should remain at least stable or come down some. Already the Insurance have had to mail out rebate checks to people that spent more than the 80-20 split allows. Obama-care is not the best we should have but it is a lot better than what we had before.

[eridani]

4. It isn't a political failuire at all, given that

--in all age demographics, 85% of the population accounts for only 15% of all health care costs. That's a big chunk of the electorate, and they're happy that more people are getting insurance. That insurance is a ticket to bankruptcy and homelessness should they ever land in the unlucky 15%, though.

In MA, health care bankruptcies are still 50% of the total, years after reform. I'm not optomistic that the lucky 85% will ever give a shit about that.

[mopinko]

15. now watch them deny the surge of entrepreneurship that it unleashes.

like al gore told us.

[leeroysphitz]

16. The politics of failure have failed. n/t

[Bernardo de La Paz]

22. Nicely put. nt

[Spitfire of ATJ]

18. Maybe because all their Chicken Little "commie" screaming was after their lies about Iraq WMDs.

[blkmusclmachine]

19. ACA is the Heritage Foundation's wet dream. And, '90s-style Republicans still heart it, even today.

[immoderate]

28. So true. That's why they can't come up with a Republican alternative.

This was the original Republican alternative to rational healthcare.

--imm

[babylonsister]

30. They're not interested in an alternative, never have been. nt

[emulatorloo]

46. Yes that is why Republicans and Koch Bros want to destroy Obamacare

Because they love it so much.

[Bernardo de La Paz]

21. GOP didn't just bet. They actively sabotaged Obamacare & still block no-cost Medicare extension. nt

[calimary]

26. It wouldn't surprise me if they did more than that.

I have a suspicious mind when it comes to the GOP. They'll stop at nothing. They did their best to keep on stealing elections after bush v Gore, especially since that one actually worked. It wouldn't surprise me at all if we found out later on that the glitches in the rollout of the ACA last fall were bugs deliberately hacked into the system by GOP nogoodniks. Just remember - they VERY BADLY, VERY ARDENTLY, wanted this to fail. And they were determined to help that along, at whatever the cost, whatever it took. Why would they not try to sneak a few kinks into the programming? I'm sure they have a team of hackers busily trying to fuck with it even now.

I don't put ANYTHING past this bunch. They'll stop at nothing. Certainly no ethics or morals or truth-telling or conscience-bothering will get in the way. I think we have ample evidence of that.

[napkinz]

29. how this will play out ...

[babylonsister]

31. You win/SNAP!

Exactly!

[sheshe2]

36. Kick!

[Cha]

37. As we knew they would! But, ain't it nice to see it all down in Black and White.. Official and

All?!

Thanks Obama.. Thanks Biden for the BFD

mahalo babylonsistah~

[McCamy Taylor]

38. Worse, they set up their own states to fail. So it will be "Blue states good, Red states bad."

If they had done nothing, they could have complained about the deficit and taken credit for everything people like---such as more health care jobs etc. But their own states are going to suffer, their own voters will be pissed as their doctor and hospitals move to Blue states. I think the SCOTUS gets bum advice from someone like Karl Rove. They keep coming up with ideas that hurt the GOP. Citizens United killed Romney in the primaries. He never even had a chance.

[proReality]

41. Hospital says it's laying off and lowering salaries because of ACA

I don't know enough about this yet to comment...

<snip>


"Royse attributed the actions to two challenges: a “the costly rollout of an inadequate software program” and the impact of the Affordable Care Act. The integrated patient accounting software was mandated by government reforms, he said.

“From the onset, we selected one of the nation’s premier vendors for this process,” Royse said. “However, one year after going live, the product’s inoperability is still costing the hospital tens of millions of dollars in unrecoverable bad debt, consultant fees and lost productivity.”

The computer software was developed by Siemens, Royse told the Daily Times later Wednesday. The problems became apparent as bills could not be sent for 60 days, he said.

“On top of that, we couldn’t send bills to collection agencies on aged accounts until around February of this year,” Royse said. “They promised us it would interface with physician software, and to this day, we haven’t been able to get that working.”

<snip>

- See more at: http://www.glasgowdailytimes.com/local/x493465877/T-J-Samson-Community-Hospital-announces-job-salary-cuts#sthash.8s6LX6xq.dpuf

[MohRokTah]

48. By the time the electio rolls around, the GOP are going to be sorry they ever screamed...

OBAMACARE!!!!!

People aren't going to want to go back, they're going to want to improve on what Obama and the Democrats built.

[lark]

49. GOP led states bet the lives of their citizens.

It's the citizens with incomes at or lower than the FPL who can't get subsidized at the level they need and who aren't helped by the intended Medicaid expansion that are most at risk. The pols have their pre-paid cadillac health plans, they don't get personally hurt by this. They just blame the lack of affordable insurance on Obamacare and the stupid poor rednecks believe them and so continue to vote against their own best interests.

It's always always the poor that suffer because the rich don't give a shit about them, only care about themselves and keeping folks like them in power.

[Tommy2Tone]

50. The problem is the MSM

It's working, but if you listen to MSM you would never know it. One side has the facts, 9 million enrollments, the other side has a big bag of lies, yet they are treated as equal. One side is covering the uninsured in record number and the other is throwing beer parties to encourage young people to not sign up.

This is what MSM should be talking about, instead of acting like both side have valid points.

[pinto]

54. Yeah, I get the equal time standard (when it's actually upheld), but the lack of verification,

due diligence and follow up is a glaring failure in today's media.

[gcomeau]

51. They did not bet on failure.

They engaged in several years of active sabotage of the economy and health care reform implementation trying to CREATE failure and dump the results on the heads of the people they're supposed to be working for.


Let's not allow people to lose sight of that little detail.